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HomeMy WebLinkAbout0097 CEDRIC ROAD - Health (2) R7 (d 17,z I46 s ME::A:e] No.2-153LY UPC 12934 smead.com • Made In USA J�qg�CYQ,�,, �d SUSTAJNABLE FORESTRY INITIATIVE Cmded RbmSourft WWWARWOWSM" If � � TOWN OF BARN_ STABLE V LOCATION J A SEWAGE# .200 —®9 Y ASSESSOR'S MAP&PARCEL /1,R I1,,'jTALLER'S NAME&PHONE NO. ,8e - SEPTIC TANK CAPACITY ICW!�? LEACHING FACILITY:(type) (size) /0 x20 NO. OF BEDROOMS OWNER PERMIT DATE: I/- Z3 -01 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet. Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY t . s9•� �� � Q 4 p 31.1 �� 1 cc TOWN OF BARNSTABLE LOCATION C ;�Zo SEWAGE # vF,3 VILLAGE G E,eV/cC� ASSESSOR'S MAP & LOT/7 ly6 %.A INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �fT _(size) Cv Xl6 NO. OF BEDROOMS PRIVATE WELL OLIPUBLIC WATE13� BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes CNo_) t ��s .µ P � � � �\ © - n J jr" No FimB.t ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Uhipatial Works Tomar r Wn" I r M Application is hereby made for a Permit to Construct or Repair (t4 an Individual Sewage Disposal System at: ..........ZZ.......... ........12'6........................ ................................... ............................................................. � Lot No*CZ15^ J 0/ Owner Address js ............ .....................115 — �7 ............... ........ ................................ .................................................. ... ..../ .................... Installer Address Type of Building Size Lot............................Sq. feet 0-1 Dwelling—No. of Bedrooms................ 4 ----------------------Expansion Attic Garbage Grinder P4 Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria PL4 .14 Other fixtures W Design Flow.................._�...............gallons per person per day. Total daily flow-------------3 !q..................gallons. $:4 Septic Tank—Liquid capacity4l_X..gallons Length________________ Width................ Diameter..._...__.______ Depth___________.__.. Disposal Trench—No_.................... Width_____..._.__._.__. Total Length__._________._., Total leaching area....................sq. ft. Seepage Pit No------- Diameter......Zt__/--- Depth below inlet_____.__________ Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit____._______________ Depth to ground water_.._...._.____._..____.. Test Pit No. 2................minutes per inch Depth of,Test Pit__-:._.__..________. Depth to ground water....__...._.___.___.__.. ............................................................................................................................................................. 0 Description of Soil...................................................................................................................................................................... W U ....................................................................................................................................................................................................... W ------------------------------------------------------------------------------------------------------------------------------------------------------------------ U Nature of Repairs or Alterationr Answer when applicable..___.._-'00........... C57COU 15 3< ...............?-(::t ..................... ...................................................... ....._:XC ........................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s b n iss e board of health. Signed --------- . ........ .... ........ . .................. --------4 .................... 0. .I?- Dite ApplicationApproved By .... .... .I. ...... ....... . ............0........ - - ...... .. .... ............................ ..................................... Date Application Disapproved for the following rear .................................................................. ------ ------- -------------------- ................. . No. -------------------- Permit ........................ Issued . . .......................... ... ----------- ....................................... ................................... . .../I No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q� TOWN OF BARNSTABLE ,�j,✓� - - - yam. Applutttiun for Disposal Works Toustrtutiun jjrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .........5...'7____...C' �Zic~ ---------------------------•-----•--••----------•----- --------- Locatio -Address c(S.._....... -- --- ------ - J ---------- --------------------- ..... -- -- ---- Iner Address a ...........................3c. c C,7 �� Z,�>�FQ7 i2D ✓mil/�1. ..... ------------------------------ ----------------------------------------- -� -------- Installer Address Type of Building Size Lot---------------- ----------Sq. feet I-, Dwelling—No. of Bedrooms................�......__.__...- Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0 Other fixtures W Design Flow.......................S�_tea__-._-----------gallons per person per,day. Total daily flow-------------- G------------------gallons. WSeptic Tank—Liquid'capacity ..gallons t-Length._)............. Width................ Diameter-_-_____-___-- Depth---------------- x Disposal Trench—No..................... Width...............j....Total Length-------------------- Total leaching area----_---------------sq. ft. Seepage Pit No------- Diameter......ZG..-•... Depth below inlet-------j..---..__ Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by-------------------------------------------------------------------------- Date------------ ---------------------------- - Test Pit No. I................minutes per inch Depth of Test Pit•.------_---------_-- Depth to ground water--_.---••-•-•----....__- (s, Test Pit No. 2................minutes per inch Depth of.Test Pit-------------------- Depth to ground water-_-_-__----------•__-_ -----------------------------------------------------------•--------------------•--...-••-•----................................................-............ O Description of Soil---------------------------------------------------------------------------------------------------------------------------------------------------------------------- x t, --------•------------•--------------------••---------------------------------------------------------- •----------------------------------------------------------------------------------------------- ----------------------------------------------------------- IL W V Nature of Repairs or Alterations—Answer when applicable_.___ ......... l�D/� __._____-T___��l __�__. :SJZ" ------...........................................................kr , . ---- f ------------------------------------ Agreement: ` The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n iss ed y the board of health. Signed--- /.../.(L ;/f -a /�'°1 Application Approved By --eo-A--------- - ---- -0--------- .......z --- ------- -------------------- ----------------1�-e ----------- ------ Application Disapproved for the following as - ------------------------------------------------------------------ -------------------- ...-................... ................ �.'...- — '/..1... -..._.......---------..........------........---------------__------------- ------ -Date Permit No. r-.... ----- J� � ----------------------- Issued _:.J..� ............Y Dat� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE GPrtifirate of (gompli2 nre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� ) by---------------------------------------................................��� Mis-5 ---- --.... -------------------------------------------------------- -------------------- -------------------- Installer ,r � at ------------------------------------------------ 7 7.... .... C'Z /e �` C-- '`'v i - -------------J ---------------------------------------------------- has been installed in accordance with the provisions of TITLE he S vei• nmental Code as described in the application for Disposal Works Construction Permit No. --- �"' dated ................. --------- ----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r I l^ � • DATE------------•----------- - =' I('/ /�_it _? .. ... �! / - Inspector -------- R / p� I}1 . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 7 — No....1..s................ FEE..`' ............ Disposal Vorks Tunstrurtiun rrrntit Permission is hereby granted...........................,FcnliTG`U » -----------------------------------------------------•------••-----.---.........to Construct ( ) or Repair (7C) an Individual Sewage Disposal S stem c �7 at No....................................................._...._ .__.... cC£l�,-e/<' r 7 F y Street as shown on the application for Disposal Works Construction P r- it No. _.�' t v `ted._[Z.�.._1 J/ _•__• .....•••. �--- �r it -•-••• , i DATE........-�-�- Board of F ea(th-��-1--------------------•-----•------------------ (J FORM 36508 HOBBS&WARREN.INC..PUBLISHERS