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HomeMy WebLinkAbout0050 CLIFTON LANE - Health 50 CrjfTon Lome - C�nfi�t'\1 (I Q Z�f7 - �003 /// 7 M E A D No.2-153LY UPC 12934 emead.com • Made In USA 3 0 SUSTAINABLE i IN Wwadwwm" i i a .r kA 7 TOWN OF BARNSTABLE 1 La Mpj9L LOCATION S0 CA k(mo g=3k- SEWAGE #__�r VILLAGE ASSESSOR'S MAP LOT 0k47-C)Q INSTALLER'S NAME & PHONE NO. �� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) size) quo NO. OF BEDROOMS PRIVATE WELL R PUBLIC W R y BUILDER OR OWNER (2� DATE PERMIT ISSUED: GP✓J 3 ' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r �• r � ` d �����vt. CUSS .�-g1...— J � �r-ec� ���c,�(3<<s�-z�v,� s r 2 No.._Sl..l._..__. y ✓ Fss............. �d THE COMMONWEALTH OF MASSACHUSE77S BOARD OF HEALTH ....................... ..........OF. 1 1b �,a.. ............. , p'firatiun for Di u tt1 urk •C�un r�u#i n rrnti#, ' Application is hereby made for a Permit'to Construct ( ) or Repair ( Llan Individual' Sewage Disposal System at ...................... .......---- 1 .as nr c�t�,.......:............. ...........--•--= .. Location-Address t o .................................. ..... ............•------- ...."e.°r Lot N ...... ...... S� �p.-�- Ownerl ►Wa .................................................G� . ............................... Y.Q.4 a��� .:...I Vl�dreJC`�=Z \ ...... -. --•---•-•-.-- M Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.... _...._ .....Ex anion Attic Garbage Grinder a g— •--•---=•-•-••---•------ p ( ) ' _ ( ) a . Other—Type of Building ............................. No. of persons...............,............ Showers ( ) — Cafeteria dOther fixtures --------------------------•------------------.-------•------------------------------------ ��� -----------•----------•••-•--•.•-•-• W' Design Flow.....:.���. ......................gallons per person pei' day. Total daily flow........................................................_......,.............gallons. WSeptic Tank='Liquid capacity._..........gallons .--.Length................ Width................ Diameter=........._..... D7pth................ x Disposal Trench—No.._+................. Width_............_...... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No....... -3 �..........:..'Dlameter.:..t��:__..,.. Depth below inlet.....�.�........ Total leaching area.....__......_.:.sq: ft. Z ' Other Distribution box.( ) Dosing tank ( ) aPercolation Test Results Performed'by---------------••.......-•--•----......•-•-----•-••......-•--••--•-•-•---_. Date...=.................................... Test Pit No. 1................miriute's per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No.,2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ ' x 0 Description of Soil........................................ ---------------------------------------•--...-----•------------....................-----•-- U ..............••......••----•••-•......---•--•--•---••--•••••-••----••--••-•-•-•-•....-•--•••---•••••--•....-••......•-•••-•--•••••--------•---••---•-•••......•-•-•---................................ W a ..................................•---..........----------•----............____.........._..........---------...._._.._.._--------......................_._.................._......................... - U M Naturee of Repairs or Alterations=Answer when applicable-_".t(�_._©1�-�__.__..__�S�:jP ���__._..�Z.......... ...............° Agreement The undersign4 agrees to install the aforedescribed Individual Sewage Disposal'System in accordance with r a -. the provisions of iITi.L 5 of the`State Sanitary Code— The undersigned further.agrees not.to place the system in operation until-a Certificate.of Compliance has'been issued by the board of heal ,+ sigd=: ---- = = ---- t3. �... Application Approved - -• ••-• ,�/%!r/ .. Date Application,Disapproved for the following reasons---------------------------------------------------------------------- --------••••--•=•-----•-••••••---- ..... ---------------------------------------------• -------------------------------------------------------------------- gg, .................. --.........--- .... �f:.�'�.�_.7 ....- Issue `-----• � - . d.- ` '- ------------- Date Permit No..... Date T THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH '........... s s ------------------------- Appliration for Disposal Works Tonstrurtion Frrntit Application is hereby made for a Permit to Construct ( ) or Repair ( Han Individual Sewage Disposal System at: _1 ............................. ............. ............................................... Location-Address �� o-r Lot No. .............. ........_....... ............_........ .....................S ...' - ......... -......... .... Owner Address 1� �! r , a ......... a ..... .<J .YSLAX i.�.... .................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms....S--------------`-_._...._...._.....Expansion Attic ( ) Garbage Grinder ( ) Other—Type 'of Buildin t a yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ................................................... W Design Flow........!S_5.......................gallons per person per day. Total daily flow....... .........................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.......J............. Diameter.... 7;�......... Depth below inlet................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---------------•-•----------•-•--..............----•-••'•-•------•...._.............._.....-•----..........--•---•-----•--.........---...................... 0 Description of Soil.........-.............................................................................................................................................................. V .................... i ...._...__..............._._................................................................... W ►r1 •----- ^---• U Nature of Repairs or Alterations—Answer when applicable.....1 :011.. _..g.1,t-�-_-----__yam � Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of^1ITA LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. . %- Application Approved B'.y --. .. :... •-•---..................'" Date Application Disapproved for the following reasons:---•-------•--•---•------•---------------------•--•---•-•---•....--•--••-------•-------•------•...........------ .....................•-----........---•--•-------------.....--------..........------.....•..-----------........._.........---------------------------------------------------------------•-•--•-•••...... Date PermitNo.....--.--./- .... ..... � - Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD,�OF HEALTH ........................ (Irrtifiratr of Toutpliatur THIS IS TO CERTIFY, That t e Individual Sewage Disposal System constructed ( ) or Repaired b Ir �! ....S.o. _iz-- Y - .. .......................•------.......----•-----••----------.....................------•--•---- - Installer at........................ ....... �� i `��``' ......................... --------------•--------------•---------•--....---•--•-----. has been installed in accordance with the provisions of TL ITI! j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..-- ?,f . .'"7 dated_.- 45.:.._"" ... %.__ .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. eI DATE......................./ -.-. .:-.l� Inspector..---=--...------.kn ]�- •--•-•-----------....... ....................... -- -- THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH .....7777-'Z> -.�..-.....OF.... YLv s .t�' -e ...................... No.IJ__.-•----- �--- FEE..f���i 4�! Disposat Iforks �onoir�tr#ion rrmit Permission is hereby granted-----------. ------------------------------- - to Construct ( ) or Repair ( L`)a Individual Sewage Disposal System atNo...---...... ....... ----------- _4ww `r' ............................................................ Street as shown on the application for Disposal Worl:s Construction Permit--No. � f`D' t d.......................................... /'+�r r ....... KIS—I'„i/ '�f Board of Health l DATE--------••----- -------•---•-�-•------•--•--------------•-----•------- t4 -