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HomeMy WebLinkAbout0025 HORATIO LANE - Health L N SMEADo KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 107c QrWedfiberSourcing V,m.NproYr4mAq POST-CONSUMER ® S't}0144D MWEINUSA GET ORGANIZED AT SMEAR COY TOWN OF BARNSTABLE U —ATION or A 1 6 Lit) SEWAGE # 95 '1 5- VILLAGE 6E r1 Lr Vi I Ii ASSESSOR'S MAP&LOT • .03 . INSTALLER'S NAME&PHONE NO. \I` r o r k'n o'.l W O0 e l u cAr Q3� d C�1 SEPTIC TANK CAPACITY 16 44 O LEACHING FACILITY: (type) aA Eu.tt (3) (size) NO.OFBEDROOMS 3 BUILDER OR OWNER W 1,I 11 A0M X PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 o�ffrrleaching facility) Feet l Furnished by d/ a / E1 4 / j�j 0 � �°� b� ,. o� k,• ,. i � �4 ,'C� ,£1,�+ N��d� ••ti�1� of 6� . �i ¢sr�� .,�-- �-�-��� ��. _� � q ASSESSORS MAP NO:—?- _3 9—3 —/F THE COMMONWEP�L'�tN-9t TS® BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uiripv!3al Wi orkw Towitrnrtinn Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �..... I..a F. i o c_ iv ....................... •--------•-----�.--........•......0 e: _Z rw Le ...................... - Location• \ddress or Lot No. ................MR- .!gAA....On t%li-J..w.�-cl-l�,� '"► ..'3..T F__ tQ__1- �4_.?' .!v€�?k ..... ON .............� / �,~r--' ..___. .... `�. 1 1 __VV• c is/..`�.A rc _ -'---•-_____..---------..............__.. Installer Address U Type of Building Size ......Sq. feet t-, Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures .............................. . d - - ---- - - ----------•----...---------...------ ---------------------------------�,.,�----•-----....---ions. W Design Flow....................... ....................gallons per person per day. Total dail flow_....`3 .P. _...........gal WSeptic Tan 4—1 squid capacity..taW.galIons Length.-.-'-?)....... Width....... ..... Diameter---------------- Depth... . x kc Disposal Trench--No. ------i............. Width...... _---------- Total Length-----l_6....._..... Total leaching area.._a a,.b.... Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (V-� Dosing tank ( ) ( Percolation Test Results Performed by..___ 'L_©_ �7 ._._ �?C��?�e'�)_ Date.S�0`3_!__$�.__.�.'.5 3 3 Test Pit No. l..<._2---__-minutes per inch Depth of Test Pit---_�`t`�_.`...... Depth to ground water... ._. � Q1� (x, Test Pit No. 2..'�. ___--minutes per inch Depth of Test Pit----1`E.4_..___. Depth to ground water....!. .....�!r....... � a •-•••-•-•---------------•---...--•.......--•-•--•......•••-•-•-•-•....................•-••-•................................................................. 0 Description of Soil-------••-©.'.a.y " o A-m A t4 ck••S t�.4.S o e.!-._...... .....-•-•-----•-------------------••••-••.....-••••••--....--- xT i 6 �. _I`....+p.+�?c ...... DJ •-••-•......-•••••••-••-•---•-••••••...-••.............•----_..... W ......................................... .`1.-..± ------- ------- `4 -------------•----.............................................. U Nature of Repairs or Alterations—Answer when applicable............................__._...._.._....._..._._................_.........._................ -•----------------------------•--•-•-----------------•-----•---•--•-----------....................... --------......---------•-----•--------•---•------••--•----------------------------...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal stem in accordance with the provisions of TITLE 5 of the State Environmental Code The undersigned fu er rees not to place the system in operation until a Certificate of Compliancy ha sued by the b d Signed . .' - ---`------ - ------------- -- - --- . f j....... ...........- � to i Application Approved By ............. .. ....a.-...c�p...��..... Date Application Disapproved for the following reasons- --------------- ................. . ....................................... ............................ ........................... ...................................................... ................................ Date Permit No. .. ..... . ..7,5............................ Issued ................ Dare . ' v/ —..._ ti.,�.., c..,. .r.-.,*.r r —......-......- r-.-,...�... ..a_... ....+.j;.�•�•..�.... ��.Mfw.T.a'�- .v......d"..�.V_... .�.. - rti'+..J' � - , THE COMMONWEALTH OF MASSACHUSE TT 5�7 33 BOARD OF HEALTH TOWN OF BARNSTABLE �/ Appliration for Diripaiial Mi nrk,s Tomitrnr#iun Vernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal) System at: ...................... :a...lI o . # c3 t ,.a -•--------------------------------------- = - 3 C hI T €�V#t c. C-...... ;1 Location-Address or Lot No. 1.�s na h.5. :... ri_a•.�C f �- �e'RI #4,.<a�. K r ", S" j= l2 1 i..,1 �.•t1-1. l!A n}a.21�.�, ._____�_._ ..._...__-_._______ .. .. _ ....................... � � w v6).S_ ftJCsirc� �+ �%l .�_ � d_.._�................. Installer Adrif'ress U Type of Building Size Lot.ALl _ki b:;.......Sq. feet t� Dwelling— No. of Bedrooms.___-__._��---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow..... '?_b_ =:.F'. ...--------gallons. 1:4 Septic Tank—Liquid capacity-xitz.gallons Length----qv_....... Width_____..'`f..... Diameter---------------- Depth..y........... Disposal Tl�enc4e No. ......t............. Width......9 t--_-___-- Total Length-----1_6...___.._. Total leaching area... A.a.-J.....1 fit. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (V-) Dosing tank ( ) Percolation Test Results Performed by..... to- - h_ s? -----......minutes `f`l.` Depth to ground water.._!?0... ? .) (� Test Pit No. 2..�J�-___-minutes per inch Depth of Test Pit----- -------- Depth to ground water....ti?o--� .? --------------------------- ............... ------------•----••----------•-.-------...--•-----•..... ------------- -... •........ ...... ------ -......... D Description of Soil---------- '•-• SM."`.......! `! '""....'�-"=•r.... '- =• q- ---------------•---------------------------------------......---.............._.. (xj ................zt.: - _...__ `fir.- - - � �+--•---•-• ........................ � tsa fell Q U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----•---------------•------...--•----•--------------------•-------------------•--------.......-----• ".!. .------------------------ 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 fu phe r agrees not to place the system in operation until a Certificate of Compliance has bee 'ssued by the Signed .f.... ...... �. � Dace Application Approved By .............. �,s, -- \..-- Q J Dare Application Disapproved for the following reasons: ....... ................ ..... ............................................ .......................................... .................................... .. ................ . ................................. ............. . .................. .---. ...................• ...................... ........................................ / Dace Permit No. .. ... �,.....'... .�� Issued ....................... ........ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ( ) t J s��(� g wer#ifirate of CI-omplian e `� PTHI IS"'�& RTIFY , t ihei,,di.uidr f l(Sewa e Disposal System constructed or Repaired tt g P Y ( -) ( ) by .............. ..... ......... - - - .. �< ......_... �.. ---. --------�--- ---- ---------- - ........................ .................................. at .... 0 ...........` ...... . � . ...... _.....................................has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------.C15..---5? ".........--- dated ............._.................._.._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....c'L....`.......�... ....._.... .. .. _..:..._. Inspectors .cr' ?/- :..... / ..................... ..%...-.......... ' --..---__,---------------- -.-------------------------------_---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q TOWN OF BARNSTABLE No..... JT5_ _-�•j-. FEE.... / ........ Mopmal Workii Tomitnulivit/ Permit Permission is hereby granted............ ..7::. to Construct (\e) or Repair ( ) an Individual Sewage Disposal System at No. r ......... -- Street as shown on the application for Disposal Works Construction Permit No..95-?57. Dated......... ._-�..�._.�.;�.0 .. �,------------------------------------------------ _------'_-•--. _ It `'/ (`I Board of Health DATE. ..............••-•--••••-- FORM 36508 HOBBS A WARREN.INC..PUBLISHERS 1W-��; N h 03, .SG AG G— v /"'-• ;r � "...' �S�"�5"�_ ��.AP_EOM'E�vL�j:2/-��- - C•-/03;.o� �.e Z'f��r ��� y) ,ors` 9� / is q � ' y - 12�5G :qC G'/��J�L,/�ABG€: i!/l.9iyf�G E.S.� `�11�b��`'U� l i��r-,.�jJ�s 7 7r'� '• �' J � .Y, ` i J T, wi�7%/.,i../Z"_DF:-ic✓� ,. G� 1f✓r tart: I(,,K5 w_ ....fie: 4 E .:. 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