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HomeMy WebLinkAbout0161 TERN LANE - Health 161 TERN LANE CENTERVILLE A= 212 - 018 IN S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENTIO% CarifiedFl6erSourcing POST-CONSUMER www.sflprogrom.org SFI-01290 MADE IN USA GET ORGANIZED AT SMEAD.COM I No.. :nau FES.. 0........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE , ppliration for Bi_gpog al Workii (>zomitrnrtion Fautit Application is hereby made for a Permit to Construct (uj or Repair ( ) an Individual Sewage Disposal System at: I&11.-.efvt LA.- I C 44.0- Location-Address or Lot No. --- 2G,.......... 5------• --•-- /QOL-Gi�--�%TC Owner Address ... Installer Address Type of Building Size Lot_ 3,r_4 C......Sq. feet .-t Dwelling—No. of Bedrooms............................................Expansion Attic (-V o Garbage Grinder (/ucy W`-4 Other—T e of Building L�9�P No. of persons ................. Showers —Type g ---------------------------- P (aa) — Cafeteria ( ) d Other fixtures ................. W Design Flow......................L!�..._..........gallons per person per day. Total daily flow................. WSeptic Tank—Liquid capacity/a ..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ......�:...... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... ...o. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (v ) Dosing tank ( ) aPercolation Test Results Performed-by.... '___ `�o-�.............................................. Date... .'a _: ............ Test Pit No. 1........r2-----minutes per inch Depth of Test Pit..of............ Depth to ground water..�'!:e....._.. (� Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........... .------------ --------------------•-------------------••-•--•------------•----•--••-------......------•---•------•..................................... .................. O Description of Soil_. ._ ..._.���!'p'.%'� -..P ^ x U ..............................-.......................................................................................................................................................................... W x •---------------------------•--•-----------------•-------•-•------------•--------------•----•--------------•-•-•-----------------•--•.----•-•-------•-•-----------•---•••-••---•-•-----•--•--•-......_. 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 further agrees not to lace the system in operation until a Certificate of Com�fiancehhasen issued by the board of hea -qi rsip Signed . ..... . .. Date Application Approved By ............�� v ----------------------------------------------------------- --- --�© "1 ?..- Date .. Application Disapproved for the following reasons- ------------- ------------ --- -------------------------------- - ---------------------------------------------- ------ ........................................ Date PermitNo. ..... "... ......... ...... Issued ........................................................ Dare G< TOWN OF BARNSTABLE ` LOCATION oT 311 R SEWAGE # VILLAGE J�0� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. P C' - SEPTIC TANK CAPACITY ®pc-> LEACHING FACILITY:(type) (size) � NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 9-17 VARIANCE GRANTED: Yes No ------------ V2f ., G �F� IT, o y Z, MID o E 4 d TOWN OF BARNSTABLE LOCATION V SEWAGE # VILLAGE ASSESSOR'S MAP & LOT i INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY „LEACHING FACILITY:(type)• (size) NO:OF BEDROOMS 'PRIVATE WELL OR PUBLIC WATER u - ' BUILDER OR OWNER DATE PERMIT ISS iiDi, DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � gip, 6 8` kFICE -THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Disposal Murky Tonstrnr#iun ranfit Application is hereby made for a Permit to Construct ( L-j or Repair ( ) an Individual Sewage Disposal System at: I `, r -- , L (_ 1 .XGT 3 Fi f Z"Iq TE..iit en it.p ------•--------------•--...........---............---••-............•................. Location-Address or Lot No. �! T/tom S C, _/ /poGLi.� yir/fY .Cn! CPtiYP�Gii��P .. .• - --•- .-- --................. .................................. ....................... Owner Address ---•-------------�-•-•-•---•- -----•-----••-----.................------.............._....------U Installer Address Sq. feet Type of Building Size Lot_ 3, 90 C U Dwelling—No. of Bedrooms............................................Expansion Attic (ti 1 Garbage Grinder (Ncy aOther—Type of Building ....... No. of persons.......3................. Showers (-2) — Cafeteria ( ) dOther fixtures -------••---------------------------•--•--•-----------•-•-----•-•-•-••--•-•----••---------.............------•-•--•------•........---•-----••-----•-- W Design Flow............... _�!U......__.._...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. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (V') Dosing tank ( ) aPercolation Test Results Performed by..._�'...'2'703..............:................................ Date... ...9 ............ Test Pit No. I.......d?.....minutes per inch Depth of Test Pit..-:............ Depth to ground water..'��" Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------•--•--•------------•---.....------------.....__......_..._........................................................... 0 Description of Soil.' __ Viz.....P"! "` �-'�... . V .........•---•••....••--...---•-•-----•--•-•--•-•----------------•---•-•-----••-••••-•-----------------•-•---••--•------•--•----•----••••._...--•--•--•----------•-•-•--------------•--••.....----------- W UNature 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 further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health ('714 ` Signed . Date q Application Approved By ........... 1 J---- ... -.... --e..-..1.t' 1...a` .-"."............................... Date Application Disapproved for the following reasons- -- ------------------------..................................----------------...................................................... .................. ------------------- Date PermitNo. ..... a........... .................. Issued ....................................................... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C'Ierttftrate of Qlamplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by ----------- i � 1 --------------------------------------------------------------------------------------------------------------------------------------- -------------........ Installer /'� at L T 2`........{ ce-..... -Je.a---------------------------..........-- --------------------------------------------------- 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. .....c� -.r.. .. .... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------- '--- .-7..: _;�.......--------------------.......------. Inspector ........ ---------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cy TOWN OF BARNSTABLE / No. -. ra•g •FEE.....1 D� ........... Disposal Worho Tunu#rur#iun ami# Permission is hereby granted.............. ..1-_ ..........0 ._t......................................................................... to Construct (-A or Repair ( ) an Individual Sewage Disposal System Street qC� as shown on the application for Disposal Works Construction Permit_.No.,�:._ /_9 Dated.... �.7.93................... 9 ................. .. .... --------------...-----....------...•....---------- /7 �� oB a d of Health DATE -•---•----•-------•••-•-......-----•-•--_..... FORM 36508 HOBBS✓Y WARREN.INC..PUBLISHERS •- j�►-i-_�SI�►J - ,DATA .L. , r : : � � � _ ';�`. : : : ; . _ - � . — - t13ED,P��ts �- _ , GAZi3AGE GQI11D 2 I I 1 G, .TA►�C - 3 oX�SoK . 4 S big?. . i Q 1�USSORS Ss - j-- A T1 rJ Ada S G ' r3g ��9_�.64 0+� (JdAT►gW / �. (i2,4t'- CBI-' ' F o� : : T L-4.. `'4''�7&w1L_4_.-. _y. 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