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HomeMy WebLinkAbout0062 THORNBERRY LANE - Health Thornberry Lane Centerville O�D j A= 186-088— S M EAD® No.H163OR UPC 10259 smead.com • Made in USA 1 I No ...�_�._..� . �.._C� S ®� Fes--fir........ THE COMMONWEALTH OF MASSACHUSETTS J BOAR® OF HEALTH �6 -' ,/ C�V.{.► ..............OF....5.R _*3".j.VrCk --� . `�_�-... Appliration for Disposal Works Tomitrnrtinn runfit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ... ' K!..................►2 ........u,...C�Nr ......................................................S ------------------- Loca' -Address t No ..........................t }i�l �.3; T.��._..�.._.. L1 ....-- a `Zoe t� ©v Z � L .�A-r��,1—sue.`-.o- I�Qb...{-1AZ\44 cc, -� -•----------------••••••--..............-••------ ........ .......�.. ....... ....__......_. C Installer Address UType of Building r �,1 Size Lot............................$ . Dwelling-&No. of Bedrooms....._3..................................Expansion Attic (INS Garbage Grinder (YES AL4Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ W Design Flow.....SS "- ............gallons per person peer dAy. Total daily flow_:-_-_� ........................gallons. WSeptic Tank—Liquid capacitylSZOgallons Length_107(.. Width.S__E�)._ Diameter________________ Depth.- .� xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................:sq. ft. Seepage Pit No............I........ Diameter._...t! ........ Depth below inlet....3i.S..... Total leaching area._._5DQ®.sq. ft. Z Other Distribution box (Y-05 Dosingjtank A)D Percolation Test Results Performed by.. 15. 4---N--a c_-.k�:�.............. Date___L `S`c > ►.7 . Test Pit No. l.... __.minutes per inch Depth of Test Pit.....1.0........ Depth to ground 1� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •------- ....................................•-•-•••••- A. 0 Description of Soil--------.. _ ..__. ...c� I��1 x U -•-•...........-••---•--•-•....................•-•------•------•-------•--------•-••-•---•-•----•------•....-•••-•---•------------------••-•••••----•----...----•--•--- --•-•-........................ W 1 VNature of Repairs or Alterations—Answer when applicable..!N_.._ a___- - --- _ _____ -__ ST SE W `Q, ................................................................................................................ ... .. ... __. __• .... . ............ Agreement: The undersigned agrees to install the aforedescribed Indivi ti Sewage isp sal em in accordance with the provisions of TITI LE 5 of the State Sanitary Code— nd ed further agrees not to place the system in operation until a Certificate of Compliance has b issued t e and f healt d. •-•--------- ----• ........ . -• _--- • ............ ................................ D t Application Approved By---•----•••-•-•--•...�- -J .... -•---• .......................................... ........ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------••--------------•-----•••••.•••-- ..--•-•.................•--•-•--•----••--------.....••-----•--------•----•------••-....--------..........._......•---•-••-••------••---------•--•••-•--•--••-----•-••---•-•----•--------•....••---._..... Date Permit No............. Issued. g \ 3 p Date v No......--••-•-............ Fic$.: M ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----4.....................OF....... 1c./..±a Appliratinn for Disposal Workii Cnnnotrur#'inn itamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .... r .. .. .....� ... .................... -•-• -- I I, cat'yan 4 AAdress tnAdd�.. 1!... L IZL/�.�........ --�{��re �� 9�%O...I""A •t`. S 1� M Installer Address Q7i Type of Building CamC U YP g Size Lot ........................ Dwelling-A No. of Bedrooms......a.................................Expansion Attic ( )} Garbage Grinder (`(c_S pa Other—Type of Building _____-•-------- ----------- No. of persons............................ Showers ( ) — Cafeteria ( ) al Other fixtures ........................ . . w Design Flow...... _ _ ...........gallons per person per day. Total daily flow.......•__.6U_______________________gallons. W Septic Tank—Liquid capacity.]gallons Length-�U_"_�. Width..S r ' :?_ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No................,__/_-- Diameter..____41.`____._. Depth below inlet... _.... Total leaching area......��.__.CD_sq. ft. Z Other (Y45 Y Dosing-tank (M)J ^_ Percolation IT Test Results E Performed b ...i-3 ......•----__ Date....] -'.�-'_'_ -_-_•_.. a 1 Test Pit No. l....� ___minutes per inch Depth of Test Pit......LO_....... Depth to ground water_9 C#J_eta Coot--L_� (s, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------_................. x - --pc�vvl l DDescription of Soil........... •! t..................................... 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 TIT?E 5 of the State Sanitary Codejb.)qn,6edd further agrees not to place the system in operation until a Certificate of Compliance has b issf healtSigned- .. - ------• -- ----------•--•-------.... A lication A roved BDPP PP Y `- = ) , 1 ....... Date Application Disapproved for the following reasons:••---••••--•-•----••••••-•-•--------•----•--•----•••---•-----•--••-•----••-----•---•--••----•................... Date PermitNo........................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH „�°l✓.....OF......: y'*Iziv .. ................................................................ Crdifiratr of funutlrliaurr THIS,•IS..TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ----•- ...--•--------•---•------------------------------------•--------------•-•--•---•-----_--•-. Installer has been installed in accordance with the provisions of- TITLE 5 of The State Sanitary 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. DATE...................... ! �^ `..1_ ........................... Inspector..................... "-,_>--•------ --------------------- --•--- <�7­<? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH31GNING ENGINEER MUST SUPERVISE '"�STALLATION AND CERTIFY IN WRITING 1✓ ? .................. ....................OF..... � N��r ,.. ':�S INSTA�L`ED�ifil%3 .". J.�... ........................ ,. No..".:..: ...::.......... ,")ONCE TO PLAN. EE 19iupnsa1._ ,orku Tnnslr inn rrutit Permission is hereby granted.------. .� --------------------------------------------------------•-•------•------•---............ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo. w- ^�------------- ^ Streei . r. as shown on the application for Disposal Works Construction ermit No.l)_ ___ >_ Dated.._.__.]__ s_`t DATE.......%-- --�-►_.. 4".. Board of Health ................................ FOR.t 1255 HOBBS.& WARREN, INC., PUBLISHERS TOWN OF BARNSTABLE � 1 LOCATION C-o�- Z-a aFv►I'�e�C./ �,t�e SEWAGE # 90"'I'Z7 �I® (- VILLAGE Cev'x - w"(l ASSESSOR'S MAP & LOT O INSTALLER'S NAME & PHONE NO. 0 SEPTIC TANK CAPACITY I, 060 Ojai(tokS 0 LEACHING FACILITY:(type) �A-to Leach P-4 (size) NO. OF BEDROOMS 3 PRIVATE WELL O<EEEDR BUILDER OR OWNER 5 b u'i`�'�� ��1' 05�9y DATE PERMIT ISSUED- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No l/ Lv+ z � 4q ' � l % I x T�IK pl.A1 -711'w5 ►zEd6ED l}ou56 e,I7-r=, se VMQC.:.SE 3"l�. 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