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HomeMy WebLinkAbout0055 VICTORIA STREET - Health SMEAD No. 2-153LY UPC 12934 smaad_com • Made in USA �J SUSTAINABLE FORESTRY INITIATIVE Cordfied Favor Sourcing wwW..finopr.romo i T V TOWN OF BARNSTABLE q LOCATION � I L�O f A ST SEWAGE # T 3� Ll7 1 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY 10M GA LEACHING FACILITY: (type) Pr I (X& (size) G.4�• NO. OF BEDROOMS_ BUILDER OR OWNER C St!i A 1 O ve- PERMITDATE: 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) r Feet Furnished by 1-'/i SpcGT'D+� 1-Or i q)_ Aa- ao a O A3- a3 3 83- as ray- 3y y 9y- 3 I,O C A T ION SEWAGE PERMIT NO. �4 VILLAGE V) 0 I N S T A LLER'S NAME i ADDRESS d UILDE R OR OWNER �PLIJLS t�'w�G/r�'� DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ��d� J 5L SS M IWA TOWN OF BARNSTABLE LOCATION � 1 L+0 rl . � - L ''� S SEWAGE ri �3 �7 1 VILLAGE C111 erth Ili ASSESSOR'S MAP & LOT Oy INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY _ GA LEACHING FACILITY: (type) A ! Co X (size) NO.OF BEDROOMS BUILDER OR OWNER CJAA;1tf A l OVC, I PERMIT DATE: 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 i Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) --�^ Feet Furnished by —�/l C,ct 0h Q�k At- 19 al - a , A l a Q � A3- a3 3 ❑ 93- ad Aq- 3`/ �y- a ► 1 No... 3. !! - Fxs. .......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ................ .....................O F.....------.............................-------------------:.....-------•----------------• Appliration for MipoiiFal Works Tontitrnrtinn ami# Application is hereby made for a Permit to Construct (L/�or Repair ( ) an Individual Sewage Disposal System at: l Location-Address or Lot No. •...............................•^.........--•-•-------^----........_........................... ..........--...................................................................................... Owner Address W Installer Address Type of Building Size Lot............................ t U Dwelling—No. of Bedrooms------------- ..---Expansion Attic ( ) Garbage Grind r 114 Other—Type of Building ............................ No. of persons.....................--.---. Showers ( ) Cafeter WDesign Flow-Other �es - --- ___'gallons per person per day. Total daily flow....................30 ...........gallons. WSeptic Tank—Liquid capacity/QM-.gallons Length..Sj....... Width---Y-j...... Diameter................ Depth... ......... x Disposal Trench—No..................... Width.................... Total Length---................. Total leaching area....................sq. ft. Seepage Pit No----------/-----.-- Diameter.A.t6....... Depth below inlet._,4f.0.......... Total leaching area..-a 1 ...sq. ft. Z Other Distribution box (V) Dosing tank ( �) _ 64 '-' ;. Percolation Test Results Performed by------"Ib...G...��t!: !f 10.C............ Date...... 3........ ,aa Test Pit No. L.4,�---minutes per inch. Depth of Test Pit---C! '__._ Depth to ground water---�0!�E...... GTq Test Pit No. 2................minutes per inch Depth of Test Pit..----.---._.------- Depth to ground water........................ a •---•-----------------------------------------•----------. ---•--•. Description of Soil � ��C S!E�• �- ------------------------- -------- ---------------- - - - .-- - -• •---- ... x w UNature of Repairs or Alterations—Answer when applicable..............................................:................................................ --------•--•------------------------•------•----------------------••----------------.....--------............--------------------•------------••--------------------•--------------•-----------....----- Agreement: T dersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the p vi o I of TITLE 5 of the State Sanitary Code The unde igned further agrees not to place the system in op ati u 1 e ca Compliance has been iss by the b r of health. igned.... ......... ��� ................................................... .... ........ te----.......... 44 APi PProved By r = --•--.------•-----------------•-----...••--------••-•-......_---------- ....--.. ---.d'.. - Date lica.tion Disapproved r t following reasons:................................................................................................................ ----------------------------- ------- --•----•-----•---•-•-------------•----•---------••...•-----....-•-----•---------•-•----------------------------------------------......-•--- ......•-••------ Date Permit No. Issued....................................................... Date No.._V...! f .,� Fes$....... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..• ................................OF..................................._...-.-------------------.._...._...................._. `$ ApVftrtafilaat for Bispoa al Workii C ontitrurtinn rd tit Application is hereby made for a Permit to Construct (V/ or Repair ( ) an Individual Sewage Disposal System at: .... Location-Address or Lot No. .................................................................................................. ...........••-.......---...-•--••---...--••-.._................................................. Owner Address w Installer Address UType of Building Size Lot..................._........Sq. feet Dwelling—No. of Bedrooms_____________3__________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ------------------------------------------•---••- w Design Flow....... _____________________gallons per person per day. Total daily flow..................,_ _O...........gallons. WSeptic Tank—Liquid capacity/Q------__gallons Len th__- ....__._____ Width_. -)____._ Diameter________________ Depth...Y__.__..-. x Disposal Trench—No_____________________ Width.................... f_._._______. Total Length._.__.__._._______ Total leaching area....................sq. ft. Seepage Pit No.........e......... Diameter_J/L.�_ _____ Depth below inlet__ _C-�__..______ Total leaching area..'ar l ....sq. ft. Z Other Distribution box Dosing tank ( ,) / '� J /•' /"� " Percolation Test Results Performed by..___�.0th... ___ ..__.._.___. Date.....4—::.2.0 ......... aTest Pit No. 1__ � minutes per inch Depth of Test Pit__1�vy.."___ Depth to ground water---AX-0 _____. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ RS _•---•----•-------------------------................................ ------------- Description of Soil !'h...... .2 -Jez------�-'�� - ---------------•----•--___ ---------------------------------•-••---_____---- x w VNature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------•------------•------------------------------•-------•----------------._...------...-•-----------------------------------------------------------------------------------••---•-••--_----- Agreement: T ndersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the p ovi ons of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in op ati I e f Compliance has been issued by the board of health. ignede''r ---------------------------------------------------------------••--•------ y y' V`'' ............ APpl. PProved By ', G :�. -----------•---•---•---------•-•-•••---•-----------•--------- ';f at�------------- lication Disapproved f, r t e following reasons:----•--------------•------------------------•---•------------------------------•----------.._. .-----------..... ..............................•-•-...----------•-----•-•--•--......_..._.....---••-------•-------........._ -------------------- ---- - --------- ----- --------------------••-•-•--- Date PermitNo......................................................... Issued............................:.......................... Date ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntif irate of Tontliti attrr 4 75 IS TO CERTIFY, That the Individual ewage Disposal System constructed ( Repaired ( ) by -� ------------------------------- ----------------------- ------------------ T�... - .................. ... .... ---- i1 R ....Installer -- at. -._,...........Z e------------- I s has been installed in accordance with the provisions of TITLE �5'of The State Sanitary Codas d e cribed�'in the application for'Disposal Works Construction Permit No. _, '"__ _; ______________ dated__.t�,� "}" .:-1 ..................... THE ISSIJA E THIS CERTIFICATE SHALL NOT BE CONSTRUE S A GUARANTEE THAT THE SYSTEM WILL UN ION SATISFACTORY. DATE.;..._ll_. _..,�? Inspector... ••-•-----------•-••--------•--------------------------•---....-----•--- TJ COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C4a�t e .OF.......... ............................. No.._ .......... '� FEE ork (9om'iirttdiou trod# Permission is hereby granted. �.:----t l •--------------- - --- •-------------------•-----------------------------.......--••--...-•-...._--•--- to Construct or Repair ( ) an Individudl-•S wage Dspos System at No............. '- ! ..._.._%d_ _. Street as shown on the application for Disposal Works Construction Permit No............ "� __-- _ Dated_. _ �"°; et' ----------------------•-•-= ............................................................ DATE.......... Board of Health J kj ./-_~__++.....................................•-.. . FORM 1255 A. M. SULKIN. INC., BOSTON ,,� r r a - !D8 - --- --- -- -- - -- - ---- -- -- -- - __ r U4 - ----- /07 00 `� _ -_- / 6.23 ,• -L E Gc1 2 of_ - /v�. k - /00 94 _ _ - - - - ---- - ------- r__^-- ti/UTE ground Pr-o7c,, -�-- PPsc � / r H02/Z Sc9LE / _ O - S C V EX7-&A./U f L I-- . E - --� O ^ MAVHOLE COV&R5 7-0 /AJ/TH//V F!A//Sk4ED GAE!/gl�E . SCHED. 40 P. V. c. 0,2 EQufiL Tt� SEpT/C (mrnrrncirn %" per- 2 of /2,. Wash&& 5-1-one O • O ° SUrno e ° O 108 /000 GAL. SEPT/C TH,VK `" Of 314~-/� ° ° washed S-for) ° ° O • r j LD E- S / G /L/ 7T� 7- H 0 Z L O G \ o / S hI BED,2OOM HOUSE L.JFC LEA /AJE � t '© l (n o d r sfsosEr� l ¢n PE,2c :e A �-�- _ _� G r .- � r— ��(p L O (n/ 2 f9TE GALS./D/9Y DATUM S E FP T/c Tl,?A-1 CU x 1 Q/j x TEST HOLE #/ TEST HOLE- qoZ r IV EFF. DLo 6 7-07-;-9 L '8/. G. P. D. NJ E✓ D /_ o ob A,/ o �Jr-t ���' Er.eCpu,vT BCD � / T� .� � � / `� � � Q / �'] ^ , P�2 o OO S E D oA/ THE G�2 o can/D f�S (/\/ L_.. �7 /V 5,A-4 0 _V O A./ T H'/ S P L ,4?^J DOE S GO/VF��M TO 7'HE BU/LD/A/G .5E7-- ST �a tr5=% BF�C,� ,2E Qc�/�E ME�/TS ©F THE E -r-e Aa U/ L L B F�2 E P f3.2 E D F(=>2: fi�J �`� �} +j :-'r r �`•?5 S C r9 L E f�S S H o 1-. A J T EFRErT H. /� / / / �Q EV REt(r iG j Wo.178 HINCKLEY O o0 e xIS-f-/nq /evatron BL DG SETB 19c,� �✓f=7 � /� O vTH , 0. 00 Pr'opoSed e /evcf-ron EQU/�E/�EtiJTS '• - - - - - -- — eX /Sf-/ r7,� conf-our-S �rOnf = Eo S / de = /U 0 vE D . re0-r- , U Bo� 2D oF= HEALTH