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HomeMy WebLinkAbout0152 CAP'N LIJAH'S ROAD - Health -- -- C� �� v;>'k I ,7-Z /// S M E A D No.2-153LY UPC 12934 smead.com a Made in USA 2 SUSTAINABLE FORESTRY INITIATIVE Certified Fiber Sourcing wwwAfWrogrem.org 0 C � � � 1 TOWN OF B RA NSTABLE LOCATIONZ �, U.06 & ',�4 i7 SEWAGE # Jib VILLAGE_ j2e►. 31//l/t" ASSESSOR'S MAP LOT J71 INSTALLER'S NAME & PHONE NO. .. �2XeIY' S�•y,' �,� �` SEPTIC TANK CAPACITY i e LEACHING FACILITY:(type) h (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: : o VARIANCE GRANTED: Yes ''No h 1 1� I � ills 4 A�FSSORS MAP NO: ,� o PARCEL NO: ,ZZC FRs.....$..... 20.:.� . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH the1cybp.m,kv-"01x528.�. . � .fit. q.;..(.)-&? /._....Bfirms.t.a_h1.e-................................................. Appliration for Bigpuiial Works Toustrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .............•-•---...-- Location-Address or Lot No. -Doyle-...._...... ................•------•--------••---•-----•---...-----... ............----••-•-- . Owner Address a .....:...Mac411bar............................................................. -----•----•----••--- Installer Address UType of Building Size Lot----------------------------Sq. feet DwellingY-X No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Buildiii yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria Other fixtures WDesign Flow......:.....................................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 ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .............................................-............................................................................................................ 0 Description of Soil......................................................................................................................................................................... v --•---•----------------•---••---•-----------•--•-•.....sansl.---&�...Gr.suel.-----...----------------........----------•------•-------------•-------•-------•----••-------•-----------• w --------------•---------------------------------------------------------------....---------------------------------------....------------------------------------------------------------....--•-••--- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------------------------------•-----...----•--•----.••----•-•--•--...-•--•-----------._.-.I.--1000---ga.11on...Lea ch...p.it................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1-1 p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued y t b d of heal ��'Signed --A- ••--•3 1_6 4$-5-------- - -a_....-----••-------- Date Application Approved By................ •� - •------•-•---•-•----------• . 1� $ Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•---------------------•-•.._.._._ •-•------------------------------------------------------•---------------••-•---------•--...------........----------------------------------------------------------------------------------------------- Date Permit No.---.-',�c�-�Ca:.. ... Issued -------------•--------------- Date J N -----------J------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH h s 1 cybp.m,kv-11 0 1 x 5 2 8tea----------------------------------------------------. ApVtiration for Ui"viial Work,5 Tanstrurtion "null Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: i 152 Ca,,Dtair, Lija'-a .................................................... .................................................................................................. Locat'on-Address or Lot No. ....... ..................... - Owner Address W J-P.Ma-ornbar ...................�:............................................................................. -------------------------------------------------------------------------------------------------- Instafler Address Type of Building Size Lot............................Sq. feet U Dwellir4-X-No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. IY4 Septic Tank—Liquid'capacity............gallons Length................ Width.._.__.......... Diameter..........._..._ Depth...._..._...__.. 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 ( Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... 4 Test Pit No. I................minutes per inch Depth of Test Pit._..............__._ Depth to ground water..._..........__._._.... (% Test Pit No. 2................minutes per inch Depth of Test Pit............__.._... Depth to ground water..._._..._......._.._... 9 ..........................................................................................................................................*------------------ 0 Description of Soil....................................................................................................................................................................... xSand & GravelU ......................................................................................................................................................................................................... ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable------------------------------------------_--------------------------------------------------- . -1000 Qallon leach oit. ..................................................................................................................... ...............................---------­--------.......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issue�,by/,t e o4rd of he0h p., Sig e g7 dI-'-- ---------- ..................... ... .......... ApplicationApproved By................ ...................... ............................ ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo..-----. ------------------------ Issued-------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1©:7T1....................OF.... ci. .......able-, ........................................................ C�Cr�gftrtt#.r laf f�urtt��t�tttre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired,(,.} by-------- J.F.Ma^®tuber - --•------••--•-------------------------•-••------------•-------- Captain nstiler rJ2 Li�a � Road CereI�311 eat. . has been installed in accordance with the provisions of i'i"— �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 CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................•-------------•----....--------........-------------••---. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS �r"e ,a BOARD OF HEALTH Town Barnstable $ 2Q.Q�7 r' "r""•'' ........... FEE........................ 14sp asal Works Tonstr Dart amit J.P.Macomber Permissionis hereby granted.................................................................................---....------••------........•-••-........._-----•......•-- to Const tic (Ca) a�i aIM11 a�l a tad vi LtCQ'.a�j p3sgosal System at No - - Street as shown on the application for Disposal Works Construction Permit �� "�� Dated.......................................... i ------ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS