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HomeMy WebLinkAbout0113 ANSEL HOWLAND ROAD- Health (2) I j3 ANi m t4ou/1 ►d c e Otr vi Iw, 17� — z31 t a M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN,RECYCLED INITIATIVE CONTEN' 4 Certified Fiber Sourcing POST-CONSUMER www.sfiprogrom.org SFW1290 MADE IN USA GET ORGANIZED AT SMEAD.COM f' fit. No., ^r..�... Fims.....l1�0............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... / - ..............OF......... .. . ApplirFatiou for Dhipaii al Works Tomitrurtiun Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at 4!ELK ............... .....>at Addres!s �� •• � ----------...••--• .... Lo .:...........c-- .._ ....----------............... ................------ . ......................--.:.------ W _..._ . � ' -`� n / er Address��: �..J ...... ------------------------------ ----------------..=t� ...................... Installer Address d Type of Building Size Lot.. _ -- -----_Sq. feet U Dwelling—No. of Bedrooms....... ................................Expansion Attic ( ) Ga bage Grinder (4}1-U Other—Type T e of Building No. of persons............................ Showers P� YP g --------•------------------- P ( ) — Cafeteria a Other fixtures ..................•----•-•--•-•- .... --------- •------------- ------- .W Design Flow............. ....•.--...._.gallons per person per day. Total daily flow................. .....................gallons. WSeptic Tank—Liquid capacity�_/.��gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...../. ... Diameter...... . X 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..------................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----...............----- ...........-•--•........................•-•--...............-------•--------............--••--------......................................................... ODescription of Soil...............................................................,........................................................................................................ x W U ... •-------------------------- •------- -------------------------------------------------------------- •---------------------- •---------------------------- •---------------------- ------------------- 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 1,a-. 5 of the State Sanitary Code—The undersigned further agrees not to place thein ' operation until a Certificate of Compliance has be is ued bye bo d of heal,h. Sign eja, ApplicationApproved By---- .... ...•---•-•••---••..................•••--•••----•---••....._...._.....----..._-----• 1 ------ Da Application Disapprove or a following reasons:.........................................................-...................................................... ..........................•----------•-----------••----•----------•-•------------•---•-----•---------------••••-------•------••••••------•-----------•---•••••-•••-••••--------•-•--------•------------ Date PermitNo......................................................... Issued_.------•-----------------------...-•---------...-......... Date r � Qi-� 1. � .10CATION SEWA 83 49 PERMIT NO.- Lot 12 Ansel ow'" d VILLAGE v- Centerville, Mass. I N S T A LLER'S NAME & ADDRESS Robert B. Our Co. Inc. Great Western Rd. North Harwich UILDE R OR 0WNER Alan Small Builder DATE PERMIT. ISSUED DATE COMPLIANCE ISSUED 2 � r � � , .. . , y3�, � �� ��� � i t Ip ��, !' g� TOWN OF BARNSTABLE 1 . nCATION SEWAGE YILLAGEeWy���. ASSESSOR'S MAP 6z LOT/7f- �✓/ Y INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1C)Q0 LEACHING FACILITY:(type)2, (size) �D�d NO.-OF BEDROOMS "PRIVAT.E WELL OR PUBLIC WATER B OR OWNER 44 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: •VARIANCE GRANTED: Yes . No ,I L _ � . ., �. . .: ' - s��. i. r-t� ` y .© � i, � � �'► /. � / N>� �- � �.� NEr� �L� �� s j 'G� No �- ._�.�:.. F>cs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ........... ....................OF.......................................................................................... Appliration for BitipooFal Workii Tomitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__......_...................................................................... ...••------•..................---••-•....---•- - - - -- .........._. ..............Location:Address ......-•-•----..........---._......_......or•Lot No. ..................••... -•-----------•-••-..................•._...•. --•-........................................... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )Other—Type of Building ............................ No. of persons............................ Showers ( ) a ( ) QI Other fixtures -------------------------------- - W Design 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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........................ P1 ............................................_................................................................................................................ 0 Description of Soil............................•--------.............----------•-----------------------•--------•---------•---..........------------------------------------............--- x U ..------•---------------•........-•--•--••--•--.......---•----•-•--•--••---.....•-----•-•--....------•----•--------------------•----------------•--•................................................... ----•------------------------------•------------•-----------------------------------------•--------------------------------------------------•--------•----------------•-----------------.........------ 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 Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Z1- 1�44 V 71h ApplicationApproved By.....- -••-••-----•--•-•--•--•--•-••---•--•--•••-•--•--......---•.................. o Date Application Disapproved tolr the following reasons:..........................--------------------------.......................................................... ..•---•---•---•-•-•-----•---.----•------------------•----•------•---•----•----•----•••--•--••-•-----•--••-•----------....-------------------•---•-----------------------•------•---------------......... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................... (5rrfifirdr of ToutpliFanrr 11 RHIS ISYT� CERTIFY, That the Individ al Sewage Disposal System constructed ( or Repaired ( ) by ,�c''----------------•------.....................--•---•---•-•---------------........-•------•--•--------- y7 `/', Installer has been installed in accordance with the pro .._visions of T � r' The State Sanitary Coot/as described in the application for Disposal Works Construction 'Permit No -----�' J_./'`................... dated,_ -_-----._-_-_-------- THE ISSUAN THIS CERTIFICATE SHALL NOT BVCONST AS A GUARANTEE THAT THE SYSTEM WILL NTION SATISFACTORY. DATE °� -------------•-•----••--•--••---------------.--- Inspecto ---------•--------.-.----------------•---••-----••---.------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q _ oF..................................................................................... � Nd'_....... ...._.. FEE..........-•---•........ �ioo, al orko �onorttrion rani# Perm's;—'- is-•hereby gran ed_ ./ ._ !":.......It.................................••---...---•--•-•-----------••--••••............................. to CAole, t` ) or pair ( )r�n/Indiv ...................................... ��`.._...-•-•--......-------------------•--------....._..........----••---•-- t Street ✓" / / ry,,//���/ as shown on the application for Disposal Works Construction Permit No....... '�. Dated__::/................�................. --------- ---------................................................._ fi / rB DATE_._...'Z= --� ---d--.Z...-•-------•---•----------•-------------------- ,/ oar d o f Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r 15)W1 a FAMILY - 3 BEORooM 9S.7s- 'Y 1J0 GARBAGE• C��LNICE2 DAILY FLOW : 110 x 3 = 3306.PP SEPTIC, TASK = 330x150% 2-49y6.P. Q r . y5E• 1000 GAL. 015Po5AL Pr'r vSE 1000 GAL. 17, 754 S,P S I DG.v�ALL AeGA = 150 5.� � r l a ! 150 6A x 2.5 = 37 5 G.P q BOTTOMQRE jc A: o F.5i 50 5.1= x 1. 0 � �o G.Po_ . . A _ T �3 'TOTAL.. DESIGN = 425 G.PD. c ? . -TOTAL.. DAILY FLOW( - 33o -.Po j PE2COLAT�OFJ RATE r 1''IN 2M1N o�L>✓55 �ouNO�TioN I� Tyr%�',� ��•r-r;,-'�+, ��;_� '00 89 / � `V 44 ��0 SUftVE.y e � ._ . - • • Tr���T -coL�1 ='G�S3 TOP FWD=$4.0 (yAm -t- 1000 INS. gp,-7 i SuQSolt_ D►ST. INS G4�• $O•S 3 50.Z Bo-A S6PTIG ` 1000 INV TANK GAL. ? mlgt> LEAGu �9.5 PIT INV. INV. WIT 49.0 sd•a 113/g•1%L WA S%1 G D 6TvN6 , GILAV4 CE2TIPIGD PLOT PI_AW PR.OFILr . LoC4�IcN ��y-fCTzVILI.0 w• I� 39S No• SCALE $GALE ('_ VP.TE i�(q�83 � GE QTtFY 'THAT TN6 �OU�tDN.T10P(SNOVYN PL'P`f�J RE1=62E►� GE 46.0-SOW GOMPLYS WITO-TNE. SIVELlh1E L•O "T 1Z ! AUP S6-rl5AGK R.6QVIQ.icl�ENT'� oF 'f�aE- CEKTE•�Z�IL.L.� N�G1-tL. , 'TO W N O I~ $A�R K E+'C A%L.EA N'D I e., N o't'• N D S LOC#.TED -WITNI T E F1..00p LAIN S�cT1aN = DAT E , BA'cTE2e WYE: INC. I R.EG I Vr r-Qr.,Tp LAW D.5 u my EVbel' 71413 PL&KI 115 NOT W-5r=D Cld AN 03TE9-VILLE MA65• INSTRuME►�7 Su2vG-`( 'THE o�I~SE'T5 SL1auo I NOT t3C- V>C.D'Td 0CTr--SWAI► r- L.�*T' �.INr—. APPLIrANT ALA,,(