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HomeMy WebLinkAbout0023 ELIJAH CHILDS LANE - Health (2) B � �� '� �� .� .� i 1 �+.. ASSESSORS MAP NO: PARCEL NO: 1676 No.. ....1���.. Fss...3©..:..� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE App ira#ilaat for Uhgp aal Workii Tvatstrurituat ramit Application is hereby made for a Permit to Construct ( ) or Repair (�G) an Individual Sewage Disposal System at: -------............................Qa4.Ks. ......KL................ .................................................................................................. Location-Address r��1 1 e Lot No. ....�`.r?.. c-�c....---....----3 a Ca w ---------------•-•--------.......--•-•-• - .............................................. Owner Address - ---•-----••----••-•----•-•--•--•------•- -�a---•-•...�U.SI��►....._Z�. 5 -tea c 1�C7 �5................. •- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------- -----------------------------------•----------------------•...-----•------•-----•-----••----......----•-----............... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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.......................... 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water-........................ 9 -------•--------------------------•-------------...------. --------••-----•--.......-•----•................•-••------•-----•----•-•--•-•---•-...------....•. 0 Description of Soil------Q Z •---Sum---------------� -CZ-°-'`�`K&4x-.....!-''�.....•• 5 x .......--.•--- V --------------------------•--•-----•--••-----••---•.....------------------•----•-•------------•---------••-•--------------... W U Nature of Repairs or Alterations—Answer when applicable..... .......... `K 8..`...... . Di (=Fvsd rt_1 w fSou►o`er �, --.. � ....... ° .r_ � 'a. -rs 175"? ... ----•- ---....----- Ag Bement: 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 place the system in operation until a Certificate of Ca=liance has been issued by the board of health. r ��' ------------------------- -- ----------- ---------------------------------------- Date Application Approved By .. � .--- ....... Date Application Disapproved for the following reasons• -- --------------------------------- ----------- ------------------------------------------------------------------------ --------------------------------------- -- - ------------------------ ...........................---- ---- ----....---........--- ------ ------ ......................................----.. ........................................ Permit No. -----?01 ----I1q .--.- Issued ........................................................Date Date V No.. ....i yg �L 7 6 F ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , TOWN OF BARNSTABLE Appliratinn for Diipoo ai Works Tonotrur#iun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (}Q) an Individual Sewage Disposal System at: Location-Address .....�:^.?7 cJ ... ..1!`)------•-•--------•--•------------•-•----- .......... ...y'' ..�......1....1................................................................. Owner Address a R I-E�C1 4_....... Q = = osh'�................`................................................No Vj Installer Address Type of Building Size Lot............................Sq. feet �U Dwelling No. of Bedrooms.............................. _._..Ex Expansion Attic g— -------•- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (st Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Da •••----••-•--•-••••....•-•-•--•----•..............••--.. ------••-•-•-•••--••--•---...---•••---•----...•••--•--••---•.......---•-_............----•---.----- Description of Soil....... ---•-••.;u=n................ ----..... co""""-S 4a --------•-Sn 5...--...--•-...--------•-•-•--- U ----••••-•---••••-••---------•--••••....--••••-----•--•••--••------------••------•--•--------------------•--------------------------•--------•---------•••••--------------------•----•••. •----•...... W Z. -•••-•......-• -----------------••-•-••---••-•--•--•--•-•----------•---•••-•---...--••-•...----••--------•----•--------------•--•-•-•-------•-----•-----•----------•-••••--•-----•••----•-•-•••-•-_--- U Nature of Repairs or Alterations—Answer when applicable_.__-b > ------_--�'W30__.......... ...____0'K 8 ' F4.a"D I F��sd K-1 w a 5 '�----I�cccyJ�....------ G'c i S T'v� $Y S �L Ag Bement: 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 place the system in operation until a Certificate of Comp li a nc e has been issued by the board of health. \d-Tet�,a -------- ---- ......................... ........................................ - Date ApplicationApproved By .. <J t--------------------------------------------------------------------------- -------- - Dare Application Disapproved for the following reasons: .......... ............. .... ..................... .__.................... .......................................... ----------------------------------- -- ---------- --- ---------------------------------------------------- -------------..................................................------------------------ ........................................ Date PermitNo. a... �-��............................. Issued .............---------------- --....-----...----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifirate of 1011,11raptiartre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( 0 ) by .--..-.Nyc \c ...-Cb.0 sE---------------------------------------------------------------------------------------................................................. ............................................ Installer ,� at ---- 3------------£-L.1 .I.--+a------------L---� -�`�5---------...2�---- ----------- ----- - C'l,w .JCL-J ,, ........ ... - has been installed in accordance with the provisions of TITLE 5 The t e Environmental 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. 77, DATE.. _ .., ='` P_............................................ Inspector ----------------------- .-----------...................................... -------- ♦ �4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��_ �%� TOWN OF BARNSTABLE 3� No......--••---._...---•• FEE........................ Disposal Workii. Twnnsfr ion an it Permission is hereby granted____ .�G�LC ._____.11 �� Sa ----------------------•-------------•-•---------_-------------------•--_._.-•--•-•••......•......-.---- to Construct ( ) or Repair ( an Individual Sewage Disposal System atNo..-•-c1-2--------- -----•------.----- ----------------•---•------- -- Street l as shown on the application for Disposal Works Construction Permit No __: e- Dated.......................................... .............................. .................................................................... - S_/a � Board of Health - ...........DATE ... -•-•-- FORM 36508 HOBBS Q WARREN,INC..PUBLISHERS