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HomeMy WebLinkAbout0496 ELLIOTT ROAD - Health (2) ,Olt �Z-7 s' 4rJ,fiq , r. THE COMMONWF_tNLTH'"C1F MASSACHUSETTS BOARD OF HEALTH SUBJECT TO APPROVAL OF f, ...........oAIRE C®NSERVAl ! 1-111, N* Applir�ataon for Disposal Works Tonstrurtion, rr . Application is hereby made for a Permit to Construct, ( Repair ( ) an Individual Sewage Disposal System at: e-- 6014 er/cJ Locat n- Ss _ 0 ....... Owner W Address a ........................................................................ _ _ � Installer Address Type of Building Size Lot.... A� 4S4 feet Dwelling—No. of Bedrooms__•-----...............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building ............. No. of persons............................ Showers ( ) — Cafeteria ( ) a Other g -••-----••--• � Other fixtures ---------------------.......................................................... W Design Flow.._.., _, .................... ..gallons per person er day. Total day flow........3�5:0..................gallons. W Septic Tank—Liquid ca acit�-- -gallons Len th ._ Width Diameter................ De th. -5- ��-- x Disposal Trench—No..................... Width......Via.._...... Total Length................. Total leaching area_.....___..____.___.sq. ft. Seepage Pit No...../.......... Diameter�."��....... Depth below inlet..; _%5..... Total leaching area...���sq. ft. Other Distribution box (4-Y"' Dosing tank ( ) r ' Percolation Test Results Performed by. �.�d ,l��a�� 'i _�`,tfs Date.:.I . . Test Pit No. I..�_..minutes per inch Depth of Test Pit_./5-.•�:. Depth to ground water../ .W....._.. 44 Test Pit No. 2. .._..._._minutes per inch Depth of Test Pit..110....... Depth to ground water.. . . ............... .--------•-----�--------------•-•-•-...�....j. _.. "_._ --.---- O Description of Soil ... ®• �. ---•••- �/: W .v a .un- - U Nature of Repairs or Alterati s Answer hen appli lXj ____________ _ ____ __-t............. 2 Agreement: l The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT!..% 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. Date Application Approved BY - Y ... �iPl1.0 ...�.. ,1`=j� �sue= Date Application Disapproved for the following reasons---------------------------------------------------•---•------•-----------------...---•••-•---•----------....._ .................•------•-----•-•...----...•-•-------•-•------------•-•-----------...---------------...--I-•-...----••-------••---•--•--•-------•-•----------------•-•-•---------•......-••-------------- Date - PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tJ.......oF...... �T� .............fit Quietifiratr of TompliFaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Z-7-1000r Repaired ( ) bY---------••-----•---•--------------------------------------------------------••--------. --------------------•----•----. ------------------.........-•--------•-••--------•------•---------•- --- � st uer at ..., � C.)/ -------------------------------------------- has been installed in accordance with the provisions of T. �f The State Sanitary Code as described in the application for Disposal Works Construction Permit No. _. ...... 7.............. dated...... 'f®.'..7. ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................•-----------•------------....-----------------_..... Inspector.................................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. 7� 2 ® ......OF... s'.................. f,•� No...............75.... FEE..�`............... Disposal Works Tonotr tion "rrrutit Permissionis here granted............................................................................................................................................... 01 to Construct j rep it ( an Individual Sewage Disposal System System atNo.. 1­ .. __ g ._. ��r. . ----•---------------••--•------..-.-- Street/ as shown on the application for Disposal Works Construction P Dated.... /v 7.q......._.... ,- .............................. DATE. .....--•--------------•---......................._..... Board of Heart(T' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .r No 411 THE COMMONWEALTH 6F MASSACHUSETTS =f` BOARD OF HEALTH Appiiratiun.flir Uhip aal Works Tontitrurtiun Vd.mit Application is hereby made for a Permit to Construct ( or Repair ( ) an,-Individ4'l-Sewage Disposal System at: .................................... .................... �' 1 ------......---•----------..... .. .... f'ot No Loca£ n- dr s -1 ............... .....? ...4e e_ ' fir.! 7. 1rQ �--� W Owner Address a •.................... Installer Address T Type of Building Size Lot.....X!XZc4sq, feet 1—� Dwelling—No. of Bedrooms....... ..............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building ............... No. of persons............................ Showers ( ) — Cafeteria ( ) a Other g P-.....� Other fixtures ........................... ....... W Design Flow...... .......................gallons per person er day. Total dailyflow........3.5.10..................gallons. WSeptic Tank—Liquid capacity,/ allons Length.. .. Width."Y' Diameter................ Depth-_.....`'.�e¢. x Disposal Trench—No. .................... Width.................... Total Length.................. Total leaching area....................sq. ft. Seepage Pit No...../.......... Diameter/0.4.�0.1.... Depth below inlet..��.;5.._.. Total leaching area... .. sq. ft. Z Other Distribution box (L.y"o Dosing tank ( ) Percolation Test Results Performed b ..�_L.. i ../�9'G' -fir : J � 1. _ a Y -_1.?•-- Date_... r_. . .- Test Pit No. 1... _.minutes per inch Depth of Test Pit._ �,�. Depth to ground water.._�l_-M:...... f=, Test Pit IV o. 2..:�,.._....•_minutes per inch Depth of Test Pit-_//0..._.. Depth to ground water... /.......... a _....---•-•- .......................................................................................... Description of SoAil - .'.'_.. / •� , .��.e ........ . .5.&.`;:_�� N........ U ....4� / .... "L— t 4��..�'__----S�/G.......�_!n.11_11'LJ' L` �`� . .�..i�` .� �-�7�b UNature of Repairs or Alteratio nswer hen appli le__._____... .. ........................................................ _. ...... ... ..F.......... l ff t� dew" Agreement: ! -G�� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with I'1T 1.1� the provisions of LIT .•75 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. Signed. ----- --------•------.----......--------------------...--------------- t �` � Date Application Approved By..--- �-- -------- � �+�-,�..-...-•................... ----����'=�- -s-----.... Date Application Disapproved for the following reasons:................... -_ ....._. -------------------------------------------------------------------------------•......:_....-•-----------••••-•----•••••-•-•--•----•••-••-•••--------••••......------•-•-•-..... ................... Date Permit No....................... - ............................... r- , Issued ..--- Date ------- ` THE COMMONWEALTH OF MASSACHUSETTS ;3 BOARD OF HEALTH �^} .1 / ......OF.... 1.. �L �: �f- .............. (9pritiffirab of. Teu ptianu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (41-001r Repaired ( ) bY.................................................................................................................................................................---------------------------------- at.....A.0. { d....°° -4-/- • ice- 1 7-��e/�.... .�i..11 i[/S.r�j. ------------------------------------------- has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works:Construction Permit No. `. ....._...... dated_....._�'./1j:*..�_�,............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................•---................---.....------....•••--...--•............. Inspector.................................................................................... THE COMMONWEALTH OF Ni`ASSACHUSETTS BOARD OF HEALTH .7 _7 alILJ........OF... ._ Ic-c..)�'S � r ., No......................... FEE._:...:.: Uiupuuul Workii Twunutriun prrutit Permission is he!Sbp granted........................ to Constructs' or.Re it ( ) an Individual Sewage Disposal System �, at No. c � `,�..,��0. ......... -�r,11.� f------------•------ Stree as shown on the application for Disposal Works Construction P N . ...... ....... Dated......._""��...1� ...• { Board of Healt DATE...................................................................... P,, FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i t \ N11h �/3©/mil �� /�� � t�.-'' •�'�`� G�"/9Gs,/;�/?}' `'`6ARNSTABLE CE��:•„ io,.s c,. © COMIMIWOE I /7-4415 1 1 j' r� vl T_. _ t ; its f}' 64 1 %/00 . ' �'' tA 3; , 7'0 AS F6 . 41A,v,41 OG �S 40770 E�~G'gsrieory � , , � , " � ,.• ,rrl/iv. z L,gyE,e Q . Dvc,sc,y fro ,�'�c.yC%%F�" /o" :.:• �cg? �z ��'9 s—, c> E C3 1f� TOE�✓ /✓UE,E'1 ,, .�� (,7 p•;a �j.q S h E O eo PR-OFI LE OF vwl: 3 _ SANITARY DISPOSAL SYSTEM DESIGN DATA . NOT TO SCALE _5 BEDROOMS CONSTRUCTION OF SANITARY DISPOSAL DESIGN FLOW 3 � GALIDAY SYSTEM SHALL CONFORM TO MASS . LEACH RATE - MINJINCH ENVIRONMENTAL CODE TITLEM PROPOSED LEACH CAPACITY : AND THE TOWN OF f " HEALTH REGV ' GAL./DAY SITE PLAN SHOWING PROPOSED CONSTRUCTION L O C A T 1 O N FOR : c .,�,-� ..:: =,....r'-' APPROVED SCALE' DATE= BOARD OF HEALTH REFERENCE /rt/ -,� r� /9 r1 �'�`r� '% � ''t'j DATE A G E N T Ur JL�4 ' `sue� GY*�` ' ,� ) j"�:I, ���(✓!*✓/C�i{./� �l%� �G.G��/� �U/t.-'�"/.-�/G"'� I�;� 1Ci�E?ii i✓.Y�',��nM ' � J. M. M O N A H A N, J R . A S .S REGISTERED LAND SURVEYORS a ENGINEE . S fv51 MAIN STREET DEN•NISPORT, MASS• 026`39 fy` r ,• ..- . I SUBJECT TO APPROVAL BARNSTABLE CONSERVAT10"-1 ` COMMISSION _ Olt r To ,eF ,Bv/G7" TO G!//rN/A/ '�/mot//Sh+EO �-i���LC / ``•, ^�7/�� � /O °•' Svc.RcrS/ ,�,,,ovC scs•� �o `, r k rj �, -� Z 110 //.P• . + opT l PROFILE OF SANITARY DI SPOSAL SYSTEM NOT TO SCALE DESIGN DATA �•_`�'+ � -f4 .7 BEDROOMS CONSTRUCTION OF SANITARY DISPOSAL SYSTEM SHALL CONFORM TO MASS . DESIGN FLOW i=� %' GALJDAY LEACH RATE MINJINCH ENVIRONMENTAL CODE TITLE - f PROPOSED LEACH CAPACITY : , AND THE TOWN OF HEALTH REGULATIONS. rf _ GAL JDAY r SITE PLAN SHOWING PROPOSED CONSTRUCTION LOCATION FOR . APPROVED f9 ` SCALE' =- DATE ''i`-'f' � ' ,' J+;r BOARD OF HEALTH ��1 REFERENCE DATE AGENT ,..- f mow,��/'• :.a" � � ,� ,_ �+ �' .. r � .- Cw, _ ..� �-• ••--. ,r 1 L;c,,;'� ...' `w 4� �� ; -- i Lr'� � ! ---'r:'. ',+",/r s ��< l t '• -r'`f NFw'�`, {E!. 136,,� do u I F M. M QNA HAN, J R . & A SS 0C I A T E S �OtirsY � ;y REGISTERED LAND SURVEYORS & ENGINEE.RS 65t MAIN STR E ET DENNISP0RT, MASS. 02639