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HomeMy WebLinkAbout0019 SOUTH EAST LANE - Health (2) l q �'ou��eaA-1- C�.� Cen (— No ................ FEs... ...20.00 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH I` Town Barnstable ...................... ................I...OF............................................... .. ApplirFation for Bhipniial Works Tnntrurtinn ranfif Application is hereby made for a Permit to Construct ( ) or Repair )R an Individual Sewage Disposal System at: 19 Southeast Lane Centerville ................................................................................•------••......... -•--.....-••-•••-•--.......-••------------•-•......-----------------------.............------..... Location-Address or Lot No. .---••Brian Lorig-------...•--........-•-•----•-•---•-••......---•-•---_----- Owner Address wJ P,Macomber Jr................................................ .......•-----••--•-..._..---••-•--•...----.......................-•--•-------••-•---•-------- Installer Address VType of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms...........a..............................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' 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........................................ W Test Pit No. I................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----------------------------------------- .................... W Sand $. Grave Y W ---------------------------------------------------------------------------------------------------------------------------:•-----------------•----------•-•---•--------------•-----........._.._.._.... V Nature of Repairs or Alterations—Answer when applicable-..-..�._iQQ©-...ba bi � h1ri�s pi �............. -----------------------------••---•-•-------------------------------•----•--••----•--•-------•---•••-•------------...--•-•---------•••-----------------•-•-•-------•---•---.......-----------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITLE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued b th oard of heal t . ned..... ------------- ... 11/11 9 9D te 'Application Approved By.............................. .............................................................. C/ Date Application Disapproved for the following reasons----------------•-----------•-------=-----------------------•-------------------••----•--•--•--------.......--- --------------------------------------------•--------------------•-------------••---•---•---------•--------••--•--------------------••--------------------•--•---------•-•-----•--•-----•------••------- �j p,� Date Permit No....��. ! - Issued // ! Date NoT ... Fss..... ... 20.CJ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tovrn Barnstable ..........................................OF.......................................... Appliration for Uhipaaal Works Tomilrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair XXX an Individual Sewage Disposal System at: lQ Southeast Lane Centerville ...... _ .................................................................. ..•--.._._..-----------•-•--•-----...----•----•-•------•----------..._._...._......---......-•-•-- Location-Address or Lot No. Owner Address a ---•--....ap.0....a.....rrihPr Si ............................................. ._..-•-•-----•---•---••--•---••-....----•...----------....--•---•-------------------•----------- Installer � Address UType of Building Size Lot..............•......._....Sq. feet Dwelling_-�L No. of Bedrooms.......... ...............................Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ............................ No. of persons..............._.._..__._.._ Showers ( ) — Cafeteria 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_.--__-____-_--.-----.-. fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-__--_--__.____--__.__. P4 ... •... •----------------------------------- ------------------- •-------------------------- •---------- --- •--------- ••---..... •------------------ --------------- 0 Description of Soil....................................................................................................-----------------------------------•---••-••••---•-------------_.. W Sand & Gravel v ......-•--••--------------•-•---•-•---•---•--•-.......-------•---------••••--------•.....-----------•-----•--•--•------------------••---•-----••••------•-------•-•••-•--•••----....-------------------- W ---------------------------------------------------------------------------------------•-------•-----------------------------------------...-----------------------------------------------•---•--_..... U Nature of Repairs or Alterations—Answer when applicable_-__--_r---- -------_ - uh � t._J., raToa � pi ..•-------•--------------------------------------•--•-----••-•-•--•--•-----••••••------••---•----------••-••...---•--...-•--•----•--•--------•--.....--•----------------••----•-----•-••.....----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI:l, 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. Signed---- ' '�---•---;•--•----- -----------------------•-.-. ------------------- ...1-1,=-1---6:.,..-------- Date Application Approved BY ----------------------- --•---/�s� .._... - l ----- Application Disapproved for the following reasons:................................................................................................................ ------------------•--•-•-------------•-••••----••-•---------------•-•••--•-------•-••---•--•-••------....•-•---•--•-•-•--•-•--•-----------------•--•-•---------•-----•-• ............................... Date PermitNo..c. -............. ....... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....T. .......oe n..............OF....... �.rnst .ble ............................................................. �nrtifirate of TantpliFane THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (,} by...t/ eP.-MaCo_lber Jr. ..............•......._.........•......................................_.........---....--.........._................_.........................__._........._....._._.__..... SOut�hclast .Lane Ci titer MlleInstaller a _. _= .................•-................................................•-------.......---•------------------------•----------------------....................................... has been installed in accordance with the provisions of 1"IT4 he 5 State Sanitary Code s d scribed in the application for Disposal Works Construction Permit No.�-- -__-__ -_.(.... dated___.__l! �1................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL F4NCTION SATISFACTORY. DATE _._.... _ ..._ ---------•-•---•------------ Inspect - :_ --.............. ------------ `t +' THE COMMONWEALTH OF MASSACHUSETTS ?-, BOARD OF HEALTH ..........m n OF......... is :?_. . .------............------------._.._......... 2 , FEE.... ..... ' .)';i No.......... ..._.---• �in�r�anaal nrk� �nnn�rnr�irrn .rrani� Permission is hereby granted.......0 .P, ',a(..;o b e r Jr. ----------------------•--•----•---................................................................................................ to Construct ( ) or Repair 1(X ) an Individual Sewage Disposal System �c� Southeast Line Center at No. ---- ------- --- Street - as shown on the application for Disposal Works Construction slit---Na _.........�__ Dated....... �j/�--��-- ---------- ------ DATE ...---------•-••............................... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS