HomeMy WebLinkAbout0030 SOUTH EAST LANE - Health S M E A
No.2-153LY
UPC 12934
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THE COMMONWEALTH OF MASSACHUSETTS '
-BOAR^D�OF HEALTH
................
Appliration for Disposal Works Tonstrnr#iun f irrmit
Application is hereby made for a Permit to Construct.( ) or Repair ( Can Individual Sewage Disposal
System at:
.... -,_-`"-- __..k_. ..................
` Location Address or Lot No.
................-U cjln:w...........L k �. ............................... ............ . `.:(4...!!...\..---...........--•.............................:....
Owner Address
.....
............ ...................... ___-__------------•.......-......-________--•-
Installer Address
Type of Building Size Lot..:.........................Sq. feet
U Dwelling—No. of Bedrooms.__............... .... .....Expansion Attic ( ) Garbage Grinder ( )
. 04 Other—T e of Building No. of persons____________________________ Showers — Cafeteria
Q' Other fixtures .---•--•----•-•••---•---•-----•• _..
W Design Flow............ . ...................gallons per person per day. Total daily flow..... -s. ............................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........I Diameter......t.0__...... Depth below inlet.......(9.......... 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........................
(s, Test Pit No. 2................minutes per inch Depth of Test Pit....:............... Depth to ground water................:........
a+ -------------------------------------------------------------
--•-----__.... ----------
----------
•--
-----------------._...--------•-----•-----
ODescription of Soil..........................................................................................................................................................................
V
W '
U Nature of Repairs or Alterations—Answer when applicable-------A.0 .......
' �" c1es _pow
-----------------f f c�T..._......�. -----�� " )'n ------------------------------------._....--------------..._......._....._._.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITL 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 boud of health.
Signed..__.... _ - - -••• ___ --- -----(.
Date
Application Approved By..................� ... ...............
Date
Application Disapproved for the following reasons______________________•-•_-____••_____..._.._..._..______-____..._______________________-__...__......._-_____...
..-•..............................•-----...-•----------------•---•---•-•------•--•---------•-------•-•---•-••---••-••-•-•••••---••-•-----••-•-•-......•-••-•--------......•••--••••-••--•--...._--._..._
Date
PermitNo........ Ix.).................... Issued......................................................_
Date
TOWN OF BARNSTABLE
. ,,,LOCATION ti AEL L SEWAGE .1
VILLAGF.__� --- ASSESSOR'S MAP 8i LOT
INSTALLER'S .NAME lCz PHONE NO. C(A. T5
SEPTIC TANK CAPACITY_� ?cS7
LEACHINU
NO,. OF BEDROOMS S PRIVATE WELL OR BLIC WATT
BUILDER OR OWNER__�d
DATE PERMIT ISSUED:_
DATE COt'.iPLIANCE ISSUED _�o -
VARIANCE GRANTED: Ycs �No ✓ __��_
YYY + t
t
I
�x��4
A.
o
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�.Cjs!.Aii� .......OF-_ *'r.. .....*----------------......------
Appliration for Disposal Works Tonfitrurtion ramit
Application is hereby made for a Permit to Construct or Repair Individual Sewage Disposal
system at: Y-N\t-'e-
-,--I c�� V'��C_yl V'\ON--
................ . . ......!��.................. .................... ........
......................
Location-Address or Lot No.
........y4 t............................... ........................ ................................................................
Owner Address
fA-4.................... '� IFILC............... ..................... ....14,t4.- S.
Installer ... ........Address
�u Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..._......S................................Expansion Attic
4Garbage Grinder
A4 Other—Type of Building ............................ No. of persons................._.......... Showers Cafeteria
Other fixtures
Design Flow.........._`—__ ....................gallons per person per day. Total daily flow----- ........gallons.
-------------------
;4 Septic Tank—Liquid capacity............gallons Length................ Width....._...._..... Diameter.............._. Depth_...............
Disposal Trench—No..................... Width.............._.... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........)....._____.. Diameter......1.0c....... Depth below inlet....... .......... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date:.__.......-----.....---.--.------.--_--
a
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.........................................................................................................................................................................
W
U ........................................................................................................................................................................................................
ZW ......................................................................................................................................................................................................
I
U Nature of Repairs or Alterations—Answer when applicable.......A_X) .........G.---�z C-A5T_ PIT—
....................
.................L!_.k...... ...........
...........................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T I TAIZ- 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- ... ....... ..............
Date
Application Approved By...................5�� ................................ Sr,
............... ..................1._:nA.M.n_...
Date
Application Disapproved for the following reasons:..............................................................................................................
..........................................................................................................................................................................................................
Date
PermitNo....--- ................... Issued.....................................................
Date
—————————— ——————---——————————————
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ ..............................
(Intifiratr of Toutpliattre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by..._.._...- 4=.AA._ .................................................................................................
Installer
ICL ;
at. . . ........ ....... ..................�WT......----......-•----......----•--••--•------------.....................................................
has been installed in accordance with the provisions of TITLE 5 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 CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector... ...... ........................
.. ............................................ ..
———————————————————————————————————---———————
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No..,Kk I.D ..........OF ...................... FEE.....2.n........
Disposal Works Tomitrurtion "Jorrutit
Permission is hereby granted...........<;;A- .....................................................................
I to Construct or Repair ( )—ah Individual al Sewage Disposal System
......................................................................................................
Street
as shown on the application for Disposal Works Construction Permit ---- Dated..........................................
.............................. ---------------------------------*-----------------------
(9� Board of Health
DATE............ I�) -��'
.................................................