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HomeMy WebLinkAbout0032 ATHLONE WAY - Health 3� A+h L6r� U 1 1 ZI M UJ I I a- I I I 1 1�T W Ia IN tn I ! ; 3 I ui - Iw I i o In � Ilo l o�l. I w . I QoIQ -1 .� n W w Lo - ou°I 0 J ( w o � ~ Q I a_j w I a� r- I � o l lW w o � � IN I .r Q > _� a I I co k S x .�I q t4 N No... -.. FEE_/ ...............„ s THE COMMONWEALTH OF MASSACHUSETTS BOARD O HE T 1:.......OF........ " ................. Appliration -fur Dispoiiat Works Tate trurtion Vrrmit Application is hereby'made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ...........1'— .�s� r = ,/ - .....................-0j------g6.p......... C ...... 9 Loc io .Ad r OK.-Lt No. .000 ner �r _ A B .WW 2? ess J '.:_... t vet-7�-_--------------- Installer Addr s d Type uildingf k - Size /6 Lot5?b_...-2--------Sq. feet U Dwelling—No. of Bedrooms..._......�"---_•-------------------Expansion Attic ( ) arbage Grinder ( ) aOther—Type of Building ............................ No. of persons----------------------------- Showers ( ) — Cafeteria ( ) Q' Other_ fixtur/es ........................................................ .- W Design Flow...............J_Y._.e_,-------------gallons per person per day. Total daily flow........ J................gallons. WSeptic Tank•�-Lijtyid capacitX10*.V.�Pgallons Length................ Width..........:..... Diameter................ Depth.-..--_._-.-_-- : x Disposal Trench No.! a`7/•...____ Width_________________'__ Total Length.................... Total leaching area....................sq. ft. 3 . Seepage Pit No..................... Diameter.................... Depth below inlet Total leaching area.---_--.-_--___-sq. ft. z Other Distribution box ( ) Dosing tank ( ) . �� — G' l s--7$�r aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ 0:4 Test Pit No. 2................minutes per inch Depth of Test-Pit.................._. Depth to ground water........................ O J__ �; r Description of Soil .....:._ ....!•. 1 -- --- r - •---•------ U x ................•---••----=-------------------------- •...................----.---•--•--•---••--------------•-------..---.-------•--••------------------- ._....--.---------------------•-------.--- U Nature 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 Article \I 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. igne . ... ...... / /..... . ...... ..... ....... ................................ Date Application Approved By....... .... ----- --- ` '/�� �� f l :.-..-7 Application Disapproved for the following reasons:............. .........................................Date............•- ...................................•-------------._....----•-------------•--•--••-•---------•--•--•-•---•..------•--------------...._....-•-------•-•--------•--•----------------------.._-----•------•-- 6Date Permit No. - Issued " `� . Date &N ._ .....__.... .................- THE COMMONWEALTH OF MASSACHUSETTS i' BOARD O H EAJ T '✓j 1........O F....... ..............:...... .......................... Xpptirati n -fur i osttl Turku Cnurt�tr rtiun rrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: or Lo No. -•--•-•-•-•-. Loc ,w...Ad +(KcC _ LiJ_.4_ ... APO!r� W Ojivner AA A ress .. '..... Ip� Installer AddrrSs U Type uilding. �v Size Lot��Q 42©------- feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No.)f persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------•----------------------------------------............................... ._...... Design Flow.............. _ ..............gallons per person per day. Total daily flow....... t' Mons. W Septic T:utk�--Li*yid ca acit /*'N-gallons Length________________ Width................ Diameter................ Depth................ x Disposal Trench 1C No. e.__._:_ Width.................... Total Length.................... Total leaching arca....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below/inlet ___ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) (�Ar" 4av - e — � Percolation Test Results Performed by.................•...._______________..._._..__._._..._._..______.___..__. Date........................................ Test Pit No. 1........ _ n),nutes,per inch Depth of "Pest Pit____________________ Depth to ground water........................ fs, Test Pit.No. 2... iinutes per inch Depth of Test Pit.................... Depth to ground water........................ O 4 -; V .._... .r r.... p 1 Description of Soil.. ." --------------- - •----------•------------- -----•--------- ••••------•-••------•-------------••--...-----------------........ �ti ......................---------------------------------------------------------------------------------------------------------- W ................................ .................... , ........... U Nature 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 Article XI 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�,h�e,�lhh. tgne ..... --�---- Date Application Approved By.__ __---.17 - ------ � ---_--------.�...�---ram---• Date Application Disapproved for the following reasons:......................... ........•-----------------------------------------___-----------------------------_-_ •-----------------------------------------------------------------------•---------------------------------------- ----------------------•--------------•------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q� . 'j...........OF........ � ��� .......... �ertifirate of Tomplianr.e T S r•-TO CERTI Y, That the Individual Sewage Disposal System constr ied ( or Re ired ( ') by ,� = --------------•---------- ------------------- ------------------------------------- ---•-•-- I • Installer �-� - - .. .._ - -•- � at.. - -- -- - - --------------- `'`• has een installed in accordance with the provisions of r�l I o he State S ttary ode desc e 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--- --------�}- ......................... Y --- ------- ----- Inspector------- ......................................................................... �-+�. THE COMMONWEALTH OF MASSACHUSETTS L�;,./J BOARD XLHEAL H �/ �........O F........ / �....../ No......... ....... FEE._ /- ....... �i��uutt1 rk,� �unstrurtiun der it Permission is hereby granted--'-•-•- .G ...................... -----...... ._...__..... to Cons tr or Repair ( n nn-divi�dua Se age Disposal em --- . .... L_e _S as shown on the application for Disposal Works Constr tion P 't o-----low?... _ _._ .____ . ` ,l�- 74 __.....--•-_-..._ '-� --- • ------- -- --- --- --- - ---------- Board of Hear f _ DATE.................................................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS /L •,• rr.R�(� Y 9 e � 0 `7 ii`.�.. t�'� r i'i� .,. v OU v r ,Cf h' 7- 3 0. oo - Q11a-3229 �� ' 3997 13 A\ 4 1 CERTIFIED PLOT PLAN . L O C A T I O N 5 C, A L E --C_ ,3�L D A T E _S� _.Jrj...l__9746 _ + i F E R E N C E B,i IAla A 0 Sy'owv atl s HND G0J/j7T ,oA19 Z 709.9 D A T E A a,E R E B Y C E R T I F Y T H AT T H E S U 1 L U I N G PEG LAND 5U R 0 R +' CWN ON THIS PLAT' 15 1 OC ATEh O .N , ? }+ E G R'OU ND AS 5 HOVVN HEREON A NL-) ZH4T IT _(70/ 5 C 0 N F 0 R V TO THE ZONING BY - LA. W5 OF TH [ TOWN OF- ,t2/4S'N-,.JZ-Z�. � WHE N C 0N5T RUCT-C h BARNSTABLE SURVEY CONSUL- TA .Ks+ TS, INC , W E 5 T Y A R M 0 U T H M A 5