HomeMy WebLinkAbout0093 CONNEMARA CIRCLE - Health (2) C Y .
LOC&TION : _ ' 5EWQStE PERMIT MO.
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IWST&LLER 5 U&& AE ADDRESSIF
BUILDER 5 tJ-L MF- ADDRESS
DL�►TE PERKA T 15SUED
D ATE COMPLI L�.t ACE ISSUES - -�- --
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No.- .K_11�----- Fas
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF H� T
Apphration -for Bi,ipusttl Works Tomtrurtion Vrrmit
Application is hereby made for a Permit to Construct ( /ror Repair ( ) an Individual Sewage Disposal
System COT
y `
O Cal N �L,�o.9��. ec sze---f-�...-------•-------`-
Location-Addrs,� or No
.---_.
1"�..�../._.'1..._... E .1 7f�-- r--•�--------------------------•----
Owner Address
Installer Address
d Type of Buildin Size Lot_.� �_D�''U-__-Sq. feet
U Dwellin o. of Bedroom Garbage Attic (��)j Garbage Grinder (N&
aOther—Type of Building ............................ No. of persons.................I......... Showers ( ) — Cafeteria ( )
a
Other fixtures -•-•--•--•--•---...--•-••-•---------------------------...............................................................................................
W Design Flow- _-_-__-_- ----------
gallons per person per day. Total daily flow---------rt-!C t�---____---_-_-gallons.
WSeptic TankT'Liquid c�acity--gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..,, ! J..�_.__. Width-_ZP%9. Total Length------- Total leaching area_40-V.....sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below in It ;,,,Total leeaclt}•ng area------------------sq. ft.
Z Other Distribution box .( ) Dosing tank ) D�' /�C�f�.' rd/2 -/7•��,
Percolation Test Results Performed by--------------- y,;---..----_-------------_----___- ate_.-_.
Test Pit No. 1................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 . ............. . •-•---•--•-•--•--B•--------------•---------------••-----•-•-------------•------•--------•-.-------
Description of Soil '1�y 't... �r' ------------------------•------------------------------------------------......
U ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•.......-----------
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 hea h.
o
Sign ---- -- -
oar`'-'_ �. S 7 _
Dat
Application Approved B
V ate
Application Disapproved for the following reasons:.............................................................•--------...........----------....---......._------
, ......................
Date
t No. r
Permi
�rr :''� r •a'ryr• -'� , "ram .� rv, ,-€r� - Y, a�*..y.`
as sue. • �' t � — ._ , �
16 0"
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s 0,90
C. E R T, I F\I E D P L ® T P L A N
LOCATION' Y�y~�'
SCALE: � 3Q DATE �/ 7
R E P E R E N C E: .6 E/IV -5
.� �� Cow• .- '-' C•�-S r- - a 7 0 ` <F - ..713/17 _
� DATE ,µ
I HEREBY CERTIFY THAT THE BUILDING REG. LAND SURV YOR
SHOWN ON THIS PLAN 15 LOCAT-ED ON
�. THE 'GROUND AS SHOWN HEREON AND
T H AT 1 T '0 0-6-�S CONFORM TO THE t.N OF Af4,r
' ZONING BY - LAWS OF THE TOWN • Or
46'gAe' 51�29154r W H E N C 0N5TRUCTE D JOSEPH M N
.
tic_• ,. ,. v MONAHAN•,JR. y
f BAR-NSTABLE: SURVEY CONSULTANTS, INC 4c�STEa�o� F
r t WE-ST .YAR•MOUTH MASS SU -`~
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 54F HEl
............ O F........ ....I..... ...............................
Applira#inn -for illiipuiitt1 Works Tons#rur#inn Vrrmi#
Application is hereby made for a Permit to Construct (") or Repair ( ) an Individual :sewage .Disposal
System t
CO �t`i111 4 �.a.A A.. C 4 02 e �(
........-•••..................:... ..�-------- ---------...------. . ------ ----------- ------------.....------------------. nr
cation.Add r or t N
' Owner Address '
- Iri'taller Address
d Type of Buildi Size Lot.10{_A"Ov.....Sq. feet
Dwellin No. of Bedrooms._.---- ..........................Expansion Atti V d' Garbage Grinder No
per, Other—Type of Building No. of persons................/_---__-_.-. Showers ( ) — Cafeteria ( )
Q' Other Ott res ..................................
W Design Floyit........ .:............. gallons per person per_day. Total daily flow-------- .-d'j� ...................gallons.
Septic Tank L Liquid' acity .gallonr Len h._____.;:_....:. Width..._.......... Diameter............... Depth................
x
Disposal Trench—NOAF �__ ;.... ���ic1t11.Sera! Total Length...... ..... Total leaching area --------------sq. ft.
Seepage Pit No..................... Diameter_----_----_--_-_---- Depth below inlet--_-_.._ ..... . Total lead itig area..................S(l. it.
z Other Distribution box ( ) Dosing tank ( ) 0 ' I�e4 �� b► -4 1
aPercolation Test Results Performed by.......*.'..-_)_.:.- e_ gir{-h-J.............................. Date......................
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water......
fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..:.....................
---------------------------------
Descriptionof Soil -.1....................:. .........!. ....---..I.------...r.--- -----.---...........-----........----------.............--••--------...----
U -•----------------•----••-•----••.....-•--•-•-•-•-------------•-•••••••••••-•••••-......-••-----•---..................-•------ ----- •------
Uw ---- ...............................
Nature of Repairs or Alterations—Answer when applicable.........:.:.....................':. =_ .....................................
r.
--------------------------•--•---••---.....................................
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 een issued by.the board of hegith.
Si d ...
tS':
VO.Da
Application Approved BY-•------ > ........ ...................
...ate
Application Disapproved for the following reasons:..................................................................................................................
Date
PermitNo.......................................................... I Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS e ,
BOARD OF HEAL H
illY1R..............O F.......... Ii�� .........................
01.rr#ifira#r of fanmphaurr
T S TO CERTIFY, t the Individual Sewage Disposal System constructed or Repaired ( )
bY` -------------
-�l.'0 ' ------------ --
I s lei
i �•� � ...
at--------V�------------�.�:---tom' �i.�►-�-�1--- ---------------•------•-------•---------....---
has been installed in accordance with the provisions of Article I of The ate.Sanitary"Code as 4escribed in the
%OAapplication for Disposal Works Construction Permit No-------- .. .............' dated.., , ' .................
THE ISSUANCE OF THIS.CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM ILLFUNCTIO)I SATISFACTORY.
DATE ... .... .....� -- •--••••-�-• • ............................... Inspector...._._ ---•-•-•-•-•- _...
t •
THE COMMONWEALTH OF MASSACHUSETTS
i° BOARD OF HEALTH
t OF.......� f .!
q ....... ....o........................... . - .1. ...........................
No.••----......•1 --- FEE.
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Permissio i hereby granted"--. .' ..• -w;d i..... t{, X .............................................................................
to Cons ) or Re r ( ) an Individual Sew Djtspos System r.
r' Street �+ V
as shown on the application for-Disposal.Works Constructi ermit Dated..Q........ <.....
_ ...
1
G .�. � ••DATE....... ------------------------------•-•-•-. Board of Health,
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS " '