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HomeMy WebLinkAbout0087 GARDEN LANE - Health B � Ail krdAn IA G i N TOWN OF BARNSTABLE LOCATIONI,,g: ,4 ROEM- AJ�J SEWAGE # 811448 VILLAGE ASSESSOR'S MAP & LOTINSTALLER'S NAME NAME & PHONE NO.F�� i}� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) ( l Wioyi— NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER BUILDER OCOWNER° DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes V No s i .SEESQRtNAP K': G�.� _ �� °SCE(. PM. �G � F�$'...(.�� No ...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF ,HEALTH 1 .. A ..! ......OF.......g ... .../ I .. r------------------- ApplirFa#ion for Uhipati al ork.6 Tomtrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........q. =/gip .. -..._ .. a----------------------------------------- ----------------------------44.4� .z............................................. Location-Address or Lot No 1CJ 0 / f -J-72 -------•-•----•---------- ..... ,� /�6 jai✓ .S-�..:.;10.vy,f�W.42 ........... Address Installer Address <' d Type of Building y Size Lot.._I�s� ©5'--Sq. feet V Dwelling—No. of Bedrooms.......... ..................... .Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ W Design Flow...........,C .......................gal lons per person per d;y. Total daily flaw----._---- .... _............_._._..__gall�ns FI R: Septic Tank—Liquid capacity/ �, gallons .engtl �.._ Width>'�°". ... Diameter................ De th.. .-9 Disposal Trench—No..................... Width__..-r_-_-______-_ Total Length...l.�_�......_ Total leaching area__-.__ .2__...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........................................ ,aa Test Pit No. 1--- _.___minutes per inch Depth of Test Pit.....Q-..__._.. Depth to ground water--.-_-_`-------------- (i, Test Pit No. 2_._4_.,7—___niinutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil..... _.-...2._._..7 .._� 1Z x W ----------------------------------------•-----•--•--------•-------------------------------•----••------------••- U Nature of Repairs or Alterations—Answer when applicable.........ILy _____________________ __----. T----------------------------------------------------------------------------------------••--------------------•- • ............. Agreement: 4G&ft G ^ P. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L i'._.� ;of the State Sanitary Code undersi ned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed e boa f h h. Signed... ---- ----- --------- ---------------••••------- --•••-•--••- / Dat �I Application Approved By................ ....... -------- -----1 f`3 ate Application Disapproved for the following reasons----------------•-----••-----•-••----•--•-----------------------------------------------•----•-•-----------_--••. •-----------------------•---------------•-------------------•--•----------............-•---•------•----•--••-- ------•--------------------------------------------------•---- . Date PermitNo.... ......................... JC� ------. Issued....................................................... Date No.._........ .�.....s5 F:EB -`�--_.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD Off` HEALTH F� � -- ., c? .....J A..J ..........OF..... ../ ........................................ Appliratinn for Uhipasa1 Works Tonitrnrtiun ami ft Application is hereby made for a Permit to Construct ( ) or,Repair (. ) an Individual Sewage Disposal System at: ` Location-Address or Lot No / M-t'�`, ��___j_ ." ........................ ... ! r'� ..'_.lam` ...� nL'o......Y_Y.44. ........... Owner e Address Installer Address r► '�Type of Building Size Lot__- .}. '' _5'`_._Sq. feet Dwelling—No. of Bedrooms.________...............................Expansion Attic ( ) . . Garbage Grinder ( ) p`14 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures .__.-'-'------------•--••-----•'-•----'--'----'--'-'--•--'-- w Design Flow__________j .......................r� gallons per person per d Total d,4 R ............................................�1 gallons 1/ WSeptic Tank—Liquid capacitv/l3 '_gallons .Lengtlyk�.:''�'.____ Widt1hr. 4+ _. Diameter________________ De th Disposal Trench—:�o_ ___________________ Width___ __. ....... Total Length__1_ .____.._. Total leaching area_ _ ;; --sq. ft. Seepage Pit No____________________ Diameter..................... Depth below inlet.................... Total leaching area.............__ _.sq. ft l% +«. z Other Distribution box ( ) Dosing tank Percolation Test Results Performed b a Y ---....................................................... ------ Date......................................... , 1-4 Test Pit No 1 .f= minutes per inch Depth of Test Pit ��"$ Depth to ground water —-- Li, Test Pit No. 2... _____=__.minutes per inch Depth -of Test Pit ._._.__._________. Depth to ground"water _ ___`__. „n, , _ _' ...................... D Description of S .............................."___�. ___l�_�':� li' ... ��° '�_ � - �" x U "---"--"'---'----....'-''•---- w ' •-••-.. .. -' •-' - V Nature of Repairs or Alterations—Answer when applicable ___________ ____:_. __._:................. The, undersigned agrees to install tKe aforedescribed' Individual Sewage Disposal System in accordance-with . the provisions of L-f:-h, i of the State Sanitary Code undersi ned further agrees not to place the system in operation until'a Certificate of Compliance has been iss ed y e b`oard,of h`e2h: Signed -,: .. .......................►... , ; x ate ion APProved BY APPlicat t.._ j DDat e Application Disapproved forthe foldowing reaso ------'------------------------'-•------..•--•....................-'-'-----------------•--•--------•-------------------------------'-----------------------------------'--------------------'----'---' Date Permit No..... 1.s�'">..... .... _ _ Issued ................•--........................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cr ? . ........... ........................ uprrtifir4tr of Toutpliaurr THINS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )nor Repaired ( } by (` f l -=`�� ......-----•-------- ...--•--------------- ... , Installer has been installed in accordance with the provisions of i i i I 7 of he State Sanitary Code as des rioed in the M._ ; application for Disposal Works.Construction Permit No ._�_ 4!41 ______ dated_....___ /` '`7.___________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA RAIN THAT THE SYSTEM WILL 'FUNCTION, SATISFACTORY. � - DATE.................... _.-$ ............................. Inspector.............. .---- ------ - 1 THE COMMONWEALTH OF MASSACHUSETTS 4f AY C BOARD OF HEALTH �"-7 41c�� !�'...C.�J.:.l`-.............OF..... . ,.✓' L. >r, ............... No._..-•-...--'-------•-•-- FEE............... - �i���a��t1 nr�� ��an�t�ttr�uan, rani# ... Permission is hereby granted............. �2-i. ' .. '== r to �Constru)yct ( ) or Repair-( ) ap Individual Sewage Disposal¢1System _''• at1\TO.......Le:!:................................................." . n __.S-. �'.s....___...__..___�- �_.r-'r , ____. __ "°�•- ___ .. ._...... _ .___ __ ... 5 reet . 4 t _" '*; as shown on the application for Disposal Works Construction Permit Now � Dated.__� f- r ................ DATE------- 9--- q...... -7 ••---'•----'-----"'-•--'................ Board of Health — .. ��---� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS f yo;THE ro� TOWN OF BARNSTABLE OFFICE OF sea MAB& i BOARD OF HEALTH .f AO'l vo s639. a���k� 367 MAIN STREET HYANNIS, MASS. 02601 Sewage Permit # 7 4/ Applicant : Norm me Proposed Installer: The plan for the on-site sewage disposal system at Le�_ 2 _ <9'�i,dex� has been approved with the condition that the design engineer must be on-site and supervise installation as well as certify in writing that the system was installed in strict accordance to the approved plan. Approved By Date 1 1� i CO �C0 A(APIAWAY C11*400 Oc 4/.5 LOG IT -4Y, 7 Z-4 41.5 /W 41?. No. 7-9 2- 3 12. go v 7--5 IZ-/r 1"711V 10CA401V 7A a49 Sg 7eA c Ac-�5 Nl/4�77 Pd5S14-Al r4 C>,Kj 45' d-, 0 c c F EV/S 7;),,(l 4 0,PO S e,49 e 4ON AJUIZ Z 4f 6 ,AP A 0A) 74 14fa A` 7- A CE 6 A r5 -aeo/ 4AJJ 1%,�'A X. A,4/-0 N- 2 4S -1 ti � AC;;;2)e -'s �v 7& ,*-f,4 jz 5 7A i,;4A,11 71,'+**vl W?',P4,Ar -rl 7ZZ V., A MO 77 10. 717.Z a-0.W. 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