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HomeMy WebLinkAbout0115 CAP'N CARLETON'S RD - Health ��6 ©��� ®�� � �� T W OF BARNSTABL LOG`ATION SEWAGE# VILLAGEjJ _ASSESSOR'S MAP&PARCEL jD INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)_T t ' (size) NO: OF BEDROOMS kZ OWNER Gi- :PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY i ® ftcy �- o - No.............. Fizz.............................. THE COMMONWEALTH OF-MASSACHUSETTS n( ARD ® IHEALTF- �Al ...OF............................... ..................................... Appliratiou for Disposal arks Towitrnrtinn Vamit Application is hereby made fora Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - Location dress t o. f� [Wgfg . t�tC. ......ED.e ..&OX.--..��_�:. 01 ALI. t Addr n e , es� W • ._.. Gt,..�. F-_.-._ .. .�,.Lne_ ... ..............1--. 1iL 1.. 'n a l Installer Address ii d Type of Building Size Lot-L_/- _.. ...Sq. feet U Dwelling—No. of Bedrooms..............__•-_..................... .Expansion Attic ( ) Garbage Grinder (W 6 Other=Type of Building ............................ No, of persons............................ Showers Cafeteria ( ) a' Other Ixtures ................................................... W Design Flow..........3...............................gallons per person le d�y. Total da*1 flow.......... _ . .........gallons. WSeptic Tank J-Liquid capacity/97P gallons Length............... Width.... .... Diameter---------------- Depth................ x Disposal Trench—No..................... Width-_---------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_------_--------- Diameter.................... Depth below inlet________ T leach'�g area_�3`_____sq. ft. Z Other Distribution box (� Dosin nk / -- -Af- ;y- �" Percolation Test Results Performed b . ....... .......:............... Date--- ....j:�_' a Y _' Test Pit No. 1.....aZ------minutes per inch Depth of Tkst it.................... Depth to ground water................._._---. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f -- /i..................................................... ® Description of Soil A Jffi�-��!'. ..."._. e? � 30...... �f ---------------••-•----._...._.. x W •---••-------------•--•--• ••-------------.---------•-•-•••---------•-----'-••--•'•-•--•••-•-•••'......••-••-•-•---...------------------------•----•••-----••--•-•••-•-•--•-•-••-•-••-••••--•-----_.... UNature of Repairs or Alterations—Answer when applicable.-____................--------------------------------_____________••••--__-_____________-_•___. ..-•-------•------•---------•--------------•-------------------•----•. ------.._..............-••-------•-•-••-•----•-••-•----•••-----•--'----••------------••••--••-•----................... Agreement: The undersigned agrees to install the aforedescribed In ividual Sewage Disposal System in accordance with the provisions of T :�IT� 5 of the State Sanitary ode— Th undersigned further agrees not to place the system in operation until a Certificate of Compliance has b i su d b the boar of health. ignedA • •• ................••-••--•-•- 1� ....._ , Da e Application Approved By..- - ----------- • - //�c�..... ------•--- -...--•----- / --•---••-•...................................... Date Application Disapproved for the following reasons___________________________________________ Date PermitNo......................................................... Issued._. .'=.....`---............-..------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD AF HEALTH ................./ ........OF....... . ......................................................................... Cwrrtifiratr of TompliFanr THI S TO CE , .. IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............ 4-1 21CFF._--_!1'�4,i .Z�----------------••----••----------...------...........------•----....-...---•-•------------.._..._.....................------------ /7� at.._________f.�C?14�7r1 ®C?/LA Installerl�iJ �y�__. ..-._ :7�_ !>>o__ i.Ai1d �',l-e-: �Q�:TIfO Sr"' has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No __ _.____..3..•$� _......... dated----� r _ _. '............... THE ISSUANCE OF THIS CERTIFICATE HALL NOT BE C0NST EA A GUARANTEE THAT THE SYSTEM PILL FUNCTION SATISFACTORY. �' Z `......................DATEe_--`-..-_••••-�--•--•-- Inspector..... . ............•. 2 ...No` FEB.............................. . THE COMMONWEALTH OF MASSACHUSETTS . B F 01 HEAL.... .. 17 &(Ilw ............ .................OF......................................................................................... Appliration for MsVaiial i8orhi Towitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Gn I-r- kbT-t.1(P eil it . .........................I........................15&....................... . ......�Rf e . 14 6� ----------- -Mmp 'o (Weg C. P.O . 6 S ............... rA 4 �X­ k... ---- .... .................................f............ ...............R.................................. ............4..... nZF A 4 ddresM . . .................................................... .................. ... . .................................. Installer A@ ess Type of Building Size Lotf&.& .._"....sq,. 'feet U Dwelling No. of Bedrooms...........................................Expansion Attic Garbage Grinder No, Other—Type of Building ........................... No. of persons...._....................... Showers Cafeteria P4 Other ......... ..................................................................... ----------------------33'5--------------------------------- W Design Flow...........1�....... .................gallons per person p�#y. Total daily flow............................................gallons. 9 Septid Tank I-Liquid cap4cityJff .gallons Length................ Width----1��Width___-_---.... .. Diameter,............... Depth................ Disposal Trench—No. q!�................ Width......:........_.... Total:Length_._................. Total leaching area..__._:._........:.sq:ft. Seepage Pit No. Diameter.................... Depth below inlet......,..' chi4ghrea.��,.../.......s*q. f t. ------------X _ Other Distribution box (.I ) DosinjeInk Percolation Test Results Performed; by. ................................. Date 9 Pe ............. 11- 7 ................ Z Test Pit No. I----- ......minutes per inch Depth of e s;tPit Depth to ground water-------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.___._.............._... ---------------------- ............................. .......................3 -W.......�­�7,��­.;;................................ 0 Description of Soil---IA�742....y........ ........ ................... ............................................................. ........................................ ......_5�..V.p................................................................................................... ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.............I...... Nature of Repairs or Alterations—Answer when applicable........................................................................ ....................... ....................................................................................................................................................................................I.................. Agreement: The-undersigned agrees to install the aforedescribed It ,ividual Sewage Disposal System in accordance with A �d the provisions of TITiE 5 of the State SanitaryCode-- T C undersiped further agrees not to place the stein in, o e y operation until a Certificate of Compliance has blkn iss d b the boar j!pf health. --,Sign( .................................. .... ....... ....... Date ApplicationApproved By__.'_._.._.,,. ........... ------------------------- ---------------------------------------- Date Application Disapproved for the following reasons:...................................................................................................­--------- ....................................................................................................................................................................................................... Date, PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ................./05.4h........OF..... ............................................................................ THIS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired z- b ................................................................................................................................... /7 Installer a1?l at: L,0_42-i-C eDIA:�.ety......2)0-S16A1,T-X-�-S — /07- A�/6 ................................e........4..........................................................................d................. *b d 'in the has been installed in accordance with the provisions of 5 of The State Sanitary de as de!�F pe application for Disposal Works Construction Permit No.-R/ ....... .......... 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 QF HEALTH . ...........V.....zt� .....OF.......... ................................................... No........... FEE---...---S—......... wwv vgotrWt , V/ Permission18 h b nted....... ....................77-­�,;�.......................................................................................... /__qLare y gra e'.7. to Constyuct QP1 rr,Repair, an In�xvidudl S-ew�age'Disposal at ...... ....... ................ ............ Street as shown on the application for Disposal Works Construction Permit-No..........r... ated...zL. --- ---- i................. 4 u ------ Board of Health DATE........................f-W-�g' ....................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS v A ! 7 Qz 88 43 S 88 f3S i�s pft x _ S'c51 B�C� ^/C� J%�fJE`1s' ��lCJE✓>=r" �a' '' • TE S T H cc PER. 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