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HomeMy WebLinkAbout0119 CONSTANT LANE - Health 119 Constant Lane Cotuit 1 A = 039- 059 r \ cp Hof�'k Cov.�on$ Crow-�oerrc� �� >JOWN OF BARNSTABLE G 1, LOCATION %/ Cass-tctv�. • I- �•G SEWAGE # � VILLAGE �tii-� ' 35 ASSESSORS MAP & LOT 3 9-5 9 INSTALLER'S NAME & PHONE NO. A A�tv SEPTIC TANK CAPACITY /O 6 Q o,10 �°a.�-. of ra•y.. LEACHING FACILITY:(type) t a'e (size)( } e%e,-t JTL-Lo. NO. OF BEDROO"�MS c2, PRIVATE �/WS WELL O UBL1C/+WATER� BUILDER OR OWNER cost �r L".ctN sla�COL- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �'. � i O�C..K- �►T �U�S�... ICI ���tr .,� � rd i -- o :`a e ��S�rd�, ` ��R 'i 13S , No. �- ! M~ d�g�b • >� -��........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... �v.91J- . -------OF ..... < - 1�1. `C _!ekL.0...............-------- Appliration -for Dhijiusat Warbi Touutrurtiuu Vrrulft , Applic on i h made for a- rmit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: 'W t ° co's�a . 0 3�1 ' ..................---•...---- ------•--- ------... .......... �r-- E3 G.o 3--�---c-�s �'' 'w`-k^---�'A L catio -Ad ress or Lot No x r Q. InaL5---------------------------------- 1 .roc---� (.....--.W.0_r�.9f r, Owner ............................•----•----•-----Address W °.. Installer Address d Type of Building Size Lot___-3_7,7Z.I__Sq. feet U Dwelling No. of Bedrooms-------- _Expansion Attic Garbage Grinder a`q Other—Type of Building ___________________________ No. of persons-.-------------------------- Showers ( )- — Cafeteria ( ) a, Other fixtures .. Q ---------•-----•--------- ----------------------------•----- W Design Flow............. 5........................gallons per person per day. Total d�ily flow........... .0____-__-__-....__--_gallons. 1:4 Septic Tank—Liquid capacitvjCQ OD�_gallons Length. Width-4---le-®_ Diameter__-.------ xDisposal Trench—No- ____________________ Width_----___---..______ Total Length------------------.. Total leaching area--------------------sq. ft. Seepage Pit No.---------_t--__-___- Diameter...1.0.....0.... Depth below inlet.................... Total leaching area.2o kr__J�__sc. ft. z Other Distribution box ( 14 Dosing to k f) n /� /50. � �� �� Percolation Test Results Performed b � f,�,_�T+1~t.....�.`�.._�CL��............. Date__ _��_C�___�7,__�_��� a y. ,.� Test Pit No. 1...._7r•......minutes per inch Depth of "Pest Pit--- ..-.Q.._. Depth to ground water_17O_i� -'----- f� Test Pit No. 2........?I....minutes per inch Depth of Test Pit../_ !-0.."_. Depth to ground water________________________ W - -- --- ------ --•----- -- • -- --••------•-•--•-- O �oV ..... �l ----------- � ` '� - x Description of Soil >d C�I.Z.�? g �� t-------------------- -----.C !u 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 Sanit Code— The un ersigned further agrees not to place the system in operation until a Certificate of Compliance h en issu by the&oarjof healt Sign ...._.. .... ate Application Approved By. _-� ��' - - - ---- ----------------------- , ---------------- Date Application Disapproved for the following reasons------------------------------------------------•--------------------------------------------------------------•- --•-•-•---------------•-•----•••--•-•-•---•---•---• ............................................................................................................................................... Date PermitNo........................................................ Issued.................................................... Date /3S ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration -for Di!ipoiial Workii Tomitrurtion Vrrmit Application is hereby made for a Permit-to Construct ( V1 or Repair an Individual Sewage Disposal System at: ................ ...... .....R ................................. ....jn�4 ....co-4-�A ............ LEti.io -Ad or Lot No................................... ....... ......... Owner Address .................................................................................................. .....................................I....................................................... Installer Address Type of Building Size Lot....3­-1,-77-Z-/'--Sq. feet U Dwelling—No. of Bedrooms---------- ----­---------­------------Expansion Attic Garbage Grinder Other—Type of Building'^*--------­---------------­ No. of persons..--____.______-____-__-_-__ Showers Cafeteria-(_ Ga Other fixtures ------------------------------------------------------ --------- ----------------------------------------------------------------------------------- Design Flov............5-5.......................gallons per person per day. Total djily flow_____-__ w�3-0----------------­-gallons. WSeptic Tank—Liquid capacityl-O&O-gallons Length.S'­G.".. Width.4.7.10"Diameter------—----- Depth.... Disposal Trench—No. ............. --- Width-1_-___-_I.......... Total Length__._.__.___......__. Total leaching area---------------------sq. ft. Seepage Pit No-----------12------- Diameter___ ---- Depth below inlet_________________ - Total leaching area­u! ------sc It: Other Distribution box L4 Dosing to 41'. '7 Cjk Z715180 ''Performed by...... ... ts ............... Date"4'r- ­' Percolation Test Results n- ---------- Test Pit No. 1......Z minutesperinch Depth of Test Pit.... 9..f.Q--- Depth to -round water....�P--------"W(/Pi Aq/ rxq Test Pit No. 2........Z....minutes per inch Depth of Test Pit--- ... Depth to ground water------------------------ ----------------------------------------- ... . ..... ..i-------- ------­ -------------- ------------- �i......... 0 Description of Soil----&­��...............Laal-"......:5.V...oqi.... z�--- ------ ---------------------171IN........ ---- ---------- U ...................................... ...............7.............................................................................--------------------------------------------------------------- ------------------------- ----------- ......---------------------------------------------------------------------------------------------------------------- ---------------------------------------- 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 Sanitar. Code—The and rsigned further agrees not to place the system in 11 atar Code— I he und rs1gued further agrees no, to pl. operation until a Certificate of Compliance has,b issue by the and of health.1 Signe ---- -- - .. .......... ..... ...... .......ss . ------- ------- ------------------ ate Application Approved By----------... �47'r. ..... ........................ -- - - -- ---- ------------------ - Date Application Disapproved for the following reasons:................................................................................................................. ..........................................................................................................................---------------------------------------------........................ Date PermitNo................................................... Issued..................... --------- ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................0 F....... .�,. A................:.......................... T.Wrtifirate of TilutpHaurr" THIS IS TO CERTIFY, T the Indivic1mal Se age Disposal System constructed (Pllor Repaired by.................................................. ... ...... ........ -------------------------------------------------------------------------------.................... Installer .10 at--. it...... .......................................................................... has been installed'in accordance wZt�e provisions of 'k�Lt'ic Ie XI 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 FUNCT� SATISFACTORY. DATE.............. ...................................... lnspector­-� ex - - - -- -------------------------- THE COMMONWEALTH OF. MASSACHUSETTS BOARD OF HEALTH .........OF.............. ..... .......................................... No.. FEE.. . ............. ii Uiniatrjurtion Prratit Permission is hereby granted_____________ Y LOT, TIT..... -1-------b,-��................................................................................. to Construct or Repair_ ) an lndividua ewageDisposal Sy te m............................................................................... R Street as shown on the application for Disposal Works Construction Permit No_____________________ Dated.. ....................................... --- -----------------------------------Board of th DATE.._.:._.. --------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. 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