HomeMy WebLinkAbout0074 CONTENT LANE - Health 1
LOCATION 7`-� SSE-WAGE PERMIT NO.
VILLAGE
-114
INSTALLER'S NAME i ADDRESS
JOHN A. AALTO!BACKHOE SERVICE
150 wainut Street
West Barnstable, Mass. 02668
BUILDER OR OWNER
9 //
DATE PERMIT 1 SUED
DAT E COMPLIANCE ISSUED p� 9 `
C �o/re lef"ter
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YENo.._........=.. ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.WN............oF.............A ...........................
Allp iration for Dispaii al Workg Tomitxnrtinn ramit
Application is hereby made for a Permit to Construct ( Lo(or Repair ( ) an Individual Sewage Disposal
System at:
.A.�7. +........................ .. .....-- ------•...
' o Address
.l . -..
� j� / .
0....................•------- .... Lz; .Y
Owner Address
Installer Address
dType of Building Size Lot....l_7.Qa0t__Sq. feet
U DwellingNo. of Bedrooms......... __________________•Expansion Attic.( ) Garbage Grinder ( )
p`4 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fix+ures -----•------------•................................•--•-••-------•-------•--.._._------ ---••-••-••••-••--••••-••-•-••......••....----••.._......•••.
Design Flow_._____ _.^" gallons per person_per day. Total daily flow_______•-__
W g J ---- ••-••••.... ..g P P �Y Y �� gallonsi
WSeptic Tank—Liquid capacity. DOO..gallons Length.�.:'�o__. Width_4!.-J _... Diameter------------_--- Depth__,).'4-.--
x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No-------i..------------ Diameter...50_.r-_T_-_- Depth below i et.._ _F:i Total leaching area.1�_....sq. ft.
z Other Distribution box Dosing tank ( ) X .
Percolation Test Results Performed b Pl-L-M- R,...Q CMD' : ._ Date...1-!;;1.g r9c�d____.
a Test Pit No. L. i!jj�l.niirttrt:es per inch Depth of Test Pit___ ____ Depth to ground water_ oT--CNe'�?c�s/��7ZcI>
minutes per inch Depth of Test Pit__ _' �•-_. Depth to ground water�Jf'!:_. =^lG��� r �
fi, Test Pit No. 2..__ -____._
-----------------••••••----••......•••• •-••••......-••-•-••. -----------•--------------- .. .......
If t� j j ��_ ���.
Description of Soil---
x
V
W
-----------------------•------------------------------------------------------....--------------•------------------------------:..•-----------------------------------------------------------------••-
UNature of Repairs or Alterations—Answer when applicable._--_-_•_____________________•.-_.---_-•_______-____-_--__-______-____-___•_____-_•---•-•--•-__-
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---.••--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposali,System in accordance with
the provisions of'T T.. y g g p y
5 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 hellth.
Application Approved B ......
= 1�l7/ .............................. '--- - =
Date
Application Disapproved for the following reasons:................. •.............................................................................................
......................................------------------------------------------------------------------••••••••••••••-••••-----••-------•-------•---------•-----� t/ ---------------------
Date
v I
PermitNo.......................................................:. Issued-......
Date
r, r
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...---......OF............. .,...
, :#lira ion for Disposal Works Toutitrustinn ramit
-Application is hereby made for a Permit to Construct ( �or Repair an Individual Sewage Disposal i
system at r
. ...d.oe T n Address or • t No
/,
�_ .Y_:�. _.0..............•-----•--••----- 7G �l2 y!l.[. ... G !......_i�4i 8/� K1_�r'. �•......--••-
ti Owner Address
. ........... ,•-•-•---,+✓�A-1_-:�1...............:.........•----•------- -...._....--------------------•--•--..........-----•-•--•--------..............-•---••--------...
Installer Address
Q Type of Buildin - Size Lot----I�.0a0t....Sq. feet
U Dwelling X' o.of Bedrooms__________.............................Expansion Attic ( ) .- Garbage Grinder ( ).
Other—T e of Buildingt No. of persons_________________':_.__...._. Showers — Cafeteria
dOther fixtures ------------------------------•-----------------------•-•....--••--•-•-----•-•-• -•-••--••---------•---._...-•------------•---••---•----------------•
W Design Flow_____-6'�'�___________________________gallons per person O ay/. Total ajl7 fiow__________�__,.1�•---�________________ llw�
WSeptic Tank—Liquid capacityi00._gallons Length________ _____ Width---------------- Diameter..........-..... Depth................
x Disposal Trench—No_ ____________________ Width.................... Total Length......... Total leaching area....................sq. ft.
Seepage Pit No.......I............. Diameter...6.P.7'__._. Depth below idet__6- '" Total leaching area__-b '��_.._.sq. ft.
z Other Distribution box ( �j Dosingtank ( ) �}�// ��-��"
y _ P � .�:•_��'-3 1 -- --------- Date---..-a."-.D-� 1 f S..
....
,aa Test Pit No. 1._7_MlA.mimrtes per inch Depth of Test Pit.'__ .1` ..____ Depth to ground water U�!___LE/J 0?-/r D
(i, Test Pit No. 2.....2 _ _` 1_______minutes per inch Depth of Test Pit_ ,I.... Depth to ground water.^:''__
►+.{ _ _ _ _____________________________ ______ k
Description of Soil { A t.1 � _
....•-
U -••-----•------•-••-•--••---------•--••-•-••-------------•---•---•-_...__...-•-•-•----- --- ••--• ---- --------------
-
W
UNature of Repairs or Alterations—Answer when applicable................................................................................................
..............................-........................................................................................... -------------------------------------------------------------•••...__.
Agreement:
h, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T t- _ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has liken issued by the board of health.
Ig .
..,... / ate
Application Apftroved BY
° Date
t Application Disapproved for the f ollo7ping reasons:----------••--•- ----------•-------•---------------------------------=
,e =
Date
PermitNo......................................................... Issued......................................................
Date
• THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEA .
...................OF......
�rrtifirtt#r laf T o utplitttcre
THIS IS TO CE TIF Y That the Individual Sewage Disposal System st ed ( r �epai ( )
by - .--•-'- ---- .... ` vlx �,
-....-- -• E-. .. =--- •--•--
has been installed in accordance with e provisionsS he State Sanitary C de as descri ' the
application,,for Disposal Works Construction Permi ..
= dated__ '" ' / ".� C
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 OF HEALTH
� ....OF._..... .. .........................................• , ' �}
NO............... FEE .........
= Dispulltt1 Work IM11 tart rrmit ... .N.. .
Permissio s by granted- ----"- `"� ................
to Constru � Repai � � ) I i a ew= � Is S st
s t l
as shown on the application for Disposal Works Construction P No. _: __ __._ '/gat,�erd�_.��.-`..`!- � __.___.__.
- ---- --- -- -
0 of Health
DATE......... ..........
FORM 1255 HOBBS &"WARREN. INC_ PUBLISHERS
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HOS ENGR. ASSOC. INC.
P.O. Box 158
RAYNHAM CTR. MA. 02768
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