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HomeMy WebLinkAbout0165 BAYBERRY WAY - Health ®ca ` '-' OCATION ,c�c1 {SEWAGE PERMIT NO. / a© // � �'/l r Y LLAGE f I N S T A LLER'S NAME ADDRESS I U I L D E R 0 OWNER DATE PERMIT ISSUED MATE COMPLIANCE ISSUED a a 1 THE COMMOAVEALTH OF MASSACHUSETTS BOAR®�0�, F HEALTH ...--- T+OW.1�(-------------OF..... Tt .�S . ................... Allp iration for Uiip.as al Warks Tnnstrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy at: .... •M.&;:�7--- ........••• - ........... 0-T' Location-Address or t No. ,Paul D. and Jill M. Kaneb 454 Grove St., Neeciam, MA ............... - -... ........ .....------......................•---•--- .............................................................................................. W Vetorino Brothers Inc. Old Jail Land, Barn' ble, MA Installer AddressPq 37 n d Type of Building Size Lot............................ V Dwelling—No. of Bedrooms......... ..............................Expansion Attic Garbage Grinder S ►+ `k Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ----------------••------------..-- Design Flow............ .......................gallons per person er day. Total daily flow......... ............_.......gallons. WSeptic Tank—Liquid capacit) .gallons Length._It.I.l". Width.b`_.(p.`..... Diameter_____ _______ Depth. `.rcp x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No. ...... Diameter......1_A........ Depth below inlet............... Total leaching area.6:�kG?...sq. ft. Z Other Distribution box Dosin tank ( ) A n `" Percolation Test Results Performed by. y4 —Q c !l y.l - -........................ Date.....A/�'.-/_�?�......--.... Test Pit No. 1__G Z.......minutes per inch Depth of Test Pit..iV........... Depth to ground water-__ _ tz, Test Pit No. 2...kZ......minutes per inch Depth of Test Pit----9.Z...........Deptl,jt,o ground water........................ � ........................................................ - .... '.' O Description of Soil.....�.'_'c�®..' �PSC>�• --••- ;-- .. •, `. G0�25 IU 1 x4 .................................................................................................................... ------ 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 iITL U 5 of the State Sanitary Code' The undersined further agrees not to place the system in operation until a Certificate of Compliance has been is e by teaAord- &ealth. Signed. . ................ .................._ram Date ApplicationApproved By---..--- ... ............................... ....................................... Date Application Disapproved for the following reasons:----•.......................•--•-------------------------------------------------------------•-•-----•-•...... .....................•-----....------•--....-------•-------............---•-----------.........---------.._.....-------------------------------------------------------------------------------------•--- Date PermitNo...... 7. :._...._. ....................... Issued.--•---••-------- ---•-----••---•---------- Da---te s-" ib THE COMMOAVEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratiun for Disposal Works Ton,strur#ion lirrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ..............._--.----BE 2 -- ••-•- ..................................... Location-Add ess or Lot No. Paul D. and Jill M. Kane 454 Grove W V_ etorino Brothers, 19 Old Jail Land, Barnstable, MA Installer Address -.4 Type of Building Size Lot-t....................... U Dwelling—No. of Bedrooms......_...................•......._..........Expansion Attic Q(o Garbage Grinder S Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures ---•-•--•--•--------------•-•-•• • W Design Flow.......... ............................gallons per person per day. Total daily flow......... ` ....... ............gallons. WSeptic Tank—Liquid'ca.pacityl ..gallons Length.l i•.•_11f... Width.0 '_�_._... Diameter................ Depth..-_5 x Disposal Trench—Now. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No Diameter......►.� ......... Depth below inlet.....U�............. Total leaching area.33.(�....sq. ft. Z Other Distribution box Dosing tank ( ) / y , f `" Percolation Test Results Performed by K.� i*:�`.1�tr`� _.��F�..............•......... Date..... -1.��-`. aTest Pit No. 1_4.. .......minutes per inch Depth of Test Pit.. .'-............. Depth to ground water... to u"��� (i Test Pit No. 2._L—-------minutes per inch Depth of Test Pit---- .... Depth to ground water........................ R+' ---------------------------•---.-.....-.-.....-....-.--....-........-...--------------------------------------------- --•-.-- O Description of Soil....��.-.��C C:�pSC t.- ._ ',) ` C� � l ,i :' ,, C= /ti' - t, -�--- _------------------------- . 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 iITLi4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is tied by . rd o health. :. a Signed.._.. :..... ` ...... -• .. r-------------------------•-. -• 1 . .. .. �� Date Application Approved By..... a- .?�_ �.�Y.. �.. .......................... ............................•........... Date Application Disapproved for the following reasons:...................................................................•-------------------------...----------••--- ----•••-•••-.....-•--•---••---•-•••-••-•...----••••••--......-••------•--....-----•-•--•••••••------•.....••-----•-••••......--••----•---....-•••----•--------•---•----•••------•---•••--•-••......--••-- Date PermitNo......... - ..................-.... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....OF........ �c..................................... (Intifiratr of Toutplianrr THIS IS TO. CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by l?:::. ............�� ?a..-------•----.......-•-------•-••------------------------------------•---•------•-------•-----------........-----...------------. ...... Installer n A , at....- GOT r�G' Y= wG =�}........... .t'�...^ ` .------•-••----------------------�} has been installed in accordance with ie provisYns of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nol.Zr%.Z. _i'................. 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 y� OF HEALTH .OF.....d. l,,:-v.1.::A:..;; :d2-`-�!�fj`C_..... N 7::. .1... FEE,::;;�5.............. Disposal Works Tonotrndion amit Permission is hereby granted....... rw, ...... ............................. to Construct! ) or Repair ( ) an Individual Sewage Disposal System at No..... q a 'a' .....L =" -C>l� k-Q-Street-�- - 5 .- d Street as shown on the application for Disposal Works Construction Permit N 2 7\ Z Dated DATE.................... -.'.�'�.n.�%.-------•--••••-•.....-•----....... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _ 1- - I I , _ 1 N T � 1 t- 1 I r' _ i r I i k i — ; i _ _ 1 : I i _ a ii f I l r 1 i ' 7 r _ I _ , i fi t- ---- yo_. i I i --AV.r -..ice.---;,;�;;,,. ,,,�,; -_- -__�•-•�- - !�.-•,,. '� '. �. -- -�— _ ___ -- -- ----- --'---- - - -- - - ;; - - ---- AA.----_.--- -----__.._.---- _—- ---- ----- _ -t._ _ .—ter•----.�- _. -------_ __ _ _ - _ _ _- - ------- --- - - -----�.— - _ _. --_ - _ "_. __ , I r _ �I I I I r r - - _ -TLAN -- t� D y �^ 1. 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