HomeMy WebLinkAbout0056 CAPTAIN ALDEN'S LANE - Health 56FCaptAiWAlden, s T.anie
o it i-ville
A.:�, 146 089 .
I
N I o.&
THE COMMONWEALTH OF MASSACHUSETTS
�L BOARD OF HEALTH
.:.............OF......
'C.�1lS: .�a'.c, G.- `...-..._.....
App iration for Uhipati al Works Tnno#rnrtiun Permit
Application•is hereby made for a Permit to Construct V) or Repair ( ) an Individual ,Sewage Disposal
System at
L /.�1. .D 1.dt ._..::�...e .......... ...... ................4?........ .............................................................
Location-Ad ss or Lot No
Ad
Ow r A dr r
W --
� Installer 'Address
Type of Building Size Lot...150__'c�_,7.....Sq. feet
U Dwelling—No. of Bedrooms........... __________________________Expansion Attic (vo) Garbage Grinder (►o`)
Other—Type T e of Building No. of ersons____________________________ Showers
I� yP g ---------------•--------.... p ( ) — Cafeteria ( )
p' Other fixtures ........................................... _
W Design Flow......'�/0._._..----••---------------gallons per r ay. Total daily flow............3-3-0..................gallons,
WSeptic Tank-Liquid capacityhde??..gallons Length_ `�" Width_°t'.i�o`y._ Diameter................ Depth_5:.`A_.`.'-
x Disposal Trench—No_____________________ Width....................
Total Length.................... Total leaching area....................sq. ft.
n
Seepage Pit No......Z------------ iameter....8_,--.._.. Depth below inlet__ ___......... T Val leaching area_�Q0___sq. ft.
Z Other Distribution box (!�) Dosin.�tank ( ) O� �� �►�'j
Percolation Test Results Performed by--_1'0�?...iLD..t9 .�64- .Q•1_?_.__.�:5-:----- Date..... t/ .............
Test Pit No. 1.4`_�_----minutes per inch Depth of Test Pit..Z;�.......... Depth to ground water...N.0w_6_-..-.-
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1:4 ...................----•---•---•--•-•-••--••••-•------•---•••......----••...........--•••---------•........................................................
O Description of Soil............ i ----4:_�f_24- t'1......../9_!!!>--------s-V-a,�OY4,:---------•---------------------------•-------------
x
-----•. g ' �f Q"_.-•• ./'2al�� Spa'v
W
UNature 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 iITi.;,,. 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 health.
�--- Sig d........................................................................•----•-••••-
Date
Application Approved By....... -- - _
7 ._._..
Date
Application'Disapproved for the following reasons------------------------•---.._..----•----------------------•---------------------------•--------•---...----•--
--------------------------------------••---••••-._...-----------• ..... -- - ------------------------------------------------------------•--------
Date
Permit No...... ... ssu
Date
Y
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
"rJ.tQr)... oF...... �N .��1.��-�'......
Appliration for Disposal Works Tonstrurtion rumit
Application is hereby made.for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal
System at:
....... ............ ------.6.............................................................
�
Lo anon Addr ss/iiJCIAt No.
I
. .. /i�f��ILfI� p(✓ yff� (M Ades /7 ........`
..
' Installer Address
d Type of Building Size Lot...
l .....Sq. feet
V Dwelling—No. of Bedrooms.............. ......•---.----_ ---.-.-.-Expansion Attic (kw) Garbage Grinder (h o)
aOther—Type of Building ............................ No. of persons....-...................--.. Showers ( ) — Cafeteria ( )
dOther fixtures ...............................................� .......................
W Design Flow....... e!r0_...._..--:•- •• alloo ss Leh_ .` `�. Width l��ai�,floDiamete -.��.�... De th_S'�.._`-'�
R; Septic Tank—Liquid capacityfd�..g per gt y �.y---_ p gallons.
W Disposal Trench—No.................... Width.................... Total Length............._....._ Total leaching area....................sq. ft.
x
3 Seepage Pit No,....../.......... Diameter.... ........... Depth below inlet..6.. ........ Total leaching area..& .-sq. ft.
Z Other Distribution box (i"0)" Dosing tank
aPercolation Test Results Performed by. l_• +v .�.b.. �-Alh.Ca kt�....... Date... f !_..` !,! / .............
Test Pit No. I'- Z.----minutes per inch Depth of Test Pit r;�..'.....-. Depth to ground water--- !_ .....
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--.....................
--•----•----•----------•----- ---•--•--•-----•----••••-•-------•------------•--------------•---------•--••......-------•-..._...-----•-•-----•-•----•-......
x ...... ."'
Description of Soil....... ���<i rQ�t'� � A/9�d. �!��"�C�1� ----............-------------••-•-----------••--•
qgp
e.
W
UNature 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 TITLE 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 health.
Signed...................................................................................... ..........................
Date
Application Approved By... -,.� - /:�... /, /
Date
Application Disapproved for the following reasons: ---------
---•--•----------------••--------•---•-•-•-•-•-----•----••--------•--.......--•-----•--•--...•------•--•'---•----.....---•-•----•••-----••-••--•---------••--•---•--••---•-----•---••--••-••-----.._....
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-�1.��!t,�..........O F...... ,
j °
Trrtifiratr of Tomplianrr
THIS IS T . CERTIFY,ghat the Individual Sewage Disposal System constructed Z,) or Repaired ( )
/ 1i
//f ..m- r
s ller
ate... .�41�=�-- - �-�'-•-•-------- -- fo_ G � -�- �/�}/Vta�te
•----•-•------------•-----------------------•-•-------------
has been installed in accordance with the provisions of I21LB r of The anitar Code a
p > Sanitary s described in the
application for Disposal Works Construction Permit i V?-e....7-..V�l................... dated---. ...................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................•-•--......---•-------...-------•------•----••-•-•-••-•-••-•---• Inspector................-••---•----•---------...--•--------.....----------•-••----.......
THE COMMONWEALTH OF MASSACHUSETTS
.�� BOARD. OF HEALTH
No.....t�! ...... -. ......... FEE.2..4 :.....
Disposal, IOU rk 4v str ' n , .rMit
Permission is hereby granted. ' = . ... ��_�(�C�:�_--•............................._....
to ConstructRep ✓
� °�;or a ( ) an Ind'ivid al e.wage Di po ystem
at No `'
'�yin--._. �y��I,.�!,......_..�-�-=---�. ..._... et ----. 7t. .....
as shown on the application for Disposal Works-Construction ,er' it','No. ... .......... ated
.......
/XJ_ !/Y/•s
DATE. .............-----•--••...............••
FORM 1255 HOBBS & WARREN, INC.,'PUBLISHERS ,vs
i
TOWN OF BARNSTABLE
5 �
LOCATION C Ct nrCt► h oq L d e n `S X h SEWAGE
r
VILLAGE ®S�ervf c c, e ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. /a
SEPTIC TANK CAPACITY
LEACHING FACILITY.(type) (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE:T 7 9 COMPLIANCE DATE:
I �
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
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S f4•�y ; LEACH 01$�•
<FP/ RESERVE
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97 CA: ,2 i, �M iTs S CA,L E
T 5i DE TZE.4 FP2a�co SELD -
- , SEPTIC 5YSTEA4 CO/v.57-2UC710AI
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Co vC2E721-_ S7'2E 1,4 77y 3000 psi //
D ,L�4 -D.-- °. ,f STEEL 20000
.'v i 1�4.de4/ - ,ice' + 1 /� A v - C E
t 17y. L t�/1 Vis�Y h/QT TO E3E �_: ��a% ��>
,'_''A4,n 5 d �-{!, e j" �' ' . C�#z ( 3f _ d_l*s, O✓E 2 5 y5 T�M Un/L 5 5 f/- �'O
S CERTIFY THE 1=X;S:WV6ti Fo, Ph_,/OA/ A ��'��"�fti �Es/v�v
IT[ D�OC-S O.Mir N 1 j/j l'rrA; The DUiLD llV G �
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