HomeMy WebLinkAbout2651 FALMOUTH ROAD/RTE 28 - Health ~�(l _
LOCATION SEWAGE PERMIT NO.
VILLAGE
IINS.TAI. LER'S NAME & ADDRESS
6 U I L D E R OR. OWNER
DATE PERM1. T ISSUED
DATE COMPLIANCE ISSUED /� �j
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THE COMMONWEALTH OF MASSACHUSETTS
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BOARD OF HEALTH
OW 81.. .............OF..... a►:1'!^. ..........................................
App iratiou for MiposFal Works Tomitrurtinu Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.' . ....19� .V.X.6.---- .. --------- -------------------------------------------------
Locati Address or Lot No.
---- .... �•--..bra.v •....�� .... ..................................................................................................
Owner --------------------------------Address
In ler Address
UType of Building ��} _ Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.__..✓w✓�x�....................Expansion Attic ( ) Garbage Grinder ( )
04 Other-—Type of Building ...W1052.D........ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures ----------------------------•-•• -
W Design Flow......... .................... per person er day. Total daily flow------3 3_0................ ......gallons.
WSeptic Tank—Liquid capacity _gallons Length_ ...___... Width.....`f ...... Diameter Diameter................ Depth......._......
x Disposal Trench—No. ........I.......... Width.................... Total Length.................... Total leaching area---f 670.....sq. ft.
Seepage Pit No---------------- --- Diameter.................... Depth below inlet.................... Total leaching area......_...........sq. ft.
Z Other Distribution box ( ) Dosing t ]k ( )
'-' Percolation Test Results Performed b . d! .. -t[�'1 if'b�12��... ... Date.............. ...1.+.j.q �—
,Wa Test Pit No. 1.../"'�Z-_--.minutes per inch Depth of Test Pit...................• Depth to ground water_.40*p
tT., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -- - -•--
.........
0 Description of Soil-- t% -`1 �t C�+�%1 - ... $t�1 ------.../'9 r/ Z• .. .
x
V -••------•-------••••-•-•----•••-••••••--•...--•-•-••--•-•-•••-••-•••••••••-•••••••............•-••••••••••-•------•---••••••-•-••-•-------•---------•-••----•--•----•-•-••••-••-•-----••......-•-••-••.
W
.
U Nature of Repairs or Altera 'ons—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 furthe agrees not to place the system in
operation until a Certificate of Compliance has been i d by e board eal
.
2
3 S�ign
..
Application Approved /By_�. ........ 2DatengrApplication Disapprovew reasons:........................................................................................................................
.....-•-•••-----•••-•--•--•...-•-....•-•••••••.......----••---•---•••--••-•-•---•-•-•------•---•-•--...•.••••-•-•--•-------•-----•••------•-•----••------------•----•----•----••----•••......-•---------
Date
PermitNo......................................................... Issued.......................................................
Daze
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THE COMMONWEALTH OF MASSACHUSETTS
t r
BOARD OF HEALTH
r
.................OF......I Est i.. . . ...........................................
Appliration for UhipaaFal Works ToMitratrtion jhrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.. ... ..... :. ......05.44 e.
............................----------------------------------------------
L cat' n Address or Lot No.
...........!,:-�&-Zl------. ----------- -----------------=-------------------------- ..------------._.......................------.
e ' Owner Address
W Yi� r!!?'- LC�
Ins er Address
QType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms... ....................Expansion Attic ( ) Garbage Grinder ( )
pal Other.—Type of Building ...W.0-0.tt........ No. of persons............___________•___- Showers ( ) — Cafeteria ( )
p" Other fixtures ..................................
W Design Flow.........Y.e2- .....................gallons per person per day. Total dail flow......3.3 0--..................•..._gallons.
WSeptic Tank—Liquid capacity/45 gallons Length... _......... Width----- ..... Diameter................ Depth........
x Disposal Trench—No. ........I.......... Width.................... Total Length.................... Total leaching area...4570....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing t
Y-----
( )
'-' Percolation Test Results Performed b d G . 4........ Date...... .......
Test Pit No. 1...!___;1.-..minutes per inch Depth of Test Pit.................... IYepth to ground water....'tP fjZD cl
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--_________------ _--____
x ...................------•-•••---•--- ----------
Description of Soil.... ---•-----�-----.1..,&-•-•--�=----�----- -----•---f'��'�--e''-P ---------,�„y�-...............................................
x
V ---------•••-----------------
,--------
••----------------------•--•----------•••-----•-•--------------
•--•-----------------------------------------------------------
._........-------------------------
W ................................................ -••-•---------••--•-------•---•••-•••-••--••-----••--•------------•-•-----•••---•--•--•------•-•-••--•-•--------•-•---•-•-•-----•-•---•-•----•----
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
............................ ........................... -•----•----•--•----•-•-••-•••--------------------••••••••--•-----•-----•--•----•----•-------•-•------••--••----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Di osal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned furtl:e agrees not to place the system in
operation until a Certificate of Compliance has been4iu4bye board ealt
Sign '
... .r.. .. . e...'S
ApplicationApproved BY•--• •. -•- '.••---........••••. -••-------•-..._....• ---------------•--------•. ........ ............
Date
Application Disapprove or he following reasons---------------••----•-•---------------------------------------•----------------•-------------•-••----•--•--•-••-
--•--•--•-••--••-•----•---------------------------••-----._...------------•----------......_-•--••-----•-
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS,
BOARD OF HEALTH
�1Gd. .................OF.....,. G.✓..°..sG. , ..................................
Trrtifiratr of Toutpliattrr
THIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
bY ------ _.... ---------------- :..................
�'� �1
has been installed in accordance with the provisions of T LE 5 o The State Sanitary Code ed in the
application for Disposal Works Construction Permit No. , "' I ............... dated .._,_ 'a .__ -_ ..............
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..••-----•......_-_....
irrttl ��aattritrtuan rrmit
Permission i reby granted ..... - _................__....._.........
to Con;
r or it ( ) '� �di i ewa S
atNo. - - ----_ .. _........
Street 3�
as shown on the a icati for Disposal Works Construction Permit No..................... D .._.._.____._�...._..___............. r
--•--•-•---------•------•••----------------• --------------...--------••--••---....•••-----••-~
oa of Health
DATE......
FORM•.1255 HOBBS & WARREN. INC., PUBLISHERS
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LEGEND
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CERTIFIED PLOT PLAN
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EXISTING SPOT ELEVATION 0x0
EXISTING CONTOUR --='0 ---- i �%
FINISHED SPOT ELEVATION �� ` Lor 18 FALMOUTH RD.
FINISHED CONTOUR — 0 ;I 1�40RSE /f;! —
o �. No. 10951 1.:.. , I N
APPROVED, BOARD OF HEALTH a0 /!',`-==`""
DATE AGENT SCALE t I" = 40 ' DATE , LE-�- 1 , '02.
LDREDGE ENGINEERING Cat IIV CLIENT S-BE -- I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED jog N®, a2222. BUILDING SHOWN ON THIS PLAN i
CIVIL LAND CONFORMS TO THE ZONING LAWS
%ENGIN SURVEY R DR.BY JDD OF BARNSTABik .E , "ASS.
712 MAIN STREET CH. By
H Y A N N I S MASS. -----= ...._..
' SHEET.L OF _2.- DATE REG. LAND SURVEYOR
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CERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION Ox0
EXISTING CONTOUR ---='0
FINISHED SPOT ELEVATION +' 1'. Lor 1'8 FAl.MOU7N -RD
FINISHED CONTOUR — 0 K40RSE —
r No. 10951 !>) �! IN
APPROVED BOARD OF HEALTH
/ONAL E tli .�
DATE AGENT SCALE,1 = 40 ' DATE , Lfi---' 1 , 162
r,rLDREDGE ENGINEERING CO. INCCLIENT I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB N0. e2222 BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO,THE ZONING LAWS
ENGINEER SURVEY R DR. 3D—�-- OF BARNSTABC�E , ASS.
712 MAIN STREET CH. 8Ys
HYANNIS MA S. - I 12oI 62. -- -- `__ ': _----.
' S SHEET.1.... OF DATE �R,EG. LAND SURVEYOR