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HomeMy WebLinkAbout0018 HIDDEN LANE - Health ��lo -oo � r � V �. THE COMMONWEALTH OF MASSACHUSETTS A K 1 SOAR® /O�j��` �1-1EALTF-I ....... ..........:. OF.....Q fnr�h4paii al ?darks Tonotrudivn ramit Application is hereby made for a P rat o Constr ct ( or Repair ( ) an Individual Sewage Disposal System at: Location-Address t No. a ,Q �j Own'ef Address........................ am --- c ----•-• ---..... ------------ .........---------•-----.-.•.......----.......-•----........-......------------------------------- Installer Address QType of Building Size Lot.....6,1 00.......Sq. feet-1 � Io. of Bedrooms___....... .11 .............Expansion Attic PO Garbage Grinder p,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) WOther fixtures -----------_----------- --------------------------------------- - d W Design Flow.......................5�t`..........gallons per person ger flay. Total daily flow........... C .................gallons.. WSeptic Tank—Liquid capacity_. �gallons Length.0--G..... Width:..-jq... Diameter................ Depth..V._-.-. x Disposal Trench—No.......... ......... Width----___.-._-______-- Total Length.........._......... Total leaching area....................sq. ft. Seepage Pit No...--___.--_ ....... Diameter.........�....... Depth below inlet............... Total leaching area..��...sq. ft. Z Other Distribution box (t-T-- Dosing tank ( ) `-' Percolation Test Results Performed by..... & -` --- -. l0...... ----. Date_. _`....:Z.....__. aTest Pit No. 1---------::�=minutes per inch Depth of Test Pit_____ : ........ Depth to ground wateiv�%'e?�.. :Z. Test Pit No. 2................minutes per inch Depth of Test Pit....17......._.. Depth to ground water-----"`........`...... %--•- -•v-----------------------------............................................................... i �......... Description of Soil----.--- 3 mod...- ------------------------:�.---�z ..fi Ot. .---- O F' U ...... ------------------------ ------------------------------------------------------------------------------------------------------------- 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 Environmental Code—The undersigned further agrees not to place the tem in operati o til a Certificate of Com lianc as been issue y he board of health. SiSigned --- -- "- y _ ............ .............. -- ..... 17. Dar Application Approved By ...... ....-.:=:..-1.�� �' e Application Disapproved for the following reasons: ............ . ...........................................---------------------------------...--------------------------------- --------------------------------------------------------------------- - -- --- - ------------------------------------- ------------- ..........------------------------------------- ------------------ ------------------- Dare Permit No. .f�•��... -------��-�-------------------------- Issued ..-- �� ° �` Dace THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ..,.......................... ............................ Appliratiou for Disposal Works Tonstrur#inn jiumit Application is hereby made for a Permit to Construct (j� or Repair ( ) an Individual Sewage Disposal System at: _ _ ..:...���1�``j o- ... -... �:}.'..�:_��.`.. !..�:....._I�� r �� I !�_.t=......................................•- Location-Address v _ or,Lot No. Owner Address W Installer Address l� Type of Buildir Size Lot...... l.(..............Sq. feet V Dwelling—No. of Bedrooms___ -_--.__.M_..�-�..............Expansion Attic (�6`�{� Garbage Grinder '4 Other—T e of Building No. of persons............................ Showers — Cafeteria al Other fixtures ............................ W Design Flow.......................= . ............gallons per person Rer flay. Total daily flow...........2�..�"'._.-.--.................gallons. WSeptic Tar.k—Liquid capacity_-_---:��gallons Length. . -..... Width` -.`Tq... Diameter________________ Depth..V_.... .. x Disposal Trench---No.t.................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.................... Diameter....___--`�1----- Depth below inlet..-............ Total leaching area..`:�...sq. ft. Z Other Distribution box (L< Dosing tank ( ) _ aPercolation Test Results Performed by.-_-. _ _'-�'7... n Jj .___._.. Date___:�:�'_:.�r.......... a Test Pit No. 1_.._..-..Z-minutes per inch Depth of Test Pit--- ...__._. Depth to ground watetu:... 1-2 .................. Test Pit No. 2................minutes per inch Depth of Test Pit.....(.z.......... Depth to ground water....."........ i 1 Descri�14ption of Soil M........................ ---- . ----.�.. v �`- e`?_Q. A c�---tact.4-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 Environmental 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 n Application Approved BY � �� - .............. ............................................... te=7 -- Dare Application Disapproved for the following reasons: ------------------------------------------------------------ ------ . . -------------- ------------............ ................................................................. .. .......................................................... ................... .. . ... ............................ ........................................ e_1 Date Permit No. "'.. ..Ic'T�.......................... Issued ------- ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------ C?• ----------------- OF ---------- -------------- Cer#ifira e of C�IImplianxe THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed , / or Repaired g P Y (!/ ) ( ) by ------------------------0. .. -------- •--� - �--.................................-----...-----------------------------------------------------..... ---------------------------------------------- Installer -� ---------�� ...................e._4_ ..ft e`. dhas been installe in acco nce with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..__ .. . ..�...1,,�._. ----------- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT �EONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE `.J..... 1...?7 :....-- -- ------ Inspector ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. ' ........... ..........OF................... ,.e��rs.• , ........................ FEES/ Disposal Works Tnnstr uan rrntit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.....................................................................................,...........-•------ -------•-----•---•-••-----•-•----••-----......-------•----------------••----•--...... Street as shown on the application for Disposal Works Construction Permit No,� a�,1feDated....... .-._._ ...._. � ------------------------•----------` ......--------------------•---------............---- ¢ Board of Health DATE....... .... �{ r FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN OF BARNSTABLE x LOCATION -09 SEWAGE # 9'? " /9© VILLAGE C�S('ry� III ASSESSOR'S MAP & LOT lqo -oo / INSTALLER'S NAME & PHONE NO. QePAn 6CI'7e2g/ D SEPTIC TANK CAPACITY /,poo QA0,7 LEACHING FACILITY:(type) l2kecaj!7-2'% (size) /,QOQ NO. OF BEDROOMS a PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes Now, E� 4 ,9-.2_ �? a 3= 1,000ja( 23d: 34 '�" 3 ff h_3: 48,, z -a 2rj 4.i�.� �._:,. -i j. i t• i t � C, :.,,c 1 -. } ,�.- f ,. Y ,J __.—_— _ ._ . /� 1ZL�ONC �''�r�Kt 11A t I ad,t�l�.�FLOW �.I tb +c, ,•'�3�4/GQPt? �p_I {^ i � � �` ^�;�„�3\ �' �. 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