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HomeMy WebLinkAbout0034 NEWPORT LANE - Health It- oct 30IC70 IAN RAIL Ostee A = 09 001 i S M E A D No. 2-153LGN UPC 12134 smead.com • Made in USA ��Y`, �J 2 3 � SUSTAINABLE FORESTRY INITIATIVE Certified Fiber Souroinp www.efipropramorp TOWN OF BARNSTABLEL� LOCATION ,P-- --f I�7.�;,7di2'�1�-eft.SEWAGE # 5 'y—/-30 VILLAGE ASSESSOR'S MAP & LOT _Q INSTALLER'S NAME St PHONE SEPTIC TANK CAPACITY LEACHING FACILITY:(type) NO. OF BEDROOMS_ :3 PRIVATE WELL R PUBLIC ATER BUILDER OR OWNER CgZ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 42:::Z1 IZ23 M�Em VARIANCE GRANTED: Yes ( No ) r� Q i for v ,. y No.._.. .••.. Fizz.... ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �.© .......................0F....BA ........................... Aliptiratiou for Uiipniial Works Tonotrurtiun Famit Application is hereby made for a Permit to Construct ( be) or Repair ( ) an Individual Sewage Disposal •ystem at: 1 �f 1 L,� :r 32 .�. a 1�. ca ..� - otion-Address or Lot No. a Owner Address AY z-�s_..zw" _ ......................o .... .................... Installer Address Type of Building Size Lot..Z- Qi d.........Sq. fget V Dwelling—No. of Bedrooms___�...................... .. Expansion Attic Garbage Grinder ►+ ---- 4 Other—Type T e of Building No. of persons_ Showers Aa YP g ---------------------------- P ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow.........55..........................gallons per person per�ay. Total gailye Pow------1330.........................ga)lonsse W Septic Tank—Liquid capacity.I��_gallons Length _ .:7 •.._ Width47.1d.__ Diameter................ Depth..5:8_ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. e Seepage Pit No---------I.......... Diameter.....---------- Depth below inlet....G............ Total leaching areaZQ .....sq. ft. Z Other Distribution box ( ) Dosin nk ( ) Percolation Test Results Performed by..... Date--- ----------------- a Test Pit No. 1... 2.._..minutes per inch Depth of .Test Pit-----1_3......... Depth to ground water..i©*_.__-____--. Test Pit No. 2.L'Z......minutes per inch Depth of Test Pit___.h.......... Depth to ground water..4. ......____ a ------------------------------------------------•---•---------- - Description of Soil----TK_1.A_- 2 4 ti� Ol dYl 501 C�. �3�'C '.....•-----------•---- x -----------•---------------I �"?� �j `p----------------•------•--------- W I 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 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 bQard of health. Signed ..... 1--.---- . . ....................... ..... ,-53 e------------- Application Approved BY '........... .................. ....................................... Date Application Disapproved for the following reasons: ...... .. ........................................ .. ... ........ .... ....................................... .................................................-- - ........------ .............:......--- ........---......................... • Date . .............. Permit No. Issued -------- -- . .-. ..... ............ ............................. to pq `� r No..... .�...... Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .0',6 Nk................OF........9.i f - - - +----------.................. , pplirFation for Elhipwi a� Workii Towitrurfinat Vantit Application is hereby made for a Permit to Construct ( <) or Repair ( ) an Individual Sewage Disposal yst LjOT _ �� . -------- . ... - ocation.Address or Lot No. �N fir' 7 . �I c..�i-:Uf r2 .......................................................... ---1��G�1t. S/t?_ E.rf_ r�i i td ...... _.GCGU,?-2 owner Address Installer Address Q Type of Building z Size Lot...........................Sq. f t Dwelling—No. of Bedrooms___.. ....................................Expansion Attic Garbage Grinder `4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other_fixtures ................................. . WDesign Flow.......... C-.............................gallons per person per�ay. Total daily,flow__-__330.......................... Ions,, WSeptic Tank—Liquid'capacity` s gallons LengthP).._&..... Width-A .._ Diameter________________ Depth._ .a... x Disposal Trench—No..................... Width_.�.____._.___.__.. Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No---------I........... Diameter.....`_)__........ Depth below inlet..................... Total leaching area:4 U......sq. ft. z Other Distribution box ( ) Dosinnk ( ) Percolation Test Results Performed by.... ? _ '� 4�F.,. ��.C'7..6 AC..._..._.._. Date_. J �..�_9 a Test Pit No. 1... -----minutes per inch Depth of Test Pit___.1 ......._.. Depth to ground water._KA ...--------__. fi ..,4 ----.Test Pit No. 2 �� .....minutes per inch Depth of Test Pit....A.&.......... Depth to ground water..N_ ........... 04 ....... . -•------------- O Description of Soil !.! •.E..j..l ..::.. l-Oia't'liU ---- i W VNature 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 b9ard of health. Signed '�5�✓'� //'� .V.i?4-- -f--------------- y�l,� V 1 Dare J r -------- Application A roved B .. ®.... _: ,{'t1 /_/ ='PP Y ..... .... ..... - .... . Dale Application Disapproved for the following reasons: ............................................................................................. ....................................... ............................... -- ...... ..-.. ................................................................................... .................... Date Permit No. --q .._...-. ....... -------............... Issued .......... _-- THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH �y.,r- ----------- OF .- 7� ---------------- .V� .... .......--- ........-- -- Celrttft.ctt#E of TompXtttn>ce THIS IS( �C FY, That the itdividual Sewage Disposal System constructed ( ) or Repaired ( ) by--------------------- Q- -' 1......... ------- --- -- -------------------------- nstaller at ------------------------ l -�-`��?R.T------- .i ILi ................-�_........l..._ ...... ...'�--.�-•.--..... has been installed in accordance with the provisions of TITLE,�Pf St n nmental Code as described in the application for Disposal Works Construction Permit No. ...-- ----te e/ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BCCONSTRUED AS GUARANTEE THAT THE SYSTEM WILL FUNCTION S7TSFTO DATE................ . Inspector ----------------------------------------- THE COMMONWEALTH'OF MASSACHUSETTS 7 BOARD OF HEALTH r -- J'— �j 1 ....... ...� ..'�..............0F.......�. �. �.r..., >...�...............................No.... ..1........... FEE.1.i .��.. Permission is hereby granted------1<�2 ..._:..... ...... --•------•---------------•----•-----••-----•-•- to Construct (K) or Re air ( � an Individual Sever Dis�.P�o�sal System atNO.. •................................ ... .....•----••Street.............. ......-- ......-----------•......--.......--------••--••-- as shown on the a plicati for Disposal Works Constructio nut No. __313 d.-O................................. ....... ............. %� .. .�. .._...---- Board f Ith DATE..... _ ............................................. FORM 1255 H BBS & WARREN, INC.. PUBLISHERS - J jp6ve 1AEL1 :::-,Li t_lf`_Ft ow 110 x 3 z 33o G•p�` ` d .._. (i,J �' ✓ ......... � go S S �G-PI-IG .TAMLC = 330,t Ir7G % ! '' i..' t CG6 / �f� • 1 � F>ISPOSAd_. 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