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HomeMy WebLinkAbout0036 OAK RIDGE ROAD - Health �(o OC.- C. r',,c2�n. ree C7, lyaf I�� 7 TOWN OF BARN STABLE I.ocA.cxOiy L-� Oa - +L._Sr,-WAGE VILLAGE ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO_� �- ®�� CA 1— 16 O SEPTIC TANK CAP!ICITY_ , 6605ot (wi�5 LEACHING FACILITY:(type) NO. OF BEDROOM.S_� PRIVATE WELL. O PLTBLIC WATER BIJIT_DER OR OWNER L;'cY_f` 4 B u&' (4c C� DATE PERMIT ISSUED:�� DATE COZIPLIANCF ISSUED_ VARIANCE GRANTED: :Yes __ _lNa � eCl "J' N ,��' _ _ s � i e- �_ No.._..�_zc•------30 FEB..... ./._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.......... ..®W ...........OF......... cls �.l ...... .................. Appliratiun for lliipuual Works Tonstriutiurt Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal system at: ................__.C a k: �D 1 ..�!b_...... ........ Q�S R��L� - ..................... _ •-Location-Address -• • --�'�-m -�.----/_Xt!E'r`l.h!��` ......................................... .7�.PROS 1�,ECT__}//.L.z ..... L X/ G TG. r /cl L2wner Address a -•-••_-`J• j•••-p/..l5 CU.................................•-•••••••--••••••••_.. ............ = ✓1!i tLGS.......----•--......---.................--•--•---......... Installer Address Type of Building J Size Lot._ �O�...- Sq. feet .. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Buildin Other—Type g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ��...................................................................................................... W Design Flow..............1__�.0�__...................gallons per per day. Total caily�flow.............3�._�--...Q................gallons. WSeptic Tank—Liquid capacityLOO.Q.gallons Length.•�_I�.._.. Width_.�f:,.t_Fi__... Diameter................ Depth. ...... x Disposal Trench—No. ................... Width.................... Total Length......._........... Total leaching area.....................sq. ft. 3 Seepage Pit No...( ....... Diameter....10......... Depth below inlet.._.: .... Total leaching area.Z:4`L.U.sq. ft. Z Other Distribution box ()(,) Dosing tankee�� Percolation Test Results Performed by..... L�Cs.... D.1�6k�..CAP .. Date.... .l 3..� .._1............ Test Pit No. 1..�,Z..minutes per inch Depth,of Test Pit....I.....Zk_V..... Depth to ground water.. 44 Test Pit No. 2________________minutes per inch Depth of Test Pit.....1.�_�...... Depth to ground water........................ a ••••--• ---- -- - Description of Soil_.. .__...__.- Z�. _. V ------------------- ----------------------- •........ ............................------- ••----------------- .......................................................... W VNature of Repairs or Alterations—Answer when applicable............................................................................................... ......-----•-•.....................•------------•-•--------•--...-------•--•-........_......._---•-•--•-•--•....._..-----•-••••----•-••--••...--••••........---••...._................_--••............. Agreement: The undersigned agrees to inst he aforedescribed Individual Sewage Disposal System in accordance with the provisi Is f"ITLZ 5 of the anitary Code—The undersigned further agrees not to place the system in operation uk'loa t ficate of p nce has been issued by the board, f health. / Signed --•-. /%�.... l_,�L Date �pplication pproved By. .:. ••-•••- '._. _ Date Application Disapproved for the following reins:...........................•------------...---••--••--------.....-•--------•----............Date•-•........... ........................................................__... .._..:............_.... Date .........� Permit No...... %....--.................................... Issued.......................................:............... Date j� .THE COMMONWEALTH OF MASSACHUSETTS. r BOARD OF HEALTH s -�w O F �AeP...sTA�Lz .. ..................•------.._...----......_.._. A_01iration for Disposal Works Tonstfurtion Permit ' Application is hereby made for a Permit to Construct (p or Repair ( ) an Individual Sewage Disposal System at: ................__.CU/�iG : ........................... 'S7 !?•11ILt6- (° - -..._..................... Location-Address or Lot No f�7/YI '�`,E'r�(7 J ;7`/•• 7 A, 099 5 P,667- 1�/CL �� L�il'/NG 7G Al ...... .. ---- -_. ---•----- ............................................................ .............. Address W ••--•------•-•-•-•........................................ .......--- ----- -------------------------"---•-•-• ••••-- "----•-----"-- •© ........ Installer Address .,� Type of Building :5 Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) "l Other—T e of Building No. of ersons____________________________ Showers Wflt YP g ---•---•-••----•-----•-••--- P ( ) — Cafeteria ( ) Other fixtures ..................................... Z-FE;--•----•------------•--•-•---•----•---______---•-•--•-•---�------••--•••-•________________ ________ Design Flow................ . ...................gallons per"persorr per day. Total daily flow_.._____.....__...��__-0____......._..__gallons. v .- tt Septic Tank—Liquid capacity_t)OQ_gallons Length__- ��..... Width:+,1_l_�2_._. Diameter:............... Depth_ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.._.(J_)------- Diameter_..- ........ Depth below inlet...... .*t .... Total leaching area1+ i.a.sq. ft. Z Other Distribution box (),) Dosing tank ( ) -' Percolation Test Results Performed by...__!=...1_ :1 !*� *.....� tx0+'^...............__� ` c `a s Pi No. 1...�:..�---mi inch � �"�4-`I o.._ Date..... •-_�_ �-"--�--/t� ��Test t minutes per inc Dep h of Test Pit______________ ____ Depth to ground water.. ....____... LL, Test Pit No. 2...'_ "_ .....minutes per inch Depth of Test Pit......!@(n_ __.... Depth to ground water..'" ............ --- ---•------ ••------ •------- _.... •----------- -•-•-•••-•••---•-•••.... .------- •.. .................................................... O Description of Soil. Z� ........................... V ..-•---•------•--•••--------- ------ ••--•--- •-•------------------------------------ ---------------------------------------------------------------------- ........ _------ •-••------- •-•••-------- V�"� _-•--•-••--•----------------•-----•--....•---•••-•••--•--•---•---•••-----------------•-.._...-:•-----•-----•--•---------------=---•--•--------•--•--•-----•-•-•---....-••--------------.._.............. 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:ITL: 5 of the State S?nitary Code— The undersigned further agrees not to place the system in operation until a Certificate of C.mp is ce has been issued by the board of health. Signed•--- r' , .... . '�..................... !�312.�.... ... d �......_.. Date Application Approved By...... ...............1/i..-••--•--••--• �•-----.... ........................................ Date Application Disapproved for the following real ns_............................................................................................................ --------•---------••-•..-----••-------------------------------•-----------•---••--••---••-•---__..Date ........� (..� V" Permit No..... ••-----------•--._....... Issued.. ------•--•••--•--•................ Date e.�sysva..esaana...... ...o•----or000.•.•osorsa��••r••••r�_••gra�aassss+nww.ao,A�asyss..os o�s�..,.:..... -«.. ..—.-_._...•..-.._ v THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH OWA.1 ....OF.............�. 'dieA/5.70 �4-+ .................._...._. Tntifiratr of Tomplinurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by...... !•- .P/X G L L......................................•---.....- Installer� at...l�?_�L....._.. G......_.- '�! ��G� -' STt•iC 11/L................................................................................. i has been installed in accordance with the provisions of Tl�= 5 o yT*.e State Sanitary Code as d `cri in the application for Disposal Works Construction Permit No.__- _�_"` % __________. dated_..._. _ .�? Pj ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................• " =` :/,........................... Inspector....... --------------------..........------------------...... K THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �J J F> ........�.............. Disposal Works Tonstrurtion Permit Permission is hereby granted_...._ ._._ .! SSG a--C_ --••-•------•-•................•-•-•..._....._...................---•-•... to Construct ( x) or Repair ( ) an Individual Sewage Disposal Syste�m�_ at No........ �? 3t� C?f�K /�/ G r:r fE't� "57t, ____------- ........... .... ......................�.._....._.............._......_...__... .------...---..__.._....�..•_ ••__ •• _.... Street CC�� / as shown on the application for Disposal Works Construction Permit No.. J-.�_ . Dated_,__-� f/rl.. _........ .......................... ......... .= ........---•--•-•-•--•--------•---:............._......-- �,J Board of Health DATE.................... 3 '� -- ---- -- ���.�..�� PtZC.-eL t io4 ' t u 4b G Wolu Y <✓ 2. 4Z 44 ` y�EU-��•l x } 441 I 40 �� 3, PaPE QI'T�,k' ��}.'/r" U!al.~S� O' ✓�;.1t h;prED, 1 Cc ��.:ST2UGT.o�! 10 Maw Fn14,QO�s'�E'� .ems CljCx "TtT(,� �= i / •� � I I " ' � �4 �ti I N / � ,�!s7c..At. 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