HomeMy WebLinkAbout0072 REBECCA LANE - Health 72 Rebecca Lane
q= 146- 039
Osterville
7i
� e>3 (
.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
HEALT
L . .__... OF........ .....4.. ..............-.. - ........
Applirat ion -for Dispaiittl VorkB C onmrurtion Wrunit
Application is hereby made for a Permit to Construc �or ( ) an Individual Sewage Disposal
v _ v�----- �� F / - --------•---------- -�J
.........
Locati ddress or Lot No.
••----_•• caner a A
. ....... ................ ......... .....................
........
Installer Address
U Type of Building Size Lotp__%... feet
�-, Dwelling—No. of Bedrooms-______ .... _ __________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons............---------------- Showers ( ) — Cafeteria ( )
QOther fixtures ----•- 2 ------------------------------------------------------------- = -
w Design Flow............ _Z,9____________________•__gallons per person per day. Total daily flow................ gallons.
WSeptic T,.tik—Liquid capaci _ __eallons Length---------------- Width---------....... Diameter_____. . _ epth_._-__,^_.__--.
x Disposal Trench—N �Width._.•___:_____ _`!Total Length__:_.__- __--__ - Total eachi g are. __..._-._.._ �. ft.
Seepage Pit No....... ' w �L-EjT re._...--.--_---.-.sq. ft.
z Other Distribution box ( ) osing tank
aPercolation Test Results Perfo ' ed by------- ............................................................ Date----•----------------------------------
,� Test Pit No. 1----------------minutes per inch Depth of Test Pit_-___-_--___..__-__- Depth to ground water--------.-------- ......
(4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.__-________-_____-...
G
Description of Soil--------�-------=-�-�--- ---`-�---------------------------------�-----�----- ---------`--' ---v--�-=--- --�'-------------------
U
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 Article XI of the State Sanitary Code—The undersi ned furthe,- f"es not to place the system in
operation until a Certificate of Compliance has �ss b t .of heal1- 6
r
ignei
_11ate
Application Approved By............ _ _ _�___`____�_
.
Application Disapproved or the followingreasons.:.
Date
Date
PermitNo......................................................... Issued........................................................
Date
No. /..... FRa........ ...............
THE COMMONWEALTH OF MASSACHUSETTS
Q.
BOARD OF HE-ALTW ,
_... ......_ _. ......__.-- ..OF........ .......... .'' .......J..............%I.,..........----------
Appliratiun -fur Biiipoiial 10orku Tonutrurtiun Verntit
Application is hereby made for a Permit to Construct.(%') or ( ) an Individual Sewage Disposal
System at't
� /
Loca/tio-:/'ddress �� or Lot No.
........................... -`..........-T-1-_�- �,�_-=---------.-.:r------------ ------•-............--/}�!::. :•- ...c _ -- e.. ........
Owner Address
W //!_____�__P_._-_�__ii_ --�-�•-- /���--c��-Q—'�
l Installer Address
Q Type of Building Size Lot. 4/,___�_ �Sq. feet
U Dwelling—No. of Bedrooms...__................................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building _.___...................... No. of persons..-_____.-___________-_-____ Showers ( ) — Cafeteria ( )
dOther fixtures ___!%% ----�:'--------------. ------------
W Design Flow................Z2.....................alons
Mons per person per day. Total daily flow...............I :.e l---__-_---.__.gallons.
WSeptic Tank—Liquid capac�-�_�_ Length-_------------- Width...... .._._.... Diameter................ epth_._..-_---._----
x Disposal Trench—No................... ��jj7idth._--__--__-,-_�/r . Total Length___.______-...... Total leachi g area __.--.._ ---sq. ft.
Seepage Pit No...._.f ___ Iat gcf.___ _ lip bZeYow ,et���-�/-'?'tr�Tot 1 acl i g re___________________sy. ft.
z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed by---- ----------------------------------------------------- ---- Date..----------------------------------._..
aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------.__.-_.-____.
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.__.__________---_._..
-z L------............ N i... '
O Description of Soil .'... `�v Z� -...V.. '� � u • - ----
W
VNature of Repairs or Alterations—Answer when applicable..____________________________________________________________________------__----------------
------------------------------------------------------ ..
-----.--•------------------------------------•--•---------------------•---------------------•--..
Agreement:
The undersigned agrees to install the aforedescribed°\Individtal Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b i issued:hy tl�e bt f healtl't .f2/�✓
e
g
I ned.. ml�
= ..._...-•-••_. ...... _-.6
eApplication Approved BY---------�f---------------------- --- :-- / -
--- -Date---- --••--�
Application Disapproved for the following reasons-------------------------------- --•----------------------------.-----------------------------------
•---••--••-••---•----••-•--••...••••--••-•............-------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued..-----.........----- ..................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1../lid✓ y�-'•..OF....... 1 ?/L'fLZG%?-'.............. ...................
Trrtif irate of 101konmphaurr �--�
THIS/, I. TO CERTIFY That/the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by Jam' '_�� /�.....r�l-f'�.
at. - - J ;� '' = f-- -`-, C-Gam.... ': - } ......_._._:..,_../ .................
has been installed in accordance with the provisions of A icI XI of The State Sanitary Code as described i the
-7 2application for Disposal Works Construction Permit No. _ ...... _.. � datea.....i f _ _l_
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL/FUNCTION SATISFACTORY.
DATE............e_1........ ...................... Inspector . . ..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O•F HEALTH i
.................r/ y<1r ✓t-: OF....... —
No•---•---•--••.•..�. FEE l r
Binpuiitt1 jUarkii Cno r1on Vamit
Permission is e'by granted-- ----------- --L-�!"=----....•. ------------......... - ---------------�..
to Construct( or Repair ( ) an Individual Sewage Disposal System
at No. �%' I.... �' ; � ./�����a s � -/�2 ��- /--_---- ------------ -U'_.__ ........................
Street 1
as shown on the application for Disposal Works Construction Pent No..... 2 7 C
i ed-- •• " - 6.- -----
9 �,G
Board of alth
DATE ----------------------------•••---•----------------'
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
I
v. oO
' 1
r
r 67,
f '
• �- �,.
_ A= ?3.*,8•
LOG•.,::iT/O.k/: ST��'✓GL,c�
,�,�./iU�/G .GOT .351^• .G�t/.� G/JCJ.G7' �/T L/.t./�•O litl/TH /' �iv/idl.� O•c"
2 /-/E,eE BY CE,eT/F Y T/-/�iT T.�•/E BV/LD/.C/ri '
SHON/.V O.V Tom//S �L�i.V /S LOCATEa O.1/ THE �
�y2oG/.VD AS SNOWti/ HEeEoAJ q,VD TNFiT /T �5�`N Of Aks-
D`�•�-> CO.VFO,e�t�1 To Tf/E• Zo.C//.VG �� �\
BY-/-,Q WS OF T/••/E 7-0W" OF ARNE ys i
M/.�/E.V CD.t/ST2C�CTED. , Q;ALA
v26343 v�l
mown- cam en9�neerir�9 � 9`cis�c��°o�
ci�/iL E.t/C./.VEE.e$ - `�f�'D ✓icy
,20 v TE 6 4•`-`�'�.eMO c.�Ti•�", :s��7 5 5. /afa r-� BEG. LAND S[/.eVEYO.e
LOCLATION ' �Yftv'�,� ',CtE PERMIT UO.
VILLAGE - - - - _ - -
INST&LLER*S W&ME ADDRESS
- �
BUILDER 5•- i-&V.AE ADDRESS
DATE PERNAIT 155
'UED
D ATE COMPLI &MCE ISSUED : - - -
Go
E
TOWN OF BARNSTABLE
LOCATION � o 44 L� —
VILLAGE (2)6fLU9 �ce�� ASSESSOR'S MAP&PARCEL
O. I
SEPTIC TANK CAPACITY Soo CA4,
LEACHING FACILITY:(type) �' i, (size) 1,0 016 C .
NO.OF BEDROOMS '
OWNER
PMI��- COMPLIANCE DATE: Nay �R[
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
.�J
. �
4
i
/�/�
�,C
� .
i - {{
_ 1
.a. J
i
I,
N
1A
203/2';� )NSTo NEW 3(,
--------------
Irmo Lrooz
--------------
IP
h 7lB�a.tH 7(DtSlls is � t I S' a
R
p'.
W � i
n
t ;
I
(. I
S
(`' - --------- --- - ---- --------- -------------------------
�k
Y �
k � 5
�Y 6
�er
It
'S e
A
P !
$�e TO
1�n
i 9�k
i 4 k
ZE �