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HomeMy WebLinkAbout0108 SYLVAN LANE - Health 0`8 ��/ LNO,�m - r y TOWN OF BARNSTABLE LOCATION 108 SEWAGE # VILLAGE (2-5 91 ASSESSOR'S MAP & LOT YO u— INSTALLER'S NAME & PHONE NO. 1C\�i=� Cbul SEPTIC TANK CAPACITY } LEACHING FACILITY:(type) NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER BUILDER O OWNERDATE PERMIT PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Sal�� /'��' �� �� �� � a � ,� ��' - s ,� 3����J� � � � � ��� 1�L� ,.. - t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Ii_npuiial Workfi Cnnngtrnrtiun Prrinit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address T or Lot No. jo Owner Address ............................. ` •-•---- -- In taller Address Type of Building Size Lot..... f�c�. ..z Sgfeet V Dwelling—No. of Bedrooms.._-.._..... ''IL............. .. Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building .............. No. of persons..............._....._..____ Showers — Cafeteria 04 Other fixtures -------------------------------- -.. Design Flow................................5 --_gallons per person per day. Total daily flow.....4-¢5>...........................gallons. WW P q P . g g „ Septic Tank—Liquid Li utd acl ca ty�s�....gallons Len th._�9.-�_•_- Width__S__-�____ Diameter.....1........... Dep th..'-9Z..__. x Disposal Trench—No.--__-------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pitt No----------- ----- Diameter...../1_........ Depth below inlet......¢.......... Total leaching area..t'6.......sq. ft. Z Other Distribution box (o") Dosing tank ( ) '~ Percolation Test Results Performed by....... �11/!. ....................... Date...�'._2Z.-.9,0.L_.......... 1.4 Test Pit No. 1 5_ r-minutes per inch Depth of Test Pit..... A�...... Depth to ground water_______ _____________ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------•.....•---............._--------......---------................................................................ O Description of Soil..... A 2!` ^__...: ,a----C-n-e.V.0.---5,W. ..0........................................................................... 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 Complia as been 19 d by the board of health. Signed ............. �..,- ............. ........................................ Application Approved By . --------- Date Application Disapproved for the following reasons- ...............................................I........... ............................................................ ---------- ------- ----------------------------------------- --- ......--------------....---------------------------------...-------------------------- ------------------------------ ....---... --------...------------------.T .Dare Permit No. ....9..... .................................' Issued .... ..........:.... � Date --.-...-.. J No... , - 3 FR$... �. ..fS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iratilan for Uiipnsal Mirks Tonstrnrtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage •Disposal System at: ..... __:f -L.a l/Lr_.... -------•-------------'.b7r o -------------------------•----•--....---- "Location-Address or Lot No. _... Owner � Address w ------------------------------------------- -------------------------------•----••----. ---------------• -----------------•--------- In aller Address Type of Building Size Lot...... ,�_��:Sgyfeet U Dwelling—No. of Bedrooms.............fit'...:--------_..-_______-Expansion Attic ( ) Garbage Grinder ( ) ►•-r PL4 Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures ............................................ w Design Flow................................ .-___gallons per person per day. Total daily flow-----!1 !_�._.............._..._....__gallons. WSeptic Tank—Liquid capacity 1s ..gallons Length___�o,b`_ Width.. *'__ Diameter-_- Depth.`'Y::_.. x Disposal Trench—No..................... Width---.-__:--_-___-___ Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No------------Z..... Diameter...... /. --__- Depth below inlet......4:.......... Total leaching area..4. .......sq. ft. Z Other Distribution box Dosing tank ( ) ~' Percolation Test Results Performed by.-_:-!-`�-__�--�f'�=_ '!!!' � ...................... Date... . ' 4-....•._... a -� Test Pit No. 1�55.:?�.minutes per inch Depth of Test Pit......_ a../...._. Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••••••-----•--------•--•-••-------••-••---••••••-••---•••---•--....-•-•••-•-•-•-•-••..............•-......................................................... 0 Description of Soil.....T ...... �,a�• .►-�=''' !=,zi ti= S e� ----------•-----------------------------------------------•---------------- x 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 system in operation until a Certificate of Complianvq h s been issued by the board of health. Signed ---------------\\ �.. ..----------------------------------------- -------------------------............. Application Approved By --........... -�-...... Dare Application Disapproved for the following reasons: ----------------------------------------------- ---------------.........................-------------------------------------------- ------------------------------------------------------------------------------------------------- ---------------------------------------------- ........................................ ------------------------------------------------ ------ Dare Permit No. ' -- ..tom'....... Issued .'"� `" 1 .. - -I Dati J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V Ertifirate of Q1.1IImplin re THIS IS TO ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ----------------- ---I �' ...... . .................... / t� 4� ..-- Insc� at ..... .-...�..$......`- �Y. 'f '..... - r ' has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. dated -_ 9'"'/...:..e— �' F� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. .............. .....-..``.. .......... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �t���a��t� n k� �un�tr�rtilan rrntit- . Permission piss hereby granted............H-C-- -----------------------------------------------------------------•--------------------.------•.-..-.----..-..------- to Construct (!�) or Repair ( ) an Individual Se ge Disposal System at No....f �:.'S 4 I'i �.......... Street as shown on the application for Disposal.Works Construction Permit Dated....%- -/..!' '":J f .......................••---•------ -;oard of Health------------------------------------------------ C� B DATE............ '�� . -r.•y-------------•-----•-----••--•--. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS I i { .Cot $S :Cot . rL . . f R I — C 'oat 86 ` .29 ac. j t2 r r I ep ti c e�.t I _ No. bed4.,60 us f i 3/ idp0dat no i I .C'ot.d 87 & 88 £�.tinzctecl '¢t'ow 4'ud 17P yJ' �i 1 �'each�s ' ctea 466' { Ccy�aci tq, 88:(S cad t 1 t i j. I to¢j (�e No State t 4 a 1 r + _. 1500 o �;,; W1 a tone .� I J, c� 11f�M" date 0 tgtt Ctpe Cl? tvL — 49 /dc�io,t Road ! E • Id ycwr vi i l'n. 62661 �S-i to l-'t 6 jj. and -i A GU.r avino, U�.te�ci i,�.�e, l'49 r nn j/o/t Oanaea CtoC�22/G �.t. { j�eairrc tot 86 a .r#2664- e � L (�eUG iLO►Ll a%Ge &n an Gd;L tltlP.d �. �c�tz - Ne�eht aa►v�.#c�iZe Eo-R7 o y 1t� t 1 (feat ;ilG.ta.'#� 82 S r - ! { L tl -1 ,aQ}}•� `/`+ t-.. t... _ ,..i r.,.j;.....r ...t._ J {..�. r `• t { ` 1 •+ ' I t- { ! 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