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HomeMy WebLinkAbout0041 LIBERTY LANE SEPTIC M No.. _. Fxs.....�l . J...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE 4.— %o New q� pvt1ra ur U44psFal 10orkfi Tonstrurthin Vanfit Application is hereby made for a Permit to Construct (V/ or Repair ( ) an Individual Sewage Disposal Syst at ...... .......--•---•. - ..� W....�� ��u!........... ----•-•----`••--`____-..---.-----.--�.-- •--------.-..--.-..-.------------.------- Lo ...... ..,---on A ress �// r Lot No. Owner Address 74a a C..J .�C... .... . !:f.. ....................... ......_.. (/ Installer Address Type of Building- 3 Size Lot..../ z.&M....Sq. feet Dwelling—No. of Bedrooms......................... ..._.._...Expansion Attic ( ) Garbage Grinder (Nd) No. of persons............................ Showers — Cafeteria p,, Other—Type of Building�........- p � ( ) ( ) 04 Other fixtures ---------------------------------- - ... W Design Flow.................//0 ............................ per jer day. Total daily flow............-�.. ................... lons. WSeptic Tank—Liquid capacity.IAOV.gallons Length._ ...e._1. Width.�...�.... Diameter__._.__.:.::.... Depth__..._..y._.. x Disposal Trench—No..................... Width�D......._...... Total Length............J....._ Total leaching area_..�.(..�._..sq. ft. Seepage Pit No......�...__._.._.. Diameter....... ............ Depth below inlet.._......_._..... Total leaching area.--...............sq. ft. Z Percolation Test Results ) Performed by. . .. Date..../9.a�. ----- Other Distribution box Dosin nk ,aa Test Pit No. 1....�-,:_..minutes,per inch Depth of Test PIt..__� .�....... Depth to ground water.... fZ4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 9 _............. ...............� . Description of Soil ..... .._.. ..�l D------� --!� ..........................--------------------•--•-•--•-•------------. x W -----------------------------------------------•------------------------------------------------------------------------------....-------------------------------------------------•--•-....._......... 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 Complia e ass been issued �by�the board of health. Signed ... == �1(r��s0'(/1 J­------------------------ Da te Application Approved By . ........---fI V-�--� -------t<- - �- Mte Application Disapproved for the following reasons- -- --------------------------------------------- -------- ------------- --------------------------------------------------------- -------------- --- ---------------------------------------------------------------------------------------------------.............................................. ------- --------------------------------- q/ /— Date PermitNo. ------ t l..'-.. .......................... Issued ...-- ------------. --------------------....------- ..--.... Date THE COMMONWEALTH OF MASSACHUSETTS ZjB9A.R.D OF HEALTH Ai L,1TOWN OF BARNSTABLE Appliration for Disposal Vurks Tonotrnrtion Permit Application is hereby made for a Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal Sy7a ___ __________•---•-----_________---_ - ----------...r. ........................... {' ____ t Lo Lon ess Lot No- --_. Owner J - Address a Q - - - ------------------------------------------- -----------�i_7� ---------- - ---------------------------- Installer Address g /� �©A d Type of Building Size Lot__________1__.___._.J__..Sq. feet � Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder (NJ) N Other—Type of Building Late- No. of persons____________________________ Showers ( ) — Cafeteria ( ) 04 d Other fixtures ...................-------------------- w Design Flow-------------_--- �U------------------gallons per l eVs&R per day. Total flow__-________�.3__-3y�------------------ ---g_all�o�ns. WSeptic Tank—Liquid-ca.pacity_1QQL�_gallons Length___`__ ___ Width--------------- Diameter________________ Depth_:___________ x Disposal Trench—No ____________________ Width.................... Total Length------------ Total leaching area------------------ ft. Seepage Pit No.___:_/_____ Diameter_______ Q- Depth below inlet________._._._._. Total leaching area_ ----------sq. ft. Other Distribution box ( ) Dosingnk ( ) a Percolation Test Results Performed by----•= � -d i /��------------- Date ,,/ Test Pit No. 1____ ,P-___minutes per inch Depth of Test Pit----/�_--------- Depth to ground water-----!------N_ __- 44 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water________________________ a ----•-----•--..---------------•---------•-- --•--•••--••- ----- ----------------------------------------------- --------------------- O Description of Soil - � __.`..._. __' U_.....- -Gam^�.� x w - - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ 3 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 as been issued by the board of health. Signed---• -�� ----------------------- -------1j 9� ---- - - -- - -- ------ -- --- -------------------------------- -- ------------------------- Dare ApplicationApproved BY -O ---- -------------------------------------------------------------------------------- ------- Application Disapproved for the following reasons- ---------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------ ............................... -- - --- -----_- -- _ --_ __- ------- --._ . -tam --------- - Perfnit No. --------1 f �----- - --------- - Issued -- --------------------------------- - -------- Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfer#ifirate of (1 omplianre THrISJS O CERTIFY, That the Individual Sewage Disposal System constructed ( Y ) or Repaired ( ) by ` "' �---------------------------------------------------- c� d at ' ti? ----------------------------------------------------------------------------------------------------------------- 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. ......q ------------a ----------------- dated _______-_-_-__-___--_____-_________-_________-__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----------------;� "-7 1- --------- Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Fim...... ..��._ ...... Disposal Works Tonstrur#ion Permit Permission is hereby granted -�----- �---------------------------------------------------------------------------------------__ to Const,t i�or Repair ( ) an Individual�age,Dis System /�t tree' C�` C / as shown on the applica bn for Di osal Works Construction t No.d_f=-- ----2___ �____�_________'_�__�________/�_j: Board o Heap DATE------------------ -- -•---...`-�1 •--------------•-------------- FORM 36508 HOBBS Q WARREN.INC-,PUBUSHERS ,,,- sti.,GL� F�1t_� - 3�3»eoo�vc ..�`l��I1-1....•_� l_ At,l`r--- �.lo G,atza.c�� G�cl�tD�tZ... •. resat�� FLoW 1 tb .4 z � 33o G.p.D, _ ------- - ---- u ��Jp.: St= ,c 2.S • 3"7S G.P.D. ��_.. �� � ' � ZZ,1 TOTAL 17 ESIG►J = 4 ZS kA - 2CDLL.T10U tZhTE :. ! _►t.f ��4tttJ• O2.L�.SS• r4,,14 o RTER su i c.•..:�-�, " � ti � �; :; �� OCR .5`t�� `0'STL;• .; ;: .�c;., �''+�„ z�,' ..°..;t',rr� 1 + . . r Q Hoc FG= 5 TOP .Y .. (I� �o0o IUV. •;A J Iwv f ..-Box �� G Sga-p-Ic I o "17 loon �Z� l T'a�1K GAL. luv. L_ t. 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