HomeMy WebLinkAbout0211 LAKESIDE DRIVE - Health 211 Lakeside Drive
PF 1Vlarstons Mills
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inae PARTIAL'1ST FLOOR/EXT.DECK FRAMING PLAN C
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TYP.MULTI PLY CONNECTIONS
,,.�.,�r•�.. � TYP.SONOTUBE/BELL FTG.SECTION
'"•"'"• 5-2
1.1 2
TOWN OF BARNSTABLE
LOCATIONY' ,
SEWAGE #
VILLAGE a'�i3✓.x--��°
------ ASSESSOR'S MAP & LOT "
INSTALLER'S NAME & PHONE NO.
Y
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) � � (size) /.
7
NO, OF BEDROOMS t PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 2
DATE PERMIT ISSUED:
I
DATE COMPLIANCE ISSUED_ `
VARIANCE GRANTED: Yes Now/!
`l 1
E / }
E
p TOWN OF BARNSTABLE
e.
LOCATION''jj SEWAGE #
VILLAGE , IN� ASSESSOR'S MAP & LOTIIJ V,17�
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
i;
LEACHING FACILITY (type) g(size) /°g9Zk5)
NO. OF BEDROOMSPRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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ASSESSORS MAP NO'.�
PARCELNO' I�
No..•. -- � Fps. OF. ��....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF,,, HEALTH
TOWN OF BARNSTABLE
Appliratiott for Diipotittl lVorko Tonotrur#ion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at
oc-ti(o�n-: ress or Lot No.
5.....................••...................... ...... ...........................
...................................................
Owner Address
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling— No. of Bedroom_____________________________________Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ------------------------------- - -
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth----------------
x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No..-_----.--_---.---- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by----•----------------•----------•---•--••-----••......-••--•-•--•-•...... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fro Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1:4 --••----•------------------------••••••••••••••-•-••---•••••••••••••--•-----•--......-•-•---•---••-•........................................................
0 Description of Soil----- ----------------------•-------••-•--•---------------------------------------------------•---------...---..._..--------------------------------------....----.•----
x
U ••••••••-•---•••--••...•-••••--••••••••--•-•---••-•••-•-•--•---•---•-•---------•--•--•--•••••-•------•----•----•-.......--••----••••......••----•......................................................
w
--------------------- ------- ----- ---- - --- - -
------•---- ------------------------------------------ ---------------------------------------....---------------...-•--••......-••--..._.....
U ----
Nature of Repairs or Alterations_—Answer when a plicable(bN..7t�'-`1 A--__A+N_-..�s.S5T:W ....... ....... ��
......Oc°6° L - S •.. C 'Ip.. P '...._..� Dom... p�� ...................
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 board of health.
Signed c `: - J�
Date
,�A�
Application.Approved By .... .........-------------- _.... � =J Gar/Z� -----
.................. ..
4 Date
Application Disapproved for the following reasons- -----------------------------------------------------------------------------..-..-----------------.
............... ............. .
--- --
------------.k..Date.-................
Permit No. , `'... .... - Issued - .........-�----- ....
Date
No...........
�f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiuu for Diupuuttl Workii Totuitrnrtiun prutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
Location-tCcddress or Lot No.
------------
Owner
S
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms,...........................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.----------------___--.__.- Showers ( ) — Cafeteria ( )
a' Other fixtures ---------------------------------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow...--.-_--................................gallons.
WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter................ Depth----------------
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------__----_--.- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY................-......................................................--- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
µ, Test Pit No. 2................minutes per inch Depth of Test Pit.-_----..-_-_---__-. Depth to ground water........................
04 .....•------------------------------------•••----...---.......-•------•-•----•-----..........----•-•.........................................................
0 Description of Soil.................................................................................................... --------------------------------- .................................
U ----••••-•-•---------------•-••••------•--••-----•-••------------------------------•---••-••••-----------•--••----------•-•----•--------•--•-•----------------•-•-•••-•-•-•----•---...........-----•....
W
------------------------------------------------------ ----------------------------------------------- -----------------------------------------------------------------------•--•-----------------•---
U Nature of Repairs or Alterations—Answer when
t a . e P "t r� t..sqa45 °v
.............. - ....... ,_.-.
- C?~--------- ------------
C�
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 board of health.
Signed ``` -,� ..... .......... . --- 'J------:
� Dale
Application,Approved BY -- � —off ..................�..................................................
Dare
Application Disapproved for the following reasons: ................................................................... 1 !
t
Permit No. `" ..{�_....................... Issued ............................................�� .
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(VETe 'tifirate of Q-Tomplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� )
b ......
`j Ins[aue[ l
at .----�C_
--- ------- K --. �...._.. .-�l 1�-------- --e-5^ ----` - ...`...�\5 ._----------------------------------------------------------
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. ,a �^-f _-_..... dated .'" '0�`'`".. �Z4
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. � 7
DATE...........
..- .-- ... .`''..--------------- ----- - Inspector" .. I_r a" , _ - ----------------
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
J
FEE....
No,.---••................... •--.............:*:
btu.Vnuttl Workii Tunutrurtiun rerutit
Permissionis hereby granted....................................................................................... ......................................................
to Construct ( ) or Repair (/) an Individual Sewage Disposal System
atNo..-_"?7 --_ �._ � S �Q -----•---- .........--. ---------------------------------- ....................................
Street /X
as shown on the application for Disposal Works Construction Perm�it�No._l,_____`p./____-_- Dated_._.___._ �'_____7...'�..............
G Board of Health /a
DATE.------ --------••-- --• -----_-----_------------
FORM 36508 HOBBS Es WARREN.INC..PUBLISHERS