HomeMy WebLinkAbout0114 LOVELL'S LANE - Health 14,L.os�ell'.s. Lane
Marstons.Mills
A'= 078 096
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TOWN Or BARNSTABLE
LOCATION 111-1_ l_OV4-� S �� , _sEWAGE # .��._._
VILLAGE 9N\lq't%SOLUN Ntb ASSESSOR'S MAP & LOT
IN TALLER'S NAME, & HONE NO. ,�, � '►����771 a1Z`�
SL P11C TANK CAPACITY
LEACHING FACILjT Y:(tylc)_ 1 R��t� (size)
- w
NO, OF BEDROOMSs PRIVATE WELL. UP. PiIBI.IC' WATER
---
BUILDER OR O WNER LE"«I�� __—
DATE PERMIT ISSUED: ? �
DATE COMPLIANCE ISSUED: �_�i
ARIANCE GRANTED: Yes No C/
_ �I
AV
No - ..... Fmc.....:;LC2...'`..
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH � � 0�8� U9
`N.W.1......................OF............ "CR,P>�� .....................................
AVVftratiou for Diapaii al Workii Tomitraarti 1 rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
---------------•---..------- .i�. Q 1[ :��.-----L......•---•---•--...--•---------•--------•--------
Location-Address .or Lot :"o.
%
QQwner Address
------------------------------------------------ .......... ....--••-�- ....................h� Ifl�-�.••.........---••---
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures ..................................
-------------•---...--------------
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
w Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___________---___-__-.
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--__-______-____•--____-
P4 ----•-••-••-----------------••-----•-------•••------------•••••••••-••••......•-•------•.....................................................................
0 Description of Soil........................................................................................................................................................................
x
v ----•--•-•-•----•------••--•••••--••••---•-•---•---•----••-•-••--••-•-•--•-•••••••--•----•---•-•••••••••---•-•-----•-------•--•---••----•--•---•••-•-•-•-••---•-••-••-••••••••......--••--•-•-•--•-••---
w
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable...... ta,4.......................
--------� lad# ••...N%) =
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TT .p of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the b of health.
Signed--- _.. :.... `....,. ........l. .....
ate
Application Approved By................. - �
Date
Application Disapproved for the following reasons:----------"-----------------------------------------------------------------------------------------------------
•••••••••••••••••--•.......-••--•-•--•••--••••••••-••-••-----...-•--••--•••••••••-•-•-......-•••••••-•....................•....-•-------•-••••-••••-•----------•---------•-----••---••••--••-•-•......._
Date
PermitNo.---•--•-_ �lg ......................... Issued-------------------------------------------------------
D�u
r_ 4.
L Fins.... r .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA,,LssTH �-
- _..�.NI. ..-----------.....OF..-- �V\ 4- ....
Appliratiou for 14-41jlo s al Workii Tomit.r "Uti#
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
..
Location-Address r Lotl 'o.
WI...-�- ................................................... .......... .STOvJ S V.......1.�5-•---------------------
Owner Address
1....... ................................................ ...............................L t -------•----..lac tA.JI......................
Installer Address
PQ
Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms................................. _Expansion Attic ( ) Garbage Grinder ( )
Other—Type e of Building ............... No. of ersons..................__._..___. Showers — Cafeteria
f-1.1 YP g ------------- P ( ) ( )
a' Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
Disposal Trench—'_\To..................... 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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
0-4
Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
r Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_._________--___-_-____.
1:4 ..................................................................•..........................................................................................
0 Description of Soil........................................................................................................................................................................
W
V ----•--------------•---•---------------•-------••---•----••-•------•-•--•--•--------•----•---•-----•--•-•--•-•----------------•--•--...----•----------------------------•-------------•-------•---------
---------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------•-----
U Nature of Repairs or Alterations—Answer when applicable...... ........ ..........!f�.......__ -_ ........................
..........'J/..------.-?•-------` '..U.!�...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'TT LE i of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the b ._ d of health.
Signed \, t -----= _
Date
Application Approved By.................
Date
Application Disapproved for the following reasons--------------------•-••--------------------------------------•-------------------------------------.........._
...............................................................;.........................................................................................................................................
G Date
Permit No.------•. Issued
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........7!6!4A)...............OF........ AK.' � C ............................................
Tntif irat a of ToutpliFattrr
THIS IS TO CERTIFY, Th t the Individual Sewage Disposal System constructed ( ) or Repaired (L4-
by---------&`v 1 kJ.---••••--. -----------------------------------------
Installer
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......... ----y..` .......... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. = ......-••••--------••-•----•----• Inspector.- .:..
� ' C
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
P�4.�.......................OF.....4�-V�CZYJ 5 11�
.................. .....................................
-y
NO.... '� y `..g FEE.. ...........
�t��rr��a1 �rk� �a�tt��rimrtt rrniii
Permission is hereby granted._...i!A U-1 Y........�ALc-0-�
to Construct ( ) or Repair (fan Individual Sewage Disposal System
at No.....A.,4-----• ��5� __... !A---•--.M�sLSlani1-...�- _\5........................
Street _.
as shown on the application for Disposal Works Construction Permit N Dated..........................................
•-------••••-•-•--•--•-••-• ..1 ........................................................
Board of Health
DATE----. �..!:�..........7----
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS