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HomeMy WebLinkAbout0333 TURTLEBACK ROAD - Health Oq ` O.�SID►15 373 LOCATIONS °t SEWAGE PERMIT NO. ,� JbL —V I L L A G E /4aysr°`'s Aj,'Its INSTAL I'A&SA. AACTO .AIKHOE SERA I DER E S S _ 150 Walnut Ctraat (' West Barnstable,; Mass. .02668 e U I L D E R OR OWNER l�O �►h J . �/�/�dn P� . Su v✓ ►- . �� rd DATE PERMIT ISSUED DATE COMPLIANCE ISSUED fL j RZ 6Z............ THE COMMONWEALTH OF MASSACHUSETTS BOARD H E&I TV rorvil-LIO.........I.....OF....... .. Appliration for Disposal Works Tonotrnr#inn Frrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ........ ------------------------------------------------------------------- �p �Loaa o -- d ess ,�/� or Lot No. U _... o ::. � `y Q - �1�:........... --------- - --------------------------------------------------- ! Address WFY...)...... ............ .......................................... /._C.�..�..�� �GP............. ........... .............._........... a Installer Address Type of Building Size Lot....:-_.....4. ..Sq. feet U Dwelling—No. of Bedrooms..........3----------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixt ..___ Design Flow................S6...................gallons per person per day. Total daily flow..............33. 6................gallons. WSeptic Tank—Liquid capacity gallons Length................ Width................ Diameter---------------- Depth............. x Disposal Trench—No..................... Width(t/..-___-._--___..- Total Length.................... Total leaching area..........,........s . ft. Seepage Pit No---------/-------- Diameter.....�3 .----__- Depth below inlet.....4�--------- Total leaching area . ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1...."2 .....minutes per inch Depth of Test Pit.................... Depth to ground water........................ G Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P; !. f._. IL...... Description of oil... =�-_-�..``.... } -- ---------- -�......--- c� - - ---------------------------------------------------------------------------------------------------------- W •-••-----------------•--•--•------••------•-•-••----•-••-•-•---•-•......---••---•-- ----------•------••---••-••-••....•-•-•-••••---•-•-••-••---••-••----•-•••-•---••-•--••••......-•••••......••-•--••-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•--------------------------------------------------..............................................................---------------------------•-----------------------------•••......•-•.........-•-•-- Agreement: The undersigned agrees to install the aforedescribed Indi idual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitar Co — T ders• ed further agrees not to place the system-'n operation until a Certificate of Compl' as' ee • sue d of health. n •---.......... --. ••---------••--•�-•---•----•• -- � Date - ApplicationApproved ---•-- ---- ---------- --------------------•..-----.---•-----------------------------.----- Date Application Disapproved f t following reasons---------------•----------------------------------------•----••--•------------------•-••-••......•....-----•----- ...............•---•-•--•--.....•-----•---•-••-•----••--•----.....••-•-•----•-••----•------•--------------•--............_..••••••.................................................................... Date PermitNo......................................................... Issued....................................................... Date ------------------------------------------ afl. ..: ..���...--�... FE$.... THE COMMONWEALTH� L M�ONNWEALTHOFMASSACHUSETTS RD ��. ......(If �R+�.... O F.........::... Applirtttion for Disposal Works Tonstrnr#ion Vamit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Systemat............... .......................M. .......................4­4..................................................................... l f'L "ress ., r Lot No. i W O er } $/�k Address // . _ ...................................... t f[[��ll a ...... ... . �?.... ........ .. •.....---......... --------------------- Type ••• ... M Installer a - � Address Dwelling of Bedrooms.._ Size Lot........... -V...Sq. feet — ..___. _______________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .......... No. of ersons-----------------•---------- Showers a YP g ---------------,- persons...,.,. ( ) — Cafeteria ( ) Other fix .. - ----------------•---•------------------------------.----------.----------------------------- - Desi Flow--------------- allons er person' er day. Total daily flow--------••-.. .......gallons. W � - ---------------•----g P P P Y• Y � -•-----... WSeptic Tank—Liquid*capacit _-gallons Length............:... Width................ Diameter...................Depth................ x Disposal Trench—No. .................... Widt, ..:.__............. Total Length..................... Total leaching area__ _.___ ft. Seepage Pit No-------- ______ Diameter..._ ........ Depth below inlet..... Total leaching ar -sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test ResulPerformed by._ '"" ----------------------•-----•-•---------•---....--------•------._ Date =-----......-------------.._. a s:., � _« Test Pit No. 1---_.. minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground Water........................ ---- --------4-------ff-__`----.-.-.-. Description of oil....._ _ �^ r -�"��' ^� j ` "'" Gw ..... f T ' %Z - - xy� ....- ., W U Nature of Repairs or Alterations—Answer when applicable...................................................................................•......_.... o- ............................................................................................................... N......_.....___..._........................_.......................................... Agreement: The undersigned agrees to install;the aforedescribed Ind• iduaI Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanita y C —T uj�der ned further agrees not to pla/ethn systoperation until a Certificate of Compliance has a ssue ' thte b d of health. ••-------- -- ----- ..--•-- ------------------- --• ... at Application Approved By...... --- --------.................. Date Application Disapproved 't following reasons:......................................................... r ---•.............................. ---......•.._ f� ---•-••-•------------------••-••-•-••----......_...--•---•-•-••-•-----•--....----•---•-••--•----•--•---••---...---------•------•----•-•••-•-•••---•--••--•••----------•-----•----•••---•--•••----•---•-- Date PermitNo.......................................................� Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD . E HE T :a. . ....: ........OF...................:..........:................... ..a ............................ . f�rr�ifirtt�.e of f�um�fittnr�e THIS IS TO CERTIF ' T t_t�he,"n }�dual ewa Disposal System constructed (1�`) or Repaired ( ) at ... --- • •. has been installed in accordance with the provisions of TI F- 5 o he State Sanitary Codkas s_cr ed in the application for Disposal Works Construction Permit No �', ............. dated... . 'r�'p__. _-------_._------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION.SATIS ACT RY. DATE........................................... Ut _ Inspector.................. ............................................................. rt HE COMMONWEALTH OF MASSACHUSETTS BC)A,R.6' H�E,[AL 4 . ........OF /vJ � '"'"� ,.,,ry��� eatIA � 71............................................................ No. -. .. ... FEE.50 ..................... "Jd � trout Permission is<rebygranted /Y...............• . � � ` to Construct ( ) a d vi u 1 e �a e i os tem JI!! at No..... ................xtr -.-3- .. ... .... ._.S_____--- -...___................................ _...---._......_._.......... as shown on the application for Disposal;Works Construction Permit No..—, .......'.:._ Dated.......................................... ------------------------•--- ........................................................................ Board'of Health DATE................................................................................ FORM 1258 A. M. 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