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Home My WebLink About0105 WATERSHED WAY - Health b5 6hed )I ; L L s r Y Y6N OF BARNSTABLE LOCATION SEWAGE #_ VILLAGE �jSSESSO,R'S MAP L�)TO1 dCy7` INSTALLER'S NAME & PilONE NO. �!✓��f �� SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATE P 4 BUILDER OR OWNER DATE PERMIT ISSUED: SATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � ' � � _ � � I � � r� �� i �s No .... - 1 Fes$.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............o F........ - 4!1`L-l .._...---------------------- .� Apphration for Diipo,ial Works Tontrur#inn 11nmit Application is hereby made for a Permit to Construct 6�) or Repair ( ) an Individual Sewage Disposal System at: \...k yS�..mm.--W--- Location-Address or Lot No. ..........-- ......�r��:� ... ?---------- ------------------------------------------ ......------------------................------ e —Address -----------•------•----- Installer Address Type of Building Size Lot....tD-.`Z`?-`1..Sq. feet U Dwelling—No. of Bedrooms_______________ ________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria A4 Other fixtures .................................. Design Flow.............. ...._gallons per person per day. Total daily flow.................. ............. lons. W g �-�----------•---• g P P P, Y• Y - -- � WSeptic Tank=Liquid capacitykWOgallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No._......__1......... Diameter.......107_...... Depth below inlet................ Total leaching area....95 ..sq. ft. Z Other Distribution box (V/ Dosing tank ( ) I '-' Percolation Test Results Performed by._. 1 1�__TE ..O.q .............................. Date.....-�..11 l � a - Test Pit No. 1.......L-.........minutes per inch Depth of Test Pit--------1 Z... Depth to ground water-----: _._......... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................................................. --------------------------------•---------------------- ------•.--...-----_---------------------- •---...... - 0 Description of Soil------------------------------------------- -•-----=---------- ---------•------------------------------•----------------•------------- _bJ_k ....................................................... 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 iITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued t board health. Sign Date Application Approved BY- • . .... .. . ........ ®•----- - -- -- . . ........ •.............. ........................................ ............. .Date Application Disapproved for the following re s:----•••----------------•---...---•-•-•••--•-•--•----•-------•---•--••-••--•-•••.._._........•---.............._ ...........................................•..-----------------•---.......------------....-----........-----------..........•••.....•-••-•••--•••--••-••---- ........................................... Date PermitNo...�Q........ ........... ................,21,-A _�o Issued......----•-........--•-----------••-------•---•-.----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.......R� .A1 (4��- TAf'::U-Z Appliration for Disposal Works Tonstrurtion Vermft Application is hereby made for a Permit to Construct ) or Repair an Individual Sewage Disposal System at: .................. L ...-.. ......*....................Location-Address t or Lot No. L I V% �,,A -L.)0 .......................... ........................ ............................................. ---"—----- Owner XWjres. ........................................................0......................................... . ......0.....................................0................. .............................. Installer Address t--I ..... Type of Building Siz4�Lot.......... ...L l..Sq. feet Dwelling—No. of Bedrooms.............._._.:......._...._.......Expansion..............................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons........_...._........_..... Showers Cafeteria Otherfixtures ........................................0................................................ Design Flow............. .:.....:.............gallons per person per day. Total daily flow....._..._...... ...............gallons. Septic Tank—Liquid capacit�.L)QL>..gallons Length................ Width..._........._.. Diameter.............._. Dept.h................ Disposal Trench—No..................... Width_..._._...._._._._.. Total Length.................... Total leaching area..... 'sq ft Seepage Pit No......... .......... Diameter......I.C.)...0.... Depth below inlet............... Total leaching area.... q ft. ' z Other Distribution box Dosing tank ( ) A -T (%......... .............................. Date.....2.1•!.21�a........... Percolation Test Results Performed by_'I._'�:2(....k�L Test Pit No. I................minutes. perinch Depth of Test Pit......_! -..... Depth to ground water...._._.:--:......_.__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit................_... Depth to ground water....._.............._... 0 P4 ............................................................................................................................................................. Description of Soil................I................................................... .................. 1------------------ .........".......*.......*.........I............. ............... 't. ........................................................ ---------------------- .............................:I ....... .............................................................................................................................................................................0.......................... U Nature of Repairs or Alterations—Answer when applicable...................................... ........................0.0.............................. ...................................................0................................................0.........................................................................................0.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin accordance with the provisions of T I T LE 5 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 board of health. Signed. ............ Z;........*------ ............................ ............................... Date Application Appro ved By. . . ----- ... .. .... ......... VIRIE-------- ...................................... Date Application Disapproved for the following re in"S:......................................0.....................................0.............................. ...................................................................................................................................................................................................... Date Permit No..Ke::4� _�30,............ Issued..................................................... Daft THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........k?lo ...............OF........... Grfifiratr of Tompliattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by..-. .. . . .......I.. tallr --------I _11 . . . ........ e at... eZ ( al W V ........................................ has been stalled n accordance with the provisions of T of�4e,State Sanitary Cad as des jn the application for Disposal Works Construction Permit No. 30... dated.. ............. 7V6 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................f L..'J. .:` .�........._........... Inspector.......... ............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD-, OF HEALTH No...............a .................... ..........................................o........ Fzz...7 lgisposal Vorks PermissiooAshereby granted........................................................................0.................. to Construct (/\I or Repair an Individual Sewage is osal Syst . ........... ...... at No..... t ee t as shown on the application for Disposal Works Construction Per DDated ...... ................................ ........................... :N- Board of Health . DATE.. ... ...........................I FORM 1255 A. M. SULKIN, INC.. BOSTON a f , 5/oe, IF.ENCOUH TFQFA ALL'i1NSUITABLE SOIL + _ SHALL BE REMOVED WITHIN A JO WIDE i I AROUND THE LEACHING FACILITY ZONE t..._ __.. _ .... - AND SHALL BE REPLACED WITH CLEAN - SAND AND GRAVEL IN ACCORDANCE WITHI 1 TITLE Y. �48 70 ' F>KOP, WATEWL 5cti?01CV.AN . K _ - _. - f 60 6 _r_ L_ T W�}TEt25HED: g ALLYN ;WAY ca] UJiCcr)N 1 _ SrIV PIT W�L L � _ oft; SgPrl(4 GGv/cam s /�'. Ai s .GOT 0 ' 0 4 cA. t a� o •ffAXTEIfi L., - . v _. 64 / r 6G 77 i i o - - GENERAL NOTES THIS PLAN IS FOt DESIGN AND 17E5I�N "TA CONSTRUCTION OF THE SEWAGE DISPOSAL FACILITY ONLY. SINGLrE FAMI LY. 3 F-W=pf .COM 2. ALL CONSTRUCTION METHODS AND MATERklb GAtL.�Gt= GPI I�DC .- D.E.O. . TITLE SHALL CONFORM TO MASS. D.E.Q.E. TITLE 5 AND LOCAL BOARD - 1 LY FLL7�f�l = 1 Ilk 3 = 330 G1pb OF HEALTH REGULATIONS. s {etc. -7At'j<-3-?CV 15v7o- 4�sc,:Pb { Q?l5taO5Al.. TWIT '� USE-:: PiT G�X 6' cJ/z srdnl , '` • 5 t IM W A LL A42EA= /79' 5o F, L a 4 q': p t], �o-rmt�r► ?q TOTAL.. sl6tQ 57Z4 �,�.�� Z S 7 SAr 7-OTAL t).t L V t=l ' L.ar10 1N 4��'t M1 N otZ tSs 112j'T" }A dt_.'E P-G 5 74 v�Y: 10 , 19 Z 7 -Torte of FD/✓ EL 7/.Dp II TEST C3Y; R::/79ic%tnicc,�fcz ( lnlvess ; T Dunnin� I 70 �J hINV t�151;�vbLO NV �� I fvY 66,7 ap IV wX lob,3 '.� �ra s 7 7 ur 48f, 64,0 rrr _ d TANK a 1NV, twv. PLOT FIAW /-ore/, AmlrL-kesHeo W,4?/ :.: I44 .` No ware 1.1D SG1�.LE - f33 4Z6 i�a 8 . . 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