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HomeMy WebLinkAbout0003 FLEETWOOD PATH - Health 3 r lee+u-3ood ;1 'l`0CAT10N / 4q T�, SEWAGE P RMIT NO. re VILLAGE --- V/yknhum INSTALLER'S NAME & ADDRESS e U I L D E R OR OWNER o � c r !�� DATE PERMIT ISSUED .�7--? DATE COMPLIANCE ISSUEDZ72 y r s"'�. .�: �� ., � ��� � 4 e� , � ,� � ZZ ti^'� 2�0/ �� D D d �. ON gi� Mffil L4l L I t 1 �� � `Y � �� ®��'k�' �'`C —©� � ''�,` r No.......1//...-.-.. Fimic .�................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® HEALTH Vie - ...... ----- OF......... ... . . " �irttti>a -for i,ti otial Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (P) or Repair an Individual Sewage Disposal Syst a - nation-Addre 4 or Lot No. W Address ......................•........ ... MnstaIIer Address Q Type of Buildin Size Lot_77�.��� Sq. feet U DwellingNo. of Bedrooms----------- ______----------_--------Exp ston Attic ( ) Garba Grinder ( ) Other—Type of Building ____________________________ No. of per s� s_._.____---_-_____-_--___.-- Showers ( ) — Cafeteria ( ) a' Other fixtures . W Design Flow.....................� _. _____.,,...-_gallons per person per day. Total daily flow__........�___..________._.-----.-.-_.gallons. C4 Septic Tank—Liquid capacity-_--_._-_-_gallons Length................ Width................ Diameter-..------------- h _ __- Dept -_ .-. -..---- xDisposal 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 ( ) I Dosing tank ( ) aPercolation 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-_.---_.___._--.-_____- O Description of Soil___.r---__________ _ ; � _ x ------ U ---------------------------------------------------------------------------•------------------------------------------------------------------- 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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in t; operation until a Certificate of Compliance has een sued by the and of lth. Sig, d•• ----- -- �A------ ---------------=------------- Date Application Approved BY -- -- ' Application Disapproved for the following reasons-----------------------------------------•----------------...----------------------------------------...------... ...-•----•-------------------------------------------------------------------------------•--------------- PermitNo......................................................... Issued..---- --- ...................... Date THE COMMONWEALTH OF MASSACHUSETTS x BOARD QFj HEA TH r, t(-;-UA :..............OF.... ...., �!H�' '# ?:._ .--. ... ...... Appliratinn -for Dinpolial Workii Cnnnitrnrtinn Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at.: ption-AddreA or Lot No. P<<r✓rya_ 1..,,.• p s •::. =---8 t�s a = Address ------------- -------------•--• --•-•-•. Installer Address Q Type of Building Size Lot-. ._. I� Sq. feet U >,e.,.---_ - Dwelling o. of Bedrooms------------ ........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures - - ----- ------- --------- - W Design Flow--------_-------_____s__�_:__..___..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. It. 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--------.--------------- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.---_--_------_---_-.. IX --------------- --- 1A ----------- f-------------------------------------------------------------------------------------- O Description of Soil-------- :•-.. ����;r► `__ __. U -----------•-••-•------•-••--------------••------•••-••-•--••••-••••-•••--•-•••••••-----•--•---••-•--•••••••••••----••----••••--------••----•--------------••••--••........_.--------------------- 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the board of health. -------------------------------- Signed---. ... ---- - ...... Date Application Approved BY .A,.-.-;'.' .. .... jc4....- ` 2 Application Disapproved for the following reasons-------------------••___•--....._----_-------_--_------------------------•-•---•__.._-_.....___.____......_..__.. -_------•--------•------•----------------------------------------•--•---••--•---------•-------••-••••• •-• •-•••••---•---...••--. --------•---- •-•-------•----- ���- Permit No. Issued - ------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH .............OF...... ............................... Trnifiratr of 0blamplianre THIS IS TO.. '1F That the Individual Sewage Disposal System constructed ( � or Repaired ( ) st Iler ( — .: at_-by--- �. has been installed in accordance with the provisions of Article XI o// The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------- --------!1_4----------- dated---77/ .5-_... ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL O S T1 FACTORY. DATE7/ Inspector------- -------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH No. ---•-•••---•• FEE (------------------- Bit-mviia2�110/rkii xnrtion JIrrmit z r Permission- is hereby granted--- ••�- ----- - -.t.�------•-• ..---------•-•-•......................•-•--------.._..--;•---._._-..--•------.:....--- to Constr tt �or Repa L Individu SOage Dis os I Sy ern/ p, �. at N � t Street as shown on the application for Disposal Works Construction P No.. ___.._.-.:._ - Dated-----� �',s' 7.�/ ________: DATE_ r Board of Health FORM 1255 H BB & ARREN. INC.. PUBLISHERS a � r' -owl Alet 2 e� 1 .179 S - . � 0 } ri yY, o I� "'9lll+++�y't' r�yr}�s '? 4 1 L� �r �/� �• �••/--ZVA .S ��T� 1 ,�'C � � �n•r f 4,�- -//•�1��*t�� •I J ! •. .' -may 37 +M S cif 'M '3Y F' }}�� •��A 't+' h 4 y':t'4r y� .ir` � �' 'TM 'y'o �' y.e L • ,. .n,, .. .., '- 5 .,p' 'rah:•1�' b •C t.. "F"�t 91. .yam-�T" i t tf• AC 9�f,p � • T ' � - t .,. . l r WvT 49 4. 5 r r 4 y �+". + ' I.�t i2�/ Co A,S�G. 7-,A ifs �•►/� , r c Of fit. y{ � r �d -♦b�+• a`�� _ 'art': �. Nyr;; r ,. 1��•. � .ry C+�4 s � �'•a" � 7y .T P^ '� -tw' •� ,, f tT �� ' 9 ''•�` .�r'yv.�x�`p F .' e i �f f 4Fi.3 -r 4 s �� ..'�'� r _ :i; b s� ':, jty'��✓. 4�.},� 0.( ay �.al 7T`a '. ^?�^a.T tr rt}v�IP re Z h.: .�{'�':;�'• � �sz' ...� asa �^:L it l'r y r�� 4s'r aT� ��4l � .•6~ 'i F .f:' '� w L 4'�' r 5-,ff�, R,a,.+gs`ll''1:''E 'z+r R T.. S��a�, °,se�>'�•��P"� r � � 4 �y � � �', �.�.�'§ �,��y,z.,�� y, .~e..�,� ,dfv a, a�sxa �•�,1,, `'�.� _'" + a',� i ::� h _ �.� S.�,'i"� �' r l r � �`r -A•z c.":F�, x'tl�f.r.... °''rdxu' r'wY'` '� '` �r�"'x° -� a✓� '' f r�#t.M � y s��. '� , �, cP ''w;`,,��yp'"} »msr. of t ;. .? F 'hl. }aq .✓"� „Y� Yxm T �^ y..! .�x 4kM5.�r Wh,. ..S��,,.t5t:,�ta �..+ �F;Sti:ff4v Y-'tri' •; �'J - ' ... .day . „ , „�. t f' BARN9TA BLE COUNTY HEALTH DEPARTMENT k BAT.IMTABM MASS. 02680 `. - T[LBOHONtB I,i 362-2511 Ext. 331 Date: January 31, 1974 To: Oman Construction 5200 Building West Yarmouth, Ma. On the basis of a sanitary survey and a laboratory examination on the sample of water taken.from a _.y pll ,.... ..,._ , ,_:.located on the premises of „ Oman Constructop. ..., . , located at lot 107 s .i G..Lake,.Marstons:Mills._. on_., .,January.31,..1974.. . . . (Place) (Date) this supply is approved for domestic purposes at the time the examination was made, i !) . If you wish further information regarding this supply, please contact us at the County Court House, Barnstable, Massachusetts (Tel: 362-2511 Ext. 3314 and we will be glad to assist you in any way possible. 01 cc W.H. Hackett Well Drilling Signed Public Health Sanitarian Barnstable Board of,Health 4 -___ _ ___...._.._...__.__w—....�._._..._......._,r.......V....-,•�......>r,-,m.................,.,u.w.m...mn*mn.r!�+.sh..m....*.a*^ra.n+�•terrkTM+*.*Y+^^r"!r'k?.."*.r*roa 'mM.nm.!-�^t,: .. ...... .... . . ...++.n•san.4;t