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HomeMy WebLinkAbout0074 HEAD OF THE POND LANE - Health -, t6 I�e c� l � Lt s17 f v 7 a rs O n s — - -. - .- _��___- No..Z.13f. ................ ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ..................OF_........, A,(3 L,V, ..............­............................................. Appliration for Disposal Warks Tonotrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: I �,V oy'7%e_ ,Pe oc/ ........... ....................................................... 1ZS-•------------- Location,Address ? or Lot No. fdt S �-o ' — '0 N i L V1 ID ............................ .... ........ ......"N;................................. caner Address . . ..... ........ . ......... Installer .................. Ad ress Type of Building Size Lot.5.4,L-10.59....:L-..Sq. feet Dwelling—No. of Bedrooms0s.. -----Expansion Attic Garbage Grinder W��,/I — Cafeteria eter 04 Other—Type of Building . . . ./4 ... No. of persons... ......... Showers ( ) af ia 04 Other fixtures .........................7....................................................................................................................... Design Flow..........-$-'5.........................gallons per person per.day. Total da*I flo --------79.0........................gallons. Septic Tank—Liquid capacity/0VA.gallons Length....W?... WidthA/ ..2-- Diameter............... Depth....IF Disposal Trench—No. .................... Width.._................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../........... Diameter.......1.Z.,-..... Depth below inlet.......4........ Total leaching area��!!�:'...sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by.-%.�40 Date....4151X;.. Test Pit No. 1....7.......minutes per inch Depth of 'test Pit....../,/.......... Depth to ground water.... . rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.........._..._.._.. Depth to ground water........................ 04 ............................................................................................................................................................. 0 Description of Soil.......Mf_P1_VYYX...........�?MJ.M................................................................................................................ -------------------"-------------- ---------------- ­-----------*"**............""-----------*-------------------*--------*------------ ....... .................................................................................................... .................................................................................................. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... 0 ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Se v ge Dis osal System in accordance with the provisions of TAI'LLZ, 5 of the State Sanitary Code— The undersign urt__r grees not to place the system in ,;,n turt r grees operation until a Certificate of Compliance has been Is y the boa f ieal ............ . ....... S* ... .... Z igned_ .......... - ----------------- Application Approved By. .. ...... ...........I.........11.................... . Date Application Disapproved for the following reasons:..........................7............................................................................. . ....................................................................................................................................................................................................... Date Permit No..... Issued...... (,.>........ Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH [-"`.v.ry..................O F........... ......................................3 .... AVVV irativu for Dispu,ittl Works Tomitrurtion Ilrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 674'/`t P- /e"Id 'Pi-• l..... ... tz8--•---•--•------•----•-----------•------•............................. -Location Address y� / Lot/�,�1?�. �� � L-r P<, lY► t V °cSha tq,vt NZAOP�ntO�r l p,nJ!.�.......... t _.._._.....-- N._.. 9.... ....................................... ......................................... ................................ Owner a � � �fQ5T Address _ -__ �(/---_• V hi tCL`� f- �eirt C3�.�..'............ Type,of Building Installer Address // Size LotS4j.[�?...'.....�__Sq. feet Dwelling—No. of Bedrooms "5�1 n_.f°r 35) Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building srw-��f in No. of ersons..4..�.G..__..... Showers YP g -------------------------• . P - ( ) — Cafeteria ( ) QOther fixtures .......................... ................. -- ---------•-------------------•-----•......--.....---...-- W Design Flow.......... ate.........................gallons per person per day. Total daily flow._.....7�.0........................gallons. 1:4, Septic Tank—Liquid capacity/�?A.gallons Length....t.a'��.. Width:`�/�._ Diameter................ Depth.... ....... Disposal Trench—No..................... Width.................... Total Leng th gth_...-•-------------- Total leaching area....................sq. ft. 3 Seepage Pit No......,-/__----------- Diameter....._ Anz....... Depth below inlet.......4........ Total leaching area.;?!'::...sq. ft. z Other Distribution box ( ) Dosing tank ( ) / / t# Percolation Test Results Performed by,-994! SIC1.._./..J! Cc�f3-� �/V Date....O/ "0115..... .....................••--- Test Pit No. I __=.__....___.minutes perrnch Depth of (est Pit......1/........... Depth to ground water................:....... 44 Test Pit No..2................minutes per inch Depth of Test Pit..............._.... Depth to ground water......................... 9 O Description of Soil......P.�OL 2�..._... N1.: .. --•-•-•-•----••-•................................. UW --••-•----••-------•-----•------•-••---------------------- --------------------••-•--•----•---••--•----•----•-------------......••------•-•-----•- ..................................................... Nature of Repairs or Alterations—Answer when applicable....:.......................................................................................... .............................................-...................................................... --••--........--------....-------------------------------------------------------•----.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage sposal System in accordance with the provisions of TITLZ 5 of the State Sanitary Code— The undersign, furtl:�grees not to place the system in operation until a Certificate of Compliance has been iss Vedy the boa d f llealt Si ned Qs c . }'� g Date Application Approved B ..�`.-'.-/1 .. __ .. ................... Application Disapproved for the following reasons:.............................='..-•-•--•-------•-••---••----............................................... ..........................................:.............................................................................................................................................................. Date Permit No..... '.�....fir--.----------------------- Issued...._.. .....................a � ....-- Date •aOn.� -..,..._..._..��• -r....-.-e+. .r.rv..++.�.wr��.-mw.-.._.r...r..wr�rwx.s.xW+4'r,Aw.o.r,..uNs..o...e,�e+..-.r..rs+,..e. ---- -.--..n.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF... fl / ro f.WAf".•0..................... ti ----_..J\ ' (Irrtifutttr of Tomplittnrr-- THIS IS TO CERTIF , That the Individual.Sewage Disposal System constructed ( ) or Repaired ( ) f by........ ............................... ------........•--•----- ....it-------------------------------------------------------- -----....... .----------------- ...... Installer has'been installed in accordance with tile a provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..V'�!�- .���`_... dated--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE`THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,�I ���- DATE.................... ''" r ._. Inspector-------••----.......------------.----------------rr .r.:.�.cs..C�e'-r'+�,r-�. «.r:.ra _.�.s,... _ ...y,.« , _ ."!:-r^•w-.tc•:'tri`s'crr��7+•+..r,ti.++.�� -- _ _ _ - _ .__.-':`"f!•C-cd`-cT-c'@*a�tt'�►.. ----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / `%�W .............:....... ........OF.....---.......--.--e...........................-•------...............-•-........ F> ........................ Disposal Works Tnnstriirtiun f rrmit Permission is hereby granted.....-�-97;m ! ...... "�?/C '?�='a s to Construct (A ) or, Repair ( ) a Individual ESew ge Disposal Syster�i l/ at No... � ' �.. A..,�'� '/ ?... Street as shown on the application for Disposal Works Construction Permit No. j5 A-A..?/Dated..... ............ --- ------------ ---- --- Band of Health DATE........................--�.-'--.. �......-..�.......................Y ' 1Y It -U. t 'I•- �• S.T: TOWN OF BARNSTABLE nl I OCATION f SEWAGE # � VILLAGE— „ "ASSESSOR'S -MAP & LOT INSTALLER'S NAME & PHONE'NO. �J �l�• J "`1�7�J o�°/S°� vv SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS�'. ` % PRIVATE WELL OR PUBLIC WATE BUILDER OR OWNER � �G v_°/� �f/2��'/✓-¢r DATE PERMIT'ISSUED: " DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No _. z_— a \� � � �� . .� . � E. ASSESSOR'S MAP NO. PARCEL LOCATION SEWAGE PERMIT NO. 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