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HomeMy WebLinkAbout0341 LAKE SHORE DRIVE - Health i Lo*e- I TOWN OF BARNSTABLE LOCATION -34(/ LA,E s4,e;'t atr&E SEWAGE # q t -All VILLAGE_ IiMbr till' MILE- ASSESSOR'S MAP & LOT v4f INSTALLER'S NAME & PHONE NO. I3,C k 917f - ® YYY SEPTIC TANK CAPACITY LEACHING FACILITY:(type) PRE CA IT (size) /000 GSA NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER n� BUILDER OR OWNER DATE PERMIT ISSUED: �� q/ DATE COMPLIANCE ISSUED: 2/ 1 /at - VARIANCE GRANTED: Yes No d7� oo�! c'a9n' f s QVC1 deg, /�f ar yy9 .a_ Fi�.ss E xk 3'f LAA647 OR,, JJ 00 No. !.� Fps...J�o_............ . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uiipuual Works Tonstrnr#iun ramit Application is hereby made for a Permit to Construct ( ' ) or Repair (V/) an Individual Sewage Disposal System at: .--d)/t +.. A �.£ .................................................................................................. Location-Address or Lot No. .ICIrA.......................................................... ......•- -----•-----•-••-•----------------•---------.-..---•-- Owner Address ..IL,.CtR............................. .. . �,.�................................................... ..... ...... 4 .... ......... .f.. .-:.......... Installer Address UType of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms.............. 1.........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................. No. of persons............................ Showers — Cafeteria a Other fixtures -------------------------------- --- d - ---------------•-----------------------------------------------..--.-..-------.............-.-..------ W Design Flow................//Al......._............_gallons per person per day. Total daily flow............3.�D_._._...__.......__.._gallons. WSeptic Tank—Liquid capacity../Oop.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Vidth.................... 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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' •----- --------------- ----•--••--•----•------•----.....--•-----------•--------•---........._--•---------•-•-•-•-•--•----............----•-•............••-- 0 Description of Soil...............................................................................-------------•----------•-----------...•••-••-•-----------------------•---•----.....---- x ----•--••--------------------•---•--••••----•-•----•--------------••----•-••---••--••-•-••-----•....--•-•--•---•--•----------- .......................................... t -•------•----- U Nature of Repairs or Alterations—Answer when applicable.--___P.F,�1L. �1.__ ltTig_../. ?9..�9�.�E.9�.4.._�1� ../.. hll uJ jo©g... .41.. Cr1 e ,A t... SI-aV _.l o.J ti/�•• t. /Qtf7�./.ttal-•J-•----------•-•-•••••••----........................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bo d of health. Signed .---......(�. � .C. N?t Application Approved B pP PP y ---------------- - .. �' Date Application Disapproved for the following reasons- ............................................ ------ ---------------...... ....... ---- .................... .................................... ------------------ -- -- ---------------------------------- --- ------------------------------------------------------------------------------------------------------------------------------- .... ----------------------------------- r- Date Permit No. f ' eq� . .��.. ...... Issued .................. ----------- Dace- /------------------'-- Fw3...3 0._....._......_ �r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' - - �' TOWN OF BARNSTABLE A firation for Disposal Works Tonstrurtinn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (/) an Individual Sewage Disposal Systemat: .. .... ..----•-•-•----•--••-----------• _._... ---•-- .: /...L Af!/ I�a.�', �?. .. . �t_/_tA('ILA L t.. ... � ....----- . .. .. -•- -•- Location-Address or Lot No. .......................................................... ............._....------•-----•-•--••......--•---•--••-•----------•---•---•--••---.............•-- �� r r� Owner Address QO:................ .................................... ......_--_........--..._._R..- - .,.�..,....f�.c..._........ Installer. Address Type of Building Size Lot............................Sq. feet UDwelling—No. of Bedrooms.............--.?..........................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) ' Other,,fixtures --------------------------------------I----------------------------------------------------------------------.------•-----------••-----.-.--•-------- WDesign !Flow...........:.!41-1........_._._.__._•__gallons per person per day. Total daily flow..........._:Un.._.__......_.._._._..gallons. 04 Septic Tank—Liquid capacity..Z!?oj2.gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No.------•------------- Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Othe Distribution box ( ) Dosing tank ( ) Percol ktion Test Results Performed by........................................................................... Date.........................:.............. aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water----------_.............. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------------------•-..........-••---••-••-•.......................................................... ODescription of Soil....................<--.......-----............-------------•--•----........:--:--------------------•--------.........---------......------...._--------...._...._•--•-- x W -------- ---•- x V Gl1F; ..-!Ag23 C.s1G-. aAC_..._. a� 2.� r�IahJ PlfcA wJc�.. =t--�A _ Zrs:(1✓J4•__�t�00 G9------- c----...'..... Nature of Repairs or Alterations s—Answer when applicable. F �:k_ Agreement: The undersigned agrees to install the aforedescrilied Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. pp `j � Signed ............. !1 .e: �•CL...•-"- -- f...... -r�-,-/`-�/9/ � to Application Approved By ....................�{," -rr+a f�.I.. ... ............ -...-------------- -�.:'....�...., �-- Date Application Disapproved for the following reasons: ..'...........................................� ........................................ ..........................................-------................................................................................................................. ----- Date Permit No. `� /... ..............------....�---..........--- Issued ...... �e' s�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Telr#ifirate n£ Cnontlatianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........... ----------------------------------------- ---�3.RtA„ .....c...--1 �'-ssC �. ..................................................-......--------------------------------......................... Installer - t9.e4 ........ ----------------------------- ---------- -------- at .. y 1. t ....-✓� ......�..-...W . . � has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..��,/��..... '-`>.. ........... dated .._` ..�. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / � DATE.------.- - 1..r-----------.................................... Inspect r-- ... `,�-ice ..... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f TOWN OF BARNSTABLE '30 00 No......... . ..! FEE Disposal Yorks Tonstrudiotj Vern fit Permission is hereby granted.......W'F`!` to Construct ( o Repair (t an, Individual ewage Disposal Syst — atNo.. .• .. ..... ......`aml �.........../f.............P,............------•---•--•---•-•-•-••--------------------- Street ����`� as shown on the application for Disposal Works Construction Permit No..................-DD�atedd...��!r'......'.`�..�.r55; ...... DATE pp Boa*of Health.... C .... l/FORM 36508 HOBBS h WARREN.INC..PUBLISHERS = LO�C T ION s f S E We A= E PERMIT N0. VILLAGE INSTA"LLER'S NAME & ADDRESS. . 4 B U f"L D 0R Q�VwNfD k DAT-E P.ERMIT. ISSUED •�r (DATE COMPLIANCE ISSUED 77 r _., r... a J• � � � � �3�� � a Y � , e �. .