HomeMy WebLinkAbout0383 LAKE SHORE DRIVE - Health 9999 Sandwich —Barnstable Town Line
(AKA) 383 Lake Shore Drj"X
Marstons Mills
—014 -010 - 036
i
71� 0 4/_ 0 0
-
Fizz ......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® F HEALTH
L..®Wrl1_................OF....... ` tom. %. -
App iratiou for Diiipus al Works Tons rartiun 11amit
Application is hereby made for a Permit to Construct ( ) or Repair Jan Individual Sewage Disposal
System at:
.......�.�� .....d'?1S? r...± X�� ... ._ .�--------------• ----•-----------------.........-•-•--------------.....--...----------.....--•---•-•--------------
�Locatio or Lot No.
1..�✓�� L ►'�Qr' •. --•--------•-------•--••--•--•------- ..........--.....................................................................................
e O
a . ......... ? Ad re
.................................... ...�_ A,
{ .-----
Ux
------------ ------
� V Installer Address ,
Q Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms................................... .....Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q, Other fixtures ......................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
04 Septic Tank—Liquid capacity.1.0MLgallons Length................ Width.......:........ Diameter................ Depth.,..............
Disposal Trench—No. .................... Width...................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----------I----------- Diameter----1-0''--------- Depth below inlet.................... Total leaching area............._....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1----------------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.........................
--------•-------------------------------••---------•-----•-••----...-----------------....._......---.........................................................
0 Description of Soil........................................................................................................................................................................
•--••--•-----•-•----•--•-------•---------•-----------•--•-W •----------•---------- ........................................................................................................................................ .
x a - •
V 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'Tmr...Z y g g p y
S of the State Sanitary Code—The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed--- .. ........... _.`� .ee186..-----
Application Approved By___. ...._.._ ,_
---- -- - ----------
Date
Application Disapproved for the following reasons:................................................................................................................
............................................----•-••-•---•--•----------------------........._------------
Date
Permit ........ _ y... Issued....................................................... f
/ Date
h
4 c r
r
i•` ,
r�
t
-0 No. ------� �� FIc$............._............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................... .._................OF............................._...........----...-------•-••------------•--------------.---
Appliratioit for Uhipasal Works Tontrurtion Frrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...... . . ---..-0:�:................. ..•--------------•-__---------.-.---------- ------------------------------------_-----
or
. '— 'oca on-Address •..-•--•-••..................................Lot No.
` Owner A r ss
a .. .......................................... ....a. . ..- ............. ...rf .
Instal.ler Address
d Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
QI Other fixtures ------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
1:4 Septic Tank—Liquid capacity.(.0.UG.gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—NTo. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--------------------- Diameter.-10....... Depth below inlet.................... Total leaching area..................sq. ft. f
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_--__-_---___-___--- ---
(s., Test Pit No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water.........................
P4 •---••••-•..............•---•••••-•-••••-••--••-•••-•••••-•••••--•-•-•------------------------------................................................._......
0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
U •••------••••••-•••----•--••••••--••-•----•-------------•-•••••••••._...._.....---••••-•--...---••------------•---•---•------•-•----•-----------•.._.....••--•••••••----•--------------....._...---------
UNature of Repairs or rations—Answe when applicable. a Rn ----- 1 O°�`�'�"
--- "."�.... --- --- A.A. ....< --------•------------•--------------------------------•---•-......----
Agreement Y,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TT 'T._: ; of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bgen issued by the board of health.
---- i �m� c : ------------- --- --519.6-------
Date
Application Approved BY �� ------•---....---••---... ...----- {� �. �...---
Date
Application Disapproved for the following reasons:-------•-----------------•-•-----------•-----------•----------•-----------------------------••-••-•-••......•--
---------------------------------•--•----------------•----------------------------...........-----------.._.........-----------------------------------•-------------------------------------------------
l q Date
Permit No......... .....)-� Z"{........- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................O F...... ... ............ ..- ..............................
Trrtif iratr of Iff-Vautphnnrr
TH& TO C IFS', That the Individual Sewage Disposal System constructed ( ) or Repaired ( }
...... ......................................••-•Y-•--•-•-•-•--•-•.......----------•------•-•••-----•------•-....._...•-•---••--•--•-••-•------••-•-•-•--•--•-
? C� Installer
has been insmiled in accordance with the provisions of T i T Imo, j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----?C------[ .LI.._....... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUN TIO SATISFACTORY.
DATE................ -. �-----�-----------------•--•------•--------- Inspector--•-•-..I-••--------------------------•----•------------------••--•----•-----•-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i
.......... !v..............OF.....fIJl1fY '`..:............._......'.......... FEE .................
� "
Disposal Works Tonstr ion anti#
Permission is hereby granted-- ... ,.......•• . ---...-•-•--•---••-••••-•...---•••••-••••••-•••-•••-••••...........................••----------
to Construct f�/) or-Repair ( an Indiv ua Sewage Disposal System
Street ..��
as shown on the application for Disposal Works Construction Permit N ............... Date __.-:••--------
DATE-
® 1 9r^A Board of Health
•-•--•••-- .......
'� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
1,;O CAT ION SEWAGE PERMIT NO.
VILLAGE
_ '11OAZ_ rvyo_
INSTA LLER'S NAME Ia ADDRESS
BUILDER OR Q .
0
-DATE PERMIT ISSUED Ial ,9t<Zs
DATE COMPLIANCE ISSUED
r
F
)// �5Y
O -
-70
96�