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HomeMy WebLinkAbout0305 PLEASANT PINES AVE - Health 305 PLEASANT PINES AVE West Barnstable A = 214 - 057 a e c s \V� lot -"v- 3 — LOCATION : SEWiC�C;E PERMIT MO. - - - - - - - -�/�f /1/, - = 11`ISTQLLER•5 IJ�►NlE � ADDRESS /sd BUILDER 'S ►.1 [TIE P, ADDRESS DATE PERMIT ISSUED DATE COMPLMI 4CE ISSUED : , J i I 413 AX os7 No.. .. �..... J THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH C/ Appliratinn -for 'Mipiiat Works Totuitrurtion Vaunt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: L_o ' :3 PZ641441 Prk/c-s /4(!L, •--•----•---•--•-•--•-----------------••-------------------------------- ---.........--- j Ocation•Address r or Lot No. w Owner = t Address ..................................... ............ . �.a Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling-t No. of Bedrooms---_----.� --------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons__________________________ Showers — Cafeteria a YP g P ( ) ( ) dOther fixtures ---------------------------------------------•--••----.............................................................................................. w Design Flow............................................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 belo inle _-...,.r�___...._... Total leaching area------..-.----__-_sq. ft. z Other Distribution box ( ) Dosing tank ( ) ®I�t,;ai — ; " 7,�. Percolation Test Results Performed bY----------- .............................................................. Date--------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water_.-----..-.-..--.----. rXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-......------------. --- P4 `•.• -------------------.. O Description of Soil d-n--6 6� ►w, `h � w - --------------- ---------------------------------- ---w 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 Article NI 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. Signec v� - -v Date Application Approved BY-- - •- �' ._.. = .- 1 Date Application Disapproved for the following reasons:---.....---•..........................._........_.............._._....--••--------------------------......----•- --•-•-------------------------------------•------------ -----------------------•-----------------------------------•----------------•---------••---•-----------------------------•-••----•-------------- Date PermitNo......................................................... Issued........................................................ ti Date No........--•---•&.. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALTH _ ......OF........... . .. ...L ............................................. Appliratinu -fur Disposal Workii Tonstrurtion Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:LOT PZ&Al-itii y iI� E S , --------------------------------------------------------------------------------•••------•-•----•. -•••--•------••----••••-----•-•---••---•---•--••........--•--••----••••••...................•--- D 1 © Isoc io�`Address C_Aj or Lot No. 1 A ..................... .........- W -(G Owner Address a ............................... •...` 'E.` Q Y4-------------------------------------------------------- Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms--------- ---------------------------------Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow....................._-____--__-__.-_-.-..gallons. WSeptic "funk—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. ft. z Other Distribution box ( ) Dosing tank ( ) `;� - af—%?- 76 aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------....... a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water_..---.-.----.---._.___- rXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------. -•------------ ----- ---•-----------et-------- -----------------jq -- cf f O Description of Soil. . ---------------- V i / W ---------------------�-- - --`---- --------r--------------------------'----'------------'-----•---------...---'---------------------s---r�--------------------------------------------------------- VNature 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 issued by the board of health. Signed,,,-- -- -- -------�9 ..C;�-,. --�---------------- -�-=_�- -°--r�_� Date / Application Approved B Date Application Disapproved for the following reasons---------------------------- .............................................. .............................•_._....--•-••••-----•--••---•--•-......•-----•-------•------_._....-•-------••----------------•-------•----•----------•••. Date PermitNo......................................•................. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / ....� .6..:t.........OF......... , .. ...f ................... %:.11rxtifiratr of fI'llutp aurr the Individual Sewage Disposal System constructed ( ) or paired ( ) by-. T �' CERT Y That = if- r •-�-�- 'nstaller �.. P has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application far Disposal Works Construction Permit No----------------------------------------- dated------��__"fir- '._.7�............. ;- _.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ---------� ......... Inspector-L,.•.-- THE COMMONWEALTH OF MASSACH TTS BOARD OF HEALT . f �........OF...... .................... No. ` -----•• FEE. ............ Per �i���utt urku (�n�iutxurtivat �rrutit to Con tmu stop ,s or R�. r nted..-' .nd vid a Se a e d p 1 --------------------------------------•--------------------------•--------- �Pkreby g ( ) i SY Lem �reet as shown on the application for Disposal Works Construction Permito,Now---------- _ and ...... �Yrea t� ............... DATE............... °?- __._ 6__.... FORM 1255fHOSSS & WARREN. INC.. PUBLISHERS i ''O � POS bta V r �Y� ,•��IJ!] EX r�. V � � RtCHAR -.. \ QUA \ a W.2. I t , 44$rig`l THE /=C)�/r✓Z�FI T/C�•t,� /S 404,47EZ> aN 7`42.7 44 SNotv.V Aj. Ju,4 2s /9'7G � up2 Alo 0 L.00&TIOKA 5EW6,C;E PERMIT UO. ILLQGE iNSTpLLE2 5 1J�t�/lE ADDRESS - D l�- -- BUILDER 5 Q &"F- �QDDRE SS D�,TE PERNAIT ISSUED O ATE COMPLI L,t,10E ISSUED : i '�u'j /O'x ve, x 2' 4'a, l i � . l f i - ,1