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HomeMy WebLinkAbout0335 PLEASANT PINES AVE - Health !33 5 P10,5(aA 1-1P�. ax n ska�b A= any eo5 ff- -_-. LOCQTIONJ SEW&C�E PERMIT UO. Lv•L r. sue - K. VILLAGE Jdllo�Ar. - - - - - - - - - - WSTQLLER 5 U&tAF— � ADDRESS BUILDER 5 Q L MF— �- ADDRESS DNTE PER"VT 15SUED '-_zD Q- 2.5-"" D ATE COMPLI &MCE ISSUED r ,• �� � ' � p o ! _ e �o I - i 7 T- Y� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ti U ...........OF.........e#h/c.ST.............................................:............ Appliratiurt -fur Di,ipuattl Workii Tomitrurtiutt Vaulit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal ��, tem at: +47! 1 �..bw� .. ........................SC. ... ��!S..l`_V� or (7 OWRCC Address ............................................ Installer Address d Type of Building Size Lot-.�GG.1.S-. Sq. feet Dwelling 7 o. of Bed rooms.......................................Expansion Attic ( ) Garbage Grinder (oo'T p., Other-Type of Building __________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' l Other fixtures -------------------------- - -------------------------------- W Design Flow�i............_IV.......................gallons per person per day. Total daily flow............ ._____._______-____-.-.--_-..gallons. WSeptic Tank I Liquid capacit4d©14---gallons Length................ Width........... Diameter................ Depth.--..--._-...... x Disposal Trench—No. ............--------- Width.................... Total Length-------------------- Total leaching area-------------.......Sq. ft. Seepage Pit No.100 ......... Diameter____--``----------- Depth below inlet.................... Total leaching area-.__-.-_-._-._-__sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by. Date ----------------- a Test 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--._---._____------_---- ' Description of Soil ...__....L��1°� 4-oza................................................ ^-. __F t ', u W f� x ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 e issued b th board of h al Signed.. -- --•. - ------------------- Application Approved By----- ---:/�----------"' ......` L.. � . pe 7 � Date Application Disapproved for tie following reasons:..................•------------•------•---------------................------------._..........-•--..........._.. .................................••-------•-----......------------------------•-----•---.._..------------•---------....----...__.......------•---•--------•------............------....-----------•--- Date vPermit No.--------_?jr--4.....=.............................. Issued........................................................ Date .�. s No. FElic :.�............ ...... y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tU Gtil<-............0 F........�`�� ................ Appliratiun -fur Bhipuutt1 Workii Tontitrurtiun Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --------•---•---••-------•-••-----•----•----•----•--••------•---------••-------•.................. ......•---•----•-•------••---••----•---•••-••.....•--•----•--•••••-•--••--•................-•-•-- Location.Address or Lot No. -•-•--•----•......-••-•--•.....................••--.._._.......•--••••--•-•---...-------••-•---... ..........•...•---•--------•------......_.....................•..••..........................---•- Owner Address fsl , Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................... . .Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures --------------- ------------- - W Design Flow.-.............. ..........................gallons per person per day. Total daily flow------------n%.........................----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. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by......................................................................... Date..-.--------------------------------.... Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water....-..-..-.,-.---- fZ4 Test Pit No. 2-----_--------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Ix -------------------------------------------•••--------•-----------------------------••-••......•----......................................................... 0 Description of Soil - ` '`��s� ---iy r xf43 �eL` ;{� _ --------- -- : W - - x ...•---------------------------------------------------------------------------------------------------------------------- -----------••----•--•-------••---•-•---------•-----•-----•------------.------ 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 issued by the board of health. Signed...................................................................................... ------------------•------------- 1.2 Date Application,Approved BY r--��--- ----- -- • --�` l?-....... ...................•--•-•--- .............J .:.--- .. .. Date Application Disapproved for the following reasons----------------•--•--•-----------------•-----------------•-•--•-•-•--•------------------------------------------ ---------------------------------•-----------------------------•----•--...-•-•--------..........-•--•-------•---•----------------------.--.......-------•---------------------------------------------- Date PermitNo........ r ...................................... Issued...................... ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD`'.OF HEALTH ,� OF.-.. : .....:.....................4...... ..........................---............ C.rrtifiraV'-"" rf, TuntlAiatirr THIS IS TO CERTIFY, That the Individual SewQg Disposal System constructed ( ) or Repaired ( ) ------------------- -.------.....•-----------•---•--•-------------•-•----•--•--••-••-•••-•---•----•......----------••••-- c, Installer, '� C-JiPs�t� r .�/6c y �L`�� U!LC�. at �G •--------•-•---••-•--..._._- ! --•.................•------------ ---------------- ................................................. has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--------.^Tf.4:.......................... dated--------- ::.i< ..' - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------------------------- Inspector..............-..................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l+G No. ....... FEE--------=---y- Bispu.6ttl urk Chun tr�trtiun rrunt - .----- �--{ oaf rf/f Permission is hereby granted------------- ---- ---------------....---------------------------------------- to Construct (" ) or Repair ( ).an Individual Sewage Disposal System j r / , f t / . . // r.i at No r -= Street as shown on the application for Disposal Works Construction it No.. �, r. Dated-..._ ...----- ..rC- ............. y ------•--------------- ar o Heap(./ / DA --------------------------------•-••-- FOR 1255 HOBBS & WARREN. INC.. PUBLISHERS � '/•'ems/"`� i N 1,, �~ `M Q � Q 21 .1 ? N a 2WIA N z Q �, CERTIFIED PLOT PLAN LOCATION ce--^/7 -l!/e-L-' , S C A L E _, D A T E __c'c 7.- .11 R E F E R E N C E �Ei,c�s L off'' i AS nAl D A T r I H E R E B Y CERTIFY THAT THE BUILDING R E C7 t_ A N D 4 U R V E Y O R SHOWN ON THIS PLAN 15 LOCATED ON T HE GROUND AS SHOWN HEREON AND T H A T I t DES CONFORM r 0 THE ESN OF&41p ZONING BY - LAWS OF THE TOWN OF �a E'iCiST�9L�3G-� WHEN CONSTRUCTC D GEORGE 'N LOW,JR. Ti V • sip BARNSTABLE SURVEY CONSULT'AnTS, INC . T�� �K WEST YARMOurH M ASS I S I you KiI) i I i oil vi . . ,4 t� + TANK .G 6 O LOT# I Dol to, fy 3 i L�C,UND � w , ( _ Do _ _ S ' � + � �� �. t� { i .. �. a t __ I �� i t � T ._ C � �� � � C � � . . �� � ", . �-� � � { � � -� �- � �� '; , .�� :, P �� M T� �� ���, ��� ' /