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HomeMy WebLinkAbout0286 WOODSIDE ROAD - Health a �(o 1��P5,� �V� w .� 8�� � ,00a 7 LOCATION SEWAGE PERMIT NO. VILLAGE INST AIL EAAA. AAl.TO'B' CK14, : .AD,DPESS 150 walnut Street a .West Barnstable, Mass. 02668 ' B U R D E U OR OWN_ ER - w. DATE PERMIT ISSUED 4 -77 DATE COMPLIANCE ISSUED �� � , rt THE COMMONWEALTH OF MASSACHUSETTS BOR® O HEALTH .................�-0-",-.0F............ .---------- App irFation for DiipnsFai Works Tnntrarctinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Qi4�KQST/�8�,�/7SS // �.........__ ... ........---•- -- ••-• •. - ............ ,p dd Location- ress or Lot No. Owner -Address a --------------J°yK-•---••At4.��r� --_________________----------------- ..__--------------_-__--------------------_____-___-----____•--___---____-____-------------------- Installer Address Type of Building* Size Lot............................Sq. feet Dwelling vNo. of Bedrooms............. ............................Expansion Attic ( ) Garbage Grinder W<h) '4 Other—T e of Building ..... No. of persons____________________________ Showers — Cafeteria P., Other fixtures -------------------•-__--___ _ W Design Flow................. !�-__---___---_-.____gallons per person per day. Total daily flow____._....._'r3�_.._......_....._._._gallons. WSeptic Tank 1 Liquid capacity.1eOL'-•gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length......._............ Total leaching area....................sq. ft. � Seepage Pit No............... ..... Diameter.....1O°e?.s`�Depth below inlet____________________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ) Q'�j Percolation Test Results Performed by---_-_----- __ _..—............................... Date.... a r ................. i Test Pit No. 1...._s�_---....minutes per inch Depth of Test Pit.................... Depth to ground water-___-Go--___- _ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._........................ a .............. . � f ---- 0 Description of Soil.... '�`t -.._'��". _. yl!:_ wk�---e----� �s - �`3.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 TITi LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' sued by the boa• of heath. Date Application Approved By------. r ( � % --------- ---------- ....&... Da--7�t Date Application Disapproved for the following reasons---------------••----•--------•------•-------------------------•---------=...................................... ------••._._......--•-----•--•------------------------------------------------•---•-•---•----•---------••--•...---------•--•-----•-------------•--•----••-••--••--------•---•-•--•...---------•.._...-•- • Date _ PermitNo......................................................... Issued------- ............................. ............... Date (� Fss...,! r............... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH .... j1 ,..OF............. +' r" .....r---------------•-•---.._................. Applira#ion for Dispas al Works Tonstrnrtion ramit. Application is hereby made for.a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ..... ... " ? ! - ... '-- s s ... ............. ' °�....-•-------------...•-•-•-........_....... Lo anon ddress or Lot No. .... .. .... ..._..... --- . ------ ..... ........----•---------------......-----.... ....................--•---.......•......... Owner Address a .....:.........Y. r�.�. d?��� ......................................... --.._..-•----•------------•--....---------•- ......--•-•--.........-•------------•-••--• Installer Address Type of Building, Size Lot............................Sq. feet Dwelling v No. of Bedrooms.___.._.....:..........................Expansion Attic ( ) Garbage Grinder (Hca) Other--Type of Building No. of persons............................ Showers — Cafeteria dOther fixtu%S ••-•-•-•-----••-•-•-••-•--•----••••••-•••-•--•-•--•-••.-•-•---•-•---••-•-•••••-•-••--------••-•-•-•-•..........•----•-••........................•-•-•- Design Flow................s`a_....,.____.__.......gallons per person per day. Total daily flow................g°:.....................gallons. WSeptic Tank Z Liquid capacityl _.gallons Length................ Width................ Diameter---------------- Depth................ xDisposal Trench-No. .................... Width........•.. _._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No. •- ............ Diameter..._/."9 s.Deptli below inlet..... .. ....... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ) :® .+,i0,04 + Q—A 3 �7 �" Percolation Test Results Performed by._•"'____- r�� *�......... ................... Date.. ..� -7�'..--......... ,`�a Test Pit No. 1....!".....minutes per inch Depth of Test Pit.................... Depth to ground water.:-: ,eL._....�__` Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Rai r O r., i ��j� f_ Description of Soil....,Q�' a �•...N .'� :!J.t�J -------- 'g✓".• ` ft- ll.�. x V --- --------------------------- W t UNature of Repairs or Alterations—Answer'when applicable...................................................... t. .., Agreement: a The undersigned agrees to install the. aforedescribed;Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha`s`bee"sued by the boa of health. ,-.)Signed -•--0:1:p ---•••......-•---- ................................ PP i� Date t` Application Approved By.......... ...••••.• ""`..- ---.7 ..... Date Application Disapproved for the following reasons:..........................:........................R----------.-----------------------------•-•--------•-...._ ...............•-------...------.....................----••......--•-•--••_.._...••••--•-•-•-•---•-......-•••-•......----- --- --- --- - ----------------- Date Permit No......................................................... issued_....................... =............................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ..... .........OF... .... .. Taf f ratr of TampfiFanrr T TOE RT F-hat the Individual Sewage Disposab_.System constructed ( e<or Repaired ( ) byt�'i-.. :. installer ." has been ins ailed in'accordance with the provisions of 5 of The State-Sapitary Code as described in the lication'for Disposal Works Construct a� aP p iorl Permit N ..�. :_4—'W. dated----- �`- ` P, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS.A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATE:---•-••-1•� '�`1 � / ............ ..•-- ----- Inspector__._._ �� � . �! THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t.............oF....... :..._......... ........... ► No........... ..�... r FEE... •............. Dispos ork.5 0 udion Vamit Permission is hereby granted.'" 40.1 •---------------•-•------------------.....................---------•-•................ -.�" to Constru or ep > , ( Indr 'd Sewage),Difi6sal St at No.-r �F +' e.!y..... ru 40 ......,................ Street as shown on the application for Disposal Works Construction Pe it ___• Dated.._/o-`_G-: ........ ........ ...... j R.A ----------------- ---- •------.-• Board of He � DATE l '_:S" ._7.7 •{, FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS. _:,; - , ,; f fit. ., !, I es ,.rlr I L .• r - ,.F, s r t', ! i ,) ty e a F s J •V o- f{'+ }+: i�r �!t'' .,.,4 t'.M� - t .J I t �+/s Ii '� t "gkI'e•'a4! f tk C .-r ' �r i a P. ` ,�;_.,,.!- y ."t t . I }1,10 as,, t.. + } a+ 11 t ,r 1 I a � f.F-1.7',1:c -.; , '.\ i �,t.. f ti •,t{ f�4- xJ:.V a s#;t rtt F':•ry s•,. 1fi. "k Iy o- ',y �" f .s+r n { hP { ,. .,It ,g + k :s ,S , �`! 4 .'� - .L r r,t s �'.:�y a s s+�,,f r, ns = " 1.:Its€�i !;_ � } t? ° :rU x i s Jr t' } 'p', 'r +.t } �. t �M_ } -s i ayt., i .,p + y ;t A.k } r'� f y�,' -E se •s}s l t_.S r b.e r �'t 1 r t r y 9 y t ' „ti �F i� .� 4 ar.. s s , 4 '' ` P`t;t ! I ' r1 I + r A V. M1-� yG .Z I -'v.1r +� t err it.r_ i t st I t',`+ '! � s ~a `< 1 . k x % F , t t.. 1 p.. 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