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HomeMy WebLinkAbout0221 SCUDDER'S LANE - Health Ion 1 i f t .J 7 4 1 �t L :1 �_��: �l � S �, , t� �'. — _ _ � - -- ' t�. r � � (n (E f{ ;'f +��f_,J. + ""j^6��"'r �. I �� '(R(�, !I ��� I; 1. � T. �L �'� ��1'" ��� !!r !� �. ►� �,, ---- - ;� � �l '�� �� 3 � i �l- TOWN OF BARNSTABLE LOCATION . /.,41„ SEWAGE # VILLAGE,/ �y��n�j � ASSESSOR'S MAP Cz LOTS O '� INSTALLER'S NAME Cz PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY Z LEACHING FACILITY:(type) NO. OF BEDROOMS—� _.PRIVATE WELL,OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �'` i /,�' �� b �� ��., J s �' �� No..c�f �.7 � Fus30.a.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..----....."......_....".................OF... PR� ��-_...._..........-.............._....... Allp iration for Bi_qvn.sal Works Towitrurtiun "permit Application is hereby made for a Permit to Construct ( ) or Repair (V,� an Individual Sewage Disposal System at: --•.a..»a. »..» e......... . .................. .------------------------------------------- Location-Address or c or Lot No. Owner Address Wa ----- ................................................... ®...VYILA.kt;�...... .. P..R.4 . U ..... Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........................................_...Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building _______________ No. of ersons._.______._____________._.__ Showers — Cafeteria a yP g ------------- P ( ) ( ) a Other fixtures . -...._.._....------•-------------------------------•--------•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............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 Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by.......................................................................... Date........................................ 0.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------------------- ------------------------------------------------------------- _... _---------------------------- •----•-•••--------------------- 0 Description of Soil---------- ------------•---------------•---••---•--•------•-----...----•-••----------------------------=----------------------------------------.....---..........---- ------------------------------ W -----------•-------------- ......................................................................................------ --.------------------- UNature of Repairs or Alterations—Answer when applicable_ :8_ _"�__ _.f ©_ ��t.__ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL;: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by e board of health. Signed ------` ---------- ---..------ -----•---------------••-•.................. �A. .3--•--76 p�z } Date Application Approved By...... �J K,.,..`-�________________________________•------- ....-- �f` �► Date Application Disapproved for the following reasons:................................................................................................................ ......--•••••-------•------•-----------------•---•-••---.....-•--••-------•-•---------......-.-•-.......----------------.-.•.--..._..-----•------------------------------------------------------------- Date Permit No....70- !Kea,5......................... Issued...:................ Date _ K 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - r ......................_..................OF.._ I�R.......!•k... .`......... Appliration for Diopoii al Works Tonstrurtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: -•-•............... ....:.v. ........... ... --•---. ===..=7----••--•---------. ...............................` ......................................... Location-Address or Lot No. ...........-�-•... l/=.r:!?:.1.a a.... .. iCi � s '_..C .?........... •............ ............................... Owner Address .........-•••••..:. ..................................•-•---........................... ..:----•--•----------. Installer Address Type of Building Size Lot............................Sq. feet U ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) No. of persons......................... Showers — Cafeteria p., Other—Type of Building .......................... p ( ) ( ) aI Other 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. 3 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........................ IT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---•--•-•---••••-••--•-•-•---••-•---------•...._..--•--••••-----•----••••.............••--•--.----••...............................................:......... 0 Description of Soil........................................................................................----•------....--------------------•-----------------------------.............. x c, w .. UNature of Repairs or Alterations—Answer when applicable '_r't : .._ �._. w �., /:rr�.....................................'r . .i ....... , Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 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 4the board of health. Signed.... .................� r .... ' "'"-�..,,•�1•�.� ate / G Application Approved By..... ----- d-' \... Date Application Disapproved forD fng reasons:--------•-.....-•--•---.....-•-------------------------------------------------•......---•-•......---•--....... --....•.............................•••-••••••----•--•.........----......-•--•---•--•--..__._._.......•--'••-•-••---•--------••--•-------•-•-•--•••----------•--••------. ............................... Date PermitNo—��...-•�Jf j------------------------ Issued........................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cc ..........................................OF.....Y :*f:.l.1. .. ..j'.. ............................................... Tatifirate of Tontpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�,j Installer at................ ((,��............. • 1. .--�`'.�..�-;, 4��,!................................................ has been iced'in aLr� Citli he p o iss ons of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._.....9 R ._. dated-............................................... LL �� THE ISSUANCE OF THIS CERTIFICATE SHA NOT B CON RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF......'`=r.'4. l:?.° .r.:P�.F...t-- .-.......-...••-.-................. 7, h - �5 Biovoottl orko 'ono#rion rrntit Permission is hereby granted•..•. '_ _. .?...... ...•............................ \� to Construct ( ) or Repair (,_j an Individual Sewage Disposal System - at No.----�'' '=!......: Cr t1 c ...............................................- . + -�k.V �`t-r ............................................................. Street as shown on the application for Disposal Works Construction Permit No. :_. _ Dated.......................................... ................................. - DATE.............. ------- .��-----•-•-••---•--•-•-------•--•-•-• f Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS