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Home My WebLink About0445 AMES WAY - Health y yS AMES WAY, CENTERVILLE A=170 1-6 IN 4,00-cub UPC 12543No.53LOR WOOF % a HASTINGS, MN L� U i { Ale no Pt, (--6 No. F 1.00 ..t�-------------- ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �,nef TOWN OF BARNSTABLE Ap.liliratiun for Uiirpnutti WorkgTowitrurtion Vamit Application is hereby made for a Permit to Construct ( or Rcpair ( ) an Individual Sewage Disposal system at 1 __. c7r Locati n-Ad re s or Lot No. / � ►A - —C_ vner a ....................................................... ...................................... ..........'-------.__............................-............................................... Installer Address d Type of Building Size Lot-____�3y%-J...Sq. feet U Dwelling— No. of Bedrooms._-•----.--.___IS-----------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _ . ..... W Design Flow......................... llons per person per day. Total daily flow..------------------------------------3�a_.._gallons. WSeptic Tank—Liquid ca acity__ allons`�Length----M-----_ Width_-._4--.-.--._ Diameter---------------- Depth................ x Disposal Trench—No.LL�� .... Width-------------------- Total Length......�� ....... Total leaching area------- _•-sq. ft. 3 Seepage Pit No........ Diameter DepxiLb inlet_._.. CP' . Total leaching area.._._....._ _ sq. ft. Z Other Distribution box ( ) Dosing tank ( A-91 Percolation Test Results Performed b i4x7vt—y—h.� /NC.......... Date............... ........ Test Pit No. I......Z--minutes per inch Depth of Test Pit......./Z....... Depth to ground water...... -_---__.-.. ( Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..-----------........... P4 ----------•-----------------------•- -----•--•---•---------------------------------------- •--•------------------------------------ .---------------- 0 Description of Soil........................... Z-••--..�_t - ' ----------------------------------------•---------------- UZ 1� m ......-----�vNE ----- '-.��''S__---•---------------------'----------•--------...._..------ •---- x .....................................................---�----�z--- C m- 5" ................................................----........................ U Nature of Repairs or Alterations—Answer when applicable-------------1.5'av---St__.A:ei K.._...9....�G��`...........___. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the.provisions of TITLE 5 of the State Environmental Code —Pe undersigne urther agrees not to place the system in operation until a Certificate of i e ' e by t of health. Signed ....... ... ....... . ....... ... .. .......... -----a----------------------------- Application Approved By ---- -- --- ----------------------- a® a Application Disapproved for the following rear f: ............................................................................ ...... . .. .. ..._..................._ --..................... ---- - - -- --' ............"—"----.............._---------------------.......-._./..-------------------- / -------Dace---------------- Permit No. ...... .. .... �'�... 7............... Issued ....... ...................... a f 70 - 2 a T No. ;...........-.... d FIms.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'V' y v ^ e f TOWN OF BARNSTABLE Allp iratiun for Diti-puiittl Morkii Tomitrurtiun Permit Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal System at: Location-Address{ or Lot No. �. N•-•--- . Owner Ay�dd�s�s •---•-••----------...... L� - ...- 0......•----------------------•---- ao Installer Address Type of Building Size Lot....... ...Sq. feet �r Dwelling— No. of Bedrooms________________ -- Attic ( ) Garbage Grinder ( ) a Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures �w------------------------------------------------------------------------------------ ------------------------------------- W Design Flow......................!:5...... 15CZ allons per person per day. Total daily flow______...__.._._...._........:?:3'a....gallons. 9 ,Septic Tank—Liquid c/a�acity-It-W—gallons .Length_--- a------ Width________________ Diameter---------------- Depth................ xDisposal Trench—No. . .-7Er$__- Width---A(---------- Total Length.__..Ye)....... Total leaching area___________________sq. ft. Seepage Pit No............./.._.. Diameter____:..Z&--____ Depth below inlet........ Total leaching area...._ ..sq. ft. Percolation Test Results Performed b ) �� a Other Distribution box ( ..-�°) Dosing tank (�� ! � /NC 3" 1 - ---------- Date------------------•j---�---...- a Test Pit No. I......�-c--mmutes per inch Depth of Test Pit_-_---I ___... Depth to ground water..___.�. - Li Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil........................... 5 - - - - -- �14 Z-fV U .............•----•------•-•------------------------••--Z•'- ....----..... ..... Q��s.-----.S�Nc _.------------....----------------------------------------------- = - I --- x Nature of Repairs or Alteration /. �L..E'YI 5'�1 U P Answer when applicable.----------- = 5�`� `- ........0...1`�C........................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Cornpiiance-has-been-isd by the board of health. Signed - ./�}. ....... ...:^ ............. �' u - . 7 Application Approved BY - L ---------------------------------------- Date Application Disapproved for the following reason ------------------ -------------------------------------------------- �. -------------- Date Permit No. _ ........-. . - --------------- Issued .....L.�_.K a4 ------------------------- ._7. '-" FDaj ------ ------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY, That th Individual Sewage Disposal System constructed or Repaired ( ) by .................r. .C _...........f =c?.. ��/------------------------- ---------------- Insriuer at -------------------------- 1.e7------/.a-.._----t---- ---1 f1� 2/ -1 P 'cJ(/` ---------------------------------------------------- has been installed in accordance with the provisions of TITI_/E '_ The State nvironmental Code as described in the application for Disposal Works Construction Permit No. ..._.. .. �hf '.. ..... dated ----------------------_--------------__.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE 16JNSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------- .......... --- ..5....----- ------------------ - Inspector ---------------------- .... ---\------------------------ --------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No TOWN OF BARNSTABLE / � �is�ru�tt1 urk� �unufr�.r#iun fermi# Permission is ereby granted-------r�`Q � ........Z�ol ----------------------------------- to Construct ( or Repair, ( ) a pIndividual Sewage, Disposal Systei at No........................ f ------.._Y�!_t �'�------ -------/ �'{' �-vc///_ --- _ Street as shown on the application for Disposal Works Construction mit No:_►- ---------_ Board of Health � DATE C... -•�-a•-----. ��; FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TA , Slue FALGtILY 3 . $Eli1?LY�/►%4S q��%/ � \ \� ��•�BO��s2�1�-- f�o 6A 3AGE Glziu�E'R, _V A ———— FLOW sE lc TAJI— 3 -�o xlsv7a=a S 0D Q �aA� — M ES r _ — A� WAY DISPoSAI DIr j_I0006AL 51DEW4L1_ 112 AJ2EA = 106 sF � 'l -3 BOTTOM AazA TOML TOTAL VAf L.Y 1:�E¢4-aC.AT7oN RATE �'r ru 2nnru� s5 a C C cn AA x> 3 R7C1 t6 PA PETERBAXTFA j�- s. a 2s s R'r= SULLIVAN 70' - f� �t, / 14310•0l 4S+g r 1 I � la `s4`9 9 EL T=6 = 43 TF =43.G Long -�'•'-�-- —w�717— � "'777«ri�aT� 2 42" �� Op� uJr MGb SAW> GIST lu INv GAL "'� 6 Son,E STDI,B loco IN If♦✓ 4o.p av•2- S ric 40•4- 4 GAL 3q, 3'l� 'rA4I` ' .C.l'.bAIJ m` r wl Mom, Z 3I4' /Z .. Sa;.IA wAKNm �: Aw.SnzucruQes s�.,r sTouE AiM rlinN 4! veep H,•334 Q4ALL. 'BE 1.4-20 1,AAP j�d P� l-c. CoQe. WIlUL All W 30 ZouE D ED nco,- FLA 1J ----1--IZ EL. ° Se—A LgC, j'ION DAMP �� DAB; Mrt� 3 19�i5 CG27'FY T� AT T�{E�u,L PLAN 5f�ow� NE'ZeoN� �' �� wlrtµ £ �Rt�JaJC� � '�i�:�tlX, � •`{ 5 ICE U 1J E �- TDwfJ OF r1A,4,3 ,La UJITfll iJ T�� t W� c, CIS F�dti ►S NOF oN AN jqSTL'0ti,P, r p2�%tOQ4 LAUD 5uevE,�, Su2ve-y AiJU, rN� OFFSETS ouL� � �I L � -Fo ESTAI'I✓1_ISri erz . UT_ �E 51'Erzv I EiJ6I 0 P-GL5 SOP MA44 , A{PpLt CA �LA SMA�t_(___ I - 'S ---�--�- �A se ��oo es.al_• y_... u 3Y ' ' r --L D:J Ni Cam. V, J -- - -- I oZTo� zk�;e, th,;- ,lye ; �t�%C S-F o �C1L C.1.�.;•i "r I R' j GF V,ER `('!.Li�'t'.�a r�� ► - {: �-ia._ ,�.�.- —ll:-� .—_T7=^'—T-�' ..,-a✓i. -.�.� r--1—.!J—.1L --- 1� I1N.. Wv- J =- C L I ;a it '' �,;�� f.ice'--r1.=•7.� " I• i Sal.l� • i I 12�' t -I. 1=' Z •I* 1. ,r')7��,=_> -- — __ {?�_,�. 4fA� �•,frl; i.l,}. E 70 w�t� ^:jA ' I -; I.-- -• '.� , 1U I r�i I iJ D. k.. n.;�aj�j i I <'.;�• ;5,1 1^ l`i I`'ir _ 3 2 <. I-y` ci l hla I 7-i✓yc. xji?F_:i',I �-�✓7 I-1�i:.r•�� Arr?I ;L��>a�-7 t' �'J•C�Iso��.1, (�-rOr'��''T'`� Lllv�'Y, _.1-----------!✓��Jsn�!� 1.��11�- 'Old �� liX RE", IT17 MAP 17') Lx 1011F'1, ql::H FIS �N 21 S. 2W4043 ZA4 sr 6r3 PE ER .0. 2973-1 Ar IL E7 '3 oup'j': IL Ala, TA9—& 43/ V tg ( ' �S TOWN OF BARNSTABLE, 1 Zo °p 1 -66 6 LOCATION 7 y SEWAGE # / If VILLAGE L�ry��U��`L ASSESSOR'S MAP & LOT INSTALLER'S.NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 BUILDER OR OWNER W i`�SoIV PER IT DATE: --2tt - 9. COMPLIANCE DATE: E GI 7 Separation Distance Between the: Maximu'In Adjusted Groundwater Table and Bottom of Leaching Facility Feet Pri.vat&Water Supply Well and Leaching Facility. (If any wells exist on.site or within 200 feet of leaching facility) Feet Edge:.of:Wetland and Leaching Facility(If any wetlands exist within:300 feet of leaching facility) Feet Furnished by BJf 3�u ��. - 0 ex c SOD Sep', -W //�1 S TOWN OF BARNSTABLEL/ C1 70 ea( -6b 6 LOCATION 7'/56 S CA.,,f4 SEWAGE # / VILLAGE ASSESSOR'S MAP & LOT LQ-Ir-� INSTALLER'S NAME&PHONE N0. , SEPTIC TANK CAPACITY _ ISM 5--e-p2VC ' LEACHING FACILITY: (type) 15�0w Oz4-�5SzSU (size) /&)c(f 0Y, :1 NO.OF BEDROOMS BUILDER OR OWNER W iltSol� PERMTTDATE: J - g COMPLIANCE DATE: - cI 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� \ ��.� - o ex.�. �3 � � � l � 6�SQD �� 4 w �� Gv��5�� Q� t5e7r