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Home My WebLink About0040 COVE ISLAND ROAD - Health L E ISLAND ROAD e 061 S M E A D No.2-153LOR UPC 12534 smoad.eom • Made in USA 4 p�rct� ). A�*p mmMDiiImam SFI �� CERTi1ED SDUGC►1G I FE$.... .��.�. THE.COt,�~NWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................... ...................OF........................................ --------------=......................... a. , ppUration for Uiipoaal Morkg Tomtrurtion Famit XX 4Application is hereby made for a Permit to Construct (Lor Repair ( ) an Individual Sewage Disposal S stein at: ........... Ac........................ation- ress or Lot No. . � _ ...tea � .---------=_l - ----- �W --.-- -----. y � �.`. Owner//- /�y� Address .. �f/ ...... ..N...�,�!__- ---------•______________ _____________z___-. Installer Address Type of Buildings Size Lot...7 ZA.C1V.--Q......Sq. feet ►� Dwelling V No. of Bedrooms....... .............................Expansion Attic ( ) Garbage Grinder ( ) `k Other—Type e of Building No. of persons............................ Showers — G4 yP g ---------------------------- P (Z) Cafeteria ( ) Q' Other fixtures ---------------------------------- . Design Flow..__r O.._.�5..�................ W W Septic Tank—Liquid capacity.]OW)..gallons Length5,6f/YR_0 Width'DC ...... Diameter_j�e§r-- Depth_.�_1&. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No-----------_------- Diameter.................... Depth below inlet.................... Total leac0��D area .---_--_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � S $4 Percolation Test Results Performed b __.. _Z'�i _<_ 1�.. `' .._. Date___. __----:... 3_� .... y { -- q aTest Pit No. 1_]`'_ .:2�..minutes p_T irr b Depth of Test Pit_._-_..1k....... Depth to ground water----5EE....1?(.W Test Pit No. 2_4!'�.Z,._minutes.Mr iwh Depth of Test Pit--__'l.::i___.__.. Depth to ground water--.S GG --------------------------------------------•--------------------•----------------....---•-----•-----------------------------•---------------------------- O Description of Soil---dk_am..------ -�-----------------------------------------•--------------------------._......-------- W V ---•------------------------------------•_ ---------- --_-------------------------------------------------------------- --------------------------------- --------•-------------•-----•--- W UNature of Repairs or Alterations—Answer when applicable................................................................................................ --------•--------------------------------------------------------•----------------.._......--•--------------------------------------...---------------------------------.............................. Agreement: The undersigned agrees to install the aforedescribed Indiv' ewa Disposal System in accordance with the provisions of I"'IE 5 of the State Sanitary de under igned fur ier agrees not to plac the system in operation until a Certificate of Complian e has een is b the and of h alth. Signed..... ---•---•• ......................-•---------•••-•-•-------•••-...------------ -------•----..._.. I Datg r Application Approved By------------� -------------------- ---- ....... Date Application Disapproved for the following reasons_...._.............................................................__............................................. --------------•----=-----...---------•--...------------------................--------=-----•--•---------.._.........------------------------------------------------------------•-----•-----•------_...._ Date PermitNo......................................................... Issued....................................................... Date Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. ........ ..............-.................OF.........................................------------..........---.................._..__ AppltrFation for Dispos al Works Tonstrnrttun rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: n ��------------------------•-•--•--•---=.....-... ------------------------------------ L n-Address` or t No. O��w,y� Addr s Installer Address Type of Building� Size Lot.___.� .....Sq. feet Dwelling-L'Ko. of Bedrooms-__.___.____ ________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) aI Other fixtures ____________________________ _ ------------ • ---------- W Design Flow..../j__Q.___X_7�...................gagbns per person per day. Total daily flow......... zS.....................gallons . W Septic Tank—Liquid capacityJ2UU_gallons Lengtha.!k 1AY WidthSE!L k��'_:DiameterUIL.D/g/.: Depth.......... x Disposal Trench—No_ ____________________ Widthx'____.____......_._. Total Length.._................. Total leaching area........_...........sq. ft. Seepage Pit No---------_--------- Diameter... 11............ Depth below inlet.......__........... Total leaching area. ......... . ft. Other Distribution box Dosing—tank Percolation, Test Results Performed by:._ 12 .__.v_____________________ ,.a Test Pit No. 1!'.tM_Z.__.minutesp Depth of Test Prt-------- ________ Depth to ground water_._._n !. f= Test Pit No. 2._1' _1...minutes per_-mch Depth of Test Pit..... .: _____ Depth to ground water....DjQk1d1.4b O Description of Soil CQ�!� -= --- ------ .....................-.................................-........ V .............••--•-•--•-•••-::__........----•••••-•-•--•--•---------•---•---••--..........................-.................................-..............------------ W ...............................................-...........................................................---------------------------•..............................................-................. U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ so .............................-..............................................................................................................--------•--•-----•--------------------------........._-••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI,, 5 of the State Sanitary Code— e>tnd se it fined further agrees not to place the system in operation until a Certificate of Comp • nce has been • ued the bo d of health. �G ' iene ................... ...........;.... ......-------•----- 1 tit Application Approved By___••-______., s_l�c...... - .................... , - ._ Dat Date Application Disapproved for the following reasons:..................................-.................-........................-.................................. ...........................................-...........-...........................-...................................................................................-•-----------------------•-•----•- Date PermitNo........................................................ Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS i. l BOARD OF HEALTH 1 r' /-4..1l................oF.. ...........................-............................... Tnrtgfaratr of Toutpli anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................................................................................................................................................................................................... at.........................................�1'�:^ �r ..� .5 `^ has been installed in accordance with the provisions of TI r 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-: 2_-414e).---------- dated________________________________________________ THE ISSUANCE OF THIS, CERTIFICATE SHALL NOT BE CONSTRUE S A GUARANTEE THAT THE SYSTEM-WIL FU TION SATISFACTORY. DATE... y3.. Inspector_._.. �_.. ---•-----•......... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r No... .�-_.1h... OF FEE........................ Disposal Workii Tnntrnrtion frrnfit Permissior is hereby granted......................... -----------------------------------• ................._....................... to Construct ) or it ( ) an&divi ual S .wage.Dis osal System at No -= ... Street as shown on the a plicat• n for Disposal Works Construction P it No..................... D ed_.____._____._________.-..__.___._........ :-- +.-- ................................... _ Baerd of Health DATE / fl... l} .................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE � ,�tom`'zJ Ll ASSESSOR'S MAP & LOT `7 OD INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) J fls (size) 16o NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 'i d v T2 DATE .COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No 9 �M � �_ • �yS`�b — - - 1 ��"�'�-1' /•-1�.�.1.`�—�� •� ._.ate ��it' Jr:.L�, //y�\//y��JL� • FDk— ND v- M,4\klL �. iViAeS�-j - �' •'� 1 _ ox'trt -V ILLPL �t ASS u � hl - 4, jr 00V7 Tli s r 3 4^i s /9 24 V b P, IF lk L FL 16 . Fr i TLs,,r tav L.v/.rn, + WLO �'l� Tom `1 L-Lop V-UDF i(. ra g Zak 1"rL ZMIN r R•d � I 1IGFy 7t-4t 74 # i �bE',:•i�`,._..� A� ice;, d�F 1 • ''1'rCa�,� arc b .T -' -5F SO 5 F v 'SC do, r�-�