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Home My WebLink About0120 BLUE WATER DRIVE - Health 12-0 Blve wokw Dr CQn"rvi ilt 2 X 02. S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR �susralNasLE FORESTRY MIN.RECYCLEO INflMVE CONTENTIO 0 CertitiedF6erSourcing POST-CONSUMER vi msfiprogramorg Si101240 MADE W USA GET ORGANIZED AT SMEA MM I of (� TOWN OF BARNSTABLE V � LOCATION I� oz aE, &D4 VQE WAG E VILLAGE ASSESSOR'S MAP & LOT 3-00w . r INSTALLER'S NAME & PHONE NO. 0 �e SEPTIC TANK CAPACITY LEACHING FACILITY:(type)� -{ � p1 (size) lr NO. OF BEDROOMS PRIVATE WELL ORS L1C W.ATE� B'U�_ I�R OR OWNER �/ C (p✓ _ DATE PERMIT ISSUED: d " DATE COMPLIANCE ISSUED: 9131?3 0 VARIANCE GRANTED: Yes No , . � � �� - �` 31` � ISd-o . - ,�� -� �� s� � � �t�bP��`5T� � / '� � J .f act Z 8 Z ,a° < THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �msrable APPROVED TOWN OF BARNSTABLE CO�SeryetianQCPC7� Applira#ion for Mnvviial Works Tomi rnr�i Application is hereby made for a Permit to Construct ( ) or Repair (k-**r an Individual Sewage Disposal tem at: Sys ....... ••- [ ............................................................�2i rP.4.-. �4U. � .......�----------------- t ROC 4Z Location s-a Add r or Lot No. .................................. Owner -•-.Add ess a •----- �- 3-.......�. .N . ......................................... .�0_ 7--1 ..9 9 .:.. .�qwL 1 ... Installer Address Pq d Type of Building Size Lot..........0.................Sq. feet U Dwelling—No. of Bedrooms.................... ..--_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ..................... W Design Flow............................................gallons per person per day. Total daily flow......................................0.....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........................................ ,_l Test Pit No. I----------------minutes per inch Depth of Test Pit.--.--..........--.. Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water....................---. a •------------•--------------•--•..........................-........................................-••••...............................••---...•............ xDescription of Soil--------------------------------------------------------------------------------------------------------------•-•----------------•----------------------•-•--••----••-- U •---•-•--•••••--....---...•-----•----•------------------------•----•----•-----------•----------•--•--•----------------•--------•-------------------•.....................-............................. ----•---------------------------------------------------------------------------------------------- , - ---- J,. U Nature of Repairs or lterations—A wer wen applicableQ _ _-_ �dC?._.q _ _!�.;..:.__. �t_l..J_ooO . . . .... --------------------- --•-----•-------••--•----................. Agreement: The undersigned agrees to install the afor cribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enviro ment Code T e ndersigned further agrees not to place the system in operation until a Certificate of Compli a been issued the board of health. Signed .--....... F.' `"� to -------- -- --------------------- ------------------------------------- - ----- .--------------..... Date Application Approved BY .s c�ti, �.�- 6- io.-�`�.----- Date Application Disapproved for the following reasons- ------------------------------------------ -------------------------------------------------------------- - - -- ---------- .............................................----------- --------------------------------------------------------------------- ------ ---- ------- -- ----------------------------------------- -------------------------------- Date PermitNo- - --------- ------------------------------------ ----- Issued ----- -- -- --------- --------............. --- . ------. Date ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Toustrurtio/tlrrntff Application is hereby made for a Permit to Construct ( ) or Repair (;e')'an Individual Sewage Disposal System at: -•-• -- ..... ...Y%C ta-E,f4.._.....E _N.................. -•••--••._.J A&kus...•-•••--•••-••••..._..••-••-...•••••••.................... Location-Address F or Lot No. .................................. .......... ...... ............. Owner Address W 1'�� ....4'•c ?......... � � ca� �QG tea t,f t�t?�nn� U r1k Installer Address 1 UType of Building Size Lot.................... .....Sq. feet �-+ Dwelling—No. of Bedrooms___�Ll.....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d 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 ( ) a Percolation Test Results Performed bY.......................................................-.................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to.ground water........................ r3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil........................................._......................... x U .....................................................-................................................................................................................................................... -•-------------------•-------------•--•----------------•-----•------------------••••-•-•••--•-•--••-----1 "fir �.............................. U Nature of Repairs'or Alterations—Answer when applicable Q. �11��0 Oft4 x__�An ->--- ----.•-a-•_• - ...............•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with n athe provisions of TITLE 5 of the State Environmel 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 ------ �- -------------- - a C 9 Da[e Application Approved BY ... . e�c -------------_--------------------------------------------------- ----�_ T (��------ Date Application Disapproved for the following reasons:'.--------.................................--------------------------------------- .................................................. ------------------------------------------- ------- -- -- ---------- ------------- ----------------------- ---------- ----------------------------- ......................................... ------....................--------=-- Daze PermitNo- ---------------------------------------------------------------- Issued --....------..--...-- -- Daw THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tex#tftctt#e of Tontlatiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b '" ---------- � . Y - -- -- - -t - Ias 1k, .... - at - {--�`^-C�-u--T 1--*----------{G -------- ---------M-YJ...p0j-- - ------....................................................................-------- has been installed in accordance with the provisions of TITLE 5 o The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---------7,2...-_Z7,(-D._n.......... dated ..........-.................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. —� DATE --D-=.................. ---.......................... Inspector .......................�N - 1: .................. -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.. ::_ FEE...� d_:............ Disposal Works Tnnirnr##inn f"Ifrrmit Permission is hereby granted...... -�--t��---------�=-1-��3 .�'�------------------------------------------------------••------....---.................•••- to Construct ) or Repair ( L.,Y—an Individual Sewage Disposal System at No......�!i ....... ;A y. c>_R_a..T, 1; ��:;.... H,=) A p" 1. ! Street as shown on the application for Disposal Works Construction Permit No._ ... �•_ Dated.......................................... ................................ =--------------------------------------••••-------••---------. - Board of Health DATE------------- --------------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS