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Home My WebLink About0046 CROSBY CIRCLE - Health 6 ccosdy Cr- - - - /// S M E A D No.2-153LY UPC 12934 smaadcom • Mach in USA SUSTAINABI� FORF.5TR1r INM ME W1W�di�vSaudnp n r i C1 TOWN OF BARNSTABLE d C� LOCATION ell"? Cr 6 s8 Y C-e le le 7 — SEWAGE # VILLAGE w?<ip v i � ASSESSOR'S MAP & LOT;W 424" INSTALLER'S NAME & PHONE NOA2ef,! SEPTIC TANK CAPACITY /a d LEACHING FACILITY:(type) Z,4c fr 7:�/ T (size) / o a G's :�NO. OF BEDROOMS PRIVATE WELL OILDER PUBLIC WATER BU R OWNER ^p _2 C�GYy DATE PERMIT ISSUED: 0 ,47 DATE COMPLIANCE ISSUED: z — VARIANCE GRANTED: Yes No �~ B5A 'i �i12�c �e A6F, r.� a -�3 °2 `f ASSESSORS MAP NO: o& 3 2 PARCEL NO: - L�- -� No.. ...�.J.. Fa$ �.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --•---- ------------------------------OF........................................-----............................................ Appliration for Di-qVuiia1 Forks Tontrurtion rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: - --- Lo C::DS 6...--._�t .. .............. ........ -----------•----•-•------------�---------------------•--...._...--------------.......---•-- uu�t Locart�u A dyes J or Lot No. ........... _L__.... ..... c �r- .tee---------------------..............................................._..... Owner Address W ,� oZ... %/ --•-......•••-••••••............................................•--••.._.._.........._...._....... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........3.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0 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. Seepage Pit No......J........... Diameter."-6-..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of. Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•------------------------•--•--•-•-•-••••----••-••-•••-•-•--.....----•--•----.._....-•----------........................................... --------------- 0 Description of Soil.....................................................................................................---------------------......-•-•---------------•-•••-•...---...•--- x W x _ U of Repairs or Alterations—Answer when applicable _._C :!� ? Tvlil/P S !S% _mil _ __. A�Nature ..............................................! Z `` r 5�--ems.,_/ -----------------•----------•----------------------......................... en . The un rsigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii`= . p 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 the board of healt . Signed._ -= . ------ 1.-._�.................. Y n at Application Approved By--•--•.. --------------------Da.e-•--••-••---•--- Date Application Disapproved for the following reasons----------------•--------•-----------------------------------•------------------•---------•---•-••---•-•......._ --------•-•---------•--------------------•--•----•---------...------•--•--------.....---•--•-------------••••--•-•-•-•••-••-------•--------•-------••--••---------------••--•-•-----••••--••---•-------- Date } Permit No...... ...................... Issued-------------------------------------------------------- Date i No. ... � FxB.. ..... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. .._...........--------....O F.....-....-----............. ApplirFation for Bispatial Marks Tonstrnrtion Iflermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_................................................................................ '.....................•-•-••-••-•••---••--•---•-••................•-•-••............•-•••...•••--- Location-Address or Lot No. ......................_.......................................................................... .......................'.....••...__.............._...._.......'-"._......._....__...__.......... W Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................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................ 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 ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.-----.............. Depth to ground water.------------.---------. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......---...........--.. 0 a -------------------------------- ••••-••'••••--•-•...-----'••--.....-----•--•---•-•'••-•-••--•'"-'-'--•---•'•-'-•..........•-- .... ------------------•-- Description of Soil.................... ----------------•------------•--'------------------•••••............................. x W x -- ----------------------------••••-----••••-••--••--------------••••••-•--•--•-••-••--_..-••-•••-----••---••••-----------•-•••-••-•-•-----•••-••-•••-•••••-•---•--•••-------•--••••......•-----•..... V 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 1 T:€ :.. 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 the board of health. / Signed...................................................................................... �� d .............•....Date••-••---•'--.. Application Approved BY.........�,�----- ........................................ .......................•--••---'-• Date Application Disapproved for the following reasons:............................................................................................................... -------•--•---------•--------•--------------•--••---'•-•------....---•---'---•-------'-----•----.........---------------------•--------•------•-...---••'--------------•'---------••--•------'-••-•..... Date Permit No...--' -.:-------- 1L....-------"-••-'•••. Issued•..............................`-------...------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH >> Trrtif iratr of Tontphaurr THIS IS TO�ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY•-'-'--......_...a,,..-r. ......��. .................'..._......----------•-------.........---'----........-----•-----------•-•-....--••----._..........-••-"'...---'''--- (�1 Installer i has been instilled in accordanc4ith the provisions of TIT 1E 7 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-.........---------•---------------------_--_--- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... •............................ Inspector....._ e ----- .................... J, v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Y7 ' :c n- :....OF... t ! .............. ?.. .................................... FEE l Wit_"_ Disposal Workii Tonlitr iott rrntit Permission is hereby granted......... • ------..(Q= ------•-----------------------•...................................................... to Construct ( ) or Repair 0<) an Individual Sewage Disposal System `J Street as shown on the application for Disposal Works Construction Per 't No.(3 2:_.zJ1'2—.... Dated....._ --'. .. ��....... ........... H •----------------- ..................... - a� e .. DATE..---- • ............. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS d