The URL can be used to link to this page

Home My WebLink About0189 GUILDFORD ROAD - Health l 8q Gu, Id Rj ctf%+-tv v 1,1f-C S M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR OAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10°6 Cerrified Fiber Sourcing POST-CONSUMER® www.sfiDrogram.org eFF im MADE W USA GAT ORGANM AT S6'IMM L a r TOWN OF BARNSTABLE 4 LOCATION SEWAGE # � _ VILLAGE ASSESSOR'S MAP 6i LOTO II�ISTALLER'S NAME 6t PHONE NO. A & B CANC'O 775-6264 SEPTIC.TAN K;CAPACITY /ova ey LEACHING FACILITY:(type (size) l z NO. OF BEDROOMS PRIVATE WELL,OR PUBLIC WATER-A&c BUILDER OR OWNER jgg4,V ,&. r DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No z , 3� 9-$ No.-- FizB IQ.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 77............ .......OF....... Appliration for Dispviial Works Tomitrurtion Frrutit . Application is hereby made for a Permit to Construct or Repair (4,) an Individual Sewage Disposal System at: ....a(411J.10 fir ht .......... .................................................................................................. Location-Address 110. ku t Rr.y,;. e.............................. Raqv- Tok.................................................................. ..i8j...C, 0& 7 Owner - g Address A4.0....&RqQ.................................................................. ..%Ii ........ ArL" ........................ Installer Addres4 Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder a Other—Type of Building ............................ No. of persons---------------------------- Showers Cafeteria04 Other fixtures ....................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow..........--................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter--....--........ Depth................ Disposal Trench—No..................... Width............--...... Total Length.---.........._..... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Per-formed by................................ Date........................................ ------------------*---------------- Test Pit No. I................minutes per inch Depth of Test Pit..............--.--. Depth to ground water........................ r14 Test Pit No. 2................minutes per inch Depth of Test Pit..............--.--. Depth to ground water............---......... P4 ............................................................................................................................................................ 0 Description of Soil........................................................................................................................................................................ U ..................................................................................................................................................... ................................................ W ........................................................................................ . Z. ..............................................'r................................................................ U Nature of Repairs or Alterations—Answer when applicable...!?.�4stloLz,li--en�.�ngt4--- 4 . ........... j%...CLS.. Weed---------------........................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI I TI LF, 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_ j. v 41.1._..,&............................................ ................ Date Application Approved By........--.. -------------------------------------- .....X,46=r'_�....... % Date ' Application Disapproved for the following reasons:.................................................................... ........................................... ........................................................................................................................................................................................o................ Permit No......1?21 ........w.............. Issued ...........................................Date....... Date No..'` r2:: ..` J FEE.... ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH OF. ��. ` Appliration for Bh4p sal Workii Tonstrnrtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair (.4,-) an Individual Sewage Disposal Systmtem at: / f J�L��-' ...Ui! C-UI�rI�4rr .. UG=� �.: ''�rt��E:.................... ..............••--.......--•---•--•-...••-••••-••-....•--•--•••••-•--•••--••-----•------•--•------ Location Address or Lot No. �{ Owner j Address a ..............................Cry .?'lD .... :, ��rF: f, I) )r i , �_ I ................................................sta .................... ....... ..........................._ dd ---•••---••--=-----------------------•-•------ Installer Addres PQ UType of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons................------------ Showers ( ) — Cafeteria ( ) Pa 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.----.----.-_-.-._..--. GL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----__.------.--.-----. P4 -••••-••---•-•--•••--------•--•------•---•-•-------------------------•.......•-•••--•-------•--•-•-------------.....••-•-••-•---•---....................... 0 Description of Soil.......................................................................................... ------------------------------•---------------------------•-••-----------•---- x V ..........................................................--•---•------•-••••----•....-•------•-•-------...•••------•--•-•--•----•---•-•-----------••...-•••--•-•••-•-••••----•-.......----••----------- W -----------------------•------••-------•-•- -----------•-------------------------•----•---•-•--------------......------------------------------------------------------------------------------. U Nature of Repairs or Alterations—Answer when applicable__:._c__,.___�;_,_-r,_ S-. � �_ r�t•_� � -,. . �_C,r!l.__________. �..� - -- --------- --------------------------- --- p wl`,AT,ia r_ r , , �-t f Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI4,� 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.... .�... ..--•--� =.....-�---------------•-------•--- r" ................ Date Application Approved By...... -----�"k�-...�-.\'-<,f.M..�.-=-�--•-----------•--.....--•--.......-- ---- ----�-•�1---._cf!..Cl.-------- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------........................ ......................................................................................................................................................................................................... Date c < r PermitNo...... ...L-•�-� ................••...... Issued....................................................... Date J:2 BOARD OF HEA TH ............................................................................................... .!::............. (Intifiratr of Tomptiatta THIS IS TQ CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by............... ................................................................ ............................................................. � . Installer at ..................................................................... has been installed in accordance with the provisions of T.1 " D of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-___._ ...... dated___--___-_-________________ -------------------- THE ISSUANCE OF THIS CERTIFICATE $HALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ .......................... Inspector................ D.................................................... 12� C—k- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............................................................................................0 F....., "o — .............. FEE.._.�n................. 11isposal Workii Tnnotrurtion rremit Permission is hereby granted.........,...:.. ...... ...................................................................................... to Construct or Repair ( e Disposal System j-,4n Individual Sews ............ at No.-........ ........ ........= ! ........... ............................................ Street as shown on the application for Disposal Works Construction Permit No.'I','.___' Dated............................................... .................................. Bol--�-of4ealth.......................................... DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS