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Home My WebLink About0029 HADRADA LANE - Health 4q cAI c'C.At-"Vilit N S M EA® KEEPING YOU ORGANIZED No. 12534 2-153LOR 0 SUSTAINABLE FOgEgTRy MIN.RECYCLED INITIATIVE CONTENTIO% CerafiedaerSourcing POST-CONSUMER wwwsfiarogramora SFF0im MADE W USA GR OWUMM AT iM ul ' TOWN OF BARNSTABLE S LOCATION,)9 SEWAGE VILLAGE�"a,�. ��;A!p► ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ;c Itp¢ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �a ��, tad r�'�' (size)�/ � NO. OF BEDROOMS // PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER S DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No 01., ® SD Gs�6 9D -- a No.... -...........---.-•--- Fmc................... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonotrnrtion Vninit Application is hereby made for a Permit to Construct ( ) or Repair, ( xC an Individual Sewage Disposal System at: rt wt t� -.. ------------------------ ----------------------------•-----------------........ ------------•-- Location-Address .- or Lot No. 4 .�.tl.C •...•-- - �!1+[tee ur�-4 - ---- - .. .... ..... .... - ._----- Owner Address. a H� ' CIO-V s P v_ . d 30 6 ti r �t u��— Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a'q Other—T e of Building No. of persons............................ Showers YP g �----------------•--------• P ( ) — Cafeteria.( ) dOther 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---•----------- a Test Pit No. I----------------minutes;per inch Depth of Test Pit.................... Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -•------------------------------ -----------•-•--------------••---•-----------............••--•---......................................................... O Description of Soil......... ............ u j3 2 - . ----------- (2 L 4ArJ VxG_ C`ve�>'l. ..................•---•-•••••--••••••••••----•---••••-••••-•••••-----•----•-•.._..--•••-•-•-•••••••-••--••-••••.......--••--•--••••.. ---- -------------e W U Nature of Repairs or Alterations—Answer when applicable._-___:!? ...... - po�-•---- `-�......_. ��sTr_w�------•-•S��T(�`, S4-STEW---------��._....__.2-1.... S 'lawe ...............•--•....... 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 Compliance has been issued by the board of health. Signed .. .-cam. �1� ..-- / Dace ..-_-........ Application Approved By ......... .dr -� ---'--'............................................................................. ................Date................. Application Disapproved for the following reasons- ---------------------- -- -- ---------------------------------- .....-------------------------- ----........ -------------------=-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------.................................. ^ PermitNo. ....-- ---/1 o-------V..2s..-- -------------- Issued ................................................................... Dare > NO-9'D -ga-s— FE$..�a.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di_gvosal Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( *an Individual Sewage Disposal System at: . .1�.! ,_.... V's............................... ----------------------------------------------------------------------......•..........-........ Location-Address or Lot No. .---`}+°!!_ :F`.!� .......•.��_Q44. dt�B� -� - ......................................... Owner Address 94 . ................... .....6------ ... _...`-t _. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons--------------------_------- Showers ( ) — Cafeteria. ( ) a' 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........................................ 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-_-___-_-.-_--_-----_--- -----------------------------------------------------------•------..._....----------.....------••---......................................................... � &AO Description of Soil.........Q-------.............. ------------------------2... /V-------------' -�* � � ..... •--•-.... utn.------------------------------•----------------.......-•-•---------------------------•---------------•-----...-------------------•------------------ •V W - - -- ------------------------------------------------------------------------------------------------------------------=---------------------•--•-•--•-•----------•-----.....---------•-------------•----•--- U Nature of Repairs or Alterations—Answer when applicable_--_-_ _ _o"� �1_�p_9------�,'r4�Lt-_->-A)---_---. . .._Q!Q-........`a--------- ---------•S5.rm. S -T-. --------ty* ..........Z-.....-----S-4ZW_e:..................... 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 Compliance has been issued by the board of health. Signed ---- ` �...,.. t� ApplicationApproved By ------ J 't'"" �----------------...............--------------------------------- ........ ---------- ..... .................. Date Application Disapproved for the following reasons- ---- ------------------------------------------------------------------- --------------------------------------- --- --------------- ---------------------------------------------------- ------------------------------------------------------------- n �� Date Permit No. [ .' .... ...........----- Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trdiftctt#e of Tompliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( x ) by '---'-�-«--IC'C.y-------'--"QO A s-It.........---0'-0'----`9----- -�--------------------_`-:........... " ------'----.'----'-----'--------...-- '-- ---n""- ----......-'----'--- — ----- - Installer -----.-...- fu has been installed in accordance with the provisions of TITLE 5 of The tate Environmental Code as described in the application for Disposal Works Construction Permit No. ----------90- .-.. - dated-------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRLIED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �G�/�� DATE...... J' j-..1. -'�.�------....-'---- .---'-------"--------"---"----.. Inspector . "= - ------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ �Z S TOWN OF BARNSTABLE No........-.............•-• FEE-2�.:........... Disposal Vorks Tuntrwtion "prrntit Permission is hereby grantedL ' C ------ i s'� _T� ....--•---•-----------•-------------•----•-•--............................ to Construct ( ) or Repair (,,.k,-) an Individual Sewage Disposal System at No....2..41 . 4. fl ........f,-A - as shown on the application for Disposal Works Construction Permit `No.B--- .................................. ��.. Dated.......................................... - -----------------------••---•-•-----•----•..... Board of Health DATE.................... = '9 FORM 36508 HOBBS a)e WARREN.INC..PUBLISHERS