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Home My WebLink About0015 HILLSIDE DRIVE - Health rs Hl*li_rrjt or Ce q ft rvl'i I-e 113 - 147 S M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR �FORTS MIN.RECYCLED ITIATIVE CONiFM104'o wffwdR6lm=mp POST-CONSUMER® UV stmxo UMEINUSA GET ORGANIZED AY SMEAD.COY 00 No._ 1j.... .. Fins......20 . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF -- . Appliration for Biiivviial Marks Tonstrudiun'trrmit Application is hereby made for a Permit to Construct ( ) or Repair (/ an Individual Sewage Disposal System at: 1f1.C..... ... .......... ----------------- •.-- ----- 1 .Location-Addr ss, or Lot No. ......_. � � Owner -A�ddjess Installer Address Type of Building Size Lot............................Sq. feet ►.. Dwelling—No. of Bedrooms..............3-------------._._.__------Expansion Attic ( ) Garbage Grinder ( ) Other—a Type of Building ( )yp g No. of persons---•---...-----.----------_- Showers ( ) — Cafeteria Other fixtures ............. --------------------------------------------- ---••------------------------------------ Design,Flow............/,,O........................gallons per person per day. Total daily flow..............3J.0...................gallons. a Septic Tank—Liquid capacity.J_QA?.gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY..................................................................•....... Date........................................ 0-1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water................... fs Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._..........._._...._.._ 0 a ....._..--•--•---------------------------------------•--•--•..............------............................................................................ Description of Soil...........................•---•--.........--•-•---•-•--•-••---...--------•------•-----------------------------......---•-------...................----................: W .............................................•--.......................................-----......--- w --.-------------------------- ........................................................... -------------------------------------------------•-•----------------------•--•---•--•---•- •-•----•---••-- -. i-------------------•----------•-------.........--------•---........----........... U Nature of Repairs or Alterations—Answyr when applicable..... 1,jg.._.avjz __S/X_,>?.__Fl�n1.�f3!/=F,v.FStlQ,4...``.L' Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIZ 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 f liealth. Signed...... ---- - - ........................... Application Approved B Da PP PP Y ..._.. - � Application Disapproved for the following reasons-------------------------•-----......----------•-------....-------•-•------••---•-----•-••-----•-•---......_..... ..--•-•-.........-•-----------•--------------------•----.......----..................---•--.........--------•----•--•--••-••.....•--------------...---••-----......---...--•--•---..............._--••-- Date Permit No..----- = �lZ� /......................... Issued............................................. zm - Date 00 No. ..... -- FEi...... _..... THE COMMONWEALTH OF MASSACHUSETTS q R - � H n M TOWN OF YARMOUTH-' Appilration for %ploal lVads Tanstrartton rnmit Application is hereby made for a Permit to Construct ( ) ;or Repair (/ an Individual Sewage Disposal wi System at: ......... ----------------------------------------- .------•-------------.--_-----..._--- Location-Address, or Lot No. . ..T.. 4)Y11-;Z9----------------------------- ----------------------------------------- ...................._..... Owner Add ess a : 1R c._:.�,/ s n�.r - �;.................. ..........W.F.s�... Installer Address Type of Building Size Lot............................Sq..feet Dwelling—No. of Bedrooms.............. .......................Expansion Attic ( ) Garbage Grinder (' ) `4 Other—Type "of.Building ....... No. of persons...:........................ Showers — Cafeteria a. Other fixtures ---------------------------------- /� -------------------•----------------------------------------------------------------------- W Design Flow........... ........................gallons per person per day: Total daily flow.............-?J.0..................gallons. WSeptic Tank—Liquid ca.pacity.l04.0.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width......k............ 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. 1----------------minutes per inch Depth of Test P,it....".............•Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.......................Depth to ground water........................ a 0 Description of Soil.................................................................................V................ •-•-••••-•-•--•-.....••---•......---.........--••--•----._.......... ^� U ------------------------------- W --- U Nature of Repairs or Alterations—Answ when applicable_ _. ..f�S--_�n4-... " sr� �� / --------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1 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 ,f health. _ Signed------( C'... . ••-•-•----•• --..._....--••-•-•---•..... ---1�f�0 �0._._... Da e Application Approved By.......... ! ....... ..................................... ........ �1�.-.� ....... Date Application Disapproved for the following reasons:.. -------------------------------------•------------•---------------••---•••-•-••-•-----.-- ..................................................... -•-•••--•••••••••--•---•--.....---•-••••-••--•••-........---•-••••-•-••-•••••.........-•--...••-•-••-•-•••-••-•-•••-•-••-•---•-..............----- q� Date Permit No....... ._:.J� !----•-•................. Issued........................ ._....._........._.... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN of YARMOUTH THIS IS TO CERTIFY, That the Individual1 Sewage Disposal System constructed ( ) or Repaired (r� by --•---•..... , A. ..I, ;••---:.....-•-•..........................•------•--------•-•............................--------aller �. at............... .............�y...rj� 4,_ -: --� ;.._...........,V4ti` - has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code'a's described in the application for Disposal Works Construction Permit No...._...Zin..y4.l-____--•-. dated...............'_`.... ._._._..__................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTER THAT THE SYSTEM WILL/(FUNCTION pS.ATISFACTORY. DATE..•--..•...--•-......... ..�g....!...................... ....... Inspector....... ...... ---.:............--------•- ... _..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CyD TOWN of YARMOUTH �d 00 No.- r.... � FEE.,.... ................. Bill-Vagn works Taff friar .emit Permission is hereby granted........... '.._ ....--•----------------------------------------•------............................. to Construct ( ), or Repair (� an Individual swag Disposal stem _... .at No..••--•••-_•-•• -. Street llJJ/ as shown on the application for Disposal Works Construction Permit No '_7.SFr�_.. Dated........................................... -•------------------------------------------------ DATE......_.... Boar of Health �__-_�Q_`_�l). TOWN OF BARNSTABLE LOCATION ,yjLl�i �- D,pi��- SEWAGE # 10 - J VILLAGE ASSESSOR'S MAP & LOT l 3 d V 7 INSTALLER'S NAME & PHONE NO. IR ,1� sLQ G SEPTIC TANK CAPACITY Lo oo LEACHING FACILITY:(type) Flt-j z4 (size) NO. OF BEDROOMS 3 PRIVATE WELL O PUBL:C�VATER rJ�S BUILDER OR OWNER A DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ,V/" I 4t o � iL �Qr v