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Home My WebLink About0079 HOLLY POINT ROAD - Health 79 Many po *Af R� CPA 1'erVi 1('@ /// ':; MEA KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT10%® 6ertified Fiber Sourcing POST-CONSUMER wwwafiprogr awro Sty O= WDEINUSA GET ORGANIZED AT SIIWt M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OWN OF BARNSTABLE G� XVV1rr M11P for Diripwml Worlig Toustrurti ll ramit Application is hereby made for a Permit to Construct ( ) or Repair (4-j"'an, Individual Sewage Disposal System at: ......... ....................... --•--.-•--------7-5------------------------------------ tiot Aor Loti3,l�._._........... 1- - -------------------------------------•----• --•--•---s - ...................................................................... W Oe-ncr ' /' � C3J.----••----••-•--------••-•----•----------------- � .....�`lA ........�d�cs.s ... (.) .�G A......... Installer ddress UType of Building Size Lot............................Sq. feet � Dwelling—No, of Bedrooms----------- ----Expansion Attic ( ) Garbage Grinder (eVO) 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. 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................--. Depth to ground water..---.............. L4 Test Pit No. 2................minutes per inch Depth of Test Pit............--...... Depth to ground water........................ R+ ....-•-••-------------------•----------•-----•-••-••---•-•-•---...-••------......--••--..........--•......................................................... ODescription of Soil........................................................................................................................................................................ W U ........---•-----------•--•--------•--•--•-------•---------------------------------------•-••----------------------•-------------------•---------------•-------•-........................-- ........ W --•------•------------------------•------------•-....-•-•----...---------------....------•--------•----------------- ----------------...--------------------------------....... V Nature of Repairs orA Alterations—Answer when applicabl .—P7-5 I/-------17--/65Od..... ��.._..�vf�..�_._7�0. .....�.�`�-Q,t�.... --t--o---..----.4-'-----..�hL�4,y ------.W? -`-------0-- ........................................................... 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 .......................... ...... C.0�t rta..�..,..._.---- ....../ .....f. .'..,� Date ApplicationApproved By ............. .w,.., ....... .................................................................. ....../... je..y -..�f.3 Dm Application Disapproved for the following reasons: ...... ........ ... . -- . . ........... . . ...................................................... . ..................................... . ........ ..... - . - - ........ -- - - --.......-- ...................... .....................- - - ......... Qs r�� Date PermitNo. ....../....�..^......5................. ................... Issued .................................................................... Dare ....vim "`...!"� '-. y r- • r Y.. w ,� ♦'.. .�..�v" 4'-.._ �S No.--�� J .1�Y� Fizz.... .......'.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OWN OF BARNSTABLE Appliration for Dire opal Workii Towitrur#ion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (4, -)an Individual Sewage Disposal System at: . ----------------------- -•--•--•-•-----•-------•-------•-•------•-•--------- •-•-..--•••----•----••--•----•------ lLoCaa for -Address or Lot No. ......... -_t.-� ..............., �f' \ -----•------•--------------------------------- ----------S Y9J:1 ._.. t� Owner Address r ------------------------------------------------- b---- � .�n....._.: 1^ :, Installer Address Type of Building Size Lot........................:...Sq. feet Dwelling— No. of Bedrooms........... .............................Expansion Attic ( ) Garbage Grinder (NO) aOther—Type of Building ..--_---------------_.--- No. of persons---------------------------- Showers ( ) — 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 ( ) aPercolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. 1----------------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........................ W •-•-------------------------------------------------------- ---- •-•-•------ -... --•...... •••---------- ------ -.... --•---------------- ----------- •............... 0 Description of Soil........................................................................................................................................................................ W x ..................................................... --------------------------....-.-------------------------------- .................................................. U at f Repairs or Alterations—Answer when applicable.._Try //-__-_-_/- 4 QD__•___'9. -_-_f ti Nature ...... :�..I ........!n.........�--------- ' 1 t e Y .......tom a� --J:?`a�:1 ' 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 .......................... ..f_.......l /./.. �. O O --.. ... �... .......<_..vr4 ..y_t,...,,_->.,.-,...,,--sa.... ...............Dare .... ...� Application Approved By ............. e,, ..�..,�,< .b ;..'...... ............................................................ .....1.. ...,.1.. ...-.. 3 Dace Application Disapproved for the following reasons: ........................... ..................................... .......................... . ................................ .............................................. ............................................................. . ..... .................................... -- ............ .............. ....................... �p Dace Permit No. ----..l... ........�.�G ................ Issued .-......... ..... Dare ------------------------------- r.- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifi ate of Tomplinure THIS IS TO CERTIFY, Tha>the Individual Sewage Disposal System constructed ( ) or Repaired O-~ by ........................ �/. ..........--.. ----------- -- -------- - ----- ..f ......................... ......_..........._............................ �� at . ........... /�{/ ""/f�l1.�s:.>. `. I.......... .....-�./�.�1./i..l ............................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..----!�3-.-....,j t�1��.... dated ..................................-......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ............... ..�. `_--t' ----..../��..... ---------------__._... Inspector .......... . ------------ ......------ ----- ...............-... ------ ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No................. FEE.---...r��.7.......- Uiopoiial Works boat #rtar#ion rruti# Permission is hereby granted....... .--------------- ✓�T ? to Construct ( ) or Repair (t e)�an Individual Sewage Disposal System at No Strect as shown on the application for Disposal Works Construction Permit Noya_:%.__ Dated........................................... -----------------------------.............................. DATE.......... ` ................................... Board of Health 1-�.-..�-.�,..-----f-- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS .TOWN OF BARNSTABLE 1V1 �LOCATION � /��[�s/ ®e>,yT /Q 1�, SEWAGE ILLAGE �'�'V),r Q /`/LL10" ASSESSOR'S MAP Sz LOT N STALLER'SS NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY /SCIO e.44 > LEACHING FACILITY:(type)116-,4_ ,�r V S (size) yX y)e V NO. OF BEDROOMS -.PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ,6141, its►U LL lAl DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: / _ `13 VARIANCE GRANTED: Yes No r s IO a� A