The URL can be used to link to this page

Home My WebLink About0098 INDIAN TRAIL - Health �$ ,A d ial A T-r-a 0 Ce A-virvole 210'01� Ji No...... ....... THE COMMONWEALTH OF MASSACHUSETTS\// FEm ..(9...... BOARD OF HEALTH APPROVED TOWN OF BARNSTABLE Barnstable Conservation Department .Z —,;t Appliration for Diripatial Worlin Tonfitrurtifi ; /—9 rr� Application is hereby made for a Permit to Coilstruc;,..t.' ) or R air Individual Sewage Disposal System at: ...... ............ ................................................................................................ Lo ati h-A it•-s or Lot No. .......... .............. ....................... .................................... ------- -------------------------*-------- Owner dres.- Inst'aller Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms............0-----------------------------E pansion Attic Garbage Grinder ( Other—Type of Building --------------------_- No. of persons_-___---_--__-____-__-_-.-. Showers Cafeteria ( \< P4 ----------- -- -- - Other fixtures ---------- ---- ---------------------------------------------------............................................................... - 0 W Design Flow............................................gallons per,)person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter-_...._......___ Depth...._..._....... Disposal Trench—No. .................... Width.................... .rotal Length...____............. Total leaching area...................sq. f t. Seepage Pit No..-_----.-_-----.-- Diameter.................... Depth below inlet......_............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 04 Percolation Test Results Performed by.......................................................................... Date.-...................................... a Test Pit No. I................minutes per inch Depth of Test Pit._._.......__.__.... Depth to ground water...._................... (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................._.. 9 ............................... ............................................................................................................................. 0 Description of Soil........................................................................................................................................................................ x '*................*--------------------------------------------*'***'*--------------*"**'*****...........*---------------------*-------------------------------------*"*"*----------------------- --------------------------------------------------------------------------------------------------------------16----------------------------------q-Q........A�).--%---------------------- U Nature of Repprs or Alte&4w* ,us—Answfr when applicable------ _-_------_ ....................... k7 7:7N 194 -;1 4: .............<3.... ...... ....................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enviro t I Code—The undersigned further agrees not to place the system in operation until a Certificate of Com fiance sb e board of health. � � � Signe ....... ....................... I... ..................... ... Dace ApplicationApproved By . ... .... ... ... ............... ...a................ .. ... ........................ .. .. ................... ................Date........................ Application Disapproved for the fi;11g* re S: ----------------------------------------------------------------------- .... . . ........................ .................................................... ...... ................................................ ..... Dace Permit ......*............ Permit No. .....q - Dace----------------- Issued ....... 0- ............ —---------------------------- TOWN OF BARNSTABLE LOCATION �� J / ;� SEWAGE # VULLAGE_ / ��, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Age "Pl- AX LEACHING FACILITY: (type)��i�� 'o (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland an Le hing Facility(If any wetlands exist within 300 ee of I hi acil.i Feet Furnished i i Zi io e TOWN OF BARNSTABLE LOCATION —WI)k SEWAGE # VILLAGk 3, , ASSESSOR'S MAP INSTALLER'S NAME & PHONE NO-Eg g�%> SEPTIC TANK CAPACITY [: c, LEACHING FACILITY:(type) 1 (size)(' . NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER_ DATE PERMIT ISSUED: (alai lcl-z, Q DATE COMPLIANCE ISSUED: �7^ VARIANCE GRANTED: Yes No �� P.� kr L+q F o: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Complian-ce, THIS,1S,TQ CERUF-Y,-T-J;at the Individual Sewage Disposal System constructed or Repaired C---y by ...... I..q....... ..... .. ....... : k ).. -- . ... .. .... . at ........... . . ........ ................ --..-.-.-.-.-.-.-..-.-...-.-.-.......** - has ..-.-.-.-.-.-.- been installed in accordance with the provisions of TITLE o, The tate Environmental Code as described in _.!V, - dated , ....-.1-..........-....... the application for Disposal Works Construction Permit No. ...... ......-....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BICONSTRU -D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... --.............-A 0j — ------------.......... Inspector ---------- ............................................... ............... 13. ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE.�J//" Dispos orksAvinotrudion - amit lk\�\(................ .. ........ ...... ..... ................................................................... Permission is hereby granted...........RV, . to Construct ( ) or Rppair %J�anlndiv Individual Sle�w g e Disposal Syst atNo... .......... 07 -e.... ... ---- . . ................. .... ....... ............. Str ect as shown on the applica 'on fo Disposal Works Construction P m.tNo.. . . ed.... .... . .... .... ................. ..... . ........ -X----------- .......... ......'. .......:V . .. ... V ......... ............. .� Board o laith -------------------- DATE.............. -... - .q ., .-.. . 7**--------------------- FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS ��,�y�•�"`•--�L.J��".r_—�_"`„^w ,r,,,�..�..,._-.��..-w---..J�-�•.+'�'`'�..�""`""-"�i,�._�.,;:yw-�-..,.;....-....rF.o;�...�..+.--s-'--•'--.r°.-F.; ....�....w1'..✓+'.:.:.,..,e....r r„e � ";.,.�4Aa.'�:.a.-. "'�'' No. ...... Fx$.... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��1��////// TOWN OF BARNSTABLE �J� Appliration for Di►ipwial Works Towitrurtinn anti# Application is hereby made for a Permit to Construct ) or Repair ( Van Individual Sewage Disposal System at: �'� .......•..... 4 ...... Lo :1 t n dr•ss a � or Lot Lddotr eNs o. ----------------....... �-....... ---_-------- ---------- - -- ---------------------- ------- Installer Owner Address d Type of Building .y Size Lot............................Sq. feet U Dwelling— No. of Bedrooms---------.----------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—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........................................ W a Test Pit No. i----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------------------------------------------•--•-•-•---•---•----•---...•---......................................................... 0 Description of Soil........................................................................................................................................................................ x V --------••---------------------------------------------------------7 W U Nature of Repairs or Alterations—Answer when applicable.....-f ��- i '......T.W:...... k).Q�,!................ -----------------------� �� ° '........... ... ......--------------------------------------------...------------------------------------................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ tal Code—The undersigned further agrees not to place the system in operation until a Certificate of Com liance as bge-+4ssurzi- y_ e board of health. Signe ... .-- .4.... .. ....:.. {Ziai.....�� Application Approved By Y.- �. ------....-0-----......i... . ................ y Date Application Disapproved for the following re .o S- ---------------------------------------------__..............................--- ,.. y ................. !/ ...... Dace Permit No. -f�. ..... . Issued ...-...�(.,�.........C�l./..!... ....................... Dare /