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Home My WebLink About0023 LONGFELLOW DRIVE - Health �, � L a �c� �e � �o� � '� �'e /� Z�2 r✓J �- L e.. d i TOWN OF BARNSTABLE LOCATION kol,Cs ova SEWAGE # Q VILLAGE ASSESSOR'S MAP INSTALLER'S NAME & PHONE NO. FULLS Rage , 3(.A-69.3°7 SEPTIC TANK CAPACITY /006 G')q- . LEACHING FACILITY:(type) r C 7— (size) jLn�n NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER_/j�_ BUILDER O OWNE � Y kuK.I DATE PERMIT ISSUED: C?D 0 DATE COMPLIANCE ISSUED: � 2- VARIANCE GRANTED: Yes No b�W�-- ��N 3 �� ^ /�,.' �'. �q� 'N'i, •/ No...... -------- '1--- � Fps.. sJ� ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE ApplirFation for Di-4pniiFal Works Towitrnr#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (V�an Individual Sewage Disposal System at: ....._. .. 1 � �/1 . .... - ... - -.... - __.. . . ........•• -•-... 4 .-----•---...--- Location-Ad r ss t No. Ow r Address C:��-l�l S �7foC�.J�'�? Goo 02 3' �!d�¢� ------------- . ...... Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........`7B__..•........•...............Expansion Attic ( ) Garbage Grinder ( ) 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....................................... a Test Pit No. 1_______________minutes per inch Depth of Test Pit.................... Depth to ground water_-_________-____---___-. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' .............................................•............................................................................................................... 0 Description of Soil...............................................................................-----------------------••-----------••------------------------•-•----•••----------_----- W V .....-•------••------------------•----••-----------..._.....---._._.....•-----------......_....-••-•--•----------•----•..............--------........................................................... W x --- ........- 1................................-•---•---------•---•-----------------------•----------------••---------•-----------•-------------•-------•---••-------------•---••-------------------. U to of epair or Al r Ioas—Answer when applicable...._.Q .._��Q�s ' � a �_._..,to- .......... Agreement: 7 7- 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 Complianc_9 has been issue y the board of health. Signe . ---- f.. .. .... . - 37" ugf Application Approved By : J 11..6A... ce Application Disapproved for the follo ing reasons- -------------------------------------------------------------------------- - ---.-...------------------ ---..... ------------------------------------------------------------------------------------------------------------------................................... ------------------------------ .............................................. .............................. ----------........------. --------- Dare PermitNo- -------------------------------------------------------------------- Issued ------ -- -----...------...-----------------.. ..... Dale l 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH # TOWN OF BARNSTABLE Apptiration for Disposal Works Tnnstrnrtiun jhrmit - Application is hereby made for a Permit to Construct ( ) or Repair ( V)an Individual Sewage Disposal System at: Location-Address or,Lot No. .._........ P/!../1•, Q, /..../: Ir�a �an / /Jys- C c/..........{l/ Owner Address W ... . �o w� �:.........�t�ic...a __ ___ .. :...:............ a Installer Address Type of Building Size Lot ...... ......................Sq. feet Dwelling—No. of Bedrooms.--..._..._�.........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures •----•---------------------------------------•--------•••-•••.....•••••---•••••••••--------••-•••-••...-••••••••••-•••••-••-•...............-•----••• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter------.......... Depth................ WZI 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-------------------------------- -•----•-•---•-----•-•---...--••-•----••-•-•----------•-----------------......-----•--•----------•••-•............•-••-•••-- 0 Description of Soil...............................................................................----------------•-----------...------.......-•-•---••----•-•••......•--•..............•- x W UNature of Repa_rs or Alterations—Answer when applicable........,,? ---e�� /_S.....pl C J .r;.............. 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- 1/�.t..;.....1�/- �i:..., --- 3/ � --.. ..- ....:A -///.. Data Application Approved BY � � .. A�r G -,.,1..... .... ...... ......... - 6 �d Application Disapproved for the following reasons- --------------------- -------------- --------------------------------------------------- /."... ----------- ................... .......................................... .......................................................................... ........................................................ Date PermitNo- ................................................ ........... t Issued --------------------------------------------.__.................. D.w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Verb irate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b .------r .i -= rr-- ..:�......--- --------------------------- ---------- C`�° Installer aC .... ... Ni l-a ... r f� .... �z�r ia= � `�..... .............................. ................---------------- has been installed in accordance with the provisions of TITLE 5 of The State Erty>ionmental Code as described in Di/ Works Construction Permit No. .............."""--_-...................---".... dated ....................... ......"".............. the application for D THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. 1.-� (2 ®------------ --.............................. Inspector .. �. -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ! No.�� .. j FEE..�Q�. Disposal Works Tunstrnrtion Permit Permission is hereby granted......-�'��' -t^_'-....A,,�!Z .,. t at�� .. -...., to Construct ( ) or Repair (V�an Individual Se age Disposal System at No.......•: -�:.7ru �.: /�.a_, , . r��i. f_%�a -� : ' ' -=•-----•---•---.....---•---•-•..................... J.:: _ L.,--.--�.�....._ Street as shown on the application f isposal Works Construction Permit No�1�.`��L�Dated._.`/.`-.-..�......��.. _ .....................•----------•---...................------••-----:.....--•••••............•---••.••••. �� C / Board of Health DATE........--------•-•---•-•--------------..Y'�/ ............................ FORM 38808 HOBBS&WARREN.INC.,PUBLISHERS 1 fffttt