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Home My WebLink About0198 NYE ROAD - Health ent- _A - 1.47 'C)98 4 l 4\ A .� / 0 No.. ..._.... j Fss.............................. -� 1 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1 ....................OF....tb..Aa4SYi.A V3.LS--------------------...----............ Aliptira#ion for DispasFal Works Tomitrurfinn thrutit Application is hereby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal System at .... 104 _1y. .....1 �J r- , -------------------------------------'-----...�--�....r-'-- ......--------•- - L cation Addre or Lot No. ......................-. ��a , ..................3_J� l.� ► .. ...................................................... Owner Address W Installer Address U Type of Building Size Lot------- f5 �f. l�...Sq. feet 3 Dwelling—No. of Bedrooms.................. ___.._._...._.__..___.Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures .................................. W Design Flow....................5.5.................gallons per person per day. Total daily flow..........................3.30_.....gallons. WSeptic Tank—Liquid capacitylOOO..gallons Length................ Width................ Diameter.-._-___-____-_- Depth............. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........A----------- Diameter........E)....... Depth below inlet........ ........ Total leaching area......200.sq. ft. Z Other Distribution box (v4 Dosing tank ( ) Percolation Test Results Performed by------------- �F -.._` ...._.-- _°� .__._..___ Date._.___ ` .". •--•---- ,aa Test Pit No. I....Z.....minutes per inch Depth of Test Pit......[:Z-_...... Depth to ground water-____'"_.__•.--_--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--____-___-_--__.-__-. ----------------------------`---A--------------------•-•••. . :..........................---........................................................ ODescription of Soil......................................��-Mra _------�A 1°!Z?-----------------•----•---------........-•----------------------------------•. W -----•---------------------••---••--------.._..••••-------------------••-•-----------------------------••----------------------...••---------------••-•-••---------•-••--------•-----•-•-•--•------•••- UNature of Repairs or Alterations—Answer when applicable................................................................................................ 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 Complia ha been issued by the bo rd of health. Signed --- ------ ... ................'---................... -----------------' .................. . � Dace Application Approved By �. .----o------ -. Dace Application Disapproved for the following r ons- -------------- ...................................................... ) - ' ------------------------------- dere Permit No. ------- Issued ... ..... ............................. THE COMMONWEALTH OF MASSACHUSETTS _f...�.. BOARD OF HEALTH ....... ....................OF..... ...�i i t,�. ..................................... Appliratiun for 11ispos al Works Toustrnrtion rami# Application is hereby made for a Permit to Construct (wl�or Repair ( ) an Individual Sewage Disposal System at: , (q fi......Rt>........................................... .................................................... L cation-Addres or Lot No. - .. 0 .................. � v�.. --...------- -........... Owner Address W Installer Address d Type of Building Size Lot.._.___PRQ0..Sq. feet U. Dwelling—No. of Bedrooms...................s,J.rr��.. ...__.....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ... No. of persons............................ Showers — Cafeteria Q' Other fixtures --------------•--•-•---- ----- ..... W Design Flow....................5-5_..............gallons per person per day. Total daily flow..........................3.3.0.....gallons. WSeptic Tank—Liquid capacity I.s?PS2_gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------I........... Diameter---------(3....... Depth below inlet........'_....... Total leaching area......° t??.sq. ft. z Other Distribution box (✓� Dosing tank ( ) _ ~' Percolation Test Results Performed by..............'A. r__ '".......d.Y.6?......... Date..... "".. _'_ ........ Test Pit No. 1....! .._..minutes per inch Depth of Test Pit------ ... Depth to ground water.....""'........... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----------- ..__.-------- _ _..... a ----•-------------------------•----•---•••...:........... ,...................•----••...---------........---•--•-----.....-------•------. ......-- ODescription of Soil...................................... ........... -!`iJ ------------------•------•----••--•-------..........•-••-------•----......-•.••--- x U ---------•----------------•--------•-----•-------------------•--------------------•-...........------•--••••-•-------------•-------••-----------------•-•-------•-------•--•-------........--------•---. W VNature of Repairs or Alterations—Answer when applicable............................................................................................... 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 Compliant as en issued by the board of health. Signed --- -- 3 --- ----- -- ---- -- Q Date ApplicationApproved By . . ...G!;1.:!.(. ... . .....----.... ......- -- -------------- ----------------------------------- ------- -------- -------------------- Eate Application Disapproved for the following re ons- .................................................. ----------------------/Dat/ ........................... ------- -------------------- ----------------------------------- -- ------- --------- Permit No. .. Issued ----------- ./ Q.. Date THE COMMONWEALTH OF MASSACHUSETTS ------., BOARD OF HEALTH .... [40-W-4 OF --... .A tZ i��IT��-3'-b------ ---- Te rtifiratr of C�omylianr>e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ------Ff---G........................................................................................:........ ! Installer at .......... .'C`. G .��................. 1`I .. i ------........... '1 .tE..- -----..._.41.6t1-�.rsM05 ................................ has been installed in accordance with the provisions of TITLE 5 f The Sit vironmental Cod as ed in the application for Disposal Works Construction ction Permit No. .... ��"—?. .. .-....... dated .. . .... ...... ----------------- PP P �5..... .... � / THE ISSUANCE OF THIS CERTIFICATE $HALL NOT BE CONSTRUE AS A GUARA T E THAT THE SYSTEM WILL FUN TION SATISFACTORY. DATE......... /.. - ----------------------------------------- Inspector ..--- THE COMMONWEALTH OF MASSACHUSETTS (� -d---- BOARD OF HEALTH I �r� l�i i—��a t,~.a V f .............OF....... .....1.-. ejI--................................................... No.----._.�............. FEE....-•-•--•--.......... Disposal Worko Torstrm inn �erntit Permission is hereby granted.......`0.4 " 62 `9 ./ .° to Construe or Repair ( ) an Individual Sewage Disposal System ) atNo---------------r...........------......-----�.-.-........;...�?.... ........:.... � , f �... _.... Street as shown on the application for. Disposal Works Construction Permit No.................,./D d... /_ ._!__ .._. --------------. lop ................................ Board of Health DATE ----- ----- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 2adt L:�f I~LAW : 110 V. 3 s 330 G.pD _ �EQi�C TAMK = 33�.r (r7t7 % • L��7 6.RD. : 100•av� �— ---- USA- 100Ci rA L... aZ\ \ '►44 t z �15=05AL PtT usE logo _,GAL . .�MWAt.L A>ze-k = l5o -r . i '8t1T"rO�VI A2EA� So ST=G.P.D. H. SO s =. A t .o = 6d S.PD. TOTAL �eS.16W = 425 lit ou PmML T1oU tZeTE : „lu 2htl IJ'0V- LP-% o 7 r P.i F.P P A. , c:- sul:Lvara � 140.24048 �; ;'F No. ;133 v ''�,��0 FCtST Ea`��`�•`;":. '�'� '`�' .,�;�a-c�°cc .�� v"� � P�1 p I as a o \ MIST P-41-71 r-6=d52Z Tor rwn = 4!0 tL=43,s .. . ..� n lod►M •P t►JN•a2 j 5UPssDIL iooc� IIJ� •�+ 4'pP� '��MKT. IW. G.O.L. 42.3 •" 2 luv f 'Box d21 sc--QnC to ��• loon a,s GAL. AJ I' 4 't• LEAaI4 Mtn• . RT .a SAAItj: .. WIT•i.1 A WA*%4ED. I•D 1 �.o• I.�• P2oT='t Lfa Lt7CATiOtJ 12 ev 31•S LJ o Sc A,"C-- T�-1LV 1 LL.E f�u YJAtt-rL 5c1>L — f�� bAT� lov3o-8y Rz o pOSGC C-MIZTII=l{ 'r$4A-r T1-1G 4ovSC 5G1ow1.1 PtA►�lI Rr--;7G: u>c:t_Moi-i WITIA TWG: �jIDC.LI►-I� E-vT- (�'�d'—.�•.._.. Aug S;cqLJlQEAAE-uTy of -rwC— •TowtJ off- FA47-►JST aL6 ANn is NoT t..oGATIRM� IN ►JTC rzv I� LE !�I�F1 c.,_= ,��5 rt�E r-Loov PLAtu.- OcT. ?0, 1989 (2CG15'[�tZ�D 1-Al.lG SUe�lc.�(o2� Tl-1l5 C7i_AI-! l!, 6JC>T L3AyCt7 Ua.y Aw OS?E2VlLlL- o I(,(ASSr, JSt'C':J/.�t C_�.1, �,u c�_•it_�• � 'T't��, bt=c:5�'r�, SI.1a�t.al� ti�R t_t rc, t�r__1'c c�M t�1 t; LOT l_t 1.e s TOWN OF BARNSTABLE Hof 470 c LOCATION/16 e /fd _ SEWAGE # VILLAGE MAP ' LOT l.1/7 INSTALLER'S NAME & PHONE NO. 764, 19 SEPTIC TANK CAPACITY /00 5 4 LEACHING FACILITY:(type) 9 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER, BUILDER OR OWNER DATE PERMIT ISSUED: / / f DATE COMPLIANCE ISSUED: !i VARIANCE GRANTED: Yes No r - I� 37 `� �"7 �� ou�r� � �� n( f1/7-o99' L)04- cw�,/V MH MH r boo S� „Z �L f „M 36 i . u � II O - 918 o - i n 9 8--_............................. ..... i i 0 Z �/� s U L Lv I- w A