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Home My WebLink About0129 OCEAN AVENUE - Health 4-CA� & IA N SMEAD No.2-153LOR UPC 12534 smoad.com • Made In USA FMUONMP400 Utm � SA SO SFI PROWM s CERTIFIED 5cwars,:r, WWW.SFV)ROGRAM.ORG o �v No..A::_y3 Fps......$.....2.0...0.0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Towm..............OF.......Barnstable ......................--------................................. Appliration for Disposal Works Tunstrurtion t1araft Application is hereby made for a Permit to Construct ( ) or Repair (X))Xan Individual Sewage Disposal System at: la? I .... ...._Almy .......... .. -------•-• •-------------- --.---..._... --•--•-----•--•----------------•--------- ---•----•--------------------------.... Location-Address or Lot No. 1.5...Q.c eaa...A.Y. .......QX a a :P:Macomber igv i11 e.---••---••••--•............. Owner Adess - .. .....................................•••••..................--•- --••..........---------...............-•--••----.......---•-------••---------------••......------. Installer Address UType of Building Size Lot----------------------------Sq. feet DwellingX-X No. of Bedrooms............3..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers � YP g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures --------------•••-------------------....--•----•----.....----......------------------------------•---•--------------.... 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........................................ 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.....---................ a -----------------------------•-•---------•-----•.....----------•-•-•--------•--••---••-••......-----......................................................... 0 Description of Soil.......................Sand_-&.-Gravel x ................ V ----------------------•-----------•--...-----•---..........----•--•----------------............----••----•----------------•---------------- U Nature of Repairs or Alterations—Answer when applicable--...... 1-10 0 0 gallon tank ------------------------------ - ------------------------------------- 1-10 0 0 g a 11 o n pit-------------------------------------- --------•--•------------•-------------------•---------•--•-•--------------------------......-•--------------...------•-------------------------•-------•---------------••--------------.........--••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TA!'I1E 5 of the State Sanitary Code—The undersigned furtl r agrees not to place the system in operation until a Certificate of Compliance has een iss d y e board heal Signe Eva .a...------ Date Application Approved BY --•------- -•-------..6--- �# Vef Date Application Disapproved for the following reasons:......................................................................................................•---...--- ......................................................................................................................................................................................................... ¢ Data PermitNo......D.�- ..... --�----------------- Issued------.................................................. Date TOWN O ARNSTABLE a*,7 ' u� I.00.ATIO .�r..� c�AGE # VILLAGE �iL�I�_ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE F/12 r.C j,b w�ef SEPTIC TANK CAPACITY 000�Z, ✓ LEACHING FACILITY:(tgpe) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER C A L DATE PERMIT ISSUED: ?,— DATE COZiPLIANCE ISSUED: VARIANCE GRANTED: Yes No (/ Ito D ` .30 t No..fJt,,:_LtZ�.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............r.. j . OF.......:� "., .^,.'. a. `' <a �.O;dam Appliration for Disposal Works Tonstrnrtiun fIrrmit Application is hereby made for a Permit to Construct ( ) or Repair (vy�Xan Individual Sewage Disposal System at: ..:-......? �;` ................... .......................... or Lot No. y •;/••'J"v..C�;w Yi CY'WV• VLZ.a L V S'�i4.............................. ....................................................... Owner Address ..............' ------------------------------- Installer Address Q Type of Building Size Lot___-•_-_.--•_.-.____•-_____Sq. feet U�--+ Dwelling�-z No. of Bedrooms___..._....a,1.._•................---------.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............................................ WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ 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........................ P4 .......-.................... ---•"-......'"--"-"'""".............""•'....._._._.........._.._....._......'-'-'.............--•"'-•----._.._...__.........- oDescription of Soil.......................5,2,,,j..-9•-j3y a-v 1-•-•"-'••"-......-•-"-----"-"-----"----------- .............................................................. x V -"---•'--••"•-•'"------•-•"••-•-•-•"•"-'...............•"••'•-_.......-"•"•-•""".._..........."•--..._.•""-'-"•••-•-"'-''"'""-"-"•-••---'""..... W U Nature of Repairs or Alterations—Answer when applicable---------- - 0© ___' Qn...t tank -- ------- -------------------------------- "•"-•----"-"...-----""-'•-""----'"•"••-----•----'•"•-----"•'---•----....••-•--------•'"".........-•---..._.._•'---1"�?.04t3_-�a�ldzx___pit. Agreement: The undersigned agrees to install the aforedescrl ed Individu Sew e Disposal System in accordance with TITLE the provisions of I LE 5 of the State Sanitary Co{e e�un� ne urther agrees not to place the system in OP eration until a Certificate of Compliance H n f� ue 'hy'the Ioard'of�iealth. fr � � Siged•. �?'3 a• - Application Approved BY............... ..........................-------------•-'"-•--- -----------...........-...... ...................................... Date Application Disapproved for the following reasons.:................................................................................................................ ------------------ Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............T:: .'. .................OF.......... ? .r: sta��- .................................................................. TrrtifirFab of TrrntpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( } or Repaired (� ) by................. ..................•--•--•-•----••-------•---"-'-"•----'---••-••-•-----..."--"--•--•---•--•-•--••-•--'.............•...._..._.___......._........•- Installer at- ?_ --n" "t ..Aye.-C r a �sv i 11.0. -� has been installed in accordance with the provisions of TITS .5 pfj�he�State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated----------------_................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................�_..... - •`-g. ............................. Inspector................. :0.-"•-"'-•........"-"•"•......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C/ '✓a- mow ................0 OF Barnstable20.00 ............ .---.................................---............................ No...................'••... FEE.... ................. Disposal Narks Tnns n frrinit T„p zn_+cyca►n �er Permission is hereby granted .....------"'••'-"•-••---------"--•-••-'-...•-----""-----•----•-•..................................... to Construct ( ) or Repair ( XX an Individual Sewage Disposal System at No............:!-.`rZ...ZQX.....Zcea' ..Alt: .Q C azcxv l e 6�Street _l.1✓2 as shown on the application for Disposal Works Construction Permit No. Dated......:...:......................... Board of Health DATE............... --------'"-""---•--•---"--"-""-'•.-'-•-"'-'.........--•-••.••••. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS