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Home My WebLink About0300 OLD CRAIGVILLE ROAD - Health 'Qd 01--lD C-Ifih GV i LIU,.'�aP�p S M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR 0FFORESTR MIN,RECYCLED 1NITLATIVE CONTENT10°k Certified Rnersmecing POST-CONSUMER® www,agroprwmrp SR MM MWEINUSA CErORGANIZE IAT ABMM V No....•-4----3h A P 7 0 V E D yy .... '..'....'...". $arnstablu Conservation CommiSSSOnCOMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �MN OF B A R N S T A B L E au 1 "�Signed slg ateAppliratiou for Uhipoii l Morkii Tomitrnrtinn antit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: , ........................ld � A 3 -......--.......... Location-Address or Lot No. \ Owner Address W .....-------•--------•--•-••----......--------•--- -•=-•-----•-- Ats�-t4t�------.............--••---.....__....................--------• Installer Address UType of Building Size Lot.........y'-�............Sq. feet Dwelling—No. of Bedrooms.............dam._-------.._.__---_-..___--__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..:......................... No. of persons............................ Showers ( ) — 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........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ W •---•----------------------------------••------•------•-------•••------•••-----•••••-..................------....._.........------------...........---....-- O Description of Soil...............................................................................-................................................................-....................... x1 U ---••--•----------------••--•--------........-•---------------•--.....------------•-----------------------------------......-----...---•--•---••-----•-•----•---------------•-•--••--•-•--•--------•••. W M. --------------------------------------•- -------------•-•--------. ---------------------------------------------------------------------•-------•---------.....---------------------------------- U Nature of Repairs or Alterations � —Answer when applicable._f4Q Zs__- ......1._ ............................................. ...............:--------- -------. •..............d -_4Q't!j�........... h ......................................... 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 ..................................................................................................... ................ ..................... Dale LY Application Approved By ...... / ?i .�..-.r- ✓ .tte Application Disapproved for the following reasons- ------------ ----------- -- --------------------------------------------------------------------- --------------------- ---. ................................. ... ......................................... ................................................................ ... .. .... ........_.......--.----........ PermitNo. ......1..,�..`..---c ..�-..5 .....---.. Issued ------------------------ -------------------------------- -- Date TOWN OF BARNSTABLE LOCATION 300 Old �c�`<�✓.�� 04 SEWAGE # 4l" 3Z5� 9 VILLAGE �P� �I ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. -1.J. Dc;scoll SEPTIC TANK CAPACITY 1 0 000 5,40115 LEACHING FACILITY:(type) Legc� YJ (size) 1.060 t cjl(o4f NO. OF BEDROOMS Z PRIVATE WELL O PUBLIC WATER B`I t-DER OR OWNER DATE PERMIT ISSUED: 7z 7- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r 4 eL`U I eSI Q ROL) �� No....,.,h.._.. FEs..�� ..r-.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apptiratiou for Bhgpiia1 nrkg� (foustrnrtirin ramit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: e ..1!?. .�...�z� 3 ......... ............................. 1 Location-Address l or Lot No. k� ..................................................... -••-------•------•-'---------------------- z� ...................................................... Owner 1` Address -------------'-------•--'•---^............•........... ...............�!..t.�:�.t4t-�--............................................................ =! Installer Address UType of Building Size Lot............. ............Sq. feet ., Dwelling—No. of Bedrooms...........-,---------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—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. 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........................ 9 --------------------------------------------------- -••••'---------- .------------------- --------•----------- .......------- .....---------- ••--------------- --- 0 Description of Soil........................................................................................................................................................................ x V -•••'•••'---•••-'••-•••••-••••--•--••••-'••••--'••'--•---••••--•---'---•-•'-•-•--•'•••-'•------••••-•---'•'•••-•------•--•'••••-•••'•-•-'••'••---••'•-•-•••-••-'•--••--...-•'"---•-•...•............... W x •---•••----•--------------------••------ --•-•-•-------------------- ---------•-------------------------------------------------------------------------•----•----------------------•'•......•... V Nature of Repairs or Alterations—Answer when applicable..__l�.ct015________--1_`rk��k.._1.......................................... -----------•.............U.r -�xn _-e -�-----�---5_y.S+Yates....-----•---1;UO o--- p'�1........... y t? r S¢ ....................................... 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 --- - -- --- -------------- ----------------------------------- -----------------_----------- ........................................ Date Application Approved By - Application Disapproved for t e following reasons- ----------------------------------------- - --- - --------------------------- ---------------- --------------------------- ------------------------------------------------------ -- ----------------- -- ------------------ --------------- --------------------------....................................... Dare PermitNo. ...... --`......3-` •-.-5...................... Issued ..................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE kTrrttftca to of (11IImylta n e THIS �TGI..CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�by .,- Installer at . C�. ...... <-+�'�' ..-.. / - �-- --------------------------------------------------------------------------------------------- . has been installed in accordance th the provision5-of TITLEV 5 f1 The State Environmental 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 UNCT�10,N�S,A�TISFACTORY. y/,`✓� DATE.--..... .......................... Inspector ................................. .......................... THE COMMONWEALTH OF-MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...� �� FEE..�� ........ Btopsn1 IV kil Tonot Ilan frrnfit Permission is hereby granted............. - ........ ........p..`......._ to Construct ( ) or Repair (,>)'an Individual Sewage Disposal System at No............. .- ..................... ..gip * � =_ � ------- • Street 7. as shown on the application for Disposal Works Construction Permit No._ .�..S D ted.._.7z.......................... ------------------------------------------------- l� J . Board of Health DATE---"....... -----•••--•- FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS -