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Home My WebLink About0950 OLD STAGE ROAD - Health MqP t7� Owrford, NO. 152 1_ /3 ORA s e6 e AVDWio l ioji,I� 3'Aeo TOWN OF BARNSTABLE LOCATION Lof 6 1?5"/ a/eO5�eeS= e SEWAGE # 9K'� VILLAGE `eM _112 ASSESSOR'S MAP & LOT . INSTALLER'S NAME & PHONE NO. ?h SEPTIC TANK CAPACITY LEACHING FACILITY:(type) .ly+-%llra fora (size) "; NO. OF BEDROOMS -3 PRIVATE WELL OR PUBLIC WATE a �z � 11 ;BUILDER OR OWNER foe PI"er✓rc, �iI�PY `DATE+;P_ERMIT ISSUED:-' f 'r94 Vjt 'r '.' ... .,.DATE"-COMPLIANCE ISSUED: ��►' �� ' RI !/VARIANCE GRANTED: Yes No w 4 /3 13 33 3 ao 3 5-- L� L 0 T 7� fi�.G ` i�',G!�1 ;rT - - on owmEq I�-----.--.>---- _� __.�._-_a I .. � �'�� ;`!, �� j j a\ F ,,� I � ti � ,� a `�. A � :�� ' , No.V7:Y:'' ` Fx .... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 77 Appliratiou for Diupoottl Works Tonotrurfiou Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: pp ....... .... atior-Address or Lot No. r Ar._. 1 ....--•I `,��'v 1 J Q I c�c.._. 4 !_ ...:1 �............................... �" Owner `�-per y �! �/ Address ...............Al.........J..P-1-1.4!'�.-_...............--.-_--........--.........._ --._---_•�L:..l-___!7:"(_...... =l:�!FMZ`S: p N_S___S._... Installer Address Q y J Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-__ ................................Expansion Attic (.N)cy!"— Garbage Grinder (F-4 a r.'c_.. Other—Type of Building ..W9vdt........... No. of persons.......... _............ Showers ( s ) — Cafeteria ( ) a4 Other fixtures -------------------------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9- Septic Tank—Liquid capacity_Ztf.c?..gallons Length................ Width................ Diameter................ Depth__--______---__. W Disposal Trench—,No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. -x Seepage Pit No.G-)-( p___... 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pd O .� - Soil - � ..!L` ---------pX,- -- -- 1 x x ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable_........_aP,.? �� -------6t e------,.a.t-:i ............... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1I'1U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in overation,until a C r 'ficate of Compliance has been issued by the boarcjlf health. Si ned_-_.. tZ/_014�el Date is —.............. � -- Date ..... Application Approved By..........-- - •-- .------------��-------Crn� ----------�-f-=-s-1- _ Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------•------------.......-•----------•-•--•------------------------------•-----------------------------------------------..._..._ Date Permit No....... --- - ��, Issued --.-- - Date t' F� .....�- ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � 10 V.._---------------OF..... - N-......'a:......... Annlirattion for Bisps al Works Tonstrurtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 72 S� .....C.s�__.ol e\ J /4_ ......... s`........................ .............:...............................o•t" --� catio - ddress _ S�o�Lot No.. ��a.y........ .....1� ri . •�---P.. ............................... r. a' Owner o A dres ................ - .........-•--- _.__....6-J .6ri.r...-------•--•.............. , )hAAA. r. __.M.�..L�.S...... Installer Address Type of Building Size Lot........ _..___.....Sq. feet Dwelling—No. of Bedrooms----jrL.................................Expansion Attic Garbage Grinder (Nove— Other—Type of Building WmGd No. of persons.........2.............. Showers / — Cafeteria Otherfixtures ---------------------------------------------•--•-•-•-.---••••••-••---•-------------•----------------------------------••............----.........__.. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityl.r"� ..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........................................ ,4 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 U x ---•-•-•---------------••-•-------•••••--•••-•••-••---•••••-----•------•--------••------•--......----••---••-•-------•-----------•---••-•--•••--•------------•-••----•-••......--•••--•------------•- U Nature of Repairs or Alterations—Answer when applicable...._....�e �. !� �e......lay...... ............... -----N A A_J........ - -�-+� - ----------------------------------------------------------------------------------------------------------------------------------------------•------ Agreement: The undersigned.agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operatioq until a C r 'ficate of Compliance has been issued by the boar d f health.. Signed - '-'«� Y� 11..X�.1 ...... Date Application Approved By.... ?�.... ✓..._--ca u_C_ / S/ ---------------•---••--- .........._.... �......... Date Application Disapproved for the following reasons---------------------------------------------------------------•---------------......-----•......--•--•---------- ................................................1---•'••-•--------•---------••--•-----------•--•--------•-•-••---------------......----•--•---._....----------------•-••---•---Da......---------- te PermsNo. ........................( q Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Irrtifiratr of Tuntnliatta THIS IS;TO CERTIFY, That the Individual, Sewage Disposal System constructed ( ) or Repaired ( ) by-------------- 1 •----------------•-•--=--•---.....----.•..............:.........----•----------••------------•--......---•--•-----.....---------....------...............-------•--...-- _ Installer ----------------------------------------------------------------------------------------------- has been installed in accordance with`tlie provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__-_-$b__.-_O..9-q.._.___..__.' dated-.---------- ................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... ...................................... Inspector........ f ................................. V.. 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.099 :'..................................I.....O F...............................................................................---... NO...-•--••N-- - FEE........................ Elisnosa ll � ,Works TMInstrudion rrmft Permission is hereby granted _ xic/1 --- to Construct ( ) or,Repair( an Individual Sewage Disposal System atNo. IG x? f` X----•y`? ................:.........---------------------------------------------------•--••------•----•----•-----•---............. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.._ l/1:)........................... C . C)' y`l c)41_ ---•----- ------ �q Board of Health DATE ��---------1--.._......_...--i..................•••---.....••-• FORM 1255 A. M. SULKIN, INC., BOSTON �) v t_ S� o o s� f" 77-7 •cam. i• --� / �'ice �.:. '�,," ,��,,��. \ y r '- G r� Ip r )tt t i� 7 If 1 � i i f 1r fr 1 1 v f r r i Ftr,, .. t3 q-, t�.,A P r 1 iOD ` 400 AA .... s 40 / -'{ CE GA • j � J� AjO qqq� rn TA �1• Y.iTT ..t1E�E APPROVED 9Y f�y 1 SCALE: _ f a'-� DRAWN BY ♦.a �t�� ..,� - - DATE: -f'6•f: '�� .9. REVISED [DRAWING NUMBER 1 - f 1'44t7f d ,� -7 � �X'7"". .-.:.-G ro:"LK." .x. _ - ;'�' "&"i'F:7R:"•F'G'.'s��.+1v�VETX•:�,^:r�S;vtTT'{S_"C'^�:"'_ii:�:�-.�z�".=— t ��F+wantaet'°..x^"r''"'or'c'a- � _......_..._...•.� .. .�,...__ .._...__. -`-_ -.. .�. ._.�,... ...............'a...� _. w....,.,........e�...r-..+--•--•.._..,�......_-_•�. t -4 tp �fJ aa.a�ey}t p. tyy ' � f V+ ► F R to 4 rµ ►a►a __w �..._.� ___ _r_ _.�- i - - - - ` '_I l i r 17 Alt _ I 1 E� { 22 d�Y- I �5 V 1�-� ••Ty y:1 L y L.a 1-7. d ' { a;A4 L 1_ f 1/ W / —?5 .i 'lr. ..P",, %�• 14 A<.• ;� 9 i o'�-; ... Ct3 +�f y_.. ' � 1 � � ^''ra ',P.}- � 'D rr� rya_• '+� c=;�'" (� ,�'�ly 1¢d 1 � `� p1s_,�, / i 16 i a . . APPROVED BY _ — SCALE �� DRAWN BY .. i DATE: / REVISED DRAWING NUMBER T �a_