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Home My WebLink About0018 PHEASANT WAY WEST - Health 8 P4•e�s�,T way wtst �t f-4I118 Iwo zo8 - 07 3 i i SIliEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR 0FoRSE% MIN.RECYCLED 1MRATIVE CONTENT107 Certified Fiber Sourcing POST-CONSUMER wwwAffprogram.org &9 01M MADE W USA GET ORGANIZED AT SIIWMM �G^ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uhipos al Works Tonitrnrtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair (,41-155 Individual Sewage Disposal System at: y at ion-Adder. .....C or I of No. .� 1.....l�r'k c -- -r----------• ...._._... -----------•-------------------•------------------•-----•-•-•----------•---- Owner t Address �4 ----------��15----------------------------------- � r.�� d M Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) ............... No. of ersons........_.__._.._._.__....._ Showers — a Other—Type of Building :............ p � ( ) Cafeteria ( ) P4Other 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water......................... ------------------------------------------------------ •-------------------------------- --------------------------------------------------------- ODescription of Soil...........................................................................................................................................fro a rf� .... x _4#. UW ---------------------------------•------------••-•--•••-----•------•---------------••-•------- -• -- Nature of airs 9r Alterations—Answer when applicable_. ._ i-_ ti ._____..__:/�.,((:.............I .__ ts1i�f�j �j ------------- -------------•-----------------------•---•-------•-•-•-------••---•--- 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 b e issued by th board /.nith. Signed G%�/ Go -------------------- ---------------- Application Approved BY ... .... ..... .. D Date Application Disapproved for the following reasons: _ -------------- ....----....--......------.. . . .------------------------------------------------ ............................................... ---------------------- --------------------- Permit No. _ --- 4 e -- Issued ----......��.-------,<.�...------...<....�5-- - -------- Date c� No_....-----•............... Fss.. ....._........... THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uiopoottl Works Tonotrur#ion Vanfit Application is hereby made for a Permit to Construct ( ) or Repair ( /� aaln Individual Sewage Disposal System at* / (� / --• 1�- f FR-5 c'" �'�.. ...... - /'/? •r'� l��•_ ............................................... t . o ation-Addre s 7 or Lot No. ./Ill.Z �`..='--•....�1..... c. v.................................... ---•-..........•-•-•---...--•-•- - -.—Owner t Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of.,Bedrooms.............................. .....Ex anion Attic 1—I g— .._._.__. Expansion ( ) 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 ( ) 0.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--_---_-___-_-__.____--. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---______---____---___ a' Descriptionof Soil.....................----------------------------------------------•---------...------------------------------...... -•�--•••---ov---� Q x r --------------------------------------------------------------------------------------------------------- ---••-• ---•-- ••-- x Nature of Re airs o Alterations—Answer when applicable �f per __ , ? U____ -� U .S--S------e- ..•`..�--------------v..�!�i.�-----�f c` SSA5 ��-.----(...-----...7_5......----------------------------�---------------•------ .......S 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 ben 'ssued by the ,oard of he Ith. 4 Signed - / .:�i��/t `-� -------------- ......................5-�---�.�..C� Application Approved By e ---- ------- - ........ r'� te ��- 9 L Date Application Disapproved for the following reasons- .........................--- ---------................--------------------------- ................................ ................................................................................................................................................................................................................ ................Da[e --------------- Permit No. A2.......... -------------------------- ------------ � Issued ----------��..�....✓�......":..��,�-.----------- Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#if rate of Toraylialare THIS IS TO,,CXRTIFY, That-the Individual Sewage Disposal System constructed ( ) or Repaired ( �r by......... ,f/ fGvi ........... .. ..------------------.---- ---------- Installer //� at ....... �J�-?..5/- ...._.....--/mot/r ./1.... �1 f� ''l/r.. ... - - has been installed in accordance with the provisions 0f ITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. 124%_----�� ..... dated ..../,0..-:...�..-��.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........f.. ..'`.'..... .. ,1....IS� ...-- ............... .................. Inspector .... ----------------------------. _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... TOWN OF BARNSTABLE a O No.............�1.....� FEE. ...... ........f Disposal 11 0 ko Tono#rnr#ion tlrrntit Permission is hereby granted... /� "�...._ - -!1...5...................................•............ to Construct ( or Repair (�--an Individual Sewag�Yisposal System at No.- ......... 7._... _ s •? .?r,/. f� Street as shown on the application for Disposal Works Construction PeERJit No.�,,y-:.�,�,.��Dated.....................: .. `.. . . ................... � Board of Health FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS TOWN OF ��BARNSTABLE O LOCA'11ON r mod%i SEWAGE # r.96 !� ✓ILLAGE4eak�u�_ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.&//y SEPTIC TANK CAPACIT. LEACHING FACILITY:(type) (size) -c�,-_2 NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER it BUILDER OR OWNER DATE PERMIT ISSYJED: 1_?eAp0 DATE COMPLIANCE ISSU Z. VARIANCE GRANTED: Yes No y P�cl� ITO �SR' i r