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Home My WebLink About0073 PHINNEY'S LANE - Health (2) 73 P�;n�w�t LA�e ce n t�fvl�l@ 2oq - 052 - 005 - - - -- - �- /!! SMEAD No. 2-153L`f UPC 12934 amead.tom • Made in USA Y` as SUSTAINABLE FORESTRY INITIATIVE Caetifled RborSowcbw �w�w.dio.opHm,o,u I I /_' �I^ � v I I I I I I r No. ..... F"s.. ..:. ............ THE COMMONWEALTH OF MASSACHUSETTS B ARD F HEALTH ...........L. .. .........OF....... .�f. . Appliratimn for Uiupu,ial Works Tonutrurtiun Vrrntit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Dispo System at: L cat.n-A ress or Lot No. ................_.....&:r4Y.. o .'. _s/:.-•------ •--- ... .----------------------• --- ...... ------- ..... Owner Address a .............•------...----------•.._......--------.....q.V&.k-------®aft ------------...--------------------------------•--------....-----.......................... Installer Address Type of Building Size Lot............... ..Sq. feet �-. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Buildiii � yp g •---••-.................... No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ..................................... Design Flow........... ...1--0......�.___.....gallons per p erd Total W y. d�'y fl�qw..._._._...�_��?..- :::::::::-----gallons. WSeptic Tank—Liquid'capacity. gallons Length-- .....6.... Width: .. Diameter................ Depth.. _.//..1 ef x Disposal Trench—No. .................... Width.................... Total Length.........J. ......... Total leaching area....................sq. ft. Seepage Pit No...... ...... Diameter....... .. ..... Depth below inlet......( .._._. Total leaching area-. 7.....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........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ....••-•••..............•---------...........---......------.............-••---...-----.......------......................................................... 0 De ri tion of Soil................................ Wts - :::::::: .:::::::: ::::::::...:::::::::.:::::::::::::. ---- ` ---- ---------•--------------.......-----------.......................... V Nature 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 L I I.L 5 of the State Sanitary 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 ApplicationApproved By................•-•.......----......--•-.................._..................---....----.......... Date Application Disapproved for the following reasons---------------•--....--•---•----•---•-------•---------...------•--•-----...----•---•-----•-------.............. ---•...........................••---...-------------•----•-----------•-----••------..............---.....---•-----------......---------••---•------....------••-•-------------....---................._ Date Permit No.--- =1�.-J95 te -•------------•-----•--------- Issued........................................... ......_ Date No............../ FEs.: 1 ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEALTH JC� / ............1..(/.�!(>.1. ).......OF........ !4:.>./. .(i. ...................... Applirtt#ion for Uisvosttl Morks Tuns#rurfiott rami# Application is hereby made for a Permit to Construct;(ri" ) or Repair ( ) an Individual Sewage Disposal 1�7 t system at: _Application.is �� - ��o�t��l/v� �f ... - ...................�--... . --- ------. .........•.................. Location Address or Lot No. .............•.--.._...... fl_.�t1 f._7......�-•--•---- -_... ..... ......................................................------••--•--•••-•--••...._......_._..... _ Owner Address a - .......... _ -o�rt f�Lt 't. t .. .... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers Rai YP g -------•-------•--•--------- P ( ) — Cafeteria ( ) QOther fixtures ..............•-...----...._... ..... Y ._........_....-•------•-----•------...............�...�....... W Design Flow........... ..I. ` ... .....gallons per person.,per day. Total daily flow.......... `.�.�.` .............gallons. WSeptic Tank—Liquid capacity.�&Iy gallons Length ! ._ ?r _ Width./ ��'•Diameter_-__�--_-_... Depth.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...._...._-.......sq. ft. I�rt� 3 Seepage Pit No....... ............ Diameter........ n.... Depth below inlet...... ------ Total leaching area.7C.?.....sq. ft. Z Other Distribution box O' Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minute per,inch Depth of Test Pit................... Depth to ground water......................... 44 Test Pit No. 2................minutes peri'nch Depth of Test Pit.................... Depth to ground water........................ rl aI •............••---••-•-•.................................•--•--.....................---...._.._...--......................................................... 0 Description of Soil........................................................................................................................................................................ V/It........!.:.. r�, .... ---....---•................•-••---•-•• y........ :.........-•--•-•--•--•--•------•--•---•-•••--•............. •.....-•••--••-••---••----•••••••---•..............--••--•------••.... U Nature 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 TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of liealth. . Signed...................................................................................... .........................._.... Date ApplicationApproved By.....................:............................................................................ ........................................ Date Application Disapproved for the following reasons:...................................................................................... .......... .., .............................................•---•-•---.....................-•-------•----.............----......-••-•-••---•-----••---•-•-•-----•----•---•----•-•--•--...-•--....................._.... Permit No.._��.:�� .. Issued .Date...... _ k - Date --__r- ra -r--..R--t________-------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w I() Ce).�.............OF...... 5�79 L�.. Ter#if irtt#r of Tompltttnrr �11 THIS IS TO CERTIFY, That the Individual Sewage Disposal System construe Yed l(e oi;CRep;ft6& by....... -- 4 ( ) 6:7 a S r7z c.t...a•t'/<I rJ ....._ :._ .-------—--•-•-•----••-•-------•--------•-•---------------------------•--•---•----------•--•----••-•----------------------.-----•-•-••---------•----••---••------.--------- ql / e4lI. -vns�Jlei .. has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._a ."YR..............:.... dated...1_/4 .0...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............S1.:...`. ...,�!��F t,•.----.............. Inspector-f ...., THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... .. ..................OF........3....................!�.. . ......................................... N o. -. 5 FEE ........ Disposal Works Tons#rWion Vrrnti# Permissionis hereby granted.............................................................................................................................................. to Construct (✓✓) or Repair ( ) an Individual Sewage Disposal System atNo.._ , 71�5; �/t/Evr°./'r' +•_�_.....( ---•-•---------•------...--•-----------•-------•-••-•........................... I Street as shown on the application for Disposal V1'orls Construction 9,.r /®A D d /-./ ��--•------------- .............................•....._.... :..............._.......__._ DATE. '' Board of Health ..._.. f_`..-�:............................_ 73 i�l�ofp,�,<�s 140*OWN OF BARNSTABLE LOCATION L d,% / ///�✓.�v�'�'�" �`� SEWAGE # VILLAGE �'rv7,6At Ile ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.A��-,e'll SEPTIC TANK CAPACITY / -S LEACHING FACILITYAtype)Z-4�-- � A ,i (size) NO. OF BEDROOMS .3 PRIVATE WELL OR PUBLIC WATER lip ,111 BUILDER 0 ER ��Y o��'� 7 DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: " VARIANCE GRANTED: Yes No �� _—r � —-- - '�q �. / °b', � �� - �` - - / � '_� i (� r' " J' / r I . 1 _ _ � i . �� I � v � 11' � i i � �� / J � c� _— p V ,61,E c��L Z� Y��' �i� y o a To I;,aIG1PAL Wr", 'SZ ,C-,,o Z ', � 3, Pi P�- Pt�c.�• ►/�",�F� urt��ss o i� P�+� r1orE�. 4, 4, >✓��I%�l Lc,.,CAt l t<s T u A-�4o -14-10 -44 1 _ ; , 4? . y Cp L7EYo;U£'j'o ;24� 1�4 N',a:t:. �;1�.lt2ptJ�,Eti�dl� (JJC;'E JCtTI.E g� �x' ' ( � � /- � �� 1 ,•THIS Vt-.Ar.l �F_ t�E-r��t�P_K-c>r1�`I Ar�ID �'r'�t.l Lp tJ�7 / Q J T� -ILI -- all k LET T'Sr- I cc uP t o r;c rt bu / T'�F 51.lF - 4-0 14.G! Ll Lc A t 1 �-j T tr/ . 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