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Home My WebLink About0141 POND VIEW DRIVE - Health ESMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR OSUSTAINABLE FORESTRYRECYCLED INITIATIVE CONTENT 10% Corufwd Mar Sourcing POST,CONSUMER awawApmorvwg ON1290 MADE IN USA GET ORGANVF-n AT SMF.AC COM q aq, 030 D No...._l._..---._._..---. Fss...30........ ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Ditripu Sal Work.5 Tunutrurtiun 11amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: i' a ....� 1........ �%lV' ------ --------------------- ------ -------------------------------------------------------------------------------------------------- a' n.Address .or Lot No. -......�--._.�--�/.-��-- ----------------------------------------------- � Owner � Address ---------------------------------------------------- � �_ 12� ---I�. --.... ---- ------ ---I.............. Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures __________________ ___ _ _ _ W Design Flow.....................................r__.__ allons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit f'7 Mons Length---------------- Width_-____l-_....__ Diameter-_------------- Depth................ x Disposal Trench—No.�9 h&._idth____________________ 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........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 •---•---•------------------------------------------------------••---------.............................................................................. ` O Description of Soil................................................................... ---------------------------------------- ........................................................... x U •------------•-•--------------••••••-----....._..-----------------------------------------•••-------------•----•-•-------•-•----•-•------------••----•---------------------------....................•. W UNature of Repairs or lterati ns— nswer whe a .ble_._. � .PAO. ,......_.. ................... ------------- ............-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environment de—The undersigned further agrees not to place the system in operation until a Certificate of Complianc^as ,,, s the board of health. Signed ............ Application Approved B ............. ., . .---- ..--------------- ..PP PP YApplication Disapproved for the following reasons -------------------------------_ -----------.....------............---------------------------- -------------------- ----------------------- --------------------------------------------..........---------------------------.. ....... -- . ......... Permit No. Issued I Dare TOWN OF BARNSTABLE LOCATION 14( I'"otj od (lssE.Cf/ Ci2 SEWAGE VILLAGE (re-A/fC/ ASSESSOR'S MAP & LOt?Z INSTALLER'S NAME & PHONE NO. T 0 MOW?l IOU 7� SEPTIC TANK CAPACITY /S-UO en LEACHING FACILITY:(type) jDcfi NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �bf t Iy ��'1 e fC DATE PERMIT ISSUED: S -� a, DATE COMPLIANCE ISSUED: *' VARIANCE GRANTED: Yes No 1 �OL 5a ---------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CZex#ifi ate of Complianre THTS IS� G TIFY,What the Individual Sewage Disposal System constructed ( ) or Repaired by - ....... .. ................ .... - ----- ........... - .........._..... ..........................- -- ---- ... at ...- %4/�....... ............... -- ��, 1«..... .._.... --------------------------_...._.............---_--------.......----------------------------- ,has been installed in accordance with the provisions of TIT LErr�5 of The�Ss t nvironmental Code as described in the application for Disposal Works Construction Permit No. ..:1.. .. `.... . _........ dated ._----------------_.._------._...__--- SHALL NOT dE CONSTRUE AS A GUARANTEE THAT THE THE ISSUANCE OF THIS CERTIFICATE SYSTEM WILL FUNCTION SATISFACTORY. p DATE-------- 17---Y - ....................... Inspector --- ,� .r. /.✓... a.....:. ----------- ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE FEE.-...... 9...... Rapood�'l or ii,-C/omitrudian "rani# Permission is hereby granted..... l= ' w' - ---------------------------------------------------------------------------- to Construct ( ) or jkqpairC(,— T an dividual Sewage -�l' posal System at No 7 ---- f . ------•-- = ---------------------------------------- -- . � - r as shown on the application for Disposal ��orks Construction Permit No----------------_y ated I....n....................._A.. .. qy -------------- - .. .. --. Board,of/Healthy l DATE _,_..T-! /l//// FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS No. _: Fins.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. TOWN OF BARNSTABLE Appliratiou for DI-vip Sal Worlw Cnouotrur#ion Vrrutit Application is hereby made for Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: v' Illy v ear Aadre s - -- ----------------- - Lot No. - /� Owner Address �- Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms------ -------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------- WDesign Flow............................................ allons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity ZS allons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No.�,�_J4_2(.f�I�,Vidth___-__.-_-_--_-_-_-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........................................ a Test Pit No. I................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+ •-•---•..............................•----.......---•----•--•-------•--••......----------•----------•---------- __-.....................................&. ODescription of Soil------------------------------------------------ ---------•-----------•-------......---------------••----•--. --••-•--•-------•-•••--•--••••----•-----•--....--..... V ... -... ----------------- •---------------- •---------- •------------------------------------ •--------------------------------------------------------------- •----------------------- ------------ W ------------------------------------------------------•-------------------------------------- ------------------- = U Nature of Repairs or,Alterations—Answer when a livable.__._ `�. . ......................................... ------- a — r ---- ------ ---- ' ... --.....-------- ------------ - - -- - ------------ -----------•--. ............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmenta-l-Gode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance Uhasbbeeissuedb the board of health. Signed ............... .................. --:-------------- ----- Application ...... ._...:.... Approved BY ............ ...... �......,.: i'J.2�� --------------------- Da � Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------- ------------------- - -- .... .........Permit No. ..... Issued . ..... .. Da[e ................ Dare