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Home My WebLink About0025 POND VIEW DRIVE - Health 25 POND VIEW DR Centerville A = 228 - 029 A/ SMEAD KEEPING YOU ORGANIZED No. 12534 2-153L0R /A\SUSTAINABLE FORESTRY MIN.RECYCLED l'�rJ INITIATIVE CONTENTID% Corofi.e Fiber sourcing POST-CONSUMER www.cfipraar.m.orp fiF01290 MADE IN USA GET ORGANIZED AT SMEAD.COM No.. ..f .... -� •• -- A p Fps.......................... THE COMMONWEALTH OF MASSACHUSE"tabjd p R o v E D BOAR® OF HEA THJ�g.. cohServationCo�fSsfoA TOWN OF BARNSTABLE U Appliration fur Uiipusa1 Works Tomit anat Date Application is hereby made for a Permit to Construct ( ) or Repair (D,:�) an Individual Sewage Disposal System at: .....------• •--••••--•-�--�......... .......� ......----•-. -----------------------............------ ^ Locati� ^d �es U J or Lot No. O ner ddress 1G8 Installer Address Type of Building Size Lo 8� ..Sq. feet �-, Dwelling—No. of Bedrooms..............�.......--.--...--..--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.....................----... Showers ( ) — Cafeteria ( ) Other fixtures - W Design Flow.................. -.......--.- allons er erson er da Total dail flow......._ .....................gallons.g P P P Y Y WSeptic Tank—Liquid capacity/"gallons Length................ Width................ Diameter.........---.... Depth................ x Disposal Trench—No..................... Width.................... Total Length............ .... Total leaching area...........---------sq. ft. Seepage Pit No.........Z_/ . .------ 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........................ fs, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water............---....---.. ►x ----------------------------------------------•---------.....------••----------......----•-•..--•-••.........................................................O Description of Soil--------------1-----5----`-- ram.._ .L S SO>C. - ....................... W U -•-•--•--•-••--•---•---------------------------•---••---------------------•------------.......-------------------------------------------------------------------------------------------•-------------- W x •----------------------------------------------------------------------------------------------......................................----------------------- ----------- --- U Nature of Repairs Alterations—An wer when applicable-l �.-.._../Qa!�4��"�'� 71------•--...............- -- ----- --- ------ - -- --- ---- -- ----------••---- 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 s b en issued by the board of health. Signed .------- Date Application Approved BY -- -- - ------------ ------- ---------------- -- ---- --- -- - --------- - .. .... ............................. ........................................ - Date Application Disapproved for the following reasons- --------- -------------------------------------- ---------------------------------------------- ----------------------------- Date PermitNo.- .... ............................... Issued ........................-------------------..--------------------- Date TOWN OF BARNSTABLE LOCATION U/jQ.0 tDOU6 SEWAGE # 7'/ VILLAGE '�-7j! 1ik �unzg ASSESSOR'S MAP & LOT=4.>?- QcXg INSTALLER'S NAME & PHONE NO.,�9O1-2�7D LAW SEPTIC TANK CAPACITY Q LEACHING FACILITY:(type) Z 71.7- (size) !e"Xe:-J NO. OF BEDROOMS PRIVATE WELL OR UBL1C WATER BUILDER OR OWNER -� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r r - Q P,i r - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH; TOWN OF BARNSTABLE. /v •3� . Appliration for Disposal Works Tonotr tWn Frrmit Application is hereby made for a Permit to Construct (" ) or Repair (p�)' an Individual Sewage Disposal System at: i /` ,L-ocation-Add /�uCX �L)i4-1 1�.� �_ ��L)"R Il t xo. f�(JJa or - W .............• .......................................... ............. -...................... W /� /!/�O<// l'Q/V 1/✓. %�� "Address Installer Address Type of Building Size Lot�-�a, ..Sq. feet Dwelling—No. of Bedrooms______________ ____-_---_--_•--___-_•-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..................................................................................................................................................... W Design Flow..................... .S...............gallons per person per day. Total daily flow._.__..q�!n.._._.............__.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.....-Lf_�------ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil............ -` �.1 -.. .�S U/ = ---'......--- � 1 J. ................. U ----------------------- ------- •-------------- ---------------------------------- •------------------- •------------------•--------•------•-------•-------•----------------------------------- W U Nature of Repairs Alterations—Answer when applicable../�Z`!��L__.�___-Z. DI�� .............................. 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 / L g ,._..w- --................ -- --------.-------- -- re Application Approved By .. ---_ .. v��W6WL----- -------------------------------------- -------.......-1 ------------------ Dare Application Disapproved for the following reasons- ...................................................................................................................................... ------ ------------------------------------------------------------------------------ ----------------- ---------------------- ..............---------------- Dace Permit No. // 1 V Issued ............. (...-,.....................'-------.-........-.--.-......------... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#tftra e of Tontylianre THIS IS TO CERTIFY, That-the Individual Sewage Disposal System constructed ( ) or Repaired (-'1 ) by............................................... - ------......................................... .........................................1�T�---....... G ' ...---- . at ......... -- > AA' ler,/�� /1 el U� --------------------------------/--_--------- ----------............. ............................ .................................................................. has been installed in accordance with the provisions of TITLE 5 of 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 FUNCTION SATISFACTORY. - ' • .� �.� ; �f" x,� :; of �1 � � -,_.--�c ,•; ,. r DATE......................................... fir..--;f-l" f Inspector .......lk--.-�t /t r l�l I , 1 µ xx 1 .tk THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q�— Wo No...... TOWN OF BARNSTABLE ...._.. FEE........lJ............. Disposal Works Tongtrnr#ion rrrmit �' GIGDi�7 �lJ� �Ll1Lg"7GnI Permission is hereby granted_.. ..................... •-•-----•-----------------•----•--------•-•........................................................ to Construct ( ) or Repair (k) an Individual S .wage Disposal.System / -------------------- . / at No............................................... - '`�J U/�1� lC I U'�_..� � i�L�IG[� �r r /- -------- _ .../.� as shown on the application for Disposal Works Construction PeT Street -.. .mated_ /0/ w v� mit N r ` DATE...... •-----•----------. ---A-.-••--------...-•------------------- Board of Heath FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS