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Home My WebLink About0123 POND VIEW DRIVE - Health 1 a 3 pundv rem X t,w S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE MIN.RECYCLED FORESTRY INITIATIVE CONTENT10% crrhfiedrrbersourcnp POST-CONSUMER wwwsfiptapramorp snouvo nuwewUSA MT ORGANIZED AT SMEA AIM P THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE �n Applira#ion for Dhipoii al Workii Tonstrnrtiun rumit ® 1 Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at ----------------------------------- ... ..% �. .............. !....... �Lo -�ss r"' "� - " ._Y. O a� s •- ......... ner Addf ss - Installer - ddress UType of Building Size Lot.................... .....S . feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures .__........ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic 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........................................ 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........................ a' •--••-•••••--------------•••------•-•-----••-•-••-••-------••••-••••-•-••-•......---........._---_--......................................................... O Description of Soil........................................................................................................................................................................ U -------------------------------------------••----------------......---•-•-•••-•••••-••_••-- x ---•--••••••-----------•----•••••--------•-•--•-•...---••-••--•-•--•-------••--••-•-----•-•••••...••------------•-------------------••-••......... - _ _ U Nature of Repair or Altera ' ns—Answer whe licable :_J - _____._. f{L__ e.__... Ag reemeaft: 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 Complianc�haen issued b r health. .. .... ... ........Signed --- ... Q �/ Date Application Approved By .............. "'--' ... ........... -------........ ... Date Application Disapproved for the ollowing reasons- ............................................------------------------------------------------------------------------------------------- ---. -------------------- ---- ---------- ------- ------------------ ---------- ---- -------------- ------------------------ ----------------------------------------- .................................... qDate PermitNo. .............. f -...- L.-�.......------....... Issued ..------.------------------...--------- ... Dace .,- _.--� ASSESSOR' S MAP NO. PARCEL LOCATION SEWAGE PERM. 0. a fl6 wi �cw f VILLAGE C�- 4 k-l. ° �� C��u L✓ INSTA LLER'S NAME i ADDRESS �d U I L D E R ) OR OWM ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED o 10 No..... FRs....::5.a.po THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �f f TOWN OF BARNSTABLE � 1�V` Appliration for Dwpooa1 orkii Tonstrur ionrrutit ` i Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Lo / � Owner /� � Address r �� ' 1,-U/t�� !:?... .. L,.✓ z� - .:.. .. ........................•--•-------•----.. P .4.wA?7/ Installer ddress UType of Building Size Lot.................... .......S feet Dwelling—No. of Bedrooms.............. .....................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow.........................._.................gallons. P4 Septic 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. 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........................ a' ---•------••--------------------•-•---------••-•••••------•••......-•••--•-----...........--.---•----------------•-•-•---......----•-•-•.....-------------- 0 Description of Soil...........................-----------•--------•------------........-----------------------------------•----------...------......-------------••••••-----............_.. U •--••-------------•----••--•---------•--•-----......------------------------------------.....--------------------------------------•-----------•-------•--•---------------.....--------...-----------•. W Nature of Re Alt rat' ns—Answer when, pplicable._,/'�__ ___.� _.. __.. _.._��U P _...::: airs or ------------------ Agreeme t: 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 ha been issued by hoard of health. _ Signed ...... mil. te... ......... ........... i Date Application Approved BY ........ �+ -+ r- -............................................................ -----------------------------------------------------............................................----r�- = �� Date Application Disapproved for the following reasons- ---- ------------ -- ----------------------------------- ---------------- ------ .............................................................----------------------------------------------------- .........------------------- --------------------------- ------- ------------ ---------- ------------ - -- Date PermitNo. -- ------...21---'----�./... -----_--------------- Issued ...................................... .... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trdifirate of Graylianre THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by = s - --------- G�� t-` C.� ---------------------------------- ------------------------------------------------- ....................../ -----------------.....-----...-----------------------.. at ....--� ...... ��6� ........ �t..... ..........�vV i ........................_._................................ has been installed-In accordance with the provisions of TITLE 5 of-):he State Environmental Code as described in the application for Disposal Works Construction Permit No. ......... /...-....--1//---5�........ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE G SYSTEM WILL FUNCTION SATISFACTORY. IN DATE........................................ `-�- TI `"�-� Ins ector ....... �J4 //!!� �p .--------- -------------------------------------------------....... THE COMMONWEALTH OF MASSACHUSETTS a BOARD OF HEALTH C(� TOWN OF BARNSTABLE No...l..l.'.. � FEE.. o.G?c.. Eltspooal .No kii Tondrudiont ramit Permission is hereby granted G ~z% -1 "�5......_.. ----- ------- -------- AIS to Construct ) or Repair (Z—'an Individual Se, fa- Disposal Systetili- " at No.---; w = ....... .�' ...�'�f 'l'-`-J......................... � ►��., /1.�1 ....................................................... Street as shown on the application for Disposal Works Construction Permit No.. /S' ............................• _• 'o..------------------..................................... c� Board of Health DATE---------------/.- �^9� FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS No......................... Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................-................................................................................ ---.......---------------------•-------------•--------------------•--•..................-------•-- Location-Address or Lot No. '---^............................................................. -.--------------- *............. Owner Address a ........................................ - •------------•----------------------------.......------....---.................................... Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling No. of Bedrooms.............................. .....Ex Expansion Attic a g— --------- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.......--.--................ Showers ( ) — Cafeteria ( ) 0 Other fixtures ------------------------------------------------------------•---•---------------------•------------------•----------------------------............... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 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.-----.................. P4 --------------------------------------------------------------------------------------------•-----••..................................................... ..-- ODescription of Soil-------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- x w x -------•--------------------•--------------------------------------------------------------------••--------------------------------•-------------------------------------------------•---......-•-...... 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 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 --- --- ------ ------------- ---- ----------------------------------------------------- ---- -- ........................................ Date ApplicationApproved By ------------------------------------------------- ----------------------- -- ----------------------------------------------------------- -- ------------------ ------ ---- Date Application Disapproved for the following reasons: .............. .. .... .......................... .............................................................................. ------ --- -- -------------------------- --------- ---------------------------------------- ------------------------------- -- -- --- ----------------- ------------------------ -- .................................... Date PermitNo- ----------------------------------------------- -------------- Issued ----------. -- ----------.................-------- ------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�er#t�tt�x#E u� C�IIm}�ii�cnce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------------------------------------------------------------------------ Installer at ---- -- -------------------------------------------------------------------------------------- .........................--------------------------------------------------------------------------------------------------------------------- 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. DATE---------------- ----------------------------------------------------------------------------------- Inspector ---..................-------------------- ---------- -----...--...............--------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... FEE........................ Disposal Works 0,41n#r ilan Vvrrmit Permission is hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... --------------------------------------------------------------------------------------------------------- Board of Health DATE................................................................................ FORM 36508 HOBBS a!t WARREN,INC.,PUBLISHERS