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Home My WebLink About0240 PRINCE HINCKLEY ROAD - Health 1��lP� ., /��/�W-- li TOWN OF BARNSTABLE LOCATION 9 yd SEWAGE # VILLAi1 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �4 SEP= TANK CAPACITY /000 0°R LEACHING FACILITY:(type) (size) IeOoG G NO. OF`BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR O WNER DATE PERMIT ISSUED: DATE COtiPLIANCE ISSUED: .VARIANCE GRANTED: Yes No ,� �� ". -- << , � � , G�� , ��® 5rt LOCA 10 SEWAGE PERMIT NO. VILLAGE INSTA LLER'S - NAME i ADDRESS BUILDER FOR OWNER � 5 DATE PERMIT ISSUED , DATE COMPLIANCE ISSUED r .�,,; �. p,►� C�. ✓jg ----`�� . 9'�- --- --�-- r` Board of Health If Town of Barnstable F.O. Go),534 No... •- Flyannl s, kiassachusntts 02501 Fws.....Aq"............. THE COMMONWEALTH OF MASSACHUSETTS BOARD - OF HEALTH t ..........7.own...................OF..... ...*Na*cl�---•--...... -----.--------•--•--------.......--•-------.-----• Apptiration for UiopooFal Workii Tonstrurtion runfit Application is hereby made for a Permit to Construct ( ) or Repair (-*) an Individual Sewage Disposal System at: 0'4 C4*Lruklls. .......---•-••. --•----•-...--•- Locati n-Address I � or t No. /1f R_.....................-.................................... ....cam-ArA, Owner Address a A .R Ctc rcc _3S4 l�1 a in S�'r-!! -+ Ly ¢ ,lgc_t rt �--------------------- •. -•------••--.....-•--••............................ Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) C4 Other 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.--__--___--_----._._.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.-_----__--____--_____. P4 •-•••--•--•-••-•------------•••--•••••••--••-----••--•••---••----••-•-•••-•--•-------••-••-••------...-•---•................................................ 0 Description of Soil........................................................................................................................................................................ x ----------------------------- - -•-••••-•••-••-•-••-•-••••-•---------------------------••••--•••••............- U Nature of Repairs or Alterations—Answer when applicable.X0� ___loo O-c s,Q,-_�,g __apt _ ±/LS �l�_4 S._.-__. rc�cmek----------------------------------------------------•--•--------------------------------------------------- Ag eement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'=- 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�tphe board of heal th. Signed.. t. _3.;st!KM.��........ ............ /2-8-88 �....? ... .............. Application Approved By..-..-------••-- }--- -- ' ......---•---•.................•--- -•----�.:?�.^_.�f Date Application Disapproved for the following reasons:................................................................................................................ `1 �� Date Permit No.....!.�K -,-Yo---------------•-•-------- Issued-....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA No.... FEs............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ...-..--"---------..........OF.....:-..-....-..-.-..%.............................------------------------------•------ Appliration for Uhipos al Works C owitrurtivaa Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (-^) an Individual Sewage Disposal System at: .....................................................................................•......._... _......----.---.------._...---.....................---.....__......_..---..._.._.._._.__...___-•-- Location-Address or Lot No. •--•--...._..:_._...................:--=-----------•---•---------------•------••--.._..---•...... •--•.....•-•------•••------....._.....-•--....._......-----------•••-• Owner Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) p-1 Other fixtures .............................................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..........__gallons Length................ Width---------------- Diameter---------------- Depth................ 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........................................ aTest Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water___________________--_-- �, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. P4 ........................................................ 1 ....--•...................•---------------------------------------------••- xDescription of Soil........................................................................................................................................................................ ---------------------------------------------------••--------•-----------------------------------------.---------------.-..-----------------•----------..-------------------------•----••-•------•---•- V W ---------------------------------------------------------- ----------------------------------------•-................................................................................................... UNature of Repairs or Alterations—Answer when applicable----------------------------------------_______________ _______!__.+..._-____________.___.. i Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i?Ti p 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........................................ y ':.:'_ ..._:.: .......... -�-� Date Application Approved BY ............ 0 �"=�_---•_____________________•---- ....... �'= S s Date Application Disapproved for the following reasons____________________________•_______________________________...._____________________.___._____._____........____ -•-------------------------------------••••-••••----••-•---........_..-•----••--•-•------------------.....••-----••-------••---•••••------•--••-••••-••-•-•-•-•-------•-•-•----•-•••----•---••---•-_•_-•- I. -•---Date•-•---_ Permit No----- I.I-/t/�-- -----•-------------------- Issued------------------------------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................OF......................... ...-.................................._............._.... �rrtifiratr of fl ompliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired bY................-P.,J- ........C ........._.........----•----------------=---------------------------------•-------------•-•-----------•------•---.........--------•------- �j / Installer has been installed in accordance with the provisions TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... '��-.:.7,�`.-Q.......... dated-.------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. e DATE Inspector__... N ------------..........------........•----• ----- " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f......-.............................OF..-.-...-...-.-..-..:..__......._......._..._......___••••••••...___......._.......-. NO.._O�.../ Gf/ FEE.............. �i��a�tal �rk� �aga��tri�rtuan rruttt Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo..................-•••••••----•--••--•-•-•---••-•-•••---•-••••-------••-•--•---••------------------•-••----------•--•-••--•••----•-••-•--•-•-••-••------•----•-....-------•-•---......_....... Street r,/ as shown on the application for Disposal Works Construction Permit No- �/___Q Dated.......................................... ` a..J•----------------•-•------------ __------------------- -- � Board of Health DATE--------�.s� �. �..................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS