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Home My WebLink About0363 PRINCE HINCKLEY ROAD - Health (:3 kl&4 , ,1 1 r TOWN OF BARNSTABLE LOCATION W-J<- SJGE VILLAGE (,r�( ��-yzt/41 _L_�� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Z---MLrnTf`' ( C69SZ :r SEPTIC TANK CAPACITY j 0-ri 5 _ LEACHING FACILITYAtype) (size) I crew/ NO. OF BEDROOMS_ PRIVATE WELL OR UBLIC ATER BUILDER OR OWNER 3�j `t DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No O� ASSESSORS MAP NO: PARCEL NO: THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE Allp iratinn for Dispatial Works Tonotrudian 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair K an Individual Sewage Disposal System at: tion-Address or Lot No. Own r Address ass .ice Installer Address U Type of Building Size Lot. �B c..Sq. feet Dwelling—No. of Bedrooms..............`�-•----------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q, Other fixtures -------------•- •-•---------------------------•-- . W Design Flow........... _ __________________gallons per person per day. Total daily flow.......... --------------------gallons. 04 W Septic Tank—Liquid capacity�llCgallons 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.4................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........................ 0 Description of Soil..........Q=&.....- ... .mil '�1 ..:.... x . W ----------------------------------------------------•---------------------•--------------------•-------------•----------•-----------. -----•------ ------•--•--------------------....--••-- U Nature of Rep 'rs or Alterations—Answer when applicable_._.,....... ............ 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 Certifica of Comphan ha been iss d b the board of health. p� Signed - ------ --- . ---- ------------- ---- �G Application Approved By ------- ..............................- . .---- Application Disapproved for the following reasons: ...... ............................................. ------------------------------------------ ..-.------------------ ------------------------------------------------------------ ------ ...........................---------------------- ................................... /`� v / Permit No. lam- ----------------------- Issued .......... . . <'Y ...........Date------ Dat .............. THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH TOWN OF BARNSTABLE Ap.pliration for Disposal Works Tonstrurtinn Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ...,. �z- ...... ycC' '=- � l /� - %� �, � �J� C - ..---- - ocatton- dress 'v r• - - .. ... or Lot No. ef, _ W !� Address dre s .._. - dress �7F.7j pa Installer Address d Type of Building < U Size Lot..,.,eA24.-_.Sq. feet a Dwelling—No. of Bedrooms_____________ --_---.-_-----_--__-_-_-Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.__..._......_...._...____.. Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow______________ 7:.-..................gallons per person per day. Total daily flow-----.:---_z_�.__?!-------_---__---_--gallons. WSeptic Tank—Liquid capacity.j�,:5&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........................ ----------------------•-....-----------------------------------•---•-------------------------_.............................................................. Description of Soil--------••--•� -•�---•• ................... U ---•---•-••-•-•-•------------------•---•-•--•---•---••----••-----•----•----••----•--••----.....-------•-------••----•----•---••------••--•---•-- W . . - U Nature of Repairs or Alterations—Answer when applicable..___.. __ . _._.__.__.11 � �.i1-f��Q�,t)- ................ S Agreemen'?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 has been issued by the board of health. Signed ......!. --- � `. Date Application Approved BY ��- - -- ) •Dater / Application Disapproved for the following reasons: .................... ................................................ ----- ----------- ----------- ---- ------------------------------------------ Permit No. ..--...--- /1 _ � � Issued .i . r Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � TOWN OF BARNSTABLE Ter#tfirate of Cfomplianric THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ..................... r'�}L-,�G` -......--..,.. . --- Installer at Y+ i .�� :.....-- . r— ..d.. has been tnstalled'in accordance with the provisions of TITLE 5 of The State Environmental CZ., das described in the application for Disposal Works Construction Permit No. ...... .-- -�---_.---- dated ...... -. ----t_-'7.----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BEfCONSTRUED.%AS A GUAR TE�AT THE SYSTEM WILL FUNCTION SATISFACTORY. n DATE `.. --.9 .......... Inspector ..-......... -ham' ..-. .................................-- ----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CC/ �`•�� FEE......:-,.ram'... Utsvnsal Works Tunstrnrtion Prrutit Permission is hereby granted. y��t `. : �c ' r... •d� .......;4_1... to Construct ( ) or Repair ( _'Kan Individual Sewage Disposal System at No.....................•-•-- -- �' �..� �� v --------- .�, der ma-�. <> ---; -'j--------- Street as shown on the application for Disposal Works Construction Permit No......4iS?.,�Dated....__If/,7 4 .? ...... DATE..--- e(_h_ / a` !--B a d%'6-Heaith // - FORM 36508 HOBS Q WARREN,INC..PUBLISHERS L0 CAT 10N 0 SEWAGE PERMIT NO. ` VILLAGE Cen4e11 W 1 G INSTALLER'S NAME i ADDRESS � 140r-LAJI R U I L D E R OR OWNER 11� FDA T E PERMIT ISSUED � DAT E COMPLIANCE ISSUED . / '' 5,96G K 6T Noes ss' � bq' f l�