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Home My WebLink About0021 RAINBOW DRIVE - Health l'i 5 M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT10, Certified Fiber Sourcing POST-CONSUMER www.sfiiprogram.org SFI-012M MADE IN USA GET ORGANIZED AT SMEAD.COM lLY c: _ _ Fxs......lC. if)...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativit for Diti-pniittl Workii Cfamitrurthill Prrmit Application,is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........................ ZP Location-Address ord.ot o. r- ...... � ��. 1 ........................... Owner Address STi2 ELe�"/®A� /r o a -----------------------(a.. 7__ ..._... 1 79' 'S ...'1t---�----------------------------•-------•-- Installer Address UType of Building Size Lot............................Sq. feet Dwell 04 Otherl—Typeoof Building f�in?c�Io. of persons nsion Attic �G�Showers (Garbage Vo) Cafeteria ( a' Other fixtures --------------------------------------------------------------•--------------------•---- WDesign Flow...........//..°.......................gallons per person per day. Total daily flow-----------------3.. .............gallons. WSeptic Tank—Liquid capa6ty_/_4,9Pgallons Length----37:-G_-_ Width-__ 7-(j_ Diameter.-.-- Depth...$77 0 & x Disposal Trench—No. .................... Width--------,.......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------/........ Diameter......../P------ Depth below inlet--------G......... Total leaching area.....3., ..dsq. ft. z Other Distribution box (�Q Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. I......"'.Aminutes per inch Depth of Test Pit...-f-Z.--------- Depth to ground water........................ LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --------•-------------------------------•---------------•-••---••-----•-------••-••.............-•-•......................................................... ODescription of Soil........PEA......44—hW----------------------------------------------------------------------------------- ------------------------------••-•-•-•-•-••--- U •-•••-•................•-------•------•-••-•--•--•--••---•-•--•-•••-•••••-------•-•----•-••••••-----------••---------------•------------••---•---------------••--•-••-••••--•-•-•-•............•-•-•-•-- W -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- 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 as been issued by the ®board of health. Signed ---------; YL r��.��GeitXa sit .ar..tt�--------- ............ Dare ApplicationApproved B ... .. ................... ............................................. .. /. i LYate Application Disapproved for the following reasons- ----------------------------------------------- ----------------------------------------------------------------------------------- ........................................................................................................------------------------------------------...----..........................-------------....-..- ---------------------------------------- Date Permit No. ------ -------------- Issued Date XZ f WmJf6-WQN-0F BARNSTABLE LOCATION S PiAla" Pf-t"e, SEWAGE # 9Y- � VILLAGE C �"'L ASSESSOR'S MAP & LOT/a' INSTALLER'S NAME & PHONE NO. I i SEPTIC TANK CAPACITY f(/yci P LEACHING FACILITY:(type) �/ ) (size) X(® I NO. OF BEDROOMS - PRIVATE WELL O PUBLIC ILD DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ' 1 VARIAN' CE GRANTED: Yes No 4 1 ofLF 2�- No... Fas.......�/?..l �...... P THE COMMONWEALTH OF,MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 1 pphratiuu for Dijrpwi it Workii Tomitrurtiuu Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / I��cCj Location-Address or Lot o. Owner a Tc _r�TT% �' .clsr f�e.r�onl l�d 7r�y . 4STovs Add ress ------ '(�Gs ------------------------- Installer Address g Size Lot . Sq. feet U Type of Building ...................----__. Dwelling— No. of Bedrooms----------3.---......-----------------------Expansion Attic (//p) Garbage Grinder (A14 aOther—Type of Building .4iac,4d_.f_jen;5_No. of persons____________________________ Showers ( ) — Cafeteria ( ) d Other fixtures -------------------------------------------------------- W Design Flow.........../.L_0.......................gallons per person per day. Total daily flow-.-___._____----.3_.3 .............gallons. WSeptic Tank—Liquid capacity./.®80galIons Length----T.--6.-_ Width__. Diameter-----.--..... Depth_..5�$��t x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area_-______-_--------sq. ft. Seepage Pit No...........1.------- Diameter--------/0...--- Depth below inlet........ Total leaching area-----3-5..dsq. ft. Z Other Distribution box (YQ Dosing tank ( ) Percolation Test Results Performed bY-----------------------•------•-------------------...----------------•---- Date............................--•---•--- Test Pit No. I------ -Z _-.cP-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 •---•----•-•-----------------•-----•---.....------.....--•-----••-•-•-•-•-------•-------....--------......................................................... 0 Description of Soil--------P£_A.....A4 -------------------------------------------------------------•--------------- "� W UNature 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 ........` s 1 a c!- �. Vic. L�*(-r..�- ........ ................. a.te...........:----- I �Application Approved B v-+ 1...... .......� r..vK- �a c................. 1 PP PP Y ..... ......._. � ,7 D are Application Disapproved for the following reasons: ................. ... .................................. .. ................ ...................... ...............-------...-------`-----...---..............................---................_.....---------------------------------------------------------....------...—..-..............-- ---------...... ..............--- ate PermitNo. ......q--y--....-57-;. 6 .................. Issued -------------------------------------------------------------------- Dace ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (VITIPrtifirate of (111om Banc[ THIS—IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .................0��Z:--- --—0.�------------- .c� rrc. fc•-..:0- 1.----------------------------- `� / I/!��. Installer at .--------...11.._1.1...._{,!�.....__.).;!� fhC=��--- _.1.� e_. r � ...- -- - - ........ ...--------------------------------- 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. ._-�...V--- ... dated ---_._.............__.........._......_.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE '._... -r . .. '^� ---------- Inspector ... ... ..... - -f ' �� THE COMMONWEALTH OF MASSACHUSETTS a f '/ BOARD OF HEALTH TOWN OF BARNSTABLE No....< L�`=� S FEE.... ............... Eiapusttl Murky Tuni5trLurtiun. "erinit - Permission is hereby granted-------------------------- �.�'r�R'-Tf?/ T T ------- '.1� :�1.: /� -T/chit/........--- to Construct (� or Repair ( ) an Individual Sewage Disposal System atNo. .n == - .r .f 'S�1••�------- ..._, , ...:.A-................................................... Street as shown on the application for Disposal Works Construction Permit No.. �`J� Dated----------a,-_---a....... ._ ..... Board of Health DATE............. " 0 ..=2-t�.1-"....................................... 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