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Home My WebLink About0047 STAGE COACH ROAD - Health �7 Slovge Caac� ftd CeA*Vale 73 - o46 S M E A D No.2-153LY UPC 12934 ameadoom • Made In USA PO�R�STtN WRIA7NE WtIB�dFmvSoureYw No......14.......... Fps.... .... ................. Q THE COMMONWEALTH OF MASSACHUSETTS n P P o 0 V E D BOAR® OF HEALTH ration Cor..�i-,7Aon sarnstablu c - TOWN OF BARNSTABLE —�� ,A001fr i e for Eltipugal arks C�uuutrurttun rruti Application is hereby made for a Permit to Construct ( ) or Repair (kj-'an Individual Sewage Disposal System at: --•........... .......•-------._...... ............... Location- ddress or Lot No. ----------------- !_......._..5... .tea ................................. •-•-•----•--._..........h"'.._.............................................................. Owner � r - i Installer Address UType of Building Size Lot____________________ _____Sq. feet Dwelling—No. of Bedrooms____..................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures --------------------------- W Design Flow.......55___________________________gallons per person per day. Total daily flow.___. _ . . gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No._49............ Width....72_'........ 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........................................ .j 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........................ 0 Description of Soil...............................................................................-------------------------------------------.....----------------------------------••--- x W U Nature of Repairs or Alterations—Answer when applicable,_.__ T!! .�_-____br-_ 4_ ------- f _:_7CIF ....................................... 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 Co en ssued b t e board ealth. Signed ...... - ... ...... --........... ......... ------ -- .......... ------�c .. Application Approved BY � -- ------ ----- .. -----...---.--.. I Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------- --- ---------------- -------- Date - .................... Permit No. ..--- -- ---. I Issued �O o2te�------- .:.-1 t } No.-. .....»V V Fss_. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH } TOWN OF BARNSTABLE , pplirttfiurt for Disposal Varks Chun-sh-udiun jrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( \- an Individual Sewage Disposal System at: -- _._------- ---------------- ----------------------- /� lion- ddress or Lot No. ------—------------- --------------- Owner -- W Installer Address UType of Building Size Lot------------_-----»»»__Sq. feet -� Dwelling—No. of Bedrooms____----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) d Other fixtures - - - W Design Flow-----_�.�____'�-s----------------------------gallons per person per day. Total daily flow----- - ---------------------gallons. GG Septic Tank—Liquid*capacity------------gallons Length---_A_.------- Width________________ Diameter----------------Depth---------------- DisposalW Trench—No.__ ' 't� �____ x �..----_--- Width_---�7_________--Total L�.gth.. /1--------- Total leaching azea--------------------sq. ft. Seepage Pit No--------------------- Diameter____________________ Depth bel w Inlet _=_" ---Total-leaching area-----------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) I� - ` ' .l\ 1.4 Percolation Test. Results Performed by-------------------------------------------------------------------------- Date--------------------------------------- Test Pit No. 1________________minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ 114 Test Pit No. Z_______________nunutes per inch Depth of Test Pit____________________ Depth to ground water________________________ 04 ---------------------------------------------------------------------------------------"--------—----------—--------------—-----—--------------- O' Description of Soil__________________________ ----- ----------------------------------------------------------------------------------------- ------------------------------------------------ W c --------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------» W ----------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- U Nature of Repairs or Alterations—Answer when applicable____. 1� ------=-1.;'x--Fx A ------ 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 they agrees not to place the system in operation until a Certificate of Com nce-has-been sued by tile board o ealth. n A ' Signed --�-- -- k --- -' 6 (0-:7 <11 Application Approved By x Application Disapproved for the following reasons- ----------------------------------------------------------------------------------- ' - - - ------------- - ------------------------------ ------------- Dne PermitNo ----- --- ---� - -------------------------- Issued ------------------------ J _�_-�- - --- ------ (Dam r — r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cger#tftrate of 01ontpliance THIS IS TO CERTIFY, That the,Individual Sewage Disposal System constructed ( ) or Repaired (L�i by--------------------------- - at --------------------------- ---------------------------------- ------- --------------- has been installed in accordance with the provisions of TITLE The tate E vironmental Cade desj b d in the application for Disposal Works Construction Permit No. .___ _ _"'__ ____��______ ______ dated ---- __�_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CON TR AS A G ARAN E AT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------/V e- f - - Ins i - -'f _ THE COMMONWEALTH 'OF MASSACHUSETTS BOARD OF HEALTH «<+ D� TOWN OF BARNSTABLE �iu�ru�tt1 ur1� �unu� iun �erBn� Permission is hereby anted----------- ---� -• - --- - - ------ to Construct ( ) or Repair �t.�.�-a[tI Individual Sewage Disposal System at No---------------- ------- x 4�?_L�l_- - -- wT,LIL �- G Wit_� ----------- --- ------- - --- Street as shown on the application for Di sal Works Construction P 't No-__ /r_ _ ___ ted� - --------- - - �i -- / Board of ii tht DATE----------------------- -� -, -------------_ FORM 965(8 WMM Q WARREN,tNC-,PUBUSHERS TOWN OF BARNSTABLE LOCATION q-7 e- C-6OC k SEWAGE # VILLAGE C�(�( y�` ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY s a LEACHING FACILITYAtype) 3 K (,`t-a,��ovzS (size) NO. OF BEDROOMS - PRIVATE WELL O PUBLIC W�TF.I�- C-- BUILDER OR OWNER e2ovC-Wvt wi' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i�vt �eailo�.t��wk TWO �°�yC4`T��4cz�LgS No.--- _7._j ..... Fix. ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH :...OF............ / ..... ... Appliratilan-fur �ioposal Marko C�gntrurtinn truth Application is hereby made for a Permit to Construct ('4<0r Repair ( ) an Individual Sewage Disposal System ..�� -- ---4 -- -•--•--- ------ ............................................................... at A ress or Lot No. c•� -�� ow r Address ' 14 --- ------------ � t �i �-. �. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling- No. of Bedrooms..----__.�_---_-•---- -------------Expansion Attic ( ) Garbage Grinder ( ) aOther —Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtu eels ---••--•----------------•-••-•---•----------------•-- .............................................. Design Flow............. _____O_._._.._..___..g lions per person per day. Total daily flow........ --------------gallons. WSeptic Tank Liquid capacity___.... alallons Length---------------- Width................ Diameter................ Depth__.____-____---- x Disposal Trench No. --- Widtl Tool leach area--------------------sq. ft. Seepage Pit No____ ________________ Diameter__ _._ _.._..____ Dept e in ing area------------------sq. ft. Z Other Distribution box ( ) osing tank ( ) aPercolation Test Results Performed bY ----•-------. Date--------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.-.-_-_--_-__-_._.._.__- (Z4 Test Pit No. 2................minutes per inch Depth of Te Pit.................... Depth to ground water........................ O Description of Soil.................................. : x . --- --•- 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 Article XI of the State Sanitary ode— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has bee iss by boa lth. igned----- .. •-•--••-- .-- -------•--------•-•-------•--- ------------- ------- --- --•-- ----------- Dat Application Approved B ate Application Disapproved for the following reasons:................................................................................................................ -----•---•---•-------•-••---------------------------------•------------••-•-------------••-••-------------------•------------------------•-------•------- ----•----••----------•-•--------------------- hh Date Permit No......................................................... Issued..../-.4- ----?_/ Dat ` 4 r � �1 IA . o . 15 --------------------------------- ........... ......................... No.. e..f le.)..... ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 17 OF........... . , , , . --. :..... - Appliration for Bisposal Works Tons rurtiou tirrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal • System at: �oca)_n`A ess or Lot No. �wner Address -------------------------------------------------------------' --•-........................ Installer Address UType of Building Size Lot............................Sq. feet Dwelling —No. of Bedrooms---------- ....:.......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ----•---•--------------------- - a -. --------------------------------- W Design Flow._,..................__.-_.____..__gallons per person per day. Total daily flow.._.___. __ ..............gallons. WSeptic an Liquid capacityhe ' allons Length................ Width___-_------_--- Diameter-----._--______ Depth-------------_. x Disposal Trench—No..................... Width...................... Tot-4lfMw gngth____..� T,al leach', g area....................sq. f t. Seepage Pit No.. ............... Diameter. . ". Depti beg° "ii et__d '�'�c t lea, king area------------.-----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) e a 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/Tet Pit.:_.._....:..._.___. Depth to ground water-----_______--_-__-__--- DP4 --------------------•------ •----•--.- ---------....--------------------•---••--- Description of Soil � -------------------------------•-"-------------------------------------------------------- x W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V 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 Article XI of the State Sanitary ode— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has.be 1 iss by e�b a'- `lth. Signed ; Application Approved B Da Dafe Application Disapproved for the following reasons-------------------------------------------- ..._.____........____._........._.._.........__.......__.____ •---...-•-------------------------------------------•---------------------•----------•------------------------------•----•-•----•---•-------------••------------------•------------••-•--------•-------- Date PermitNo.............................-_-------------_------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..L .r.� ..:..............OF:......: THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( —J or Repaired ( ) bY.........,................... ------•---- -----•----I. i ---------------•--•--................................•------- 7f -y' ;(/ ns aller r'�'•---.. j �y at.. f.:= _ 4-.t.fr , 2='� 4 _4f al.� '.=_. ?. J�' --- ..�...t. ., ..r.�.. r,.�. ... ._..._.. has been installed in accordance with the provisions of Article-XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No"'.te �,1______-____---_..-___•__- dated------ � .:T ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.- ='----.-.-•------- FEES lVorkii Tonntrurtivit farAit Permissionis lie •y granted-------------------•----------Sl----------•-------------------•..........----------------- --------�-----------------•----------------- to Coristru t -( t, or Repair (/ an Individual Sewage Disposal System _ at No. C. .-f. . a I t / v' . i J•f _ / /� t/'�� , s u Street ' _ .-••.�----�--r��.._.-_-�::.;.:- v-------•-•-- ------------------ as shown on the application for Disposal Works Construction Permit N__4164------- Dated-__ :7 ___.-_---.. ......................................................... ............................................. Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS