The URL can be used to link to this page

Home My WebLink About0124 STONEY CLIFF ROAD - Health 2q STonty enta volt �qo -036 5 M E A D No.2.153LY UPC 12934 emead.com • made in USA SUStAMW rvRw�w� WITIATiVE rAlllBid Fi�i�SOYfCL10 r IU No.. -.._....... F>cs..... .. LTH v�< THE BOARD AOF FHEALTH TS TOWN OF BARNSTA'*rCsrdbie Cvt iJ�i D ApplirFation for Bi-sputiFal Workli inn s Application is hereby made for a Permit to Construct ( ) or Repair ( n In divl u posal System at: •.•- a•`-r------ -------- ---- -a L� - .---•-------. ........----............... .� Lo do j�.A?ddress .. h-/ �d or Lot No. .... .....••- Owner Addr s a ........ .'.--------------•--------'E�:u.� . . ............. ?. .__. Cl�(�C1C �.(�.-:.. ....al.... Installer Address UType of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin a —Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .-•-•---•---•--•-•------•--------------•-•----•-----------•---------••---------•--•--; W Design Flow............................................gallons per person per day. Total daily how............................................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 ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date._:. a 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........................ 0 94 ---•••••---•------------------------•------------••--•-----•---------••-----..._......--•--•-•--•--•........................................................ Description of Soil............................................................................... x V .....---•---•-•••--•--•-----------•----------•-••------------•--•--------------------------------•-----••••--------•---------------------•-•-•------•--••-----••-••--•-•••------....----=-•-•-------•---- xt--------------- U Nature of Repairs or Alterations—Answer when applicable..._. _______-�__Q! l.< _:_W. ---__ ---•----------------------•----------------------------------------•-------------.....-------•----....-------------------------•-------------------------------•---•-------•---•-•-..........••••-- 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 Com anc as be by the board of health. . Date Application Approved B PP pP Y ----------------------- IqDate Application Disapproved for the following reasons- --------------------------------- = ------------------------------- -------------------------------------------- ------------------------------------ ---------------------------------------- --- ......................---- -------------........................ to Permit No. .-..9. �------ �...................... Issued ........ Date TOWN OF BARNSTABLE LOCATION tQ.A'�-\�\j c SEWAGE # VILLAG ASSESSOR'S MAP & LOT I 0-0 J INSTALLER'S NAME & PHONE NO�� i � ��(ow SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Q��._� j� (size) �i�COy r ` NO. OF BEDROOMS PRIVATE WELL OR BLIC WA BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANj rE I'SSUED: ® VARIANCE GRANTED: Yes rN o �� -��r ��' � I �^17 `�,� � a� � �►i �Q��tr � j r f ' �� ®� � . � � ,.. �. i _ Awl 110 ��.. � � THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH TOWN OF BARNSTABLE .ppliration for Disposal Works (9- ton rrrmit �. Application is hereby made for a Permit to Construct or Repair pp y ( ) p an Indtvidual Sewage-'P9posal System at ---•--------- ��-gN Lo,do �nAddress �—�J or Lot No. ....-.. _ �J _ .. `rt'..e---•---•---......--^................. ....................-----0�....... ......_ ......................... �...._ Owner Addr s a -----•-- � -- -CT(`!\'EPr!!��--------------•----........... ......-. __..A..�-_\ C 1f�Srl N.!Lh...�. �s !�4? ...... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.•----------*-----------------------------Expansion Attic ( ) Garbage Grinder ( ) `4 —Type of Building a Other` yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------•---------•-------.----•-•-------------•----------•-•-----------------••-••---...---•-------......---------------- 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 ( ) t Percolation Pi Test Results minutes p y Test Depth d -- --- -------------------------------------------•-----------_. =.Date------------......-•----------......... I� of Test Pit..................... Depth to ground water------------------------ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...----------.-----.-.-. P41 --------•---------------------------------------•-----------.-.----•--•-----------------------------------•-•-----------•---_--------_------•---------•-•-- 0 Description of Soil...............................................................................:......................................................................................... x -----••-••-------------------------------------------------------------------------------------------------------- t ---------- r V Nature of Repairs or Alterations—Answer when applicable-----�� .....-- -.QA<< ��___ ?. _Z_._ .1 _� -----------------------•--•-•--•-------------------------------------------•--------•-•--...-----------------••---------------------•-----------------------------------------------.....------.....---• 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 Compkianc as been-issued by the board of health. g �.� Application Approved B ;J Date PP PP Y -- `''---l:�i(.....L..... ........•'- --'-------...-----'.------"--'-'- 1�"'--- ... �--..-1�� rl Date Application Disapproved for the following.reasons ..------"""--'-"-- --------------------------------------........................... .................---------------- / ` Da Permit No. ...�' .e� .w---` .. - " Issued --------ll r �-- -., ...--- Date 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C.er#tfira e of (gantylinurP T-1 IS IS TO-C IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( by ... \....-i.. . - --"----"...-"r-., ' .... ------------------------------------------------------------------------------------------------ Installer----�-- -----��.---- atIon=~� I....... .K. --------- " ... "'' ... ... .. 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. ,�r-. .. ....... dated ....f/----. �f--�- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION kfISFACTyORY. DATE ' " " " Inspector .-.. ------ ------ ---------------- THE COMMONWEALTH OF MASSACHUSETTS ° S BOARD OF HEALTH TOWN OF BARNSTABLE �f Diapoa atl Wanks Tonatrnr#ion jlrrmit Permissionis hereby . +►�j............................................................................... to Construct ( ) or Repair ( )'an Indivtd al Sewage pisp°sS -System at Street n as shown on the application for Disposal Works Construction Permit No` .. Dated.......Jl^.rZ,. .r- ..-� -� - s � �.. ........ Board of Health Ii DATE........ -•------- ................................................... FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS