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Home My WebLink About0273 STONEY CLIFF ROAD - Health I-10 -Dq SMEAD No.24 53LY UPC MU anmadxom • Made in USA �4M► SUSTAINABLE fORE5TR1r lNffWK c«�wwaera�o .wwdrwr� Lto APPROVED 7THE COMMONWEALTH OF MASSACHUSETTSBOARD OF HEALTH �� TOWN OF BARNSTABLE > Date ,� �rlirtt i>aru for Bi-nVo!3al Wnrkii Towitrnr#iun Pamit Application is hereby made for a Permit to Construct ( ) or Repair (1,-) an Individual Sewage Disposal System at: � ?_', 's i Rz � C " q••yy �� 3•. cation i\d s or Lot No. Ow c dd �i 1/ �•• F ress a � � ✓ 1 �.J C/�' 7- 1 -•-,'Y1C`' 5\ ........................ Installer �.. �... r Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms................•--..-.------------.........Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- 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 ( ) `" Percolation Test Results Performed by------------ ............................................................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------ • ...............•••---••--.............---------•-•-•-•-•-----••-•-------•--••------............................ ............................ ODescription of Soil................... 1--- ---•----------•-• ;----------------------------------------------------------------------------------------•----------- ..... W Irw U -••-••-••••--•----•------••-----•--•-•-•--••--•-•---------•--••-----• --••-------------------------------------------•----.....------------------•-----.....•---........----------•-- ----------------------------------------------------------------------- --------------- ............................................ ----------------- Nature of Repairs or Alterations—Answ when applicable--..................... S , r��`.� U D O �--` ----------------------------------------------------------•- 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 Corn i ce ha been issued by the board o ealth. Signed ...................... ........ ------------------------------------3 Dare Application Approved BY .....- ..4...- --,�- t..vZ.."" f 3-� ----..................................'---'-------------............ 7-3 Dace Application Disapproved for the following reasons- -- ----------------------------- ..------------------......------------------------------------------------------- -------------- ------------------------------ -------------------------------------------------------------------------------------------------------- --------------------- --------------- ------ a ~� ��.3 Dace Permit No. ..........e?..-.3............6 96---------------- Issued .. . ......�.�d...^..�. ..."�1 ----------- Dace b -7 r THE COMMONWEALTH OF MASSACHUSETTS G� BOARD OF HEALTH r TOWN OF BARNSTABLE Alipfiratiolt for Uhj o!ittl Workii Tonitrnrtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (4--) an Individual Sewage Disposal System at: ......................................................� 'S �•,, _ _ .._... ............................... 2� cation-:\ddrl s � �or I,ot No. 1 ...................... -•'--�-----��ILV,��^L�-1�-r................... •-----•--�-----�----•--'-..---------`....... .....-.�`..+-- =-...�:_6:-•---- Ow c ddress ffic C. 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 ( ) dOther 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 ( ) aPercolation Test Results Performed by-------- .............................................................. Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water-._-_-_-_-_-____-_------ f4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ..... ..........---------- .------------------------------------------------------- .----------- ---- --------------------------------- ......... --------------- DDescription of Soil ------ = -- -----•------- --- ------------------•--.._..._...-----------.......--------------..._...------............................. U •--•-------------------•-------------------------•---------------------` ............................................................................................................... W •----•----•-----------------------------------------------•----•------•- -------------- ................................ ------'--•--.................... -- x Nature of Repairs or Alterations—Answ r when applicable---------------- ------ 5�•. I �� g U P -� ....... = ��-?rv�! .............. _Q Q.Q........L,--- ---................................................................ Agreement: The undersigned agrees to install the aforedescribed Ihdividual 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 Comi Ice has been issued by the board o health. Signed � - ...-.. .-.-..-- - - '.......- ............. :....,. Dare Application Approved By ..s..E- ,- -,p - (..2 T..� -.�. Dare Application Disapproved for the following reasons: -------------------------------------------------------------------------------------------------------------------------------- .................... . .... ... .................................._....... ............. ........ ... .......................... .............. ...... . .....- 5.3 g Dace Permit No. ..........1.. ...-..-.. ... d.- Issued ...............1..�d....^......3...". --3------------ Dut -------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifirate of Complianre T974 IS TO E TIFY, That t e Individual Sewage Disposal System constructed ( ) or Repaired g 1 at l 1 , tr 4tii .............. -.. �` -.�.'. �..�-------------- --- - — -------------d2----0------!----------- ------------ -------------------------.-..__.... has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in ---------the application for Disposal Works Construction Permit No. --.. �--..-4._F.O_------.- dated ------.__._-_ - - -- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........1.�.- -1 - ----.....----------------------------- Inspector ).....- ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq� TOWN OF BARNSTABLE No..l.. _`f.. FEE.� '....:`.. Disposal Work. Tanitr ton permit Permission is hereby granted-- `"� . ..�.- to Construct or R,pair �dividual Sewage Dis os stetp\ ( r (� g , P y U Street / j 7 3 +Q as shown on the application for Disposal Works Construction Permit No.____�.�.___��_ Dated_____________________.._......_...____..__ ..................... -= = ----_... •..........................•----•- Board of Health DATE -••-•-- ........ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS • C,. TOWN OF BARNSTABLE LOCATION SEWAGE # 3 �)!'0 VILLAGE CC�iv' wJ II ASSESSOR'S MAP & LOTS} 0 INSTALLER'S NAME'& PHONE NO.Caf(�6w* [ I` SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 4-. L r �- (size) / ®0 0 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERI)o Nok <.t%3 kA is. e,0 DATE PERMIT ISSUED: 913 DATE COMPLIANCE ISSUED: :w VARIANCE GRANTED: Yes No 45 5 �AO O3 A �8 II Y. J 1