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Home My WebLink About0384 STRAWBERRY HILL ROAD - Health 38 t+ STro�wwcy Nett (enttcvit tQ IN 5 M E A D No.2-153LY UPC 12934 smead.com a Made In USA fie—) SJSWNA BLE . fORESTRtt WRIA7IVE CaNBodFbuBourolnY i I I 1 i t y Ficic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OWN OF BARNSTABLE Appliration for Disposal Works Tnnstrnr#ion 1krmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Sys3eat: (,� Q >Z ,l N� R v l+1 l c tiO onw-n Nd , �s..� so ---•-------•------------------ ��.._ R N ------R ---.----...------ A es ............. .........�.rn ,s ........ d awl ...... ............................. staler Address Type of Building Size Lot----------------------------Sq. feet aDwelling—No. of Bedrooms...._.3..................................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.1.0.0o._gallons Length................ Width................ Diameter................. Depth................ x Disposal Trench—No..................... Widt ..•.j•..._. Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.....4.............. Diameter.........I---I- )�epth below inlet-__ .......... Total leaching area..................sq. ft. Z` Other Distribution box ( ) Dosing tank ( ) 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........................ P4 ----------------------------------••---- -•-••------------...---------......---•-------------------......................................................... 0 Description of Soil...............................................................................=........................................................................................ U --••-•-•-•--••••-••-••-•••-•-••--•---•-••-••-•--•-•---•••-•-••-•--....•-------•--•-•---•-••••--•----•----•--•--------•-•---•••--•-••--.... -----------------------------------•------- -----------•-----------....................... UNature of Repairs or Alterations—Answer when applicable............................................. ... a. - Isti:...... = 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 �C '1-------------------------------------- �� --- 7 `� o Application Approved By� � .................../ - B Dace Application Disapproved for the following reasons: ------------------ .}r == - ---- ---- ------------------------------------------------------------------- ----- -------------- - --_------...---------..-..--.................................... ............ ------................................ Dare Permit No. d.."....1.-e... �------------------------ -- Issued --------- 2 *�+d Dare s � • L F� N --- --a :_-------� q FEs...... �J:. z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE A y iration for Di iposal Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal S stem' t cam.._•_. --- - . --.. L cation-Ad ess or t No. _I.1 .._.. ... W! I ._......_.. wner — -ANI;ss- a ._.......1�-�-w>_.Q.�..................................................... ---� Y��....................1-p�-K----..1.A ry Installer Address < Type of Building, Size Lot _: :-__,_•______..Sq. feet U _ . .--I Dwelling—No. of Bedrooms....... .............•_........_...__.._..Expansion Attic ( ) _ .,...Garbage Grinder P-4-I Other—I ype. of Building .`?..r_.__._ _f__ .__• No. of persons............ _'__.` Shower's, ( c ;) =Cafeteria ( ) Other fixtures .. � . .. .. ,.� ? ��f ............................................................. ......:...... W Design Flow._:.........................................gallons per person"per day Total daily, flow .:_ .....•. gallons. (4 Septic Tank Liquid capacit'}r'�� gallons Length ... r Width_ ""'._ Diameter................ Depth---------------- Disposal Trench No. ________ L:..._ Widnth.. . { __ Total Length ................. Total leaching area....................sq. ft. c .t „/' , b Seepage Pit'No` __��`?__:______ Diameter _______ ____ epth below inlet._ ............. Total leaching area..................sq. ft. Z Other Distribution box (`r) Dosing tank '(J4 ) Percolation Test.`Results z .-Performed liy ----- --__ ------ ------------------------- Date...................................... Test Pit No 1..._ .__._minutes per inch Depth oest P>t _______. Depth to ground water........................ f=, Test-Pit.No. 2___-_ --=`n inutes per inch Depthf T of Test Pit :.__..................... Depth p to g round water________________________ 04 DDescription of Soil,. °__� . ---••-. --•••-------------- --••--, -•-•••..----•••---••-••-•-------••••-•.....•-••-••--•-•......••--••-•-•--------•--- V --•---------------------------------------------•-------- ______________ _______________________________ .---------------------------------- _••_- 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 has been issued y the board of health. v Signed .. - L �% --------------------- /O �a.... . Application Approved BY A.. 'fi ----. a-- - -�"--------.------------------------ 1 Date Application.Disapproved for the following reasons- --------------------------------------' .............. ---------------------------------------------- ------------------ ----------------------- ------------------..----- . -----------------......... --- ------------------------------------------------....------ ---------....---------. .---'...---- - ------------------ ? II'a7 Permit No. o-------.------..- ---------------------- Issued /.e-------A:.......-------. ..c- ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#tftrate of C omplian e THIS,4S TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � ) by------------- ....... .. ..v...-t.........................tall.. . Instrer at - - - ..��...�}�!i ��xy .. �,�------. ------ -- ------------------------------- 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. -...1(>�.....T4-1 t"s n dated ...l. �,�..-lz `7`THEV. ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONfSATISFACTORY. � DATE.. f 1(' - Inspector f�t �`f ........... :< THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..?��_..-.��1-"-• FEE.... Q Disposal Vorkg Tunotrnctinn antijt Permission is hereby granted_..........(? ? .: ._y. ... l' '.�!`...k_ ........................................................................ to Construe ) or Repair (1i)'a Individual S,e)vage Disposal System Street pp as shown on the application for Disposal Works Construction Perm-, No..!_ . Dated.._" ,_.- ��e ............. . ., _� ..�� ._. ,- � /y Board of Health ` DATE........ :.. .................................... FORM 36508 HOBBS&WARREN,INC..PUBLISHERS TOWN OF BARNSTABLE i.00ATION � ,R,,✓G�sr SEWAGE # �' VILLAGE ASSESSOR'S MAP & LOT ' INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /000 �-k► L LEACHING FACILITY:(type) j „ �� (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: :6— b `"qo VARIANCE GRANTED: Yes ` No s a i � , '� ?o