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Home My WebLink About0017 VICTORIA STREET - Health �e�fier�ttt� 14 - oho SMEAD No.2453LY UPC 12934 Nnoad.com • Mad*in USA WITIATIVE C�r�rdFlar$m*o N FRs ..... ..� THE COMMONWEALTH OF MASSACHUSETTS Lz,�L �- 77 BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di►ipatgal Hi a1rk,i Cfa mitrurttam rantit Application is hereby made for a Permit to Construct ( ) or Repair ( t,-) an Individual Sewage Disposal System at: ..... -?.....lV.t - e vx=�'- .. ................ .................................................................................................. Lo anon-Address or Lot No. --------- .... -- .� Owner A css Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms............._-------------------------Expansion Attic ( ) Garbage Grinder ( ) 134 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ________________________________ _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Gd Septic Tank—Liquid capacity/0?l vgallons Length________________ Width---------------- Diameter---............. Depth................ Disposal Trench-- No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...................... Diameter........._...--_-.-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......... ............................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit�................... Depth to ground water........................ a+ -----------------------------•-------------------•-•---•--•..._..........•.....__--•-----------...._........_..............-------------- •----------- ---•__. ODescription of Soil........................................................................................................................................................................ x --------------- ----------- ------------------------------------------------------------------------------------------------------------------------- -------_.... ------------------- x -------------------- ------------------------------------------------------------------------------ _ Nature of Repairs or Alterations—A sorer when a llcable.-__. ��c �iN_...."..�_�5......_. ....!-�...................... U P } PP 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 een issued by the board of health. Signed ................................... .. :: i/�--------------------------------- /�i3 �..`. ........... Application Approved By ................ ...�.. ................. ....I .,t.4B2n.gY... ............................................................ Dace Application Disapproved for the following reasons: ... ....... . .................... . ............ .. ---................................ ........................... ................................................................................... . . . ... .......... .. --....... .----- -- . ........................................ Permit No. .......... ...4...-......)... 0 Issued ------------------ ..................................................... te...... �� Dare •`�.t-+�IW'i.+^"+•.-^+r"-w./.'v..'Y .r-rwJ..'t.r.-5,,,,,,,.-t; �,.tis-..`vY� r....:-_......•.�..» :��..�•,W �,.. _ .. wr'-1,.. .,,• I•• .yu .. `�,... ,-.c�..�.s•...✓ w+'-\y....+-v _...r.tr�..i -,.� ....�..:'.�SJ'� No......................... F>�s.....��'�............ THE COMMONWEALTH OF MASSACHUSETTS //_3/5,/BOARD OF HEALTH TOWN OF BARNSTABLE Appliration.. for Diritiosal lVnrks Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair ( tom) an Individual Sewage Disposal System at: ll Lo ,lion-Add n'ss a or Lot No. 1 ................................................. ............••--...••---••SG Mg, ................................................... .- nn Owner — A dress , Installer Address VType of Building 4 Size Lot............................Sq. feet Dwelling— No. of�Beclrooms_____________3----------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of 'Building ----------------_--..----_- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity/.UGv.galIons Length---------------- Width---------------- Diameter.-..-.---- ..... Depth................ x Disposal Trench--No. .................... Width.................... Total Length-_--_____.--.._--__. Total leaching area....................sq. ft. 3 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. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:4 ............................................................................................................................................................ 0 Description of Soil------------------•------------------------.....------------.......--------------------.-----•..........---•••........................................................ W V ..........-•--•--•••.............•--••.......••-•-•••--••-•-••••....--••-•.........•••.....-------••••••-•---••••--•-------••-••••----•••••----•••-•----•-•-••••-•-......--•---••---.................... W U Nature of Repairs or Alterations—Answer when applicable.-_T�_1_---�._Q-�--'__-_.-.-1.�Sk�,�---!.-(-.._..•........._.•.- �_V ..`I. _.�-J - . 4t...........L ................. ......-------------•---------•. 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 ------... ...... - ....................... -`/ �2.��....:...... Date c Application Approved By ................).11�... ..�� m.-.-b ............................................................................ ....1 .-..�.ate"' Dare Application Disapproved for the following reasons: ... ................ ........ . .................................................................................. ....... ........................ ...................................................................... ... ......... .................. . ....... ......................... . ........ ........................................ Date Permit No. ..........III..�/....-...... Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (11'ertifirate of Compliance THIS IS TO CERTITY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by . ...._ '.rc=�' �'.S.......A�...../n. s. . // t Inuallcr at ....L..7........1/i..C-.fU✓..z`' - 5 .-.--...r -,.,.. .-'V Lt 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. .... ........... dated .._---------._...................... _... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. \ DATE...............................�-/ -- I �'....�L/l. Inspector ..-__-.-.---1. ........._...•..._......................_....... .... .. ,............. . 1 Q THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......./ l TOWN OF BARNSTABLE No.....,._ - d�� FEE 5i!.......... � Disposal Works Tonstrurtuan "rrmit Permission is hereby granted...... G.--'�.. -._... ......�?SL!�------------------- to Construct or Repair ( ) p (,) an Individual Sewage Dispos System at No.........1--2........... +.<.. 1-`^ ........ �..............- r.y:--......Y�("` 1 Street / as shown on the application for Disposal Works Construction Permit No. �"r_Ihl-___ Dated.__./._-..�.�...--.�.�.... ..................... ...i. -------- •---------------------------------------------------------- .................................... Board of Health C r--- DATE.............�.-..1..'�--"--•�-t-�- FORM 3850a HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE t a5 LOG`!►_T10N j`7 U��.��-.� SEWAGE # J Ll VILLAGE ��e�y-�r U �' ASSESSOR'S MAP & LOT• U INSTALLER'S NAME & PHONE NO. In'l (,� k �`7 ,j ,�7Gt✓ SEPTIC TANK CAPACITY ,,t,vv LEACHING FACILITY:(tyPe) Z-/- , � 1 �fir,.t1 ✓ (size) 7 jc2, NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ?4 t— BUILDER OR OWNER rnt:_ ,ramLjc-: S DATE PERMIT ISSUED: T�� DATE COMPLIANCE ISSUED: W VARIANCE GRANTED: Yes No �� T F r -s 1 s .. LOCATION SEWAGE PERMIT NO. Lot 6 Victoria 83-370 VILLAGE Centerville INSTALLER'S NAME i ADDRESS Robert B. Our Co. Inc. Gmtmai: WeA . rn R . Nn_ Rarwi ch d U I L 0 E R OR OWNER Louis Gordon DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED i 0 �e i i