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Home My WebLink About0030 WEDGEWOOD DRIVE - Health 30 (A)ed twc)v cf Psi v-t-, CuW Vi I b Al SMEAR No.2-153LY UPC 12934 smazd.com • Made in USA OCYc% i qbSUSTAINABLE FORESTRY INITIATIVE cartired Rber Soene6io W.w..Rn�onrae�aro 137 C� far No....._/-�5:nyja_ - /F. s..3d ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di►i.pooal Wi orbi Tontitrnr#inn 11amit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at 3o ��a Derr ✓ ........................ ••-•-�_•---1240-----•---•--•------- �_.-•---•. ::- ... ` L lion-Address or Lot No. . �o •-••••-•---•••••--••----------- ------------------------------------------------------------------------------------------•-----•- O� ncr Address W •-•...................••---•----••---•---•--..__..----•-----••----•-• Installer Address UType of Building Size Lot............................Sq. feet t Dwelling—No. of Bedrooms-_-•-•-•----3-----------------------_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons..........------------------ Showers ( ) — Cafeteria ( ) 04 Other 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 ( ) b-. Percolation Test Results Performed by-----•------------------•-...-•-••------------•--------------------•------ Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit-_-__________-__-___ Depth to ground water........................ fZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 -..-••••••-•----•----•-------•--•---•••----••••--•••--•••._-•-•...••---••-•-----•-•-••-•••••-_•.............................................................. 0 Description of Soil.........................................•........_......-------------------------•---------- --------••----------------------=--------•-------- ...................... W U W •---•---------------------------------------------------------------------------------------------------------.------------------------------------ -- ............................................ � UNtpre of Repairs r lterationk—Answer whe ap licable.___--LAS.4411____.___-/_`.- _?______��C�.�__..__._�1.�_c� ------- -•••-• =Q:�C_�S_.> _�. i_� --...-�-------- S t�_1`c_ixa----------------------------------•--•..._.._..---•---- 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 b,en issue the a d of health. Signed 2' ---- ------------ -- . ... ......------..---. .....-------------------------------- Application Approved By .............. .. ....Da,e J�$ Application Disapproved for the ollowing reasons: ............................. .... . ....................................... .:........................ ......... ...... ................-...... .-...-................-........ ---.----------------------------------- Date Permit No. .........C�.J��.' �-.. ................ Issued ........... 3_------�...�-..`�t�...-...... Date y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE A;jVlira1i>an fur Diripatial Works Cal witrur#ilan Frrntit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at• /n )�1 ,(//� ///� �y ...._...S�j � �.W_Vagp---..`.`_'�..................... 1 G�✓!Imo-•-••--••---...Lot No.•----.--------•--•----- L ttiott- \ddress o ..-_•-•-(',q X�o .................................. -----------•--•------•------•................•-•----••--.....-••...............-•-......_......... W Oo nor Address ` 0,..................- ......................................w Installer Address UType of Building Size Lot............................Sq. feet a Dwelling— No. of Bedrooms.........._.3--------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ---------------------------------- ------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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. 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........................ R: .-------•------•--------------•----•-----•-•---•--------------------------•--••-••--•---•.....------......................................................... ODescription of Soil........................................................................................................................................................................ U ...............•-.....•-----............................................-•--•--•---••...-••-------•------------.....----•-...........--•--•........---•-•----.............................---••-•....... W ----•..............•---------...----------------------------------.......---------------•--------------......•-------...----•---•---••-•-•---- •• ••----------....................... U Nature �o�f(�Repairs /)orr Alteraattions—Answer when ap licable...--115_ ,c/l fI________- _ .t ______J_ "}�j 1_--•----1 a_ •�l_. I ...7 t'... ........_..CC_?...........'�r..�.�.�?..�.I.!�.!^......._4.i.��....._..ls�-_ -------(�_��('.�!:........................................................ Agreement: tl/ 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 brad of health. Signed .... . 2_d. '.9 J� Dare Application Approved BY -------- Y�.. ... ., /...... iApplication Disapproved for the ollowing reasons: ............................................................................ .................................. Permit No. < ........ r`....... - ��.a-..,,�. ... ..... Issued ......-----..;�.-'-•--� �- T,.S-................�.. Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#iftra e of Q-11ampliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( by ......................................._.......... f�/�. ................ -- - ......................................... ......__ ...................................... Inuallcr / at ........3.d------- --.Gt/n. �f..Q.l�/ .1�. .......✓1 -- - c�/. 1..�� -------------------------------------------------------------------- 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. .f�' .-�� -ram.; .......... dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTOR �- DATE ............ ....... ._ �^....... ._.. Inspector ------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No... •>�'_-.�,,j 2�. FEE........................ Rapasal Workii Tunifrudiatt rrrnti# Permission is hereby granted--------Z................... AAe/ d.-------•-----------------•---•--•----------------- to Construct ( ) or Repair )�n Indivir ual Sewage Disposal Sy tem l Street as shown on the application for Disposal Works Construction Permit No.!��_5��. Dated...... 3. _ ...............................-• -....................................................... Board of Health DATE------------------ -,c� FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE , LOCATION� al�!�Q_( 00b SEWAGE #�� ' � VILLAGE�611leAll f '�.- ASSESSOR'S MAP & LOT Jam^' INSTALLER'S NAME & PHONE NO. 42 SEPTIC TANK.CAPACITY LEACHING FACILITY:(type) Cj'a do � (size) &a a4l NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: �/� DATE COMPLIANCE ISSUED: `Y -- VARIANCE GRANTED: Yes No coo, Cat. 5 2 ,per r 67