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Home My WebLink About0117 POINT OF PINES AVENUE - Health i17 Pointer Ping Cc n ttlrv,rit - �b O LA SMEADo KEEPING YOU ORGANIZED No. 12534 2-153LOR 0 FSOURSTMr" MIN,RECYCLED INITIATIVE CONTENT90% Gruried fiber Sourcing POST-CONSUMERS wwws8propremarp Sfi alm MADE W USA GET ORGANIZED AT SMEADLO4 i �J r.J � Fas.. s. .. -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVED TOWN OF BARNSTABLE 00MOttb Cmervation Department Appliration for iri w ul Workii Cnllgt r r tJR 4i-t__ Date Application is hereby made for a Permit to Construct ( ) or Repair ( �/an Individual Sewage Disposal System at: ...................L L.2... Q.a, `�...-:v ---P.."e.S..__ -... •- Location-Addres of Lot No. .................. ................. ..y1.` -•--•--•---- ............. .......... O+rncr Addr s Installer Address Type of Bung- No. of Bedrooms.--_-__�3---------------------------------Expansion Attic ( ) Size Lot.-Garbage Grinder q(f ) eet Dw Other—Type of Building ---------------------------- No. of ersons---__--__-__-__-____---.---- Showers — ( ) a g p ( ) Cafeteria QOther fixt/ures ------------------------•---------------------------- ------..............------------. --_..-------------------------- Desi n Flow........._ . - �J ._ _-___. _ Mons per person per day. Total dailyflow...-. W g �-- ---- - - --- -----g� P P P Y• � ?.-..�a------------------------gallons. Rr Septic Tank IL Liquid capacity-/OODgalIons Length.--.- ------- Width- ......... Diameter---------------- Depth................ Disposal Trench-- No. .................... Width.................... Total Length...___......._... Total leaching area....................sq. ft. Seepage Pit No ........... Diameter----J_`p�..-..... Depth below inlet....... __...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►4 Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................minutes per Inch Depth of Test Pit.................... Depth to ground water........................ Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ...............................•--...---••------•--•-----•-----•-•-•--...----•-••---•......••-------......................................................... 0 Description of Soil........................................................................................................................................................................ U •................................•-•----••--•--•---•••••-•---------•-----•----•••-•-•--------------••-•---•-•--- -------•------------...-•--••-----•-----•-------•-•-•--------••----......-------•..---- W x ....................................-................................................................................. .................-.............................................................. U Nature of Repairs or Alterations —Answer when applicable...... r✓-"�►Y...... ................... g�f._..._.. �! r w ,-5_rGX_C-----•----•--_--•--------...........-•---...............--•---------•--•--...... 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 issu�bbthhe�brd of health. Slg ------------ .. -- ------------ � .� Date Application Approved By ---- --------- .... .. ........ .C�/�.7:7.�'.�....... Application Disapproved for the following reasons: ...................... .. ...................................................... ............................................... ............ . ..................................................................... ....... . .............................................................................................. ........................................ Date PermitNo. ...��... i'...................�............................. Issued ............................. .................................. Date �-,-... rt}:......yly`-...........,wlsn�..;-.z.--•,� .a-R.- e�.......L��-�^ _-.. ...-..`n..-�.•srd.aL.........dti�-.R...t�.'Lir+�......... r�^s"a„'v'_.r.w.a-...�.^.�....�..-.........-�S:-w,...yd;,.,Ja....:.ems."as'..t�+r ��%k�.7'^�'WL 7 No....,7 ?-.&.X_ ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH TOWN OF BARNSTABLE %A�l r 5 Appliratinn for Ubjpniul Wnrk,i Tonfitrurtiun rrrmtt Application is hereby made for a Permit to Construct ( ) or Repair ( t_/an Individual Sewage Disposal System at: c 1..1_.7....... . .......... ! ................. ................. or Lot No. Location-Address M �'��`.. it(_t I E' �T'PV Owner Addr s �1.4 Installer P Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms.-__-_�-------------------------------Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons-------- _------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------------- - W Design Flow..........'S_-�________________-----gallons per person per day. Total daily flow---___��,- - ........................gallons. WSeptic Tank 4—Liquid capa6ty.1000gallons Length-_.-------�------ Width___ ..------- Diameter_............. Depth................ x Disposal Trench—No. .................... Width.................... Total Length___._......_.j_-_- 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........................ rz Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+' ----------------------------------- --------------------------------- •--•------------------- "...... •---------------------- ..... •...... .------------------ .:.-- 0 Description of Soil........................................................................................................................................................................ V .------------------------•-•--------•--...-----------•-•-----------•----...----------------.....----------•-------------------------••---•-------•-------•-----------------.............................. W U Nature of Repairs or Alterations—Answer when •...................( ........... ..._...t..✓1.. 3 f` C- 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. U Dace ApplicationApproved By .................... J... ..� ...........-................................................................... .L ..-..7-.-..�.3....... Date Application Disapproved for the fo lowing reasons: . ................ ... ..... ..... ................. . . . ......... ..................................................... -- . ........................................ Date Permit No. ... -.-3..-...�.G..�'/ Issued .................................................................... ............................. Date P THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CE1ttfi ate of Compliattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �� by ........ .. .. ......-LI...._.. ' ..Q. _1,..# : .--S,P. ? s.; � -----------------------n--.-----------------.._...---.......................................................... at ................................t..�. ..........:. Q l..�`..�._.......d�C-_...P. 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. _-.-.f6� ... .-_..... dated __.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU. A AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. -� DATE......_.._..._..__....0 - ._ .__........ Inspector -----.- :_..............................................._.......... -------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE yg C � � Ste `... Permission is hereby ranted------------------- ---- b to Construct ( ) or Repair ( Llar"'Individual Sewage Disposal System at No........................ /-7 wi_" 7u" -- ----- ------. G��.. .........--i---'- .-....- Street as shown on the application for Disposal Works Construction Permit No.�3---1�� Dated........................................... -•-------------------------- — -...................•....................................... Board of Health DATE... ..............�- ;7 _ --•-•------------ FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 4�3 LO CAT ION p y� S AGE PERMIT NO. v I L 51E INS A LLE 'S NAME & AD R E S S B U L D E 13 0 OWNER DATE PERMIT ISSUED 022 DATE COMPLIANCE ISSUED �� I°. �. . TOWN OF BARNSTABLE LOCATION ` O� K�oK- DN, '�S SEWAGE # �Q r VILLAGE C-c f`ems�� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1 cc)0 2)vo, 1l J LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL O UBL A-TER BUILDER OR OWNER �- DATE PERMIT ISSUED: _ DATE COMPLIANCE ISSUED: - �L�/ • q ' VARIANCE GRANTED: Yes No �/ o t moo �c�1z� eawK No.... ............ Fic$.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1....OF.... r A.-�<^:. ........................ Appliratiun -fur Mgpuiitt1 Works TIInitrnrtion Prrniit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System t r. ............. �__ / Location Address,.,� or Lot No Ow --dam' ne Address Faller Address UType of Building Size Lot............................Sq. feet a. 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----.--------------------------•-.------ a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water..-._.--------.-- G� Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_-._-._-------.--- P4 •---------------------- -------- -----•-••-------------------••---------------..........----••-----•---•--•-------•--•----•------------------•-----_------- ODescription of Soil---------------------------------------------------------------------------------------------------------------•------------------------------------ ------------------- x U ------------------------------ ---------•••-•--••-•--------•---••----••-.............................................---------------------------------------------------------------------------------- -------------- ------ ------------------------------------------------------------------------------------------- --- F . ------- U ature of Repairs or Al ration —Answer when applicabe .___ ._._ ,__ ._�_:._..-. _ �- �_+�- ..:.._..___._.___.. -� _, --� , r,---------------- ------------- -�------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been—'issued b the boy rd ofk'alth. Signe d;._ •�� lr/_1 ' � - C�� -----• •-- � Date Application Approved BY .G �"/.� i�� > ...... Date Application Disapproved for the following reasons:............................ --------------------------------------------------------------------- ................ ....•-----------••-•----------••--•--------------------•-•••-•-- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF_HEALTH ....... .......OF............ /f .. vyt..... ................................. IVITIrrtifiratr of ITPumpfianrr THIS IS TO ER" I�V, Tl,,�,the Ind' dual Sewage Disposal System constructed ( ) or Repaired ( ) � �,- . by.. J ....................... --- ---"------------------------'------------------------ ------ -- ..................... I JInshalle has ben installed in accordance with the provisions of Arti l I of_ he State Sanitary Code as described in the application for Disposal Works Construction Permit No.-:'___________.. ... ____---_-- dated...___. ..` ..I _I�.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE :.., Inspector ------------•----•---.--- r THE COMMONWEALTH OF MASSACHU E S t 1 BOARD OF,,� HEALT.Ht �Il� .........OF....... /..................... c-{!fp.......... _ �* P40......................... FEE-_.. -----•--...... Ui poliM-Works Towitrnrtinn "ritit Permission is hereby granted �---• --,.._1� �- i �1 a'-q to Constru t ( ) or Rep " .( an Lndividual Sewage Disp .Al System, at No. �t = ----- --- 'f/ str� as shown on the application for Disposal Works Construction•-Perm teSNo,n------------------- Date _ _ --_ a--•- ------- :�.........` -�. .............7--�� r DATE. 9 .�! Board o£ Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS