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Home My WebLink About0007 TERN LANE - Health (2) Tern tme, (eytl , / 9a � tia4 r' / off./ �� c� _"S�Q-/ e s Olp I I v I 9�/-_ \CD- 0-Y-i APPROVED THE COMMONWEALTH OF MASSACHUSETTS rn bte Consew De ment BOARD OF HEALTH 19 Signed eat OWN TOWN OF BARNSTABLE ApVtiratinn for Ali►ipwiai Wi urk!i Tomitrnrtinn "ermit Application is hereby made for a Permit to Construct ( ) or Repair ( - an Individual Sewage Disposal System at: V 1•11el 7.....:$. .._�� ----------------- -- - -- L. n-:\ddn•sy or Lot No. ri, ----------------------- -------------------------------------------------------------------------------------------------- Owner y Address ----------------------•-•-------•--- .._..-- ------ ------------•- ------------------------- --------• -----•-------------- .................................. Installer Address Q Type of Building Size Lot............................Sq. feet U 3----_-•__----_-_ _. _Es Expansion Attic Garbage Grinder (Dweliing—No. of Bedrooms. ) pi Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures _________________________________ _ W Design Flow...........S6 _-�___________________gallons per person per day. Total daily flow.____-7Z5........................gallons. R' Septic Tank—Liquid capacity------------gallons Length________________ Width................ Diameter--.------------- Depth................ Disposal Trench--No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. 3 Seepage Pit No-------f ------- Diameter---Ja._.------- Depth below inlet_'-(.( Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �_4 Percolation Test Results Performed bY-------- ----•-•-------•-------------------••--•--•----•------------------ Date........................................ ,aa Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+' -------•------------------------------•---•-----•------------•------------------•--•------------•---......................................................... 0 Description of Soil........................................................................................................................................................................ - ------------- W ••••----•--•---------•---•--....--•----•--•-•-------•----•--------•---•----•-----------•------------------•--•--------•----------•--- . .. --- ------------- ------------- UNature of Repairs or�Alterations—Answer when applicable___ -e_ � ......4W�G._p'.�.... . ........... fs 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 Com as- su b the board of he th Sig Ace-1r ........ .. ...... .. .. . ----- Date Application Approved BY .... ...... ........................................ ... - �� -�7 Dare Application Disapproved for the following reasons: ............................ ........ -- .......I........... .............................................. .................... ............................ ............ .. ....... ....... . .......... . ..... . ........... --- ........ .�......... ........................................ Permit No. ......... ``... �.� ............. Issued .............----- .. ...........Z...... to Date IL j`1-.�.�;'..ur u .2 �-..�.:.r�.v^'^'^..-.'.�—ti....�•••.r.+..�.-.�.�-..�...•wv.....a.�e.:..^-ti.•-..°r.irw'�-.%:ra:.p-S.--wl�c^�•-.....vw-:r—.:,�+�:wa....d.•}-w�•wt.:y�"`�e� u"#''�tinC.w*!�`� CQ- �� Fas........................... . ' THE COMMONWEALTH OF MASSACHUSETTS ff BOARD OF HEALTH. C, /TOWN OF BARNSTABLE U Appliratiou for Ui►ipmial Works C onMrnrtinn ramit Application is her made for a Permit to Construct ( ) or Repair ((,� an Individual Sewage Disposal System at: tl / 1 _..._� ------------------------ -•--_---•-•-----•••-_ 4_'i_:.:.�:-�--._ _��._'�.�:::.. ......................_. r_._._.... .....___.__ .,�_ Locit.on-Address or Lot No. ` v�K�c T` � '- ti(�CN ---------- -••"''•"--'-•••'-'"• '-'------------------------------------------------- owner Address Za � Installer U Address UType of Building Size Lot----------------------------Sq. feet t.. Dwelling—No. of Bedrooms._-------------------------------------Expansion Attic ( ) Garbage Grinder ( ) NOther—Type of Building ............................ No. of persons-________-_-____-..____-____ Showers ( ) — Cafeteria ( ) 0.1 Other fixtures --------------- ------------- - - W Design Flow.........." _`S ...................gallons per person per day. Total daily flow..___= O._._.•._......._._._....gallons. 1:4 Septic Tank—Liquid capacity............gallons Length---------------- Width.....----------- Diameter---............. Depth................ W Disposal Trench—No ____________________ Width___-__--_-----._-__- Total Length.................... Total leaching area...................sq. ft. x , 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. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water.._._-_____-_-_.._---__. fit Test Pit No. 2................minutes per inch Depth of Test Pit________________•_-- Depth to ground water........................ a ODescription of Soil....................................................................................................................................................................... V .................................................._.. -.. -----------------.•1 ....-'-•-•--•'•---•---•-•....•--"- "'- ••' "' ....._._...... .... _q U Nature of Repairs or Alterations—Answer when applicable -=r`nt.. .�ak�1. -_____ _. �.... �`'-1 `....._... S (_(..`... .. U` ....__.....fig S. r --.-.-k1C 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-h-as--been,issued,by the board of health. t Sign— -' �� . . . (2... .'...`7. V --�.../ ///• Dace Application Approved BY /� ..............- ------ .-.. � Dare Application Disapproved for the following reasons: ..................................... .... ....--........---............._........... - ----------.................. .. ............. .................................................... ... .. ............... .. . .. ................. .. .. ... ................................................ ................................... Permit No. '` ��- --------------- Issued �j "'...a-.�:. 1� .l --- ---. ............ -------------'-- Dace ----- -------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ..... .. ............................. . . .. .---- t ................- tnscauer at ..................................................... 7-.-'M` 214.. ---- - ......................---------------------------------------------------- has been installed in accordance with the provisions of TITI. 5 of The State Environmental Code as described in the application for Disposal Works Construction Per No. ._l�d-..-, ,�? -------- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCTION SATISFACTORY. DATE-_.... .. ~.. .. .` ... .. .... - Inspector -.-.-... - ---------------- ------------ -------------------------------------- -------•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l.� /� �� TOWN OF BARNSTABLE No `-------------- O FEE-- :... Disposal Workii Tonatrudi an Vrrmit Permissionis hereby granted-------------- ... = -•-'--•----------------------'--•-'--•----------------•-------------------.......-•-•-•--- to Construct ( ) or Repair ( ^)-ari-Individual Sewage Disposal System at No.. r Street as shown on the application for Disposal Works Construction Permit��`___✓?_--3! Dated.._. ,��.2`-..-...`... .......................G.. ... - -- ----�---z;.. J. .�DATE------ Board of Health ( --------------------- 1/ FORM 36508 HOODS Q WARREN.INC..PUBLISHERS