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Home My WebLink About0060 ARBOR WAY - Health -� 1 ' � 1 .. Y � � �Y: � .. +\t _ } � v / � `' � 7, � � r � � I c 4 . � _ . ,. t 1i' � V L ��P �, 1 i3 � .� I _ 1 - � - n Ii. - ,, :.ons Mills �.23 003 T 1 No. 4210 1/3 YEL a TOWN OF BARNSTABLE ; LOCATION SEWAGE VILLAGE �1 _�J(JN�S ASSESSOR'S MAP & LO' /S& INSTALLER'S NAME & PHONE NO.. 'd/��11L13�� - SEPTIC TANK CAPACITY /SODaz LEACHING FACILITY:(type) (size) Da NO. OF BEDROOMS PRIVATE WELL PUBLIC WATE� BUILDER OR OWNER DATE PERMIT ISSUED:_ DATE COUPLUNCE ISSUED: VARIANCE GRANTED: Yes No � g� � �� \ �� i i � J `� , � �� O � '� ; _ �� \ � `b � � � � ��, ��. No....U1T.. FES..... Q.. THE COMMONWEALTH OF MASSACHUSETTS 'BOAR®ZF HEALTH �/!+� ...............OF.... --- .................................... Appliration for_Disposal Works Tonstrurtion Prrmit � Application is hereby made for a Permit to Construct ( ) or Repair /0 an Individual Sewage Disposal System at: .... .... ��.. . ......... .............. ----- ---•..._.__.._..---.......___••----•-------........--•-----------.._........_...-•----•--......__. .. Location K�;,171�;; �es� (( ��Q p t No. � .... _ l..w\! ........... _../TF!4? _ or !Y ........--- Owne ddress W --sf d 11 .._..<�- � ....../..1t ......... �7 Oc.O ,Y. --......0_ _ --.:__ �........... Installer Address Type of Building Size Lot_ __PA�...Sq. feet �-, Dwelling.-- No. of Bedrooms_____________ ........................Expansion Attic ( ) Garbage Grinder ( ) aa Other—Type of Building No. of ersons____________________________ Showers g -••-•••-•-•--------•------•• P ( ) — Cafeteria ( ) dOther fixtures ---------- ------------ ----- -•-------- --•• --------- --- ---- •••• - ---- w Design Flow.................. per person per day. Total daily flow.._.._. allons. WSeptic Tank—Liquid*capacity-AWO..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 Test Pit.................... Depth to ground water_-___-_______________._. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .............................................. -------- -- ------------ __.................... _ --------- .. . �--.---------- x w U Nature of Repairs or Alt ations—Answer hen ap livable___ �Q...____.=_Ql �.....�JJI!!1._..........� ____________________ - ,/QUU ............. ..-.<Z5. ...--•----•---------------------------------------------••--••---•-•----------......--•--•••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I 1i LTj, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been • ed y the b d health. Signed •-----•-............. •--- Date Application Approved By_________._•----•-_--� Date Application Disapproved for the following reasons---------------------------------------------•-----------------•------------•-----.............................. .._._._....-•-•-••---•-•------•-•....-•_....-•-••---••••-•--•---•-•-•-•------•--•-------•----•--•------•--•----•-•--•--•-----•-•---••••••-•-•----_._.•••---•----••------ •-•••----•--••------------ �/ Date PermitNo..........(U.`n-__-___-.Y-6.7................. Issued....................................................... Date ?r L/G/ `7 No.........L.....L.!...✓ Fss........:.?..... ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................OF.... .. ApplirFation for Disposal Works Toustrortion omit Application is hereby made for a Permit to Construct ( ) or Repair /W an Individual Sewage Disposal System at: Location-Address or Lot No. _ ...:C.�% z _....:%` 1............... �1 �... ...-- =--- ...... Via.......... �/��•��-.� Owner ddress :r%�..:.....' --------------......-•--•-"-�-....---•--- ------r---..... -----=--........./.[.. ., _._Y....... ........ ,!? _5d ............ Installer Address `U .Type of Building Size Lot feet Dwelling' No. of Bedrooms.....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ---------•-------•--••------ P ( ) — Cafeteria ( ) Otherfiactures ..............I....I.,_.... ,...., »-•-••--•-----------------------------------•-•-•-----•--•------•-- ------•... w Design Flow..............:.....-------.------.----gallons per person per day. Total daily flow.......s3 iO............__..........gallons. WSeptic Tank—Liquid-capacity-/MD..gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.........._.........sq. It. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.................... fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------•.....-------•-••------ ------------------- - O Description of Soil-•--------•-•--r--�---�-----z�.--�..S.S.......•------- = �!s �=5� !� � ---------- x w U Nature of Repairs or AltAr ations—Answer when ap licable.__ -5 ----------a_WK)C &W...-�/'7'.................... d . ...................... --------------------------•-------•-----------------------------------------............••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI:1; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in . operation until a Certificate of Compliance has been is, e y the b /d,Q��lth. 9 Signed .................... ....,. 1 .E �s Date Application Approved BY -----------------(✓ U---.a.�,.-.......�.-..--••--•-•--------- �� Application Disapproved for the following reasons------------------------------------------------•••-••--•---•--•-•---•------•-•----••-•-•--•-•-......------•----- ...................................................... ••---------•--•••-.....•---------•....•------••---••----•-----•-•----•-•-••-------••-•-------•-----------••--•-•••---------•-••-•---•---•-------- q Date PermitNo........�4• Y-3.7.................. Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... "l. .............oF..... 4.--............:...................... �rrtif irate of Toutpliattrr THIS IS TO CFZTIFY„ That the Individual Sewage,Disposal System constructed ( .) or Repaired ) ____..�2Trico ' r by ...---•- ---------.�'� /�.. ..( -------------------- •r......-.—Installer. -•....... ........ . ------••--•------ has been installed in accordance with the provisions .of 1'1'"-[ 5 of The State Sa arry.Code as described in the application for Disposal Works Construction Permit No.._ _,P _.ftg:..7..f.. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY, : DATE..'" ........•..... . Inspector_...- .?................. ......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 F�F HEALTH N !.:�1..0. _.... _./..... .............OF....................... ..................................... FEEv� .......... Disposal Works Tunutnulion Prrutit Permission is hereby granted------------ - G27' • to Construct ( ) or Repair an Individual Sew a e DispTit System atNo. '60......... ....•1Z''Z= ----..... ' -- -- V!_�.............................................................. reet as shown on the application for Disposal Works Construction Permit I __ _ 7....._ Dated.......................................... ...................... -' i-- ------------------------ --------- ------ �_ Board of Health DATE........--------- V........................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS