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Home My WebLink About0183 BARNSTABLE ROAD - Health 1�63 'erns-��1� � . ASSESSOR'S.MAP NO. PARCEL 90 Q L0CAT10N SEWAGE 141T NO. 3ld VILLAGE va n n IXS7ViL . R'S NAME & AD DRES Fg) U1 ! DE R OR ® HFR DATEEWT ISSUED DAT E COMPLIANCE ISSUED Q d v -° I r No..`B.. .-.qQq. Fps..... s.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF1 (HEALTH Cv�l1 .... oF.' I3nrY►s![�cp A-------------------------------------------------------- ApplirFatiou for Bispvii ai Works Tomitrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (yL) an Individual Sewage Disposal System at: a 6 8 3 ir►�... s�... Q. . y. 4a�n.f s........... ...........................................................•------------....----•--------------•-- ----------------------- ... Loc lion-Address or t N . kNo�g�!�k�!��..... :_../ors----•--•----------------------------- ia.3..Rmrns�a��--��: f tzu�i�s.---......--------------•--- ............ Owner Address ---------!�9...---eanc-............................................................. -350 /y14rn 6p�" .,...t 0 __ -plas _ Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling Le!fNo. of Bedrooms...........:------------- ..........._...Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 W Design Flow.Other fixtures ________________gallons per person per day. Total daily flow.__.............._........_...._......_•..gallons. d WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date......................................... a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--______________•--__._. G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------•--------------------------•-------------------•----------------•----•------........................................................................ ODescription of Soil------------------------------------------------------------•......--------------------------------------------------------••-------------------------...---•------•-. x W ------------------------- -------------------------------------------------------------- ------------------------------------------------------- ---------- ------------------------ U Nature of Repairs o .Alterations— swer when applicable.. 4boop • !e--%-gnt1---/bqo•........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i=s,.; p of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is—sued by the board of health. Signed...... •.K �_nt.------•--•----------••-------------- ----- e Application Approved By....................................... •. ......... - � Date Application Disapproved for the following reasons:_______________________________________________________•___--------------------------------------........._..._ ....---•--•------------------•---------------------------•----------------....--------------•-----..............---........------------------------------------------------........................... Date PermitNo......................................................... Issued....................................................... Date "s q0q ko....................... . Fmc.... ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................OF.... .............L)1C_ ........................................................... Appliration for Disposal Works Tonstrurtion jhrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at:----. 'b B - &r')� .................... � i 1 ! "AAe.l.. ............ .................................................................................................. Localion-Add,ess or Lot No. ----------------------—-----------r............................................................ .................................................................................................. Owner a ddress" 8 ofO'co .356 1'.erj, Uorl""rif4............................................................................................;..... ....................................... m_4..........................4................... Installer Address Type of Building Size Lot-._------------------------Sq. feet U Dwellingl- -"No. of Bedrooms........................41................Expansion Attic Garbaage Grinder Other—Type of Building ............................ No. of persons._...__.................____ Showers Cafeteria 04 Other fixtures Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width_..,:......_.____ Diameter__--_.__--_---_- Depth_............... Disposal Trench—NTo. .................... 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 ( ' ) P-4 Percolation Test Results Performed by.......................................................................... Date........................................ P-1 Test Pit No. I................minutesperinch Depth of Test Pit.__.__..........._._ Depth to ground water_.__...._............... 44 Test Pit No. 2................minutes per inch Depth of Test Pit..._........._.._... Depth to ground water.............._....._... P4 .............................................................................................................................................. 0 Description of Soil....................................................................................................................................................................... U ....................................................................................................................................................................................................... ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicabl,_T�2 t-44(, 1_5*00 0,k4 -&,Aj e 7-axk 10 ---------------- -------------,?tt--__l i----------------------- Xgreement: ............... ........... ............................................................................................. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of-I TL 51 of the State Sanitary 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.. 5/.V.-0�' j 6 .... ...... -- -------- --------------------- Application Approved By...................................... ---- Date Application Disapproved for the following reasons:.............................................................................................................. ................................................................................................................................................................................I........................ Date PermitNqe...................................................... Issued....................................................... Date N LIC THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7-6 t P rle .........................................OF .................�4......................................................... Tntifiratr of Tompliana THIS IS TO CERTIFY, I Teh2aA 3.the .111I.5n..d..,.r...id....a..l.(.?.S..e 1., ag-e7 Dis osaS7stem constructed or Repaired by............................................... ............................. .. ... ... ....................................................................... at S ....... ........... . .......... ... ......... .........y ------------------------------ has been installed in accordance with the provisions of "'11Z D- of The State Sanitary Code a qjestriAed in the application - el-I.1 1 1_0_0........... plication for Disposal Works Construction Permit No....�Y..6.....qr..Q.9......... dated-_----------- ------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI VNAT71SI�ACTORY. DATE................................. ............. , Inspector.......(-------------------------.................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ll 1 No.... .................................................. _.. 0- ............. Disposal Works TalInstrurtion "nutit Permission is hereby granted............A..._ _..... ('�............ ................................................................................. to Construct or Repair < ) an Individual Sewage D1SDQsaI SysteN . 0 .jp !� ...............f2�v.......................y................................. ................. at No.................... ..........UA. N;n# Street 17... . ........a.............. as shown on the application for Disposal Works Construction Permit N63.��._?�N... Dated....._ ................................................4--- ...d.�........................... Boar Health DATE..................... ....... . '6.................................. FORM 1255 HoBB & WI�REN. INC., PUBLISHERS