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Home My WebLink About0055 BUCKWOOD DRIVE - Health �"� 6ackajood pr.) nI No....................�� Fss... �,../.ck� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , Appliration for Disposal Morks Tonstrn.rtinn Virnfi# Application is hereby.made for a Permit to Construct ( ) or Repair ( L}-di Individual Sewage Disposal System at: .............';_S_-......1�.... w� _...Q b:. .... ....._..---._..�1`:�:_:.�.... 1r `.__...---------....---.........---••-.........._.. Location-Address or Lot No. �... c:.4�........ u ✓. ...............— Owner Address Wa ---------•-•------- .� C_............ ................... -f. .. ......,,--------------_-____._-_--___....--•- p� Installer Address 6 Type of Building Size Lot...........................Sq. feet aDwelling—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_3.�_.�___.............................gallons. 04 Septic Tank—Liquid capacity............gallons Length............... Width................ Diameter................ Depth................. Disposal Trench—No.................... Width.....................Total Length.....-_.r......... Total leaching area....................sq. ft. 3 Seepage f..._.___ E? .-_. Depth below inlet.._............. Total leaching area...................sq. ft. See e Pit No..._..___ .._ lameter__._ .. __.__. Z Other Distribution box ( Dosing tank '( ) Percolation Test Results Performed by.......................................................................... Date............ ---------------- .. 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.............................. .....................•-•---•---....--------------•------...-•-----•---•-------------•-•---•-------..._.....•---••---••- x ;.. = --------_-•---------------------•--------- U Nature of Repairs or Alterations—Answer when applicable_.._.. -----------d.Isv ....1Q,�(Q.:.OP .._. .. Q- .......................................................=.......................... Agreement: The undersigned.agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I.TLE 5 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 board of health. Sin d.._.....__ ......... � - 4 // ` Dat Application Approved By----•---•-•-- •----•-=....... .................•--•• G .......... ate e Application Disapproved for the following reasons------------------•----•--•----•--•---•--------•---------•--•--------------•---•------••-•-•--•-•-.._....._---_... .......--•••--•--•---•................•........_..------•----.................---------..........-___.___.--••••---•----•--••...--•---••-••-•---••••-•-••--•--....._...•-•••----••------................ Date i Permit No...1�_•...-` _: ---•-------- Issued_........................................................ Date .No................ ... Fps.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF (HEALTH .±. .......OF. .ti.lAa2....Vl. s ... ............................... Application for 11isposal Works Tonstrnrtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair ( I-)--a'h Individual Sewage Disposal System at: - --•-•_.. Location-Address a ••- or Lot No. -------------------.1„..�!.:A,.4:....� !,ta-Mtirr,ie-------------- :�A'!I! e ....... ......_........._. .._ . . --- Owner Address a Alfa r �-.- r iC r ,� t �,; `� ...... ... d _ - •- ti 1.._........ Installer Address Type of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms..._____,,.___5_____________•__-----_-_---•_--Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building No. of ersons............................ Showers Other—Type g --------•------------------- P ( ) — Cafeteria ( ) 04 Other fixtures ------------------------•-----.._....----------------......----------------....-----------------------....••----•...-••-- W Design Flow..............S^± ..............gallons per person per day. Total daily flow_:�a_.9....._........................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.........I........... Diameter._..;1. ......... Depth below inlet-..k............. Total leaching area..................sq. ft. Z Other Distribution box (l- Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................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........................ --=------------------=--------------------------------------- .......................... O Description of Soil :~:.................... i I ..................................,(4.................._..........._._.._..._-....•..._...._.._..........._......__- W 1 Ur.. Nature of Repairs or Alterations t Alterations—Answer when applicable__-_---�tsti-s'�:.4!1S.k...._...._?�s <,_s _..___ Y.<c,.._ ...... >a r u# Q T,G-t t L,t.. C .Agreement 4 j The,undersigned agrees to install the atoredescribed,.Individual Sewage Disposal System in accordance with the 2rotitjsio6s fof:ilTLE 5 of the State Sanitary Code—The undeisigned further agrees not,to place the system in ' opterat>on until a.Certifi4. cate of;-:Compliance has been issued b. the board of health. �; ., _ __._.p. e - _.,_._._.- �____ .'Signed -------:<--- a• � 1 �[S p� G� 1 L Grp_ ___ D-, x} Date Application Approved BY---.__ -.�!�� `�_-__--- r_---- �, � _ l� :__._._ -- �• ate ! Application Disapproved for the following reasons:_'............ `. ` .... ... .. •---•--------•--••--••---•---•--•---•._.....__---•-- ......----•---------------------..._.....---•--•---•-----••-•-•-•._...-••--•-•••••'1-•---i-•-----•---=•-•---•-----------•-•------------•••••-•----------••--•-------••-•-•---_--- Date PermitNo.-_ ......... -------••-•• Issued....................................................... Date ------------------------------------------------------- t ------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF... .�,� 1ti-S�.�9 .................................. Trrtif iratae of Tomplionrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�)/ by............................ ..t::A!�h.!).......t.�Ou-c_....------------------....-•-----------------................_.................._...•-••----......_ Installer at................................................-�------�t.!L k.. �t..vG..�------...j..(Z ............... �i r��f`wl .s. ._........---------.....----------- has been installed in accordance with the provisions of T " r ,.�-.-�`->o The State Sanitary Code as described in the . application for Disposal Works Construction Permit �o..z .. dated-------/..o _1..�1- 6 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE............................. : ............. Inspector....------....,...----...--.--....--------------.....----......-----•---.....--- ---------------,v-- - ---- ----____ _!. ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH JYt•.. ....OF......4Z. i2.'�: la ............................... NO.V Cam_..!_• tL, FEE........................ cif��r�ro�tl orko �on�trnr#ion ��erntit . Permission is hereby granted_________ __ __ t...!�.....S`E'��.._�,_..._.. a.. ..._._... ............................................................ to Construct ( ) or Repair ( '-)—an Individual Sewage-Disposal System atNo. :� _ .. /c ............. Street �-- as shown on the application for Disposal Works Construction Permit N _. d D•ated.._.�.0.-.. ................ �� Board of Ilealth DATE..._......- TOWN OF BARNSTABLE IbC'ATION .a r3vc�1�Vd01� �o2F�� SEWAGE # VILLAGEot/cS ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. C CAVE L4 1VOS-0—p�TTr _ SEPTIC TANK CAPACITY �--f/ /( ";A J LEACHING FACILITYAtype) P12�` G64 S (size) u, a� NO. OF BEDROOMS PRIVATE WELL O BLIC R Awe BUILDER OR OWNER C+4 4-21-I s -Ho e i!ow-"k DATE PERMIT ISSUED: 9 ` LD COMPLIANCE ISSUED_NCE GRANTED: Yes__ No V �i w — s n 3