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Home My WebLink About0017 EDLEN LANE - Health I � rd len lant , 0 4AA; ,T TOWN"OF BARNSTABLE LOCATION 7 �' 1z GU 1-�'Ai � SEWAGE # �-7- CI L!3 VILLAG ASS E SSOR'S MAP & LOT -c�Lc0� INSTALLER'S NAME & PHONE NO. < F SEPTIC TANK CAPACITY 42<�S:gl! -:S C'-Ss�a a S LEACHING FACILITY:(type) L eciGk P+ T — (size) S C/- f SN L NO. OF BEDROOMS PRIVATE WEL WAT R BUILDER OR OWNER DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED. VARIANCE GRANTED: Yes No / 'i ' r LO . ��' o �� I LJ � 'C t� `� 'g s /� l/ / No. ..._._.... 9 F$s_.......-- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t�...........................................OF.............A: iz......................................... Applutttion for Disposal Works To'nstrurtiun rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (L-}-fin Individual Sewage Disposal System at: ............... _N_!L.... .....••...... ................. ..._.._.... ....-----............._.. Location-Address or Lot No....................... ._.....1 : --.CX ._.._�._C i..E !..- - -- -- --- ................... _inn ................................................_ `Owner a Address-----�.�.. J-J-S----•..............•-•-----.................:. .-----........tA%.......................................................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms._................. . ..........Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building ............................ No. of,;persons............................. Showers — Cafeteria p•' Other fixtures .................... •------' c.: v:....:...__...---...:........_..: Q ._ WW Design Flow.......... .6................::...gallons per person per day. Total daily flow........ .....................gallons. WSeptic Tank—Liquid*capacity..............gallons Length ......._.. Width............._... Diameter................ Depth................. Disposal Trench—No_____________________ Width..................... Total Length.................... Total leaching area-__.......:..._.....sq. ft. 3: Seepage Pit No......I.............. Diameter....1_13!........ Depth below inlet__...4cf. ....... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by....................................:.........•••---•••••----..._•----:_. Date........................................ aTest Pit No. 1..........:.....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.:.. ------------•-----------------------------------=--------------------------------------------•-------------------------•••----•=----_.... V .....•••-•••-•...-----••-••••••••-----•--•--••_•. - ............................•--......---------..............-----------•---------.....••••..........._..._....- ....................... UNature of Repairs,or Alterations-Answer when applicable...____ _010.......... zI G_._��.____..ST�.w. .............. ............................... . =-----•-------------------•------- ------•--- •.............. -----••---•_. Agreement The undersigned agrees to .install the aforedescribed ,Individual Sewage Disposal System in accordance with ' the provisions of TITLE 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 by the board of health. Signed.. ----... Date Application Approved B " ........... Date Application Disapproved for the following reasons-...............------.......................................................................................--- ........_•-••---•-•••-•......._•••-- x:.............................................-------r-•-•-•--••;-•---...---------------------------•--------•-----••......................_ (3 Issued_------•--••----•---•---•------•-- PermitNo._• -.....�._�..._�- ._. :.....D ...._ Date r THE COMMONWEALTH OF MASSACHUS$TTS BOARD OF HEALTH `�..O LtI....................OF.. 'A2NSC 4 �. '................................... Applirtttion for Disposal Works Tanstrurtiun rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (�- --an Individual Sewage Disposal System at: .....--.........L-2__.. r; / _1:�+4�N ........................ ..................`� !awv :s-- --------------.----.........._.._..._.. • .... ... .. .. �" r Location-`Address or Lot No. - ....._.I Y�'(Z _.__....�,!!Z!N...le: .T.......................................... ....................aA.` .F.........................---------"........»«...._........ w Owner Address ._... :..... -._...• ---------------------------------------. - .�..,.....--...... ,--..... ------.-..----•-•-----•------------------..._-.-- Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms..�3...................................Expansion Attic ( ) Garbage Grinder ( j aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria d Other fixtures_. ......... -------------------------------- -- -- _. ---- WW 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. 3 Seepage Pit No......I.............. Diameter.... .�.`...... Depth below inlet......4.-1 ....... 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.................... GLt Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ------------------------------------------- ---------------- 0 Description of Soil........................................................................................................................................................................ UW •••-------•--•-•--•----------------•---•--•--•....••--•--•-----••---•------•----•••---......_.......----....---••-•-•••-•------•-•-•-••-•-••-•----------._.........----•-•........-•••••--••-•-•----••-• Nature of Repairs or Alterations-Answer when applicable-------A_0 0.._......L{�C� c�w2.'.......i ............. .......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLI 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 by the board of health. Signe ........... - c� r "'"" .•.... -,, / c! Date ApplicationApproved BY .... ........................................... ................................. ........................................ Date Application Disapproved for the following reasons:--------•---•----•-----•--...---•---•---------•..........................•-----=--------.....---••••......--- ...................................•-----•-•----•------•--------•---.....--•--.....•..................._.--••-----------•---------•----------------......------••-•-----..........------•••..........._ Permit No........... L�--�� /� Date ..- ___. Issued:............... -------- ..------- —-------- — +�� Date -------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .....1?.L...............OF.,_\Z"`A.V_K-S1..A '! ..............................0............ Trrfif irtttr of T-autplittnrr THIS IS TO CERTIF_K, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � b �� Installer at............................- •---•-. _.i 1: -t`r•----L u'.u::..................... = ....... •---------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.•�._-..... .�...f.------•- dated_........�.1---------- �... .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......0...........- _ I - ............•...............•------•-••-----•----- Inspector•.. J.............. ---------------=...... ..._......... ------------------------------------------------------------------ =- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L�G(2� ....�..-x............�-. ............OF.... u14 ..�4 ...... .....................•---......---• —`'`- No................... 2�...... FaE.... ....... 19ispottttl urku��on trttrtuan rrmit Permission is hereby granted.......-.......... .•............ ._ :i .................................. ................................ to Construct ( ) or Repair ( an Individual Sewage Disposal System atNo.:.........................k.-..........1:-�-1_f_ -.....I.. 1�, .......... f.., " --------------------------------•- ................. Street -�-- -..........-•------ Street as shown on the application for Disposal Works Construction Permit No�_-�U Dated........... .................... / � 7 Board of Health DATE ((( ----------- / ....