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Home My WebLink About0113 ESTEY AVENUE - Health es+ef Aw., 91~ .36& TOWN OF BARNSTABLE ��31 LOCATION J;j / 4�41W g/ SEWAGE # VILLAGE ASSES OR'S MAP & LOT 6"26 j INSTALLER'S NAME & PHONE NO. . f SEPTIC TANK CAPACITY LEACHING FACILITY:(type)o"- (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER . C i�r Ly DATE PERMIT ISSUED: DATE .COMPLIANCE.ISSUED: VARIANCE GRANTED: Yes No ci Q - W 3 �VI NQ kA h. 45 �� Ai _a ..�.. cam. ' �. �\ • ... �. _ � - y f k � ��/ ti � - � _ _ rj ( III 1 \i^t ( ,, ! `` �/\V � �� -- ��: ; . � n ,. 4 _ . a . . E . :� ASSESSORS MAP NO. ��•� PARCEL NO: — 7?6 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------.Town ----------------OF...... M.:ajae. ApplirFativat for Dhipaii al Work.6 Cfumitrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: ......... . ...Zatej..AV.ejaUe---y-auja 9.a--. -•-----------....---.._..--------•-----....:...._.._..._...-------------------•-----------•-••---- Location-Address or Lot No. ---•-•--- r°..:_AxnoId....1,a_4'_13A&D................................... ..........--...................................................................................... Owner ----••......----•---------••----Address Installer Address UType of Building Size Lot.................... .....Sq. feet �-, Dwelling]-No. of Bedrooms..............4...........................Expansion Attic ( ) Garbage Grinder (X ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..---------••-•-•-•------------•-------------•-•-----------•--•-•--•------- -------- W 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. 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........................ GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -----------•-----------------•-•-••••----•-•--•--••-••--.....•••-----•••-•------•---•----•-••-------......................................................... 0 Description of Soil........ ang x W x •---•••-----------------------------------------•••------------------•-----------------•--•-•--•-•--------------•---------------------••-•-----------•---•••----------------••--•---------------------- U Nature of Repairs or Alterations—Answer when applicable..'-.500___ .......................... --•----•-•-•--------------------•-------•-------•-•------•-•---•-••.._...--•-•••-------••------....•-•-••1' QL?0.._>4.axaii " �a�h plt Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T`�'La� p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issu b he bo d of hea . Sign °.....-----•--• APx°.111_�A,.6. Date Application Approved BY , --+� ---------------------------------------- Date Application Disapproved for the following reasons-------------------------•------------------------------•------•-----------------•----------------------•--••-- ---------•-------------------•---•-----------•-•.._..-•----•••----------•- -7 Date PermitNo..... 'c --•----------------------- Issued_....................................................... Date A' n t�A Fss._...!......_............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ..............................OF......................-....--......__......•...................-......................... App iration for Mipoii al Works Tonstrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__.............................................................................. -.....---...----•-------------•---•--•----•-------------••------•••-----•..._.._...............__. Location-Address or Lot No. ....................._.......................................................................... --.....-----•---•----------...................------....-..-•-••-.......__.._...._-....._.....--- Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) al Other fixtures .......................................... W Design Flow............................................ per person per day. Total daily flow............................................gallons. W4 Septic 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___________________.___- -----------•-----------------------------------------------------------••-•---•-----•----------•----......................................................... 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ W V •••••-------•---••-•---•--•--------•--••...•-----•-•-••------------•-----•--•-••-••-•---••-----•••••-••-•-••••••-•---•••----•••••---••••-•--•------•••-••-•--•-•---•••-••--••-•••-••--••-••••-----•--••- W •-•-••----------------------•------•-----•-•----•••-------------•--••-••-•••--------•-•••-----••-•-----••-••---•-----...-----•---•-•••-••-•••---•---•••••--•-•-••---•--•••••••-•--•••••-••••-._._...--•- V Nature of Repairs or Alterations—Answer when applicable.............................. .............................................................. -----------------------------------•-------------------------------------------------------------------•--•-=•------•--••-•----•--••-----••-••-•-•-•-••••••••....................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TT-T I 5 of the State Sanitary Code— The undersigned furti:er agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................=.................................. ................................ a�.� Date Application Approved By•-•--•••0 11---- 4�.c�nn .. ---------------------------------------- Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ •--------•------------------••------------------------•-------------------•------...........---------------•-•---••-•-••-•-••••••-•-•••-•••••---•-••----•-............................................. Date Permit No......a_�._:•:�'._y-------------------------•_. Issued-..................-------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tatifiratr of ToutpliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } by----------- ---------------------•----•-------•-------._....-•----•-------•-------•--------------•-------------------...---•----.........--•--------------.:....---...._........--------........._ Installer at---------------------------------------------------•--------------------------------------------•-------------------•--•----------------------------------------------•-------•-•-------------------- has been installed in accordance with the provisions of T1TIE 5 of The State Sanitary Code as described in the 11 application for Disposal Works Construction Permit No.___.?.,?r---DL _ (_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... ......................................... Inspector Inspector---- ---Z-Ai`-l�----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................••--.............OF.................................................................................... Disposal Work$ Tnnstrudinn rranit Permissionis hereby granted......._••• =••-••--••••••••-•••.....•-•-..._.---•---•••••-•-•-•••-•••••-...-••-•••---••-••-----•-•-._........-•-•-•-----•.._.._....._•----- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal `'Forks Construction Permit NO—VA, L.__ Dated________ ------ZL,!....... �.7._.. -}_— Board of Health -/ DATE.............V--A.... -- ...�--7---•-•-•--•••-•-•-••--------• FORM 1255 HOBBS & WARREN, INC., PUBLISHERS