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Home My WebLink About0018 FISHER ROAD - Health l8 Fcrlw Ke , �+mtr 8�+ � ay7 NW 'S`JNUSVI4 ��SNpJ•1S�ya�i �L7F.CJ �� VULL Odn c� —Pei -A 0% as a I Imi I f I i y 1 i o { i C . TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE b ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. S SEPTIC TANK CAPACITY - LEACHING FACILITY:(,,,) �' ��'� 1`��`��° si.) yt` 7( NO. OF BEDROOMS PRIVATE WELL O WA-ilR� BUILDER OR OWNER Qy S-e DATE PERMIT ISSUED: S DATE COMPLIANCE ISSUED: aq- 2-3 VARIANCE GRANTED: Yes No t/ •t a r THE COMMONWEALTH OF MASSACHUSETTS AMOM BOAR® OF HEALTH ,TOWN OF BARNSTABLE �utt�t fur Di.!ipnia1 Workii Tomitrnrt"tun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( L,),*"'an Individual Sewage Disposal System at: .................1-di� ....... �A:b-------------------------- ----------------------------------------------------------------------•--- •••--....-------- L -tion-Address or Lot No- � �4....__.._ �AvN� ............................ ..........----------- �¢� 1�..� ......... Owner Add ss `� 14 14 Installer Address UType of Building Size Lot............................Sq. feet Dwelling—,No. of Bedrooms-___�"�_____________________ _ _ Expansion Attic ( ) Garbage Grinder ( ) -------- 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow:__.._.5__�S ........................ ..gallons per person per day. Total daily flow---. ._:2�3 ........................gallons. R: Septic Tank L Liquid aci4k5M.gallons Length-----l9----- Width_(a___________ Diameter---------------- Depth................ W Disposal Trench--No• _-_ gjlr _ Width----- .......... Total Length-_&_0'f...... Total leaching area....................sq. ft. 3 Seepage Pit No--------_---------- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. 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........................ Grq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......____.............. P4 ••-•••-•--••...................•----•._...-------------•-...--•--•-•-•••-•-.._._.....--•----•--•-•--......................................................... 0 Description of Soil............................................................................... ------------------------....---•----•---•----•---------------....._..._.._..-----...._.. x c., w ................. U Nature of Repairs or Alterations—Answer hen applica le.__—_._t-_ i ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been -ssued by the board of ealth. Signed ---------- --- -..... .........-... ...-... ....------ .N� ll{{�� 3_u..� .. Application Approved By ......... ... '7= ..- � Application Disapproved for the following reasons: ..:... .. ........................................................................... .............................. ....... ..... . ..... .. ....... ...................................................... Permit No. .........,1.... .-... - ..% Issued to Dare �,.s.-.. ..::'iL..be�h+t..:�--..�i�ti�.7k...o.�.'4tta��,.,y..�.+�:��M-'` "cis+.+nuJ�+W�"�:'s+�rntrsw;sll(.-<r+�l•� '.�+"3�.s^....''M�:.wa-.�.,;#cL•- 1,'��1th;,'�i��++'�t4'lk�y�iy .:�+�j1i��'��i:a�vicv�,�Y.C+'::f�.wa•.�y t,;;. No.. Fss..... �r-- r" THE COMMONWEALTH OF MASSAC'H'USETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripoti l Hlor s Tomitrnrtinn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( L,Kan Individual Sewage Disposal System at: ................1 $— ............................�l � - ---•-----------•---------- ..................------------......----------'--•---------------•------......------•••........... Lgocatioti-Address / or Lot No- .............. ___..__.._______________________ _______________________________________________ _________________'_.__....... _....._._.._._ ..•.............................._........__..._. W owner Address a ......... ---• -- Installer f Address Type of Building Size Lot............................Sq. feet Dwelling—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.... .........................gallons. WSeptic Tank Liquid capacitym_�(_'!)_galIons Length----- �?----- Width_,�i........... Diameter---------------- Depth................ x Disposal Trench--No __17A .. Width_____ __________ Total Length._�Z2....... 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •---••--........-•--••-•----•••••----•••-----•••--••-••••-•-•••-•--••-•....................................................................................... xDescription of Soil........................................................................................................................................................................ V ............ ................................ ••-•--••---••--•----- ---•-••••--•••••---------•-•••••-••••••••••-•-•-------••--•'-•••-•-----•--••---•••••-•----•-•...............................•-'-... W -----------•------------------------•----------------------------------........--•--------...----------------••. -----•-------------••••---••-•---••-•••-------•••-•••......_.._......•--••-•-•-_•---- U Nature of Repairs or Alterations—Answer withen applicable__ .! .: ` ___.?<:(Tr, 's -a(?C`t.sec.-V------. ........................... t--......?�_..._..� .c C{ ra uQ I 1 . C ! t>�•1 c, }tu•F Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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.............._ ..-. �...........: :..:<.............................- ----- ..:_ ` 07 �...�,..�C .... ...... Date ............ Application Approved By ......... ter__. ..... ,.,- /..................... ----------- . v� Date Application Disapproved for the following reasons: ...... ..... .... ---------------------- ----- --- ----------------------------------- -------------------- Dace Permit No. .......... ....... .-... a...c/........................ Issued ................................ ` Dace THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE V TT Erfifi ate of V.IIittplianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired y at .............. e..1.......F - v-------_ ------------------- ( .. _... �.t,.�.............. ...................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......c ...... 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 OF HEALTH C� TOWN OF BARNSTABLE i �a tt1 nrkii Tunotrudinn hermit Permission is hereby granted------------ .....................t ce!`...- .............. to Construct ( ) or Repair (�,)-an Individual Sewage Disposal System atNo.............................................1 1 . , ...... ---------------------•---- �y Street as shown on the application for Disposal Works Construction Permit No Y?-, _.._. y. Dated.......................................... C� Board of Health DATE................. <<- F- ------------------------------- FORM 36508 HOBBS&WARREN,INC..PUBLISHERS