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Home My WebLink About0034 FRESH HOLES ROAD - Health +l-3b Fi�CS111kItS -LOCATION SEWAGE PERMIT NO. - �3 'VILLA'GG= INSTA 'S NAME A ADDRESS S UILDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED e ` TOWN OF BARNSTABLE LOCA'.rION /'/l)--1 Z 0 Y /1��.� SEWAGE# q a VILLAGE 1 7 A/ ASSESSOR'S MAP &LO'T� INSTALLER'S NAME&PHONE NO. tll�o fr /Pd I-TIlf-rB�V-7 Tr 4F 73' SEPTIC TANK CAPACITY 14'0-d LEACHING FACILrrY: (type) * e® (size) 6 6� NO.OF BEDROOMS 0 r/ BUILDER OR OWNER A, PERMITDATE: r COMPLIANCE DATE: e2. Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or.within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet eaching f o l ty) Feet r Furnished by 49 1I7 141 r' 136 �� v� r S 4 r P tflf�.j N .. Fimic /.....0..........._ THE COMMONWEALTH.OF MASSACHUSETTS BOARD QF HEALTH � ....:.....oF............ v�, Appliration for DiupuuFal Workii Tonotrur#iun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ran Individual Sewage Disposal System at: :;::' �T�J ,�� --- tio dress .••• /� •-_-.-_•-••------------or.Lot No. ...... 1./G�/ .... ................. ......_... Own Address a •--• 01�0 ....... ,�..... -----•------------------'------...-•---....----•-----------•-•.........--••'•-- M Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch. 1 enth of Test it.__.._..........._.. Depth to ground water-._________-____---___. Q+' --------------- ----------•.... . . ..... ...... . ODescription of Soil...... • --•. . .......... ..... ..... -•--------------------------------------....................................................... x ------•..........................•---•--------------------•--------•-•--•:--•----•---••-•-•-•-•----------------------------. -- -y }�...I .......... U 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 TITLE 5 of the State Sanitary Code— The undersi ed further agrees no to place the system in operation until a Certificate of Compliance has bee issueWth of th.Si ne :... ... i® Dat ApplicationApproved B ............................ .... ------•••-•-•-------------•--------'-------• .......... Date Application Disapproved for the following reasons-------------•----•----------------------------------•-----------------------•--•---------------•-•----.......... ..................................."----.............-•-------...__...._....•--------_-......----------•._..........___..--••-------------------•-----•----------•---•---•-----•--"Date-----...--'--- Permit No.............. am- �•g--'--------------- Issued---------'-•---•--••------•-•••- Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH App iration for Uhipo al Works Tomitrnrtinn Prrmit ` Application is hereby made for a Permit to Construct ( ) or Repair ( )'`an Individual Sewage Disposal System at: ........... _ .............................. ------••-•••_-•-• ---- ---------------------------------------------- Location.-Address or Lot No. •' ..................... - --••---------------------------- ._....---------- Owner Y ..F rf Address .+._;:!" .."3'°wn....................................................................... Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) C-' Other fixtures ........•............................................ Design Flow...................................:........gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.............gallons Length................ Width................ Diameter................ Depth................ xDisposal 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........................................ Test 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........................ e 1 > , Description of Soil...... y"t�` r ' ...: ' ? ,`s W -•---------------------------------------------•--•---•------•-••-•---------------•-----•--------•------------------ --- -._ - ..__.....-_ ........ .. -------•.. UNature of Repairs or Alterations—Answer when applicable______:�'`�"" r "_.....? '....�........_..=:a�` � -------------------------------------•-•••-•-••--•-•-•----••---•--••--••••-----------------------••----•--------•----------------••-----•------•--------••----•---••••--•---•--............_........-•-- Agreement: The undersigned agrees .to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLP; 5 of the State Sanitary Code—The undersigned further agrees nq�.to place the system in operation until a Certificate of Compliance has been issued by the board of health s '— r°�ODaI�� r Application Approved BY --------=k�••--- I Date Application Disapproved for the following reasons-------------------•--------------•--•----------•-•-----------•---------------------------=-------------------•-- ..------•----------------------•--•••-------•-•-......--•••-•-------•--g----••.......-----•---------•-'•----•-------•-------------------------•-•-------------•----•---••--•-•---------••------•---•-- Date Permit No-------------' ..�� "�----...... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH 011 r.... .OF...... .. ...r.. h. ......... .........:.......... C9rdif irate of Tam;diFanrr THIS IS TO,CERTIFY, TLtrthe Individuat,15ewage Disposal System constructed ( ) or Repaired r ... s r _ Installer at rr�. ._ .. !r !`{,. 7�4�4rf�N,.�.w .r..'!± t'f `f' r � ----- --------------zeL' ........ ...... ' ------•-------_.............................. has been installed in accordance with the provisions of TITLE. S ,If' Sanitary Coge� yle d in the application for Disposal_Works Construction Permit No-------------------------------- dated_...............................................b� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. y DATE......................(� .��4 V-S ---.. Inspector-----------•••. THE COMMONWEALTH OF MASSACHUSETTS ,. BOARD PF HEALTH No....� ...... �' FE> .�...... Yllr T andr ilan rrmit �.. Permission is hereby grant ed_:.L.. -f'._:_.._...._ to Con tru,t ) or Re ( f dd' lC 1 ewage�,' Vf -, stem at Nod__ " _ �� ,G.` _ "' y{ - � -- as shown on the application for Disposal Works Construction Permit N ..... __ r Dated.._ --------=--------------•--• ... -.- .....------ -------•--•---- B ar d�e ,...--• DATE �l,'�s�.>,1 ^---•---•----------•-----------------•-- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS