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Home My WebLink About0020 GREGOIRE CIRCLE - Health 20 Gregorie Circle A = 273 - -012 Hyannis TOWN OF BARNSTABLE LOCATION 27 12E(..DLQ G�Q� SEWAGE VILLAGE �/��{ ��.� ASSESSOR'S MAP 6z LOT INSTALLER'S NAME 6z PHONE NO. �j } ¢ SEPTIC TANK CAPACITY � (} � LEACHING FACILITY:(type) (size) �(Y NO. OF BEDROOMS PRIVATE WELL O1R,•P,UQBLIC WATER BUILDER OR OWNER- 1t1�( i �(JNt�7 p DATE PERMIT ISSUED: `/ Z e DATE COMPLIANCE ISSUED: - 2. 2r VARIANCE GRANTED: Yes No t� 4, V S i N N N of Finas........N' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -_� .�. -.. ......OF.-...... s!R-.�N?. c�4�c--............................... Appliratiun for Disposal Marks Tonstrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at .............. Y..Gt-tz� ............. ...... ...................................._----------- Locion-Add ss r Lot No. ...... ± � . .....: �.L :...- ........... ...... •..-s -. ..............._......_..... C -Address a � td Yc r? -•-- 1 •- � •"' ----- --------•-----. _G1..I'!!l11!`.� ....................__......................... . Installer Address Type of Building - Size Lot............................Sq. feet U Dwelling No. of Bedrooms.......... Expansion Attic Garbage Grinder p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ..........................----------•-••----•••---_. .-• - WWDesign Flow......_.. ......................gallons per person per i day.• Total daily flow........ �1 ..................gallons. WSeptic Tank—Liquid capacity16LV._gallons Length....T....... Width Width_____ e.__ Diameter________________ Depth................ x Disposal Trench—No_____________________ Width..................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No...:__:J............ Diameter.._..lb-1........ Depth below inlet.....V......... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) .-. Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 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........................ a --------------------------- .. --•-•••-•--••....•••...•---•••••--.....-••-•••••-•-•-------------..._..................:...-••------•••---•-•-... -------- -O Description of Soil........................................................................................................................................................................ W ••••--•-••••--••------•----•••-------------•-•---•-•.-.._._..••-•---••-----••---.._...••-••--_•...---........................-••-•-••-•••-•••-•••-------••----•...._.._......._.._••---.._...._-••-•- UNature 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 iITL U 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--- 4 s ...... •sr •� Date Application Approved By.............( J--... �*s,��...... �.�a.... ... -^ Date Application Disapproved for the following reasons:...............:.......................................................................................... .......•-----•--•---•--------•---------------------------------------------------------•----•---......-.--------•----•---------------.....------.._._..---------------....----••-•-••......•••-••---._ Date PermitNo....... ? -.._�.;r� .............. Issued.....-•----•----=........................._........_ Date D-7�t O l Fss.......!VaG THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �..0 ..Ae �......OF..._..�.t ... ....................:.... Appliration for Disposal Works Tonotrurtion 1rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( L)-an Individual Sewage Disposal System at .».......... -• __. Location-Address ........... r - - or Lot No.................................»_. ....._. ,d tl,.yt1� .l l f � �c^C.r�, — - .....•................»........ (f Owner Address Wr{tJ a P• ��.+ e7 ....... b`'t.r_� rrt�t C ................ ................ a Installer a Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......... ..............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building .............. No. of persons............................ Showers — Cafeteria WP4 Other fixtures ... ----------�-----J f Se tic Tank—Li uiid ca acit 1061)..-gallons Length .`...... Width ._: Diametl .................Design Flow............ ....................gallons per person per day. Total daily flow.._........ . .............:----gallons. .P q � P Y p •• - g � Depth................ Disposal Trench—No..................... Width.................... Total Length_................. Total leaching area...................sq. ft. x 3 Seepage Pit No.......I._._.__-__•- Diameter.•.._I A!........ Depth below inlet.....a(.......... 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........................ Test Pit No. 2----------------minutes per inch Depth.of Test Pit.................... Depth to ground water........................ a, .........-••-••............•........ ..................................•---------------•---......................................................... 0 Description of Soil----------------------•--------•--•------------........--------•-----------------------------------....•--.....••-•-•--•-----............-•-••••-•-................•--• W W ---------•--------------------- -------- -------- •---------- ------------------ -------------- ----------------------------------------- ---------------•--------------------- --------------- •••••...•-•-•-••••-•----••--••-••-----•--•••---•-•••--•-•--•---•-----•----•-------•••.............•••• •••... •. -••.....•.................. 0 Nature of Repairs or Alterations-Answer when applicable..._ + ` "x' - ^'�T"•' ............................ �.eT?x�..... _�`._.......... r ...,....../+ 5 �? .. F ( f` C�_ )`�3G?r GiA F/! ` ..( t :�:...:�.._ t-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL% 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 R - ---- w- Die f Application Approved By------------- ''-- --- . . .. •------------------------ ------------ d .............. Daatete Application Disapproved for the following.reasons:--••-----•-----•...................................:.....•--------------•----..:•-----...........•••......««» y .................................. ............................... ................ .................................. ............................................ ...............« y Date Permit No....... ............. Issued............................ .................»...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF.. 1�-r .ts..w... 1 fUrtif utttr of Tuntillittnrr P THIS-IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired75 by.............• .s.p..r............ —l- = .-,-�,A( .........------.........----•----------------•----------------. ............«-------•-- r Installeerr at — /) (^ (2lv C�1? ?,fir.... °�{ F (.. -n R*k'41 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.....9._�..^__6..�+. ,7.._. 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 ........ ••-•.......................... No... .. . FsE.... ......... Disposal Works Tonstru tiott f rrutit Permission is hereby granted .:_t C..? r'.. .. C....................................................... to Construct ( ) or Repair ( V)-an Individual Sewage Dttisposal System 'i :=. O 1 -tr x:+ s ,/, e!d �.,r ,C'.•#• n.(.. ---._....... -•--••---•-------------------------•-............••.............. at No.:................�----a.--------------�- --.�.,.----•--�--------------- Street r /� as shown on the application for Disposal Works Construction Permit N N ;L._7_ Dated.......................................... �e `- ` DATE........................ ............. .....�............................. ---•---•--••... rd of Health