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Home My WebLink About0114 LILLIAN DRIVE - Health vsn ui open woo peeves 6£C06 '®N TOWN OF BARNSTABLE LOCATION SEWAGE # 5�;>— VILLAGE ASSESSOR'S MAP & LOT - M INSTALLER'S NAME & PHONE NO. ged761t47J2 C®N� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) (off/a NO. OF BEDROOMS PRIVATE WELL OR BLI TA E . BUILDER OR 146h -r, DATE PERMIT ISSUED: L - DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �O cd' �,� 1�' �� f �� GGo�a 7 No..l......- — F�s..�..?.� ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Barnstable Conservation Uepartrnent Appliratiutt for Uiipuual Works Tonle t tt Application is hereby made for a Permit to Construct ( ) or Repair t(( 04 an ndividual Sewage Disposal System at: . ...............�--•.................:' ---.D,e�r/F ,!yi n..�................ ••----------..... ... Location-wAd�ress • 1.2 /nI/.4 ....../f 1.c . --•--•...... , I.I GG ?✓..,��r .U£.. Owner ^Address ,-a , GlT &.a> .tST — ! O -v .!'1 ,�YJJ�-.cS. ----- -.--- es.s-- Installer Address UType of Building Size Lot----------------------------Sq. feet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .- w Design Flow............................................gallons per person per day. Total daily flow.............. -31310..____._.__......gallons. W. Septic Tank—Liquid capacity/�?�..gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench-No.,.................. Width.................... Total Length.................... Total leaching area------_.............sq. ft. Seepage Pit No--------- Diameter......A2/-__- 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........................ G14 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ P4 .......-•.........................................••-•-•-••-----......_..-------•-••-------•--••-•-----------------------------•--------------..--------••-- 0 Description of Soil.........................................................................................-----------•-•-------••--••----•---••-•---•-•--.............................. U w U Nature of Repairs or Alterations—Answer when applicable.______-_,4�6-_-._-_-_&A_9 . .-__:.____ 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 be n issu by the board of health. Signed .... ---------- ----- --- . --------. ..--- .. ...... Application Approved BY .... . ..... ..2..... � Kte Application Disapproved for the following reasons: ............... ............................................ .. .............................................................. --------------------------- - ---------- -- --------------------------------------------------...................................---- ------------------------------------------------- ------- ------------------------ --------- Permit No. ----... ................ Issued re Date No... a.... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 2 .� lirttii�a for i n �a� park C� �t nmit Application is hereby made for a Permit to Construct ( ) or Repair ( >c an Individual Sewage Disposal System at: ----- . 1Y.-----.Gi��/A� ,oeir/� ,,........ ��►�..s ....................................................... Location-Address or Lot No. U1..��4`./ 1/'t1. / >!N ..._.. j/.... ----•----•-lilGG n......1�!!�........----•--�..,��-....!±N Owner' Address a ....................................................�G& ^7 L aST �G S �- �By /yl W / Installer Address d 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 ( ) Otherfixtures ------------------------------------------------------•-------••••......----•-----------------------•-••-•--•-•----••-••...._..--•••--•-...--•-•-•-- W Design Flow...............5 .........._ ----- per person per day. Total daily flow___.......... C?.........._._....gallons. WSeptic Tank—Liquid capacityAlU q..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 Depth of Test Pit.................... Depth to ground water........................ W •-•-•••--•-•--------------•-------•-•. ...................................................................................................................... 0 Description of Soil.............................................................................................................................•.......................................... W U -----------------------------------------•-------------------------•--•----------------...----------••------------. ................................................................................... --------------------------------------------------------------------------------------------------------------------------------------------------- ---....-.--. U Nature of Repairs or Alterations—Answer when applicable---------. Q_______._ Gl�ci --_/'�.J.7-.... .. �� J" ••- 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 /h s be nissuee ss by the b�oard�of health. Signed .............lJ.... ...:.................. _� ...................��.. -------------- ... Application Approved BY -------------- �! 51 --- ---------------------------------------------........................ 9.-�. --^-�- l�te Application Disapproved for the following reasons- ------- ---- -------------------------- -------------------------------------------------------------------- ---- ----------------------------------------------------------------------------------------------------..............................................---_----------------------------------------------- .............. --. Date PermitNo. ........... Y 7 .................. Issued ------------------........------ ----------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r TOWN OF BARNSTABLE t (Eer#tftra e of Tontyltttnre x THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( A::�) Y ---------- ------------------------------- -- ------- InstAer at ........................ ... ............ -/GG-/.. ............. l-----------------------..��1 y- !`l.j/........--- 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. ...........�1a2-- .. dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. C� DATE......... ..... l...c ........... Inspector ............... .......----------------------............. ---- ---- -- THE COMMONWEALTH OF MASSACHUSETTS �7 W 7 BOARD OF HEALTH TOWN OF BARNSTABLE No.....-..02...-.1f..7� FEE... d_.......... Disposal Works T11no#r ion ranfit Permission is hereby granted................................fJ�Q�GGO - ----•- ------------------ ------------------------------ to Construct ( ) or Repair (V-) an Individual Sewage Disposal System atNo.•-----•--•••-•-•••••---....•---•-•-•-•-••....Z/ /........ ------------------(l`............./ti/r-S� Street q as shown on the application for Disposal Works Construction Permit No./�0-.' �� Dated.......................................... Vc - ------- DATE...-•-•-•...................•--•----•--•-•-•-•-•••........................•.... Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS