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Home My WebLink About0231 OLD TOWN ROAD - Health _ co Sc, —c,'3� TOWN OF BARNSTABLE L nCATION1 6�� /Art/ SEWAGE # 9�-/� VILLAGE P CASSESSOR'S MAP & LOT2—6' 9,.r L5.91 INSTALLER'S NAME & PHONE NO. 3 SEPTIC TANK CAPACITY /006 51- LEACHING FACILITY:(type) ee)d (size) NO. OF BEDROOMS - PRIVATE WELL OR PUBLIC WATER • 1 &R OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Ji ` VARIANCE GRANTED: Yes No r� Gig) ., O C c FORA OWE TOWN91 .. S ABL ROGATION do2 1 b4 `7_i�K'A/31 SEWAGE # VILLAGE_ 41ri y- ASSESSOR'S MAP &LOT C/ INSTALLER'S NAME& ONE NO. SEPTIC TANK CAPACITY .BLEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER •' PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well 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 of leaching facility) Feet Furnished by �1 1 ✓. c��v v I \ I � i No. Fim THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH 6arnstable Conservation Departmel7t TOWN OF B A R N ST A B L E 3pma,��I Signed -fir t ravviial Work.5 Towitrnrtilan rrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... - Locat' n-Addr•ss Lot N / =FGQ-��--- --- - ...................•-•--••--- aOwn �— � dress ................ Installer 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 ( ) a' Other fixtures ______________________ _ _ _ Design Flow..............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity/KZ�i'gallons Length---------------- Width---------------- Diameter................ Depth------------_--- x Disposal Trench—No. .................... Width.................... Total Length--------------- Total leaching area....................sq. ft. 3 Seepage Pit No--------— Diameter--------C)------- Depth below inlet.2 D._.____._ 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........................ O Description of Soil-----_ ¢.. x U ----•--•••--•-•-----------------------------•---------------------------•-----•----------._...---••-----••----------------------------•----•••-••---------------------------.._.__...------..------•-_.. W ----------------------------------------------------- ---------•----•---•-------...--•••••----•-------------- ------------------------------- - �- ---------- ------- U Nat re of Repairs or Alteratio —Anse er whe applica ___� -- / V c .. /� -- --- /a-� --- -----_.� . -- -A---•------••-----•--....------•-.-••--.-•--------------------------•---••-----._......______---- 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 ------------------------------------------------------------------------------------------------------- ......................................... Dace ApplicationApproved By ------------------------------------------------------------------------------------------------------------------------------------------------ ........................................ Application Disapproved for the following reasons: ................. ..................................................... ......... .. . . .............. . ............................. . ..................... .................._.................................... ........................................ Permit No. 1-------7 7/---------....•�,..�..................... Issued - --- ._............. - -......._te...... Dace FBB... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OFLBARNST4�BLE 'Apli i atiou for llirai. wial Wor1w Cnowitrur#ilin ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: = . l ��- ---------------------- � «.........«....... ........ .«- �-� Location-Address r Lot No .« � - . .....-........... _..-•___'•_-_---._....___......................................................................... Own'r'- L ddrC55 ... �t/s.,7 1 . l---- ...........................................................!' ..�.............. 4 Installer Address VType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.___. .........................._.__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons...........----------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. R; Septic Tank—Liquid capacity/ allons Length---------------- Width---------------- Diameter--..------------ Depth................ Disposal Trench—No. .................... Width-------------------- Total Length............... <. Total leaching area....................sq. ft. Seepage Pit No......... Diameter--------4--------- Depth below inlet. 2�......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------- ...............................................�=.....---------- Date....................................... Test Pit No. I----------------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........................ ,_.._.. A................................................................................................. D Description of Soil...... ? �. - - ....z:C?�� ............... V ............................................. •-----•--•-----•----•---•----•-----•-------•-•----•---------•--------------------•----------•------------------------------•-----••-•---•----------------- W = --------- ' .... ...... ---• --------------------------- UNat re of Repairs or Alterations—Answer when,applicable - ----- ..._...... ... f: --'---.-, l.F? ... �.r... - p -..�.-.f....�' -------- Agreement: al 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 ------------------------------------------------------------------------------------------------------ ---------------------------------=----- Date ApplicationApproved By ------------------ ------- -------------------------------------------------------------------------------------- -------------------------- Date Application Disapproved for the following reasons: ----...........................------------------........------------------------------------------------..-..-..---------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ---------------------------------------- Date Permit No. �`,� ~ ............... Issued ............... .. . ....--....... - ` Date THE COMMONWEALTH OF MASSACHUSETTS \ BOARD OF HEALTH TOWN OF BARNSTABLE (11rdifirate of Tompliance THIS- IS TO CERTIFY, 'What the Individual Sewage Disposal System constructed ( ) or Repaired by .............. - .........^__xezey..----------------------------------------------------------------------------------------------..._- ------------ ------------------------------------------ m,tau at .....- ;43 - . . .....-_ is/Ht(L--....�i_�t ---- ------------ �f- 'N' ", 5-(/7C .. ............... - - has been installed in accordance with the provisions of TITLE 5 o The State Envignmental Code as described in the application for Disposal Works Construction Permit No. _.---- ---; .-----.�_- �.� ..- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-..... -"�. '� ......-" -... .--..-..----.:.--- ----- Inspecto'r'�':-... -- --- r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �i��rn�tt1 �rk� �u�ts�r�s#uan �rrnti� Permission is hereby granted-------- ----•---- i?! ,( -----------------------------------------------------------------•----------•----- to Construct ) or Re air ( ) an ndividual Sewage Dispo al System atNo.............. ........ Street Cqj / as shown on the application for Disposal Works Construction Permit No._%_q:f2_c1- Dated........................................... --�'1 .� BOard of Health DATE......... ��' - 'r---------------------•--.-----------........ 1 FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS