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Home My WebLink About0604 SCUDDER AVENUE - Health boy scudda� Ate,, m AM;'T as , 1 613 TOWN OF BARNSTABLE LOCATION �Q� >C U d� � /�cJ SEWAGE 1 VILLAGE ��(/,y?rS pz l ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B MM 775-6264 SEPTIC TANK CAPACITY /J� U LEACHING FACILITY:(type) ,/, )0/D,00 ((size) /l1 NO. OF BEDROOMS__L _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER C /7s�/�/✓(� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: i� VARIANCE GRANTED: Yes No �{ � � SL: �.i ._ C� t `�. �- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uispniial Workii Tnnitrurttnn Famit Application is hereby made for a Permit to Construct ( ) or Repair ( r✓)' an Individual Sewage Disposal System at: ...........- - - - Location-Address or Lot No. S '�•^-- - c- A p -�°........................ ............ .................................................... Owner Address w t- -�13 cn t�eu 3 Installer Address d feet Type of Building Size Lot...........................S q. aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 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 ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P1 ----........................................................................................................................................................ 0 Description of Soil...............................................................................----------------•-------------------------------------------------------------------•... V .....•-----•--•-•---•-•--...-----••••--•-•--•---•---••--•••-•---•----•-••-•--•-•-•-•.............••--••-••-•--••--=-------------------------------....._.......-----•---------------......._•----._...... W ••---•----------------------------•-••••---••---•-----••-•------------------•------------•-••-•-•--- % V Na re of Repairs or Alterations—Answer when applicable__.. 01 � A _. ! - �i __._. ... -- q.1.° .....vw_w._u............................................................................................................. 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 Com has been is a by the board of health. Signed .:----- ---- --- ------ ------------------- Dace Application Approved By ---------------- - .- - cam. ..._--------------- --- -- ----.................................. ...---...---------- 1 a-- J. 1 3 " � . Dace Application Disapproved for the following reasons- ------------------------------------------------------------------------------- ----------------------------------- ------------- ....................'--------.........----'----....--------'--...----.....-'------...-------------'------ D ---------'-'---............_....Dace / ate Permit No. �'( �� Issued �I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tongtrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (,,i .)>an Individual Sewage Disposal System at: .... - ----•---•................................... Location-Address -- or Lot No. ` 1 5 1p►�M C 1�AS? .l!? .................... .............. --------------------........................._....•- Owner Address Installer Address r Type of Building Size Lot................. Sq. feet V Dwelling—No. of Bedrooms___.. .....................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of pers6ns............................ Showers — Cafeteria 04 d Other fixtures ------------------------------------------------------•-•-••--•------•---•--••-•--•--------••--••--•------...••--................--•--•.....--•••-... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-•--•-••--••---------------••••-•--•••---•---••--••--------•-------•......---------••-..................... .--------------------------------- •--------------- ODescription of Soil........................................................................................................................................................................ x V -••-•••••----•----••••••----•••-•-••--••-----••----....-•---••••••••••••-••---•------....•---•--•-•-._.....-•-•--••--------••••-•••-----••---•--•---•••--•••••......................•----•-••---•-•••--- UW ` .y�,� A f Nature of Repairs or Alterations—Answer when applicable l ..� � __ �....'...... ---------------------- Agreement: 14 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 ---------------------------------------------- ----]17 L4- o... Date Application Approved By ................. ........ cam- z ` .------------------------------------ /..... ..!7, Q `/ Date Application Disapproved for the following reasons- ---------------------------- -------------------------------------------------------------------------- - ----------------------- ---------------------------------------------------------- ---------------- ................................ --------------------------- ------------------------------------------------------------------.------------ ------....................---------- Dare PermitNo. ,��...r/(v---------------------- Issued ------------------------------------------------------.---------.. ----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' HEALTH TOWN OF BARNSTABLE T-Wr#ifira a of Q.Tkomplinure 4 THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( LI) by_------- ...... ... --------------- -------------- ......................................................------ .................. .---------.----- -------------- Installer at -------- ?Cp S-C-t -----...1.RK.fir-...................tM.�( 9.)v.l�).c,S..1P G .---- ------------------------------------------------------------.------ --- has been installed in accordance with the provisions of TITLE 5 of cThe State Environmental Code as described in the application for Disposal Works Construction Permit No. ............ dated ......Z�................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU U�AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.--- .. ` 1 _ . Q-------------------------------------------------- ........ Inspector ----...- ' THE { COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE y FEE. ..i Disposal Works Tonstrudion rrrmi# Permission is hereby granted...... _E3........ —P U_C-?.....-•••--•-•-.........-•-•--••••-----•-•...................•••................. .. to Construct ) or Repair ( &w.)'an Individual Sewage Disposal System atNo..-- R Y.9r.•--•••..............•-••......-------•.....--•...................•... ............................................... Street g� as shown on the application for Disposal Works Construction Permit No.;,Zx*-!2A._. Dated..........................•............... ............................... ......................................................... •................................... Board of Health DATE................ �3�•9,� ` FORM 36508 HOBBS 8 WARREN.INC..PUBLISHERS