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Home My WebLink About0033 STRAIGHTWAY - Health .33 ,SS'-I rai.0�cuou� � ".an/y� TOWN OF BARNSTABLE LOCATION SEWAGE # -PISS VILLAGE adq ASSESSOR'S MAP & LOTg?r d--_/ IV INSTALLER'S NAME & PHONE NO. I SEPTIC TANK CAPACITY � � 4 LEACHING FACILITY:(type) (size) � 4(wgWla' NO. OF BEDROOMS e PRIVATE YELL OR BLIC WAT BUILDER OR OWNER '�5 ✓n1Gl�i IE DATE PERMIT ISSUED: — DATE COMPLIANCE ISSUED: ` VARIANCE GRANTED: Yes No ' t 1 -IfF V �i ' S No....... APPROVED �G n ble Conserii-- n Dep .me Fxa.:....................� ,qZj_/ _ T E COMMONWEALTH OF MASSACHUSETTS 8 _ OAR® OF HEALTH igned Dat® TOWN OF BARNSTABLE Apli iration for Dicipo ial tvrbi Tomitrnstion 11rrmit Application is hereby made for a Permit to Construct ( ) or Repair (n Individual Sewage Disposal System ... .. ��-U9 ' •-------------------- f 11 ioi' ddrrss or Lot No- /- 1�- -------------------------------- •--•-----•-------•---•---•---- -------•--•-•••-•---•----------•---........-----•-•- 41d AD a ��.'1.... Installer i`Y. .... v�T/'7-LC/l! f ....n-CressGCS (/�Vd...... ................... -. .-.^................. Q Type of Building Size Lot............................Sq. feet V DwellingFlo. of Bedrooms------------------------------ -- _Ex ansion 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. WSeptic Tank—Liquid capacity........__..gallons Length---------------- Width.......--------- Diameter................ Depth.............. x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercTest pit\o.Results 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........................ 9 -----------------------------------------------------------------------------••••-••----•.-..-....................................-•-...............--•-----• 0 Description of Soil........................................................................................................................................................................ V W --- •------••----�---.------------•----------------•------------.......---...........------••-•--..........-•......-----1----.....IUNature of Repairs or � �a CX/S�I ... l io n��. ..�-.►�------0...... ... k------------------------------------------------•------------............--------- 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 li a n i d t o f health. Sig ie ............................. ... ................ �f�'�`t� Application Approved By ....------ = =- ... ............................................... ,f��' Dace Application Disapproved for the following reasons: ........................................... . ....... .................................................. -- . . . . re Permit No. .�y ..... ...... Issued ...........� � Dace %w_.•.r-.-.+.+..."U�v.-. �...r,.. �^il�..-+--v ... __�. � w,r�'..«x .. - v - -' ♦ �v.. -- � v �..i o�. .. a ..-.—,... .. .. �f No................_....... Fss...............lJ.:................ THE COMMONWEALTH OF MASSACHUSETTS ` $-- 9✓ y BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uiripwml Wnr1w Tomitrnr#inn rrrntit Application is hereby made for a Permit to Construct ( ) or Repair (_—) an Individual Sewage Disposal System at �5_" S�`��✓rlc, �v .............................................:......_-----.... ---------------------------------- Lorttirn r-��dd•ress-"• ----- or Lot--No. Cl.chcr �lress odl Installer Axess Q 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 ( ) a' 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. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... a Test Pit No. I................mmutes 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........................ DDescription of Soil........................................................................................................................................................................ V -------------------- •------------------------------------------------------------------------------------------------------------ •--------------- •---------- ._...........---------------•-------- I x --•----•--------------------•----------•-----------------•--....---------............---------•----•----•-------•-----------------------------•••---•--- U Nature of Repairs or lteratio s—,,Answer wen applicable._ �_`a'fC�j�__.__r7___. 1c:��(-/__.._��?....�..... _. ----•-•-•-••--•- •------------•-•••---.....••--••----------•----•-•-----------•--- 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 Co me kras been C/ i >zd - Yohealth. _ e boa.d L/ �� ,z/ Signed` ....................... e -- - ............- .. ........ ........ ............................ / / Dare" Application Approved BY .. ............ ............. T ..: ------.....-------- --- . Dare... .. Application Disapproved for the following reasons: ...................................... ................................................................................... ........ . .... ..................................... . . .............. ....................... ....... ..............��............ . ........................................ Permit No. �...1 .... Issued ------- 1� ............` ............... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (9Ertifi ate of (fIImplian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � 150b_�r1).�.....�-1��.�..C...M kvt by ......... ........_...._... ............... . ........................__........ Insrdlcr . .........S---- ...-------/----�{c � .....-1;�- has been installed in accordance with the provisions of TICfLE 5 of Th((�tate Environmental Code as described in the application for Disposal Works Construction Permit No. ..T�--..._,� �.... dated .-_,�._�- _47 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIDE SYSTEM WILL FUNCTION SATISFACTORY. DATE...__.._:......".."' /�/ ..-�' / ....................... Inspector--r.. ......��? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE _� No. FEE._...... .. lJ Uinp,anal lughii Tnnnt rurtwi n�prrntit Permission is hereby granted-----------_-------_--- ✓� .......�..� ------------------- --- to Construct ( ) or Repair (bran In ividglal Sewage Disposal System � Strcct as shown on the application for Disposal Works Construction Permit No...'....... _�Dattee/d_---.��'��..�...L� r... Board of Hcaltlil DATE.......--------.------=-------`--------�47-------.._...----------------------. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS