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Home My WebLink About0018 VANDERMINT LANE - Health wem,44 000 4 -1 v TOWN'OF BARNSTABLE LOCATION /'► �v-m�v►�b ,rr1 Q SEWAGE ) VILLAGE_ ( a nn rS ASSESSOR'S MAP & LOT . GRAIG MEDEIROS INSTALLER'S NAME PHONE NO., 78 LINDEN ST. SEPTIC TANK CAPACITY HYANNIS7M�A�0g260 LEACHING FACILITY:(type) Q /,nm all-��'-tiA43,itTsize� NO. OF BEDROOMS PRIVATE WELL OR,PUBLIC WATE R OWNER C3 oV f mro DATE PERMIT ISSUED. 2� DATE. COMPLIANCE ISSUED: ��- ff" VARIANCE GRANTED: Yes No t:z W �' e. � � a r� q � �, � ��, .� �, � � � � Fmc.........�_.C:2........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH v'�.............OF.... -6 ... ---------------------------------------------- Appliration for Disposal Works C onfitrur ' n rr�ti� Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at /� Loo t/i n j Address / p_or Lot No� •--••-•••--.�! _.. �....... !C_c..��.. ._.. 1.._ `r`........................... !✓....... � ...................... O er ddress Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—' No. of Bedrooms.......................................:....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .. No. of persons............................ Showers — Cafeteria Q' Other fixtures .....-•--•-•-•-•----•--=---=•-•--------•--•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. G4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ W ' 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 ( ) 1 aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fi Test Pit No. 2................minutes per inch Depth of Test Pit_______-_-._______-• Depth to ground water........................ Ra' ----------• •--------•-•--------------•------•--•----•-----------•-------•--------------------------------------------------------•------------ ODescription of Soil--------•------. `a?'! ................................................... .................................................... x W ------------------------------------------------- ---- ----- ------- .. . U Nature of airs or Alt ons—Answer when applicable...... `�`'.. -'e--�C __.___ --------------------•----••----•---•--------- ------------------------------------------------------------------------.....-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI:!,E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasjbDn issue by the boardof health. Signed. ................. •-- -•-- ApplicationApproved By--••----•-••...!. .. �•--- -----• .............. .................................. -•--------- Date Application Disapproved for the following reasons----------------------•-----------------------------------------------------•--••---------------•••---•••-•--•-- ..............••----•------------.....---•--------------------•----------...----...:.....--•--------•---....-•----•------•----------------------........................................................ Date PermitNo. - -............•.-----------•=--•-_.._.. Issued_....................................................... II Date YYY 7'L� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............O F.............................. Appliration for Disposal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (---)"an Individual Sewage Disposal System at: ............. _........ ......-- ............................................. •-••••-----........----•� ---•••--•-•......_ ..__ C, 0 I— f� Location-.Address �,__ i . or Lot No. '1 _ / .fie/_! 4+'`• ' __•___:/• " ... 1 " '� Owner i :! C �_.. re F ............ •••; ............ .... = adL +. ss Installer Address -- Type of Building Size Lot.............................Sq. feet 1-1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .---.....-•-•----•------•--•-•-----.._..-•--•---•--.........-••..................•-----. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............galloris 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............ c:__sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T4 Test Pit,No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..........M--------------------••----•--••-•---------••-•-------••----------......__...---•----•---------------•----•---------..........•------••••--•--•- O Description of Soil-•---------------- § =' ....------••----._......•---------•---------•---- x __ W ---------------------------------------------------------------------------------------------•------------•------- .� :k'----•----- ---------s j V Nature of Repairs or Alterations—Answer when applicable......... _...................................r _.,:-.;.�� ^ !� � y I,f ( - . J I Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL1 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 .'• ' Application Approved B Date Application Disapproved for the following reasons------------------------•----------------------•------............................. ............................ .-----•-•--__.__.-•........................................-----•---••-----•-------.................................__Date----•-..._.._. 63 Permit No.. �S_....... ...... Issued -----............................ Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........•...................OF..... .- ^� `' .............................................. Cwrrtifiratr of TompliFana THISIIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired �r Installer at... -n.° r-- --fir--••- .r"--`• e---- / I// .�_ 'q,.+e'i >."�.,�`e..n.:°wd.a.+ �.�;%•...Y^e- - 1 r?Q .j �. s'� has been installed in accordantcer"with the provisions of TIT1 .5 of The S tate Sanitary 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....................... .-_' _-. Z........................... Inspector................ -- -------.:.---•----------------•-..................... THE COMMONWEALTH OF MASSACHUSETTS M^�� _._, BOARD O-� HEALTH --- . �y�-,.�,..- �"�"...........,OF....... '?`r* l� d3 e:...................::.. ............................................................ Q(� c No....D.0................ FEE........................ Disposal Work$ Toustrurtion rrntit Permission is hereby granted...._¢_-' ._ : ,��---wt I...... __� � " to Construct (� ) or Repair (t?�)an•,Indivldual bewage Disposal System at No. ... ` y ', Stree�t�^_-•: <.,.t. y�i .._-- �r __�,.^t.................... as shown on the application for D>siposal•,Works Construction Permit No.. . t�O�ated.......................................... •--...-•---------------------- ----....................................................... 'r Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4