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Home My WebLink About0015 WASHINGTON AVE EXT. - Health 15 Washington Ave Extension Hyannis --=- A= 309-102 \ TOWN OF BARNSTABLE LOCATION S i 1 U .LFEWAGE# c VILLAGE /ASSESSOR'S MAP&LOT _ INSTALLER'S NAE&PHONE 0.r,� SEPTIC TANK CAPACITY Q 0 6 Ex 5 1 ij J c LEACHING FACILITY: (type) —/ CI— (size) NO.OF BEDROOMS ;? BUILDER OR WNER E e PERMITDATE: COMPLIANCE DATE: 9,— e A TSB Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and 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 leac ' g fac' ty) Feet Furnished by 0 o 1 ASSESSORS MAP NO: .( `-��..7f' PARCEL NO: /lJ®2. ... No. .•. --- — FEs.. fir............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Dhi-pn3ttl Workii Tomitrnrtion Famit Application is hereby made for a Permit to C U�truct ( ) or Repair ( ) an Individual Sewage Disposal System`at: V[& I �1 .V�.......... .......4.. S ---- ------------•--- Location Address i- Y Lot No 017 /eve //��c�f�t/�ls iv1 ...............�`Y.......------... Own A r]�s 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 ( ) 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. 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....................... (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 9 ................................................. -•------••---••-•••••••••••-••••••••-•---•-----•........................................................... 0 Description of Soil........................................................................................................................................................................ x ,� �� --------- t----ff----•-------------------------------------------------------------------••---..............----....-•----..... V N ure of e�airs o,�j terations—Answer he�plicable..__.__Ll /�`___________________________1..iLt_.. ..._ ! ......._ . . Agreement: Li The undersigned agrees to install the aforedescribed Individual Sewage Pisposal,System in accordance with the provisions of TITLE 5 of the State En men 1 C e and s gned furt If'er agrees not to place the system in operation until a Certificate of mplianc as n i su oard of health. Sign (: ........... ...`..ZO.... ..T.S Dac Application.Approved�y-......,� . ............... ...................... .....................�..... - - - - - ..: ��.'' �` Dare Application Disapproved for the following reatons: .............................................................. - - - -------------------------------------------------------- -------------------------------------------- Permit No No ..... ' -� ................ Issued ........%;7 �---------- Due THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABL.E Appliratinu for Diripwml Workii Tatuitrur#inn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... l/-Asl,.....42 Ci(J.1t1......,f�J 4�- --------------- - ...........................j------------ -i-----------..-----u---e•--•------ ---••-- t \ddress o Lot No. � � s � sH ..Loaon-:-------------------------------------------- - 1 _.. . .a ... .._ _ ...--- Owner r U Address - - --------- --------------------------------- Installer Address VType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__________________________________-..._.Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d 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........................................ a Test Pit No. I................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........................ 04 ............................................................... ..................................._......................................................... 0 Description of Soil-------------------------------•----•-----------------------------------------------------------------------------------------------------------------------------.----- x Uw -----------•------------------- ..........-------------------------------------------------------------------.--------------------------- Nature of Repairs or)AI.terations=Answer//when applicable._._._..)C _. ., ......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State E,irorimental Cye—}�-heund�Fs�igned further agrees not to place the system in operation until a Certificate of Compliance has bee❑ issue Eby? e board of health. �- c.�'`'" y Z �5 Dace Application.Approved y-'....... ('...................................................� .. ...._......... ---- / Date Application Disapproved for the following reasons- ------------------------------ ------------------------/ .............. .. ....... ....................... -------------------------------------------------------------- cpR Permit No. Issued ...... .`...........- Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gec#ifirate of Compliance --TFIS 0 GERTIFr`I'h the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ----..,?`, --- ----- -------........_-- -- - ............................................_.. --- - ..... .......... - ...... ........ ` � Inyrdler at --------4..1._.[........ --- ---------- .... - --------... ------------ ------------------------------------------------------------- has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -.� .r�---_.. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,ram-....DATE. c<��-�-�' -.. -�� - 9 Ins ect cf THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �•-•-•--- � �7� TOWN OF BARNSTABLE Q L7 o No....- •--- FEE---- ' ui iplls- 1� a %!anatrurtfun Vermit Permission is hereby granted----------�---------.>...... 1��,�.......Er�e�4 ................................ to Construct ( ) or Repa ( ) an Individual, Sewage Disposal System atNo.. /. ----------- .............................................................. ��Str as shown on the application for Disposal Works Constructio.n•`Per' itrhi �?� ated............................- - = � r A Board of Health f DATE.......................... -------------•---....--•---------!`A FORM 36508 HOBBS R WARREN.INC..PUBLISHERS