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Home My WebLink About0026 BANFIELD DRIVE - Health -f3 q oa3 - �� FEXIS.Ot 100 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE App iratilan for Disposal Works Tonstru.rtiun t1rrmit Application is hereby made for Permit to C nstruct ( ) or Repair ( ) an Individual Sewage Disposal System at: ` ��. •..-•--------__.._�_C�. ate - ... ..--- o... ..----- ............................. -.. .... - - -- •- Location- ddress or Lot -- ---- ---- Installer Address t Q feet Type of Building Size Lot___________________________S q. U Dwelling=No. of Bedrooms___..•..•._..______________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building .:.. No. of persons-•------------------•______- Showers — Cafeteria P4 Other fixtures --------•--•----•-------•----•-- . . Q -------------------------------------------------------- •-------------••---------- 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W - - ODescription of Soil............ _ .. .....;.................................................................................................................. -------------------------------------------------------------------------------------------------------------------------------- ------` U Nature of Repairs orr Alterations—Answer when applicable__ . N c�_�_)............................................. ............................NN Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir ental Code—The undersigned furt er agrees not to place the system in operation until a Certificate of Com lia a ha een issued by, the boa ad of h lth. Signed �----------1 ...................................... -----.................................. — Dare Application Approved B . ........... ......... -' ........................................ Due Application Disapproved for the following reasons: ----------- ...... --- ----------......................................------.....................................------ --------------------------------------------------------------------------------------- --------------- ------------------------------------------------------------------------------------------- ---------------------------------------- Permit No. .. � d —9 0` ............................. Issue — Dte a Date TOWN OF BARNSTABLE LOCATION rib 6 el"i l,i klyf,SEWAGE VILLAGE 00+ N + ASSESSOR'S MAP 6z LOT ± e'f7 INSTALLER'S NAME & PHONE NO.G r►4w �E' ljj c�S • 4 7 7-;,,g SEPTIC TANK CAPACITY /ems rt LEACHING FACILITY:(type) �, , �tJ (size) &10-0 G� NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WAT R BUILDER OR OWNER Le: -( o DATE PERMIT ISSUED: 2 0 - DATE COZIPLIANCE ISSUED: VARIANCE GRANTED: Yes ( No �4®Wf'_c a6` AY gss fDoi r No. ---•-------- .._...... r... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispog al Workii Cnnnstrnrtion Vamit Application is liereby made for a Permit to Construct l( ) or Repair ( ) an Individual Sewage Disposal System at: vog 6 �CO-31 , , ` � op, v` .....---•-------................................................................................. ............................................--- --.=............-----•-----�..............-- `}+ Location-Address ( or Lot&o , .."�?.. .V`.. !.�.� ...... ...._. ..... ........................................................ .........., Addr ---------:-•------------ ........ ....... . ---- --_......... .. Installer Address Type of Building /� Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms _ Expansion Attic Garbage Grinder g— ----------•------- P ( ) g ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria aOther 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix --•••...................................•--------•--•••----.....-----•-----•-•-••--•.._.._.........._..••••----•-•.....•••---------•----•--.........---•- xDescription of Soil.:. r> - �.....=-•--------•----------------------------------•----- U ----------------------......................---••--••-•------------•------ ------------------------------------------••----------------------------------- W -----...---•---------------------•--••--------•••-•-•--•---•------------------------ ----------•---•---•-----------....------•-----------...•-•---.....------------••---••-•••---•--••----....--••.•---- V Nature of Repairs or Alterations—Answer when applicable__ "------- '__v.a_ ______________________________________________ Agreement: r 4/ 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 tbeen^issued by\the board of health. ?-- ,,� Signed .............�J�Y... ........................ -.LN...E:................................ ---------------------------------------- Date A lication Approved B �� CJ PP PP y`"-------- -...-------- . .......... .... �.'. " a :; ..--------.......----------- � ---------- Ap plication Disapproved for the following reasons: ..................................................................................................... Dale ...........................................................................................................................................................--.................------------. ----.......----------------------------- Permit No. .. "' n--- ....... Issued -, ----------------- ...9 d' a ...........................�e-.-... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifirate of Complianre THIS IDS TO CERTIFY, That the,Individual Se age Disposal�System constructed ( ) or Repaired (W). _ I� 9111 � � r \ Ins'aller � ------------------- at ..... ..................C7`+- n- - -Y�l..... ..........v---------------------...............+- has been installed in accordance with the provisions of TITLE 5 . f The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. ff �....��........ dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE- . ^ . .......... ................................... -------------- Inspector. �r � ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 36 .cZ No_,��..�._...... �?� FEE........................ M111 .0al Mks Csomar ion Vami# �� 1- � r�ohs. Permission is hereby granted.................. •---•-----•-----•-••-----......_. ...------._........t.•-----....-- to Construct ( ) or Repair (f)-san.-Individual Sewage Disposal Systems 1 { + a t at No................ ....... (a '1 �,G ?. r --- r�--- ( "� �^ z• �9_.. -•-----•_... �> t............ Street as shown on the application for Disposal Works Construction Permit N . ....'�� .�� Dated.._.. _.._. ?_..._. ... Eoard of Health DATE.................................................•--•----•- FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS ,ik