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Home My WebLink About0037 CLAMSHELL POINT LANE - Health 37 CLAMSHEL"L POINT LANE - - - -- - _ — -- — — ------ - - Cotuit A= 006-058 i i 7 r C' Fss..... . ..._ PO LtZ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH AWN.------- ......:.:...OF.......6W. .. 4_ 164Z .... AppUrFatiou for Disposal Works Tonstrudivaa rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: !h ...10. .e.....---- Lo ation-Address .-or Lot No. Owner Address ... Installer Address Type of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms.........3..............................Expansion Attic (N) Garbage Grinder (� ) a`4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P (---).— Cafeteria Otherfixtures ........................................._...-------------••-•--------------•-•-----••--•-••--------------- W Design Flow............1.1.0........................gallons per person per day. Total daily flow.........3 0......._.......__......gallons. WSeptic Tank—Liquid capacity.40W..gallons Length................ Width................ Diameter___:____.__----- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........I........... Diameter........$.I_._._ Depth below inlet.......6......... Total leaching area...5Vi.5E.sq. ft. Z Other Distribution box ()C) Dosing tank ( ) aPercolation Test Results Performed by------ ........... Date____. .................... ,4 Test Pit No. 1_.._.�__-_---minutes per inch Depth of Test Pit----1Z......... Depth to ground water____ ........... 114 Test Pit No. 2.....? ......minutes per inch Depth of Test Pit...L-Z-....... Depth to ground water....1v ........... P+ --------•-------------------------------------------------------•-•-•-----------•-----•-----------.....-----------•---.....-•-------------.........------.... O Description of Soil..........�44Pf"Fll��----....15�,O*YA------------------------------------------------•---•-------------------------------...-•----------. x U -----...••------••-••--••-•--••---••----------------•---••••--...........----------•-....-•---•-••---....---------•--.•--•-•---•---•--------•-•....---------------------------••--•--•-----•-••-----•-- w ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•- U Nature of Repairs or Alterations—Answer when applicable_--__.•........................................................................................ ------------------------------•--............................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI`IiZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is d t b d o lth.................... ... ............................................... .....��/!/ ........ y - Date Application Approved By........ - �-- y Date Application Disapproved for the following reasons---------------------••-•---•-•------•-------.....---•--•------••----------------•--•....._. ...------........_ -----------------------------•-----•---.......--•---------.......---------••-----•------......------•----------------------------......•----•----------------•--•--••------------•----------------•-•--- Date PermitNo...7AIM37-------•-------------------_ Issued..................................................... Date � • C. i No.................-••--••• FIc$.................._..... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... ................OF.......................................----------------...-... ..........-.............. Appliration for Disposal Works Tonotrur#tun Trutt# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -••............._...................---...-•----...................---••------•.......-•--•....-- -----•..._..••---•----•------------------••----•--•---....---•---•-------•--••------••...-••------ Location-Address or Lot No. ......................».......................................................................... ....•--•---•••--••---•--••--_..._.._......•--•-.._........•-•-----•---••---••--.............------ Lt. -D Lai,7 Owner ` _ -Address W -----•-t=G^I .5� •?C.`�; i:�J� �ird / i�J it.1.:.. ,.✓.?�-✓`-�--�--•------------------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ............... No. of ersons............................ Showers a YP g -----------•--•----•-••-•------------------P ( ) — Cafeteria ( ) Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 ( ) 1-4Percolation Test Results Performed by•-----•--••••-•----....•-----•.....•-•--••---•-•----•-•••----•---•-----_. Date........................................ Test Pit No. 1................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........................ P' •---•------------------•---•--•------•---•••-••---------•-•-•----...•---.........-------••-•-•.....---•--.....----•-•--•---•------------• ------------- •.... O Description of Soil....................................................................................................................................................................... x V ---•---••••---••-•--------------•--•--•---•-•--...--•----•--------•---•-------•---•-------•-•.........._.....----------•-•-•••-....••-•-----••-----•••--•----•...........------......---••-------.....-- W x ........................................................-•--------------•-••-----••-•....-----•••••---•-----•-•-----••--••------------•-••------••••-------........................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... . ----•-••----------------•-----•-•-•----•----------•----•---•-•---------•-•----------•--------•------••-•................----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T IZ 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 Yy the board of health. Signed---....--- r...••=......--------:! 1 = -•---.................... Date ApplicationApproved By.............................................................. ---•-------•..................•- Date Application Disapproved for the following reasons:................................................................................................................ .....................•----••------•-••--•••--•----....--•--•-•••----------••-•---•...._........-----••-•--•....---------••-•----•---•--•---•-•-•••---••••-----------••---•----•-•-----•--••---•--•-•--- r'.r j� Permit No...�_._1_.._ - 31---•--•--------••-•--------•--- Issued-.......................................................a Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF Tniifiratr of Tontplianrr THIS IS TO CERTIFY,That the Individual Sewage Disposal System constructed or Repaired ( ) Installer at has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... ._.`-2.....1 ........... dated ... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................-...-----••......---•-•-••---•--•.. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t ~7 ..........................................OF..--..................................... No/.�......1 /r.�) Disposal Vorb 'T'unotr ion Prrmit Permission is hereby granted .�_ ......................n.....:_�. to Construct ()c) or Repair ( ) an Individual Sewage Disposal = DisposalSystem ! .YY�.. ....at No................ _-aVIA.•----- . tee _2 as shown on the application for Disposal Works Construction Permit No./i..2�.. Dated.......................................... ...................................................................................................... DATE_ Board of Health FORM 1255 HOSES & WARREN• INC., PUBLISHERS AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION c3'1 �c n�4Nt�LL ( P; tJSEWAGE # IN, VILLAGE C � � �,i ASSESSOR'S MAP & LOT C?o� INSTALLER'S NAME 6s PHONE NO..-':? -7-7 SEPTIC TANK CAPACITY LEACHING FACILITY:(type)_ (sue) NO.. OF BEDROOMS ,PRIVATE WELL PUBLIC W TER OR OWNER til L� .C_(� �( DATE PERMIT ISSUED: t- { DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Ll/ ti r http://issgl2/intranet/propdata/prebuilt.aspx?mappar=006058&seq=1 12/28/2018 ------------ Df 3/S P-�To�IE e� p�llriL./T' otE toC.-Co !6 AMP AL 01 4- QO Yy► CEO v 0 O � 1� K G 00 O OOOOOO �G I ly �14i . , M m t o4 Is 21 Ta �G�Il.�' (oX S ► ® °I FFUT 9 6z �3 860Q0Or''I x //o 0r3 =�3 q� o° �,8�►S a o i •SEPT C 7� � /� 5 � s 6i /, �e c rPl Ar DTTdtw! �9Re.q x 5 /,O A7. 5� ml l;a 96 519, pd o l .� u d TES , l(.0/ RE. 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