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Home My WebLink About0042 CROCKERS NECK ROAD - Health Ca1uLt b2o- z�1� j TOWN OF BARNSTABLE o Cm LOCATION �i?�c°,C,�.�/d/,�{C /J°SEWAGE # VILLAGE--� � 7— ASSESSOR'S MAP & LOT 10�0 Oqq INSTALLER'S NAME & PHONE NO.-&1)j614NdZp& �D SEPTIC TANK CAPACITY LEACHING FACILITY:(type) dam. (size) / NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER �Ue BUILDER OR OWNER 7 H1. -7XNB ZoO DATE PERMIT ISSUED.: Q DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No f a� ,�57' �� , a � .. � .. i e �� ' O .. S z� �- cp 1 c �Ll w� , No.... FRB.........1.Q........... THE COMMONWEALTH OF MASSACHUSET.TS APPROM Cam � BOARD OF HEALTH ,TOWN OF BARNSTABLE trtt#� fur Diripv!ial Wnrk,i Tnn#rnr#inn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: jo �....--••--� -------------•--•-•-----....-•----------....---------...............---•-------------------' 41v n jor-.tio0_\dcrl z or Lot No. .........._.........:.�.Jl ................ ....--•^ ----•-------------'--............................................................................ O cner ..........................•------•"--------Address Installer Address VType of Building / Size Lot............................Sq. feet Dwelling—No. of Bedrooms----------------0------------------------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. l----------------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 '-••-'--••-•-•--------------••-•••-••--•••••----••-•---••••••-••••-•••---•-•'•--•-•-....•-•••••-••-.......................................••-•............... ODescription of Soil...................................................................................... --------------•--....-----•----....----'--------------•••••...........-••-.•••--- x w ...•---'---------------------------------•- ---••------------......................--•'••---------'----------- ------------ ------ U Nature of epa r or Alterations—Answer when applicable---------/. 7.L1,,:...3.........................�3.................... ............. .rr --------------------------------------------------------------------------------------------------------------------------------------------------------- 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— he undersigned further agrees not to place the system in operation until a Certificate of Co ce has been iss ed by e board of healt Signed -- - --- ---- .. ... .... .................Dace............ ............... Application Approved BY ._Date .�..`1'� . Application Disapproved for the following reasons: ............ ........................ .- . ........................................ ......................................... ... . ................................... ..... .......................... ... . ... ...... . ..................... ........ ................................. ........................ .............. Permit No. ........... ., ..../ J ',� -- Issued .......................................................�fe...... Dace C) Ll f Fis.......... � ®. . THE COMMONWEALTH OF MASSACHUSET_TS BOARD OF HEALTH ' TOWN OF BARNSTABLE -3 Appliratiou fur Diri wial Wnrl uui i� C� r Diu nr n ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -- .......................................................................................... •:\ddres or Lot No. -----D H...... . :.5 IL 10W/..Z -"-"------••............................. owner Address w ac'e) •..... Installer t ( v Address UType of Building t t. Size Lot............................Sq. feet �. Dwelling— No. of Bedrooms.___--_-_---_ 6.1______________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _____________________--___ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures . l --------------------- --- -------------------- W Design Flow............................................gallons per-per npe` day!:Tdtal daily flow..............._..._............._......_...gallons. WSeptic Tank—Liquid capacity------------gallons Length_a ...... Widf�h---------------- 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. I__---.--_-__:t ninutes per inch Depth of Test Pit.................... Depth to ground water.................. ... LZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil............................................................................................................................. ---------------•--............._....... x a U�] ---------------------•--------------------"----......-----------------------------"---------------------•--------•----------------------------•------------......--.................--------"---....---- V^ ......................................................................................................._----------- .,._........._--__--..-----•---_--_----..--_-...-.--.-.----.............L......._... Nature of Repairs or Alterations—Answer when applicable.--_--.-.1..,..1 L�_.__ ------../SU U &,4L WJ (o ....------ -f...... , �, --•---------------------------------------------------------------- -------- ---•-•-- ................•----- ------. ........... 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 Compliance has been issued by the board of health. Signed �'"" ....�� *.:. s .0 . Date Application Approved By ............... .,,.� - 3 J Q.---- .. ......................... -- -----. .....: ..A.. . Date v Application Disapproved for the following reasons: ...................................... ...... . ....................--.. ............_.............................-- ......... .............................................................................................................................................. . . ......... ................ . ..... ................................. Date `` .... Permit No. .....9.`yea.......... .. ---------------- Issued .....................-----................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r� TOWN OF BARNSTABLE Califirate of Tomplianre THI IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (,/) CG o at ._.. .. .... � .(7( �.C=. -- — .. .. ...A?----------------- T ------------------------------------------------------------------ has been installed in accordance with the provisions of TITLE 5 of.The State Environmental Code as described in the application for Disposal Works Construction Permit No. _.-__1..,3.-...-1/7._ — dated _........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................................... .. /fir 1141 --- ---------------------- Inspector ---..:......_.... .._........o..... 'I�` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE /�� FEE... ..... ........... DispoulL orkii Tonotrurtion "unfit Permissionis hereby granted. ------------------------•--------............................................................ to Construct ( ) or Repair (✓I, an Individual D*spo al System atNo. 2 Cl2pC,KE G1C K ..... .(I..--..-----------------------••-------------- ------------------•--............. Street q as shown on the application for Disposal Works Construction Permit Na./.�:..y�\Dated........................................... .......... ............... ...................................•--•-•-•-----••---•--•-- ...... v Board of Health DATE-----•----------�--...�d........��-------------------------------- FORM 36508 HOBBS R WARREN.INC..PUBLISHERS CA