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Home My WebLink About0125 CROCKERS NECK ROAD - Health 125 CROCKER NECK�( COTUIT _ A 019.039 1 4 TOWN OF BARNSTABLE LOCATIO d� �f- , j�"('� SEWAGE # � t�2VILLAGE 6 d ASSESSOR'S MAP.& LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY zl D� T { LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: '" DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �/' �� -� Y p. p � \:. 4 B �. f �r No....Is----Y-u Fiva....J?d.. . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Bit.-iVn!3al Workii Tomi$rnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (V/ `an Individual Sewage Disposal System at: Z S C� �e l GU ec Rod Ccl 1. fi ............... ....•-- ---._...--------- ---- ---------- ---•••- �---------------------------------------------------------------------•-- 2 Location-:address 1) or Lot No. Owner Address a Doi �-er e c> rvF ---�----------•----- �- -1--5---------------------------------------- -----•------......--- �e............................................ Installer Address d Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms---------------3._-_-_-_--_------_---.-_-_Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons...........----------------- Showers ( ) — Cafeteria ( ) A4 Other fixtures ------------------------------- -- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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........................ P4 ••-•••--••••----------------------------•-----•-.._...-•••••------••••-••-•-•-•----•-•••••-••--•--........................................................... 0 Description of Soil........................................................................................................................................................................ x U ---------------------- ............................................................................................................................... ......................=.......................... W ----------------------------------------------------------------------------- --------• ------------ ------------------------- --------------......------------------------------------------....--•--- roe oC e ! e------�--------------- U Nature of Repairs or Alterations—Answer when applicable.._._..�a..� ---...--�- -----------------------------•------------------------------------•---------------------------------------------------------------------------------------------------------------------........_....... 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 ........ . ...... -------��...'... ..-:.. J Dace Application.Approved B �y _ .. Date Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------ ------------------- ----------------------------- ---------------....................--------...---------------------------------------------------------------------------------------- ............. .. -------------------- Dace Permit No. ----------1-6-- ---------------------- Issued .../---------- .. Date �' . c No...... ��1.. z �3U.OG r THE COMMONWEAL_TH OF MASSACHUSETTS BOARD OF -H�LALTH TOWN OF BARNSTABLE , pphration for Ui_v-,pv!3a1 lVarkri Tomitrnrtiun ramit j Appwication is hereby made for a Permit to Construct ( ) or Repair (V' an Individual Sewage Disposal System at; n . ..................................................................................... a _.___ ....... ........... ...... ....I I - ._..__ .. __..............--...... �U Locatiotn-Address �`or Lot No. �(....... .--. Owner Address w O 5 f �t a$ - a`�° <. Installer \ Address UType of Building 3 Size Lot............................Sq. feet .. Dwelling— No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage"Grinder ( ) aOther ,T pe of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) � Other fixtures W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. .W Septic 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. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit__-________-_____- Depth to ground water----------.............. t4 ._...------•-----•-----------•-•-••.._.....•••--•••••••••••----•--.......-•-...-•--------------••---......................................................... 0 Description of Soil------------------------------------------------------------------------------------------------------------------=---------------------------------------------------- V - ...........................•__...._...••••--•-••--•--••--•--•---•••----•---•••••--------•---•-------•-•-•••--------------•----•-............------................................................... W V,,, Nature of Repairs or Alterations—Answer when applicable--_-__L42-_�_ca_ (__e------77_1_1-P------:Z ................ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-••••• 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 b ndersigned further agrees,not to�place the system in operation until a Certificate of Compliance`has,been issuedrby the board of health. Signed ......1 ce w.-- ------ ��--- 7 �J.. ---------------- -------- Date Application,Approved By ----------- - -.�� --------------_.-----_---------------..-_...-------------- ------ Dace.. Application Disapproved for the following reasons- --------------------- -------- --------- --------------------------- ......-. ............ Date Permit No. . .....q---5---- -9-.. Issued ................: -Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of C�omplian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓j byw -!-t e- L e -' S ----------------------------------------------------------------------------------.-.._.... In a C �c�c v t< )2� . at .. - ..... ........./V Q ---------------- ----- ---------------- -----------------------------_--....-..-...._......---_.--------------------- 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. --- --- ... -:CJ�.--_c?. a..___. dated ---- ...�.��.. f..-._P..�L___. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------- -- ~ - ---------------------- -- Inspector ..._ --------- �� ------.-.-...._....._----------------- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y TOWN OF BARNSTABLE No.... ...`.Z7d FEE 30:OG- Dispnsttl Workii Tomitrnrtion "amit Permission is hereby granted /,act l_-{- _I_.._....Le......•.... -----...•-•-----•---•-•••-----•••-•••-•••••-••••••------......•.......•-•--- to Construct (_ ) or Repair (t/)'an Individual Sewage Disposal System --• at No......ba• ••••.. c�c K� ••... e K i�cA �I f } ..........................................................1 as shown on the application for Disposal Works Construction Permit No.__��.._,_____:n20Dated_____- -1C1...... _ [ ------•••...............•........... /Board of Health DATE............. -^---� "✓✓ FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS TOWN OF BARNSTABLE LOCATIONSEWAGE VILLAGE_ (jS ASSESSOR'S MAP & LOT INSTA'LI.ER'S NAME & PHONE NO. Z, �` S y F z yak _ .a SEPTIC.rTANK CAPACITY T� ,p LEACHING FACILITY:(type) / ro_ d>o (sue) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER V {� DAT .'PERMIT ISSUED: DATE'' COMPLIANCE ISSU VARIANCE GRANTED: Yes No M / J o