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Home My WebLink About4015 FALMOUTH ROAD/RTE 28 - Health IS Fot m 6u -h R ol,-D tea$ L",E -- - - -- - - - A 0 SMEA® KEEPING YOU ORGANIZED No.10334 2-153L MADE M USA GET ORGANIZED AT SMEAD.COM TOWN �/OF BARNSTABLE L OCA�ITON s,4 )AX /�i � /-A SEWAGE # VILLAGE ASSESSOR'S MAP &LOT 6` 0 'OP-7 6< INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILrN: (type) - (size) NO.OF BEDROOMS BUILDER OR OWNER ��/SS' �/ Lam• /Y /re PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 leaching facility) Feet Furnished by �1�1/ l 0 list 9 ' 6 � ! - � ----------------- La0''CA T ION � # i2�� S W A G E PE MIT NO. T te . r Lo /? VILLAGE "? Ca. 6tt,� I N S T A LLER'S NAME i ADDRESS BUILDER OR 0 ONINER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED . � � �� 7� 67 �? L O/Cy A T II O N' ��` SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME i : .-.:°ADDRESS f"GJ �Ol�S�12iJG ii74? . I BUILDER OR OWNER DATE PERMIT ISSUED G IrK DATE COMPLIANCE ISSUED I � • i P P r 34 . P P y� 13- 36 AXJ44 C40-cfAL J .- No... .. ...:...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...--....e ......OF....... ------ rile". / ApplirFa#iun for DiutjuuFal arks Tour rnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair (d-'J"an Individual Sewage Disposal System at: ti PC K4 Ga-70,-T E1 tf'W4red- " �JQ Location-Address or Lot No. .......J.13 �_ .... ----------------------- ..........-------------------------------------------•-•-- Owner Address W _ f�z.;AAL _��iRA cE Y`� Installer Address ,�// Type of Building Size Lot___20.4 feet- Dwelling—No. of Bedrooms.................................._.........Expansion Attic ( ) Garbage Grinder ( ) W Other—Type of Building _ /. _.. No. of persons_._:!n.................... Showers ( ) Cafeteria ( ) Other fixtures -__x_ __ _ems_. dr'��ll:S ,::�------------ -----------------------------•---•------------------__-------•------------------- W Design Flow..................7-5.................gallons per pfr day. Total da)ly flow-------,2.7'--S._...____________galllons.�� WSeptic Tank—Liquid capacity/� galIons Length_&6_-�._-_ Width_ _-/Q._"Diameter... x Disposal Trench—No..................... Width..........._.__.__._ Total Length...............jr Total leaching area....................sq. ft. Seepage Pit No....___/-_________ Diameter........,C0...... Depth below inlet......99.......... Total leaching area._A2f..2_7.9a-.ft-. Z Other Distribution box Dosing tank a Percolation Test Results Performed by.... .r!'T �..fE__,Alxy--_____----_._________- Date___.-?::_9__.__...... Test Pit No. 1_.C2____minutes per inch Depth of Test Pit-------- O. . bepth to ground water.._�O f=, Test Pit No. 2__ ....minutes per inch Depth of Test Pit........ZfV bepth to ground water------ Phi •---•---•--- --------------------•--- -•-•-----•-------•.......-•----•..._---•-•-••••••-------•-•-............................ O Description of Soil----... � f� ,ld� � /--...41 ....P!7._=�Z------ P67.-P*M_-4E----..If. _.- ....................................................-..................................... V 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 TITLE 5 of the State Sam ode—The undersigned further agrees not to place the system in o rati until a rti sate,of Compliance has n issued by t e bo d of health. igned-=-- -•.. .... -_- o . ... ...................................... t Date /pplic.a • n Approved By............. --------- --------•---------- ••••. •�z-/-mar Application Disapproved for the l wing reasons:-----••-------•-••-------------------------------------•----------------•----•-••---_----_.Dat _...........- .............-........................................................................................................................................................................................... Date PermitNo......................................................... Issued..............................................•......... Date R � ' No........................ ............................_ THE COMII�IONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliraation for Disposal Works Tonstrnrtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair (/fan Individual Sewage Disposal System at: 1-V1.r)Q1,_oV&_L....LogNE--------------------------------------- ............................................./---..---------------------------------------- .�- Location-Address or Lot No. 40Z/� ---------------------- ..........--...................................................................................... Owner Address W Installer Address Type of Building Size Lot....1,04,0aq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building g No. of persons.... .................... Showers ( ) — Cafeteria ( ) Other fixtures .... �mv. jam;-- ------ -------------------------------------•----------•-�:-----------.............---- W Design Flow..................:IS.................gallons per .per day. Total da�y flow--------/27t. ..............-gallons.� WSeptic Tank—Liquid capacity./ gallons Length Width.40_:-/Q.. Diameter..... Depth.--r'_-.7. x Disposal Trench—No..................... Width.................... Total Length............... Total leaching area....................sq. ft. Seepage Pit No_______ _________ Diameter......... Depth below inlet......Ard?........ Total leaching area..*f2,_7. Z Other Distribution box ( A-Y"_ Dosing tank Percolation Test Results Performed by._.. / T ...��../ 4....................... Date.... = ...-R Test Pit No. ......minutes per inch Depth of Test Pit___.....& .�Depth to ground water.._ 00, (s, Test Pit No. 2_.K!z....minutes per inch Depth of Test Pit.._.....1 � De th to round water._.. P P - - - P g Gd O Description of Soil.......BGT ...AIZV` ._.-... �J..�'!T.4` v -......+_'Q-----=......UP1a{G----- ..-_.-5V�-6!_G•.................................................................................................... W .......................L44. ...... � ...f�1 0.• 9.jV------------------------------------------------------------------------------------------------- UNature 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 TIT iZ 5 of the State Sanitr,} ode— The ndersigned further agrees not to place the system in op rati until a rti-sate of Compliance has\\ eeeen issued by t e boa d of health. �,. Li_ V l Date oIPPlicat' n Approved By.......... l }Zl • - - Application Disapproved for the 1 wing reasons-....................r•---•-•••------•-•---•---------------------•---------------------------Dat .........----- •-------------•--••-•-••-------------••-............---•--.......••--•-----•-----.....------------••----.----------------------------•---------------•-•-•••-----••---------------•••------•------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Ttrtifiraa#r of Tonapfiaanrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (` ) or Repaired (� by----. ----- Installer at---------------------------------------•-----------•----------------------------•-----------------------------------•------------------------------------------ has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Coe as described in the application for Disposal Works Construction Permit No------"^'_��.—..1.1__ _¢_._... d-ated.._..__j.. .. .. . . .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RA TEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. Inspector.... - r DATE..... --------------------------- ....... ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cf ` O F........... 7��+^ .. .......................................................................... FEE...:...2 t�''�.....No..... 4 Disposal Works Tonotrur#ion Vvrrutit Permission s hereby granted...............1� ... -..._...._ .._ ...= ------.....---Z7.....I...W......... ...... to Construct ( ) or _Repair ( ) an Individual Sewage Disposal System 7 0 E_ �C' 7 IE atNo.. ......... 4p... ..... . 4vx.k!�Q...v1gtC C . -------------------------------------------•-----------------------------•--•----...... Street as shown on the application for Disposal Works Construction Permit N63 _:`94... Dated....... 1-6je,/'............... ------'��''- -L�ealt --- ---........................ oar of H DATE................. .................................................... . Sh FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS^