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Home My WebLink About0124 HIGHLAND AVENUE - Health CIAO i SMEAD No. 2-153LY UPC 12934 smead_cont • Made in USA -CY J� �Oco� SUSTAINABLE FORESTRY INITIATIVE Cert.ied Fiber SoUrcing w.w.afimoureraoo row b6L r LOC�j'TI SEW&C,E PERMIT UO. II�1�T QLLER � �tJIE � AD RES'S . ----DATE P-ERNA1T _ISSUED_ DATE COKAPLi.&MCE ISSUED,: 4 p 1 t •-�'t .. ,�� ______ � �� ° �. �� ` TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP 6z LOT C��C� �•� INSTALLER'S NAME PHONE NO.&P�ae-61-77 COAk5' /' 54>0--9i',;e " SEPTIC TANK CAPACITY /DDrJ C' S�4C LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER ,�� cSU� �•J DATE PERMIT ISSUED: AJ C)^.J c OQ-D62 O yf2�Z6uJy£� C�5�1? VARIANCE GRANTED: Yes No r �� .. /o CFSS'POoa ��OOG t . . g��p mb No..r V- (75) Fsnc.... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �P cF7"!� w ...... -- OF .............. 5./ ...-�.......... - ---------------------------- Apphration -for !iVviiai Works Tonstrurtion Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair ( S<'an Individual Sewage Disposal Syst at: .............. ........0,eaz�7 .............................................................. J __._..•Loc.• n dres� � fL>__ ----------------•• or Lot No. --- --------------------- ... ....................................... _ ��.A... ................... er r•. Addres WSJ/,� Installer Address j Q ype of Building Size Lot____________________________Sq. feet U Dwelling le to. of Bedrooms-.�___________ __ --__-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 ( ) aPercolation Test Results Performed by------------------------------------------------- ------ Date---------•------------------------ a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-----------------.------ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit_-____-_-_______.__- Depth to ground water-..------------.___--._. 9 ---------- -- ---------------------------------------------•--------------------...------.......-------------------------------------------------- O Description of Soil__ --- V --------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- W ---- ------------------------------- -------- ---------------------------------------------------- ---------------:-------- --------------------:----- U Nature�eirsr Alterations—Answer when appli ble.-___ ..._ _-_-_ -_-__--.- ___________ ___ ______ _ __._.___.____.... - ., � . Agreem t: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued y tly�boar o health. Signed--- ............1...... -- --• --------•-----------------•-----•- Date ApplicationApproved By-----•-----------------------------•-••--•------•--------------•----••-----------•--•---•-------- ----•----•---------------------------- Date Application Disapproved for the following reasons:---•---•--•-........--•---••--•--•••-------•..................•-•-•-----•------....-----......----------------•- ...............................•-------------•-------•-.•---•---•------------•-----------•••-------•.......---------•-•------•--••----•---•----•--------•--•---------------......•-•---------.....------. _ Date a_j Permit No.......l-Z-p......................................... Issued. y" Date `k_-, - ...__. F;as...: .%"" ......... THE COMMONWEALTH OF MASSACHUSETTS t BOARD-OF HEALTH 1G1�lrN -.OF.:........ S Rt. -: ..................................... a. `,.Vpfirtttion -for R_qp gal Works Tonstrurtion Urrmit Application is hereby made for a Permit to Construct ( ) or Repair ( V<an Individual Sewage Disposal Systey it: ---- - ---jj------- ---- -------- -----04t_�- �------ ---- ---------------- Lo ddre/5 or Lot No. ` ....................... ...... .. --- --- .... .............................. �A�, Installer Address Uype o wilding Size Lot..................... ......Sq. feet Dwelling�No. of Bedrooms-�.__-______________________________Expansion Attic ( ) Garbage Grinder ( } a• Other..—Type of Building ---------------------------- No. `of persons---------------------------- Showers ( ) — Cafeteria ( ) W d Other fixtures ............................ -----------------,------------------------------------------------------------------------------------------------------- W Design Flow-------------------------':_-_:-___-____•-gallons per person per day. Total daily flow_--_-_--_------------_-_-___-_____-- ----__gallons. Septic Tank—Liquid capacity_----.--_-_gallons Length................ Width_::.............. Diameter................ Depth.__--_-__._---- xDisposal 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...--_--__--_--_--...- t14 Test Pit No. 2•_______________minutes per inch Depth of Test Pit.................... Depth to ground water-_--.----_-_:-.-___---. a x Description of SoiL_,✓.I '2'T___.._. -------------------------------------------------------------------------------- --------------------- ------------------------------------------------------------------------------------- = V Nature ofe airs;or Alterations—Answer when appli ble.__ .... ....... ......... ! _ . ._.____�'""... ._ -_------- --- --------- -----------------' Agreemcfnt The undersigned agrees to install the aforedescribed Individual Sewage Disposal System' in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued by t boar boarij health. VA Signed.- . ........................................... Date ApplicationApproval By----------- ---------------------------=-----------.------------------------:................... ---------------------------------------- �8-. Date Application Disapproved for#tlte following reasons:..................................... ` ------------------------------------------------------------------------------------•--------------------..------------------....----...------------------------•-----------------------................ ' Date PermitNo......A---.......................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ............... OF............. .................................... �rrtif irate of GlomVIiaurr rc-& s THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed-`(' ) or Repaired s by ToSC/�rl �... ...f 6K 7 &..------f...._.-'°/" -<n _.t.1�...----------------------- ---------------....----- ....................... Installer r ._...� - -----------------.,: has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__--r_�0...:...................... dated......I�IA ._C�li_�9 _.._.._... THE ISSUANCE Off THIS CERTIFICATE-SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,f DATE "_y..[....?�� ... -��------------------•----•------..... Inspector ' !.. G� V , THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HEALTH17,0 w..........°oF................ 37Bc ........................... e� o......................... FEE....it!= BisVosat Workii Tomitriirtioit Vandt Permission is hereby granted............. irs......e..----!m4orl.ou-------}..soM.71...10-C--•---------------------------------- to Construct ) or Repair (�an Individual Sewage Disposal System atNo.--------t/9-141G "Q--------!1v /-----------.�'0" vt cr---------------- ----------------------------------------------------------------------------•------. Street as shown on the application for Disposal Works Construction Permit No----- ....... Dated__M "y fl'17 ------------— ?.V--- ....__._....... Board.of Health DATE.... ---------- -------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS '