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Home My WebLink About0032 KIMBERLY WAY - Health ! Kimberly Way $ Coiuit A = 027 052 - - - - - - - - -- - - - - ------ i -TOWN OF BARNSTABLE LOCATYON A3 Kf And k� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT ' - INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY L�L�OCs LEACHING FACILITY: (type) (size) -s NO. OF BEDROOMS 't B OWNER PERMIT DATE: � I Z y 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(1f any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� ` � . . �v�� 22 �� f ' �4° .� { yT ,.rt �1 �� `3/ .r No................. 1 FEs 10........... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HI�EE A ...---.....OF...... ...7�.t............. Appliration for Dhipagal Warkii Can gtrnrtirrn Farm# Application is hereby made for a Permit to Con truct ( or Repair ( ) an Individ Sewage Disposal System at /�� di ------------------- .. .. G%!?�t .........-• (� 6;Q;VLK ........ i . catio dre srf /fp �.. .. o. d"`� ..... ............................................. W , Cywner^ d ess, a ................................................. Installer Address d Type of Building Size Lot__ ...Sq. feet U Dwelling—No. of Bedrooms._.................................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) a' Other fixt W Design Flow________________ _ ____________________gallons per person per day. Total daily flow__._._____ _8_16----------------------gallons. WSeptic Tank—Liquid capaci/0"gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .........,.,�...r .. idth____ ...._........ Total Length.................... Total leaching area............_.��q, ft. Seepage Pit ..........T_._.. Depth below inlet....... Total leaching area__-1�.�_....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....................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil ^'7-- ---__--L �f--• ............................... U -• - •••-•-••-----. .... - _... VNature 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 Sanitary Code—The un rsigned further agrees not to place the systevf in operation until a Certificate of Compliance has bee iss d y t oard of Health. Signed...... ..... .....• --•- � � ApplicationApproved BY__. .............................................................. ..... P- --........ Date Application Disapproved the following reasons______________________________________________________________________•________....._.._.._..._________._....-. ................................•-•--.._..._.._........._._...._..-------....-----------•---------..._...:.---...............----....-----------------------------------• •--•--•-----------•------.._.._ Date PermitNo........................•----.........-.._._.._......... Issued....................................................... Date No.....y...�..`/.......� . FEs...... ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® QF HE/A TV ...........OF..... - 1...`—. ......... Appliration for Diiivviial orki Chia iitrurtiAn Frratit Application is hereby made for a Permit to Con tr uct ( or Repair ( ) an IndiI�L vid Sewage Disposal System at .....................�"'. .......3.-- A1.0 Z 4 •. _ .........!6 ................ ........................ ----- L catio dre s �}» __` t No r - ...... -.1....._ ... d/ .... __.-____--•__________________________________ O net rf d ess aw 1. � -.. .......... ........... ... ..... : ,��-..._........... -------------- Installer Address ft U Type of Building Size Lot.._ !_ ........... Sq. feet Dwelling—No. of Bedrooms........... ............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 44 Other fixt W Design Flow................ . ....................gallons per person per day. Total daily flow.....__._- __ �.. ......................gallons. WSeptic Tank—Liquid capaci/. gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No. .............r.�_,. )Width____ .............. Total Length.................... Total leaching area........ -�'�q, ft. x Seepage Pit No.. 0__j4il fil�r...__......�:_.... Depth below inlet....... Total leaching area.. .1.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (24 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........._.._......_... 1:4 // -�` ------. P .J. ... O Description of Soil --- a'- ---------=--�-� -- - -- •----._..... --••-----...- ----------�-•---------•-•-------- U -•----•••-••-••• -•••-• ............••...••. -----------••--------------------------••----------------•----------._.........••-• ...--•-------- W •••------•...........•.•______________ VNature 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 Sanitary Code— The un rsigned further agrees not to place the syste in operation until a Certificate of Compliance has bee iss d y th oard of health. Signed..... ----------------------------• ...- f ............. Application Appro7By �Date Application Disapp following reasons:-------•-----------------------•----•--...----------•--•------•-------------•-------------=••••....-•-.._..._. ..••-•••.......-••-•.-•-••••••-•••-••-•-•-••••••-•••------•-•-----•-•-•---••••--------------------•...._..................._..---•-•-••-•-•---•-----••••••-------...•---- ••--------••..........--- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA _T r VJQ_ f. ........................OF..................................................................................... (Irr#if irtt#r of Toutplitturr THIS IS TO CER T,a-t tie I�dpvidual� age Disposal System constructed ( or Repaired ( ) ( amy- at ----•-••----•••• ........................................................ has been installed in accordance with the provisions of TIFF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................V.............. dated................................................ THE ISSUA CE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL UN yION SATISFACTORY. DATE......_..°Z -P/................................................. Inspector --•� ........................................................................ COMMONWEALTH OF MASSACHUSETTS f` / BOARD HEA H" g� No...........-•••..../... t FEE........................ � . �i��r�a�ttl u � Permission is ranted------••-•- �...-----.. ... ...... .... ................................ Yg to Construct `( or ep it ) a Indivi al Sew Di or_� st �u � �a t as shown on the application for Disposal Works Construction Permit o..... ... ........ Dated.......................................... -------------------------• -•- -•--------•-•---•----------...........-•-•---•.........•--_-•-•- .i ' Board of Health DATE------- ----------- ................................................ , G' FORM 1255 A. M. SULKIN, INC., BOSTON 1.10 GAR.6'AGE �¢.ttJi�E2 _ . �2"s'U� ol,.lLY SEPTIG TP►vK = 330x15c>0/- 4976.PC> H i^., U5E 1000 GAt-. qi .(e "r.' W 015Po5�AL_ PIT V5E I.UoD (aAL. ' loo-4- 50T TOM AREA- • j O 5•F• 5a S.F X. -IOTA1- [7.ESIGN = .g25 6.P�• LE�lGI/ . /may TaTAL. DA I LrsC F :-C>W' 330 G:Po• �, () /sir- \t4) Cr- pE2Co.t-A.Tiot4 RATE; 1'IiN 2MIN ot�tt~55• �'D S�- .� M qA0 DAVIQ �y C. �cn Vn THUUN No. 29976 k .p Nc. 19334 F 'OMAL qc �L �`` �I ►�� y ag Y / TOP FWD= lot to 33u7 GGrtrj 1000 I14\1J _Z - SvQwr� also N� GAL. ., C SEPTIC BUX '� TANK to�v JN`� I LFCtLLu IN V. INV. c G �►S;tzo C.aZ-rIFICA P1-07 PI`A-W �` - , Z ,g t�1o. t5GALE' S'GALE; - dU AT-.a -7 3 A:t � REF QE GE . GEQTtF.Y -FNAT ?NEzc,P. NuUS� SNot�(N NFREotC GgM(�L;�{5 Y�:IZN..t. 6 Sot%>S;LtN L.00 TED. W1T411N•T GLoop F?l.Al gA.�cT,EV-4 N`(6 1N� TtliS Pt-QN t5 NorT 4n5c P 4>1,d A os-rEtz.V1Lt.� - �KASSy _ 1► ,5Tt2.UMENT 5U9-Vey F--T. 4E 01=r,S.E'T5 6QOULD No-t Da U5EDTG C7ETEFt/^I►�ltr L.oT -INE.S 1APPL ICP.►-J'r QH$J LOCAT,IO.N SEWAGE PERMIT NO. f i Y� VILLAGE I N S T A LLER'S NAME i ADDRESS 6 U I L D E R R OWNER DATE PERMIT ISSUED 17 7 DATE COMPLIANCE ISSUED L l t