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Home My WebLink About0080 LEWIS POND ROAD - Health 80 Lewis Fond Road ` A = 020-012 - _ — - -- -- -_ -- Cotuit LO CA ION SEW � PERMIT 110• VILLAGE I N S T A LLER'S NAME & ADDRESS BUILDER OR OWNER I DA T E P ER III IT I S S U E D �- DATE COMPLIANCE ISSUED I a i Noi9.1.:.�a. ,l - Fns..... ..................... THE COMMONWEALTH OF MASSACHUSETTS 6a BOAR® OF HEALTH Apptiratiou for Uiupati al Vorkg Tonotrurtiun Vernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: A . ®.. 1.! -fe tv°- - C- /1/l Ass - ----•------ -------- ----•-----------------------•-----------.---------------.-.-•-------------------------•---- Location-Address or Lot No. Owner Address Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ............... No. of ersons._...................__..__. Showers — Cafeteria P� YP g ------------- P ( ) ( ) Q' Other fixtures ............................ gallons er 9 Septic Tank—Liquid capacity...........gallons P LengthP n-per-dayW;dOt1-daily.flow Diameter-------------- Depth_--gallons. W Flow I W P 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' ................................... •.......... •---.----....:.....-------.........-••--....................................................................... 0 Description of Soil.....................-----------------------------------•-•---.....----•-----•-•-------------------------•--------------------------•---------•-----------•-----•----••- W U -----••------•---•----------•---------•-•-------------------•------•-•-•-------------------•--------•---•-------------------•--------•-•-----••------••-------------------•----••---•------••--------•-- x ---------•---------------------------•-------•---------------•••--•--------------.......-------•---------•--•------------------------------------------------------------------------------------••-•-- U Nature of Repairs or Alterations—Answer when applicable._..._.....q�(d._...._........ .......................... z� ---------.-z T-------------------------------------------------------------------------------- ----------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. ,x Signed ... ..... ----•.. ............ .................................... ........ Date ApplicationApproved By.......................... C__- -----------••---------- ---------------------------------------- Date Application Disapproved for the following reasons------------------------------•--------------------------------------------...................................... --------------•----•...------•--•....-----•-•---------------------------------•---------....-----........•---------•---•------•------•- -----------•------•---------------•--------•---•--•------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------- ------_. . . .............OF....................................... Appliration for Biopuoal Works Tuntrtirtiun rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ti Ls ' A('`AS .................................................................................................•-_•-•-•--•---------••-.._..._.•_...---- •_........_........_.....----•---......-- Location-Address or Lot No. _�-k-.-�t ....!' A .................................................................................................. Owner Address Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Pk Other-;Type of Building -- No.,No: of persons-••-_..____________________- Showers ( ) — Cafeteria ( ) aI Other fixtures .............. WDesign-'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........................................ W Test Pit No. I.................minutes per inch Depth of Test Pit.................... Depth to ground water--___-_-________---_-__. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••••••••-•••-----------•----••••••••••-•••••••••-••••••••-•-•-•...•••••••-•......................•--......................................................... 0 Description of Soil......................................................................................................................................................................... x V -•••••••••••••--•-•-••••-•••••••••••••----•••••••••-••--••----••••-•••••••--••••-••••..........••--••-•-•••---•••••••••••-•••••••-•••----•••-•-•-•-••••-••-•-•••••••...•-•...•••-••---•-•••-•.......... W x -------------------------------------------------------------------•--------------------•--------------------------------. ------------------------•-------------------------------------____.......... U Nature of Repairs or Alterations—Answer when applicable.......__.. - -------- /... . . _...}�_ ........................ n c.lt......•... 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has be(;ij issued by the boar of health Signed........_ l Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ ................••-_.._........._....-••-•-••••••••••----•-••--•--•••••••_____----••••-•--••-•......................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................................................11.......I.................... (Irrtifiratr of Toutpliattrr THIS IS R CERTI�Y-5hat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b •.�.__••• .................................•--•----•--------•....--------••----------•-•-••-•-••--•-••--____•••---___.....•----------- Y------------------------ Installer . . -•--••-••-•-••-•----------------- has been installed in accordance with the provisions of TITLE 5 of Th........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA/TTIS ACTORY. DATE__...__.......... . !_��.f� Inspector.___•_______________ ------••__... ------------------------------------- THE COMMONWEALTH,OF -MASSACHUSETTS BOARD OF HEALTH OF..................................................................................... t FEE...... ............. Diovooa orb onotrlirtton rrntit f Permission is herebyrante __. .____ ..._..._ !^ _______________________________ g �+ • .....------•................••••••.................._.. to Construct ( ) Repair ( Individual rage Disposal System atNo z f .. ........................................................ Street as shown on the application for Disposal Works Construction Permit No..................... Dated....)............_...._..........._._.... .................... . Board�f�He lth DATE............................ 1 .. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS �� 7 i 0 e TOWN OF BARNSTABL'•"E — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION . OWNER AND INSTALLER INFORMATION ' � ` Nt ` MAP NO.' PARCEL NO.ADDRESS: F, OWNER NAME: ��%'1�� '�.�`p,'' , Z f!&f �' ,�"%'�/%> , ,yw `V I LLAGE: C10%0 / INSTALLATION DATE: BY: ° 1 ADDRESS: CERT. NO. TANK �INFORMAT-ION n Al LOCATION OF TANK: CAPACITY TYPE AGE V'- FUEL/CHEMICAL F I r TESTING CERTIFICATION C ] PASS C ] FAIL DATE LEAK DETECTION C ] CHECK IF. N/A TYPE/BRAND } . ZONE OF CONTRIBUTION C ] YES C . ] NO . DATE TO BE"REMOVED FIRE DEPT.' PERMIT IS SUED E ] YES * ] NO DATE. CUNSERVA%.ISN IF N/A DATE r ANBOARD ,OF HEALTH, TAG. NO ]C I[ ]C ] DATE fn ..,PLEASE PROVIDE A SKETCH—SHOWING THE°TANK LOCATION ON THE BACK OF .THIS CARD i r � rl • I ! lV BP ' � � :.� �• i' !,j � ' /. it �'• - �4 i i &-JA)('S� fOOd (Co,46f i S M E:A KEEPING YOU ORGANIZED No.10 2-W53L MADE W URA GET ORGANIZED AT SMEAD.COM - - - --