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Home My WebLink About0020 PINEY ROAD - Health 20 PINEY ROAD Cotuit �` A = 634 — 024 -- - -- -- -- - --- - ----- - .1 TOWN OF BARNSTABLE LOCATION 2.0 R'n e,4 SEWAGE # S^lv VILLAGES �-�J' "AS ESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. , P k1'►CeC j/ 22� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) I r UOD L (size) NO. OF BEDROOMSPRIVATE WELL OR PUBLIC WATERS 611C BUILDER OR OWNER DATE PERMIT ISSUED: !'] DATE COMPLIANCE ISSUED: 2 VARIANCE GRANTED: Yes No �' bVC pp� No.... FEz...4V. ...42- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V ...........Zvw.........OF...........cQW ..................... Appliration for Uhipogal Works Tomilrurtion rnmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: A .... ....... 401-lee,. ............� -----------•----------------------•------------------------------------------------------------- I c -,Or.;ss.. r Lot N.. ................. .................................................................................................. � caner Address 7_//Ij ..... ......... Installer Address Type of Building Size Lot-------------..............Sq. feet U Dwelling�w. of Bedrooms.......... ...........................Expansion Attic Garbage Grinder ( ) 0 '_l P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures .................................................................................................... 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. f t. 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__.________-_-_-___.__-. P+ ........5Z------------------- -------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil--------------- .. .......................................................................................................................... X ------------------------------------------*------------------------*------------------ -------------------------------------------*-------------------------------------*--------- ................................................................................................................. . -------------------------------------------- U 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'TTLE 5 of the State Sanitary Code—The undersi ned further agrees not to place the system in 1-� operation until a Certificate of Compliance has be issued by-9 bo of th. Signed. . ... . ..... .. ....... .. .......... ... Date ApplicationApproved By............................. ................................................................... ....................Date.............. e agree,0j,,*ne, "r u't'as De issued by t of th..... . .......... d. .................................... Application Disapproved for the following reasons:.............................................................................................................. ..........................................M.............................................................................................................................................................. Date PermitNo....... -------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS r- BOARD OF HEALTH r, ..OF....... ��,, ,� .57, „---------------------- Appliratinn for Digpuiia1 Works Tnn,itrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: J . �... . .......... .................................................................................................. Loc ion-Addres or Lot No. �-/�i Ate' wner Address hW1 ...............� _ � C-� f ---•--.................................. ..•----..........................•.... .......................................... Insta.ler Address Q Type of Building Size Lot............................Sq. feet Dwelling o. of Bedrooms :�-------------------------...__Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P� Other fixtures ---•----•--•-----------------------------•-•---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 0� 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I.,.............minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ...... - - - • - -----------------------•--------------------------------------------------------------------------------------------------- O Description of Soil............. _ __ ... UW •-•••-----•-----•--------•---------•-----•-•--•--•------•----------------------------------------------------- - ------------ --------------------- -- - Nature of Repairs or Alterations—Answer when applicable._--___ __--.L_____________ �,�______-------------------------------------- --------------------------------------------------------------------------------------•---------------------....-------------------------------------------------------•----------------------.....-••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ?" L J of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by t e bo o" i lth. Signed. = --•------ ---------•---- r Date ApplicationApproved By............................ ---.....•-•.....................................••---•-------•-•--- Date Application Disapproved for the following reasons:.............................................................................................................. -----------------------------•---•---------•----•--•----------------------...--------------•------------•-•---•-•----••...•------•---••--••----•-•----------------•--•--------•-•-----•----•--••------- pp _ Date PermitNo...... ...................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7�7...mow.............OF... ,CJS.J,r !.G.�....---................ Trrtifiratr of Tomplianrr j T E,j2TIFY, T at the Individual Sewage Disposal System constructed ( ) or Repaired / /4[ O b ------------- ----------- ....� . --•--- --•-..... - -------•-------------------------------------------------•---------------------•---------•--- y--- at----�Q-•-------�-G/t/-�\/ �r!f!!.. IJ L � --------------------------------------------------•--------•------------------------------- has been installed in accordance with the provisions of T'LrTIE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._5'.7—...Te,;;3,....... dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT HE SYSTEM WILL FUNCTION'SATISFACTORY. A �, DATE �-. �� 1' y� Inspector......... / --1J ------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Nofl.:'... f aZ- FE Disposal 0 g Tian #rudion rrnti# Permission is hereby granted = •----y ! -------------------------------------------------•----....................----.. to Construct )XRb r ,�'' Indiv';ual Sew is osal System St:eet as shown on the application for Disposal Works Construction Per 't N�7.6��... Dated.......................................... .................. .--—---- --------------•-------- ^� Board of Health DATEE..............�.�.�,. I' .............................. FORM 1255 HOBBS & WARREN.- INC.. PUBLISHERS