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Home My WebLink About0455 PUTNAM AVENUE - Health �f5ur �u-}�ia.�-, otvel� ors - o�z � ca - - - � 7-- - � TOWN OF BARNSTABLE LOCATION SEWAGE # Q VILLAGE ASSESSOR'S MAP & LOT ®/.;L-. INSTALLER'S NAME PHONE NO.,,F6QWTf e2&rAGeT yd � SEPTIC TANK CAPACITY D !J LEACHING FACILITY:(type) �l�' f (size) NO OF BEDROOMS PRIVATE WELL OR BLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes N� e t JI �, r` �� I v,' _. 6 '- l a. . . Fzz THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Allp iration for Uiopooa1 Workii Tonitrurtion Frrutit Application is hereby made,for a Permit to Construct ( ) or Repair kX) an Individual Sewage Disposal System at: ...... ..... UT�c.!- f 'J� .... •007D-7. ................•----•----•-- •-----------...---•--•................... - Locati n-A dress or Lot No. ... - f1D/`l.............�� l Jr�,/ .--1 ............................. Owner Address 7...... ...... .oW1 s Installer Address UType of Building Size Lot �.AA2;; -.-Sq. feet t-t Dwelling—No. of Bedrooms________________�... .................Expansion Attic ( ) Garbage Grinder ( ) t4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures -----------------------------•-- . W Design Flow:.................. -------._--__gallons per person per day. Total daily flow--__.__----_!�1................gallons. WSeptic Tank—Liquid capacityl. ?.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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fit Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ -------------------------------------------------------------------------------------------•------••......................................................... 0 Description of Soil------•-- -- --------A-------` .- _.._._ee x -••-----------••-•--- U -•-••••---------•---------•--•------------•----••--•••---•--------------------------•--........-----------•---------•-••....----•---•---••---•--------------------------•---------...----------•-------- ------------------------------------------------------------------------ ------------•----.----•-------•••••••-------•-•-•--------•----•••----------•---••---•---------------------------•••----.••---- U Nature of Repairs or Alterations nswer when applicable- 0574—/.... ....! G...... Q.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5, of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance b n issued y t and of ealt . Signed --------- ------------------------ ---- ................................... .......... ---- Application Approved BY 1- ................................ --------------------------------- 7 ----- ----- to Application Disapproved for the following reasons- ------------------------------------ - --- ---------------------------------------------------------------- ----- -------------------------------........................................................... - --------------------------------------- --------------------------- Date Permit No. / G ....3.P,--(--------------------- - Issued ------------------------ ......... ........... ---....---------------...------.Date No.... G--- Fss _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Narks Tonstrnr#iun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at: .�UT.cJ.�21 /T' Locati -Address or Lot No. ................�.�...d/lf y, 1J7711gyL1 e.. Owner Address Installer Address U Type of Building Size Lot,,5�. =._Sq, feet I—I Dwelling—No. of Bedrooms____________________.______________Expansion Attic ( ) Garbage Grinder ( ) W Other—T e of Building No. of persons____________________________ Showers — Cafeteria QI Other fixtures -------•------•----••-•--------- - W Des•gn � _gallons per person per day. Total daily flow_____________ ___ _ _a________________gallons. ign Flow._.�=-------------- ------------------- �-�.� WSeptic Tank—Liquid capacity-/ell!2gallons 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 ( ) J.-4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I________________minutes per inch Depth of Test Pit_-____________._____ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-_____________--_--. P -----------------------------------------------------------•----------------._......._..------------......................................................... O Description of Soil---------Q = ------- �------ -----5;;7?•-Z -----/ � �5 1 -------•------------- x W ;> ------------- - -------------------------------------------------------- ---- --•---•-------•--•-•-•--------------•••----•-•-------•------•-•---------------------------------•--•----••-._..._.._....-- V Nature of Repair or Alterations—Answer when applicable_.;,_ -___ ...... ��.. e. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h ben issued y the�b-and of healt . Signed ---- ----------------------------------- -------- Application Approved B to Application Disapproved for the following reafons: I. - --------- ------------------------- ----------- q• D PermitNo. / G ` 3 ------------------------- Issued ..........................................................ate......... Date V THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH TOWN OF BARNSTABLE (Er r#tftca#e of ("UTIImpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................................................ �-o?T� a sT °�-1 _.... _.. - Installer has been installed in accordance with the provisions of TITLE 5 o The State Environmental Code as described in the application for Disposal Works Construction Permit No. -------�# _.:_ .:, _ _ .f�_. dated -............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A:GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �- DATE --------7J-----�^.�-v------------------------------------------- ---------- Inspector -- --------•-------------------............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF `'HEALTH TOWN OF BARNSTABLE FEE........................ Disposal Works T-14an#rnrtion Vprrmit Permission is hereby granted...............�� / JG6%7j--- !O� J .-• o(. .................................................. to Construct ( ) or Repair (X) an Individual Sewage Disposal System atNo..................................-'��5------_----- 1J7 1 _�_. � .._.. 0%U ........--•-----------------------•----......--••-- Street q as shown on the application for Disposal Works Construction Permit No.-AK 2 Dated.......................................... -----------------------•-------------- . -..-------------------------•-------•-•--------.._..----- DATE-----------�.7:I7- ------------------------------ -_----- Board of Health FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS .ww