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Home My WebLink About0008 WESTBURY WAY - Health co- mot---� —� I �I smEA D V'•-' r. Vnil r)PrA�"— �10. 103�e. 2-153L MAnE IN USA T nPGANIZ9-p AT 3MC4[%_GCW NA TOWN OF BARNSTABLE LOCATION &OY SEWAGE # 9/- VILLAGE eJ07-077- ASSESSOR'S MAP & LOTQr--A&- OZY INSTALLER'S NAME & PHONE NO. seJaTOLO 77 C6NI r-- 9�F- SEPTIC TANK CAPACITY �D®� LEACHING FACILITY:(type) (size) 6x/D _ NO. OF BEDROOMS PRIVATE WELL PUBLI WATER BUILDER OR OWNER DATE PERMIT ISSUED: Z.�y �/ DATE COMPLIANCE ISSUED: /O VARIANCE GRANTED: Yes No � l000 .7x�k- THE COMMONWEALTH OF MASSACHIASETTS .(QP BOARD OF HEALTAStab1,� a R o TOWN OF BARNSTA ``- s°rU v a co Appliration for Uhipasal ork,6 C�au Application is hereby made for a Permit to Construct ( ) or Repair (� an Individual S U es�osal System at: a t'e j ------------------------------------------------------------------------------------------------- ation- dress or Lot No. .......... .- ................ ..._.. t . ... Tv.�.......-..................... O ner Add ess Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms________________ ...........................Expansion Attic ( ) Garbage Grinder ( ) �a Other—Type T e of Building No. of persons............................ Showers yP g -------------•-•--••-------• P ( --->--- Cafeteria dOther fixtures --------------- ---•---------------•-•-••-----------•-------•-••-•----•--------------•--•--•--••------------- ------ W Design Flow................ .................gallons per person per day. Total daily flow............ �..........__._._..gallons. WSeptic Tank—Liquid capacity/4 ..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.---.------ '------ Diameter.....fQ._....... Depth below inlet.......6......... Total leaching area..................sq. ft. Z Other Distribution box (pC) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....---................. Phi ........................................................ .........................................._... ----y------............................................Description of Soil....................Q-�s --..._L c.I4/G1, f'�-... - x W �,,j ---------------------- ---------------------•----••---•----------••-•-------•-•-•----••-----------------•---------------•--•---•------•-----••-.�J -------------� ------ U Nature of Repairs or Alterations—Answer when applicable..............14DQ- _:. _. ....f�1 .__l _ '.�...... --------- -------------�...... � ........ YJ .2w.......................................................................... 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 as en issu b the board of health. Signed......... . .. ...A........ .... . --------------------------------- Dz Application Approved By " ..... . . ....... -- = l�� D ate Application Disapproved for the following reasons: --------------------- -------------------------- - --------------------------------- ----------------------- ---- ---------------------------------------------- -------------------------------------------------------------------- -------------------------------------------------------------- -- ------------------ --------------------- ----------- Dare /� /d -- �� Permit No. .. T=... ... ................ Issued .---- {� Dare THE COMMONWEALTH OF MASSACHUSETTS 001(0 413y BOARD OF HEALTH TOWN OF BARNSTABLE-- Applira#ion for Disposal Works Tottstruffiatt'-permit Application is hereby made for a Permit to Construct ( ) or Repair (5<) an Individual Sewage;disposal System at: C> ................ C,cJ S� ?Ulf,/---- �. .............. Location- dress or Lot No. Owner Address M Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms................................._----------Expansion Attic ( ) Garbage Grinder `k Other—T e of Building No. of persons............................ Showers Pk YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures --------------- ---•---•-•-•---•---------------•----..•-••----------•----•---•-•---•-•--•-......--•-•--------•--•-. -...._... W Design Flow................:. zi------------------gallons per person per day. Total daily flow------------\3- n..................gallons. WSeptic Tank—Liquid capacity Z?Cn.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...........1-..... Diameter...._l�....... Depth below inlet......-.6......... Total leaching area........... .... ft. Z Other Distribution box (�c) Dosing tank ( ) Percolation Test Results Performed by.................. ....................................................... Date................=-•----------....-•--_.. a 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....................... ....../6��I 'l__. = D/G ` 3 - 1� 4..... V .....-•••---•-•---------•-•-•...-------••----•--••--.....---•-•---•-•---•--•------••--------------------•----•••---•----.....------•----•------------------------••---•----•----•-•--••-----------..---- W UNature of Repairs or Alterations—Answer when applicable____ 4 ......... U��L v 7_ 7-_-- /�--------- ................. ZJ!V ------ r� GrX/ /t ......�._.5y 7 / ................ 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 /has en issud by the board of health. Signed ..........U..:......GG //�� ---- Application Approved BY Dace Application Disapproved for the following reasons: ------------------------------------------------ ...............................------------ -------------------------- --------------------------- ----------....- -- ------------------------------------......................................................---- ---------------------------------------- / Date Permit No. ---- 7 Issued 6 l Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fer#ifirate of Cgumpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�V, ) by C' d ........................ �Q .................-------........................... .... at -------------------------------------------- ----------------- ' ------..Gt��V...-- ------- 'U ......................... ---------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. i!7�....- '' dated ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE h= ``�- Inspecto -- ��i' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..1. . TOWN OF BARNSTABLE FEE.U511 ...- Disposal Works Tunstrudi an Prrmit Permission is hereby granted............................. D of C:DT ......................................... to Construct ( ) or Repair (.�) an Individual Sewage Disposal System at No............................................. --------/2 U'�jc�- - C.O%1Jj%— ----------------------------------------•-- Street as shown on the application for Disposal Works Construction Permit No. Dated_._ ---------------- -= Y - - /................................ Board of Health / DATE----- ---•------------...-_-- C FORM 36508 HOODS Q WARREN.INC.,PUBLISHERS