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Home My WebLink About0055 HAMPSHIRE AVENUE - Health SS NQfftQS�lifl Aut NO his 3'li - 139 � i Received Lniversal ®neTm www.myuniversalop.com phone:l-866-756-4676 U NVI O524 MADE IN USA TOWN OF BARNSTABLE LOCATION SEWAGE # 7 VILLAGE_ ASSESSOR'S MAP & LOT (- l 7) C/ INSTALLER'S NAME & PHONE NO. � L yrv� CSC 71 Ca . s� SEPTIC 'TANK CAPACITY ��C1 J'�► Z ASS �•- ^cam/ LEACHING FACILITY:(type) Pfl-e- c-O-S`i- IPA (size) GJ 3f NO. OF BEDROOMS PRIVATE WELL OR P-- B-L-IC--W-A-TER BUILDER OR OWNER c \,,-- e-- a Aco e-.) r DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No V � 6 Y THE COMMONWEALTH'OF MASSACHUSETTS BOARD OF HEALTH 77777bw ......OF..... Applutttinn for Disposal Morks Tonntrur#inn Frrntit Application is hereby made for a Permit to Construct ( ) or Repair ( � Individual Sewage Disposal System at: --...............�_ ._.. .!A. �Y�...._..1� �::�...... .......... .r � ................................................... ... -Location- ddress or Lot No. ......---.s4 lae.�.S ._. ...G �,� ............................. ........... ...._..r:? .................................... Owner Address a --••--_....G P. ,. 11s��t .C.... �/.ca w wa ... Installer Address Type of Building = Size Lot............................Sq. feet U DwellingNo. of Bedrooms.---. ................................Expansion ansion Attic Garba a Grinder '4 Other—Type of Building No. of persons............................ Showers — Cafeteria Ca Other fixtures ----------------••------•-----•--......................... W Design Flow......... .....................gallons per person per day. Total daily flow....... 3t.-....................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.......I............ 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........................ Test Pit No. 2................minutes per inch• Depth of .Test Pit.................... Depth to ground water........................ x ......................-----------------. 0 Description of Soil------•--------------•-----------............-•---....:----....-•-------......--------------------------------------...-•---------....-....•--........_..----....---• U ---------------------- • ._- W ---------------------••--....-----•----•--•----•----------------------------------------•--------------------------------------.....-----------------.........-•-----------1P............... UNature of Repairs or Alterations—Answer when applicable.------1 l0_1J...... _�Q... Z'.w�sZ...... ' -------may _ ..e± �s` �.. -� --.------•------------------------•-••-•--•:...........------------------•--•...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TMI L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Comphanc has been issued by he f healt cc Signed---------- ....... ------ •---- ....... ..... ..... .'............�.... Date Application Approved B — F-- ....... Date Application Disapproved for the following reasons:............................................................................................................... ....................••--........-•----------------•-----------------.....•----••--•-----•--------......••---•----._...........----•-------------...-----••-••------------------..............---•••-••-- Date Permit No........ .8.-..�f_'33.r .... Issued---------•-----------------------•••..... Date No.._..i�'.. ::._. :33 FBs...... ._. 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1' Z>.taa.!ti.......OF.... ................................... Appliration for Disposal lVarks Tonstruetion 11vermi# Application is hereby made for a Permit to Construct ( ) or Repair (L-r)Ian Individual Sewage Disposal ' System at: ............. A�v-e I.... - •--..................--•--•••................. Location AAddress ` or Lot No. ............................. ........................ \1_...A......... ............................---..... Owner Address a CIA F iT Nl11/1 fit!j 1.. �'��p r� w.. ... Installer a Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms...._,.�'_•................................Expansion Attic ( ) Garbage Grinder ( ) a, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures .................................. ...... W Design Flow........_<-�,�-_'5 ......................gallons per person per day. Total daily flow......Z: � _....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ ..x Pi posal Trench—No..................... Width.................... Total Length_......___..(...... Total leaching area....................sq. ft. =i �epage Pit No.....:__I._......._..�Diameter.....'. ...... Depth below inlet..._� �. ........ Total leaching area..................sq. ft. Z Other Distribution box ( ) t Dosing tank ( ) Percolation Test-Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.....:.............. Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ....._..-•••--•-----••-•-•••••••-••-•••---•..........................•--------•---------.._....-----••--------.....•--••••-•••------•....................... 0 Description of Soil......................................................................................................................................................................... W -•-----------------------•----•------------------------------------------------•-----------------------------------------••----------------------•-•---------------------•••--•-•.:.-----•--- UNature of Repairs or Alterations—Answer when applicable..._._ _ftl_ __._... _ __._.. x ...... ......... ---•--••---^ ...........•n��f.... c u )_cT:�, �. G G_Ann_._.=-----•----•• -•----•-•.............•-•-------•-----............._.. ..............y. V ---•----•---y..-^ ---- � •-•--•-••--•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has--been issued by the board..of health's f t i T,� Signed--------1- - --- ---------- .......... •--•--•••. — _714. 'Date Application Approved BY- - •_ ------- _ -, Date \ Application Disapproved for•the following reasons________________________ __________________________________________________________________________________.._ ...-•-•.................••-•---------•-..............----•--•----•-----••--•-----.._..--•---•----------..._....-----------•-•-------•---------------------------------------••••••••-•-••-•••--••--_-••-- Date Permit No........ = t 3��`...................... Issued --•-----•---•-----------------•---._...--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .f:a.Y� !........OF.. ��. . .. � .v4 h�--e.. ........................... Trr#ifirate of Tomplittnrt THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby ......................... •--AZ• ••-•-._.................1-•-•-•• ........ _ l Installer at. r A1t1 t+�,,Q.�i�-.-Y- -.............iL...........-----•--�-I -------------------•-•-----------...------••-----.........._..._... has been installed in accordance witli the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No . ...... dated................................................ , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ' DATE.................... Inspector.--••--•••------ ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i�1 I(L IP�S �. �a t ............. � ..........................................OF..-................._.........._......... -•_.;,;...._............. No.. ,-..y ?� FEE......... .... ....•. Disposal Works 10.1,lano#rur#ion ramit Permission is hereby granted............ - +^it ...........".-7r. -•-------•--•. ...........................••--........... to Construct ( ) or Repair ( Q)an Individual Sewage Disposal System atNo.: ... _IF1.V!! (....................................1 =11111111�.................. '----------------------------------------------------- Street , as shown on the application for Disposal Works Construction Permit No�M::_y Dated.......................................... ..........................•...._.t. - ...................................................... S^ V' Board of Health DATE .. . ... . ....... x-