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Home My WebLink About0162 WALTON AVENUE - Health 1 fe R WaH+n Ate, "�Vl; S �,,. s' TOWN OF BARNSTABLE LOCATION ICC>2 /74a*1 ��-- SEWAGE # VILLAGE � t/ /�'!ri S ASSESSOR'S MAP LOTG"''�` � INSTALLER'S NAME & PHONE NO.XY 6 &4 c-o r-o?,lSa_ SEPTIC TANK CAPACITY 9,4/ LEACHING FACILITY:(type)%'00�3 CaAI. /0,-f( ize) O� X 6 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER / S / .4 0�e4.S DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: . VARIANCE GRANTED: Yes No / W t� A, TOWN OF BARNSTABLE LOCATION Vv CpQ.r-!M SEWAGE # F VILLAGE.v;,A a _ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY t �� LEACHING FACILITY:(type) (size) NO. OF BEDROOMS_S PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes No � . tr ,;�_ .. �' ��' � � '. a.. I, -�*� i tom" ��. 1 � � ;^' � i `� � r`� II �� t i ` P, � �: j 30 - No... --......... Fxs............................. APPROVED THE COMMONWEALTH OF MASSACHUSETTS ry ' o en OAR® OF HEALTH ;gnu Date OWN OF BARNSTABLE Apptiration for Diripo Sal Work.. Tontitrurtion Permit Application is hereby made for a Permit to Construct ( ) o r Repair (�an Individual Sewage Disposal System at: ................................................................................. --..._.� > Location-Address or Lot No. _1+ Esl� rcc ..5--------------------------------------- .-•••------••---••------•------•-----••--- - -----------------------...............--------- Oancr --•---•-•...........................••.•....Address Installer Address Q Type of Building - Size Lot............................Sq. feet U DwellingNo. of Bedrooms-------..-.... .Es ansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons----------------.-..-------- Showers ( ) — Cafeteria ( ) p" Other fixtures ------------------------------- - - W Design 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GT4 Test Pit No: 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ---------------------------------------------------------- •............. •-•......... ---..---................. ..-•--•--•---••---.......... --•--------•--.-•--- 0 Description of Soil-----------------------------------------------------------------------•--•-------------------------------------................------------------------........•..-•--- x w -•-•-•••...-•----... -- ----- p UNatu e of Repairs or Alterations—Ans ver when ap licab]e_,tD.,5it4-�.�............ .......__P..(OQf�...._d-/-zk.. - ...........ram••--•-..... > -� .L� 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 ha ben is ued by e board of health. Signed ................... .. . ... ......... ..: ...................... ..:.... �../....Q..'.. ..I.. Date ApplicationApproved By .. .... ...o........... .. ......... .......................................... ................. .................. Dale Application Disapproved for the following re nr: ....................................................................... .......... . .... .............. . ................. ........................ ... .... .. .......................................... ................................. ... ........... .... ...-...................................... ....................... 77/ 7 Dace Permit No. .. . .. / ole .Issued ........... rY1 41 � 3( s No 1 - Fas..-.-...�. a -� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 41 -"'- 7 / S TOWN OF BARNSTABLE Appliratiou for Diriptt!ml Wprlw Togttitrurttun rPrmi# Application is hereby made for a Permit to Construct ( )Gor Repair (L Kan Individual Sewage Disposal `. System at: � �I ��11 1�� a.. . fir,/ 1 :�.. ve ............. --------•-• IN .-...... Location-Address or Lot No. O,cner Address 'r W Installer Address Type of Building Size Lot............................Sq. feet a Dwelling— No. of Bedrooms------------- ............... ........Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------ W Design 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 leachingarea....................s . 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........................................ Test Pit No. 1................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...................... P+ •----•••--••----------------••••-••••-------------•------•--••--•-•••------------------•............................................................... iO Description of Soil........................................................................................................................................................................ V ........•••---•-•--••------••---------------•-••_._.....•-•-•-•-----------••-•-••---••--......_......--•-•-------•-•---------•--------•••-••------------•--•-----•_.-_------•---...........----•-........ W x .......................................... .............................................. -- --- ----------------------------------•---•----•--_ U Nature of Repairs or Alterations—Answer when applicable- l� .�t± .�.�-.........(-"...-.4.�-..� .._... ----•-......f .Xf> � ` -!_ `S�,'� 1- ................................................... 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 been is,ued by , e board of health. Signed .....�............ .. e ----------.... .......7^..�.L.'.. .!.U Dare Application Approved By ..... y.....r?�' 1 ........I .................. ; ........................................ / r ........ Dace Application Disapproved for the following red. ns: .. ................................................... ............................................ ........1...............�'?..-n '^---------------------- ..........................................._�f. ..........�...... / •.` (� ) �� Date Permit No. "A.......... '. 1,��f................... Issued ....../.I l l r 1 i t /Dace e• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Complianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓)"� by -------------------- fiCU............. .....__..... _........................R.... ... ......-- ............ at ... .�..�n. ..............��!/.! l.. Y.i........... .................4.0o qA F2 .L...S.................. .................._.................................. ......... has been installed in accordance with the provisions of TITLE 5 :f he State 31,pvi nmental 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..................... ..._.( r$ .9 f.......................................... Inspector ....._.... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -� TOWN OF BARNSTABLE ..._.......�._...�.. FEE.. .................. M11111afittl Tprkv Tnnntrudion "motif r4 N t o Permissionis hereby granted....................... ...................-----------------------------..--...------------------....-•----....----------................. to Construct ( ) or Repair (✓�an In ivirlual Sewage Disposal System I atNo.-� -,)-•--•-••- �I� r�-......... U ............................... .......... (�= = .................. -/------�---......1....... as shown on the a lication for Disposal Works street .- 1(� p p s Construction Permit No.- -_.t...._....�- ated_-_-.....�/.- ,1.1�.1..�._ f Board-f Flcalth �� DATE............��T.I FORM 36508 HOBBS&WARREN.INC..PUBLISHERS