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Home My WebLink About0065 CAPTAIN ALDEN'S LANE - Health �_`6 5 CAP I ALDCN i T;y�dS%.C�2VILLC A= 146-086. 002 I 7 6 i t .a ASSESSORS MAR NO- PARCEL N0: 0 4 e) THE COMMONWEALTH OF MASSACHUSETTS 3 BOARD OF. HEALTH TOWN OF BARNSTABLE Appliration for Diinpwml Workii Tawitriartinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ner - ` Address , Installer Address _ d Type of Building "' Size Lot--- 6f_3! ___.......Sq. feet Dwelling— No. of Bedrooms-------_------------------------------- ....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building --------_-------------------- No. of persons----------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------- ---------------------- - ---- n Flow Design ..........................:....S gallons s___-- per person per day. Total daily flow.._. _.. ..............................gal Wlons. WSeptic Tank—Liquid capacity/Wo-zallons Length:6q'.4_._ Width-4:-Iff__--- Diameter---- Depth__��-_<_.... x Disposal Trench--No_ ____________________ Width--- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No-------------/----- Diameter._....: ...... Depth below inlet......:¢.......... Total leaching area....�? 3.__sq. ft. z Other Distribution box ( ✓) Dosing tank ( ) Percolation Test Results Performed by ______________________ Date.__",_Z�.: 5� _ A Test Pit No. I-_4n_�._.minutes per inch Depth 'of Test Pit:____4_�........ Depth to ground water.... w.............. Test Pit No. 2................minutes per inch Depth of Test Pit---------------------Depth to ground water....._.................. P ----•---------- -- - - Description of Soil.......!-- _s______._�� v i vrrl---•� ti ------ - V - W ----------- ------------- ---------- -------------------- ----------------------------------- --- ------ -- - -- UNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc h iss by the board of health. -3 Signed ....... .. - ..--- -✓- ------ ---- ------- - ----- ..... ................. ire Application.Approved BY .--: `--�Jae. . ..: ,...=-� ---- ------ ----- Dare Application Disapproved for the following reasons: -----------------... ...:......-----------------------......------'' --- - _....................................... Y .. .. ---------------------- --------------------------------------------------- ------------------------------------------------------------- -------- ..........................:............. Permit No. - 5 :-.:-... --- Issued ..�.. Da--- -- _ Dare � n .S 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apli iration for Diopoti al Work,i Tomitrurtion 11amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...,... v- ,4.�E 9 /3 Lo,alii�./nA-Address/ ,pp or Lot No. W e (� lAr7 mer Address. Installer Address \ d Type of Building Size Lot--- S, r S- Sq. feet Dwelling— No. of Bedrooms-----------------3.-._-__------_...__._-_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------------------------•----------•-- ---•------•-•••••---•-•-----•--•-•••......•... ........ W Design Flow-------------------------------- .s ..gallons per person per day. Total daily flow..... ..............................gallons. WSeptic Tank—Liquid capacity/e te70gallons Length.!Q'_4Ft_._ Width.4.4----. Diameter.._-------- Depth..s..'.5-.... x Disposal Trench—No. .................... Width... '.....--- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No.............../----- Diameter------- Depth th below inlet-_-.-.1!�....... Total leaching area....Z :' ..s . ft. z Other Distribution box ( ✓) Dosing tank ( ) Percolation Test Results Performed by.... 4 ._.. r=...�= 5C...................... Date.. ` ,.a Test Pit No. 1...G..�..rninutes 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........................ � ---------------------------------------------------------------.............................................................................................. 0 Description of Soil.......I-.,Z 5 �=J iv. ..--� ............................................................................................... -------------- x V •--•---------•--------------------------------------•------------------------------------........------------------------------------...--------------------------.................................... W UNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliane�Chaissued b�and of health. 3 /7)) /96Signed ---- Date Application.Approved By -------------a-- ----'"-- =r=—� ------------------------------------------------- ---------- ..-- Date Application Disapproved for the following reasons: -" " .... ... ...................."" ............... ...... .................. . .. ................ .............................................---..............--------...----------------------------------------------.._....------------------------------------------------- ....... --. ..................... Permit No. .......C7.5---------- .��------------------------- Issued -------------------1?_--. Dare `J...... ...... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 'Gr#i f ira e of C�omplittn e f THIS IS TO CERWIFY, That tie Individual S wage Disposal System constructed ( ) or Repaired Ivy'G K - by ......................................... ..... ,"1 ------- ?�-�5'-7` ��ll Installer . /� �/ at .............. .�'t.-7 .. -...... -- -- �-_- , r� --- L_A------- F��---g.4, "-`'(--------_------- ----.----.------------------------------------------ has been installed in accordance vfith the provisions of TITLE 5q of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _..,,fir..-_. ................... dated ...3.---....C),/' -.�.3. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ .. ................. 7 — gr_ Inspector ------------ - I ----------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dd - TOWN OF BARNSTABLE FEE...Id�......... Rio not ork �unotr�udian rrmit Permission is hereby granted------ ------•---------------------------------------•----......---...... to Construct (�e or Repair ( ) an Individual Sewage Disposal System / oT �y d `� �,( _ _ �-,/ -�- ------------------------------------------------- at NO.......Y.--•-'i"'-l---SR---•------•-•----r/�!�.------�l=D��9:J........J1�....--�Street--�"--• --•- --•-•- as shown on the application for Disposal Whorls Construction Permit No l'�... 'Dated..._.,3_.--.7..-.,G� .... -------•-------- ---------- ----------------------------•------ Board of Health DATE------•----�---`-------/-...-..../.�------------------------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS /S TOWN OF BARNSTABLE CATION 1. -J�q i3 G 8 0- .n AC�C�C L v1- SEWAGE # - �1 TILLAGE.(25 y s S-lam_ 4 - ASSESSOR'S MAP&LOT J G,-d -\GAO;- INSTALLER'S NAME&PHONE NO. I�a fiol,6�'f C1!112S+. %SEPTIC TANK CAPACITY .`D yD Q A L LEACHING FACIL IY: (type) (size))6a—qa L- NO.OF BEDROOMS ,. UII,DE OR OWNER s S r A e_ C o(15 PERMIT DATE: -it—COMPLIANCE DATE: n 3— 7- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet'of leaching facility) Feet Furnished by - R rt U • k3 3� �3 a_ a 2L - j' _41.4I , 11 t 1-j p`rgm' E � 1 1 I t � 4 , I � . I y• �� , - G � G G era d Z vva7��rarl } ' � rj � � •,� { r rra�r rmovw W?VM oN ' � ��► f . `��.i� �� 4 � � h�� •gym tj ' C � STf- �-� Voatuoz- 3 t + y po ;zrrr�d �+o s4moi�v vp _b boy 451 , sou" ' 'I _ t, ._._... 1;1o_ 11-06 lla I t 7r'°�l gib pf bt+ ;5,b-1'Z-£ ?Ml , tilt IV toft Ilea, 0' l_arq& o +.:. A i I S� Zs } i 9va ov 14 O �1 ot' 1� Oo0/ /'/� I - ooI it _ 1 i {7001 I I I. 14 y J. 1 d 1 t�t7 dnJ �r 0££ mOfi Par- 3 Ov t . It , '/L 1Jj%-r%rtUl'! FUR PL•'I(COLA' Ion TEST A111) OUSERVAT1014 I'1'1'S I i! N , LOCATION �(-QS 1�T- 6,�iv.r .• VILLAGE �F NO. ds r._- ✓��c�.c -1 APPLICANT_T ,Z� DATE ADDRESS FEE ENGINEER TELEPHONE NO. 7_t (Non-refundable � ,�r- �' �z ✓ /�.i.i.-- TELEPHONE NO. DATE SCHEDULED 3 —?� Lb'irA6 •. . . . . . . . . . . . . . . . . . . . . . . . . . • •ApPli�ant:s•signature •OIL LOO SUB-DIVISION NAME ; ��, LA,,/� EXPANSION AREA1 YES ,/ DATES ! TIME TOWN HATE PRIVATE WELL ENGINEER HOARD OF HEALTH EXCAVATOR SKETCH: (Street name�etc. ,dimension8 of lot, exact location of teat holes and percolation tests, locate wetlands in proximity to test holes) es) I , .� 3 Z.f: L,— ? 9d ►�. ��, s »- :, N It d s,. PERCOLATION RATHi TEST 11OLE' NO: ELEVATION; T S'1' HOLE N0: ELEVATION. 2 i sS 1 TES 3 3 a 4 5 5 . 6 7 6 S � 7 e e 9 ' 10 9 10 12 12 ; 13 ; 13 la . 1a 1 s' 15 6 r 16 SIIITAB'LF, FOR SUB-SURFACE SEWAGE: / LEACHING r'IELI) I,LACaIIIJG I'I'1'S LEACHING TRENCHES UNSUITABLE FOR 'SUB—SURFACE SEWAGE. REASONS.: NOTE: EN(IINE01iiNG PLANS MUST S110W NUMBER ASSI(INED OIJ L'I:ItC TEST Al'1' A'1'1t)tJ - — c)1(Ic11r1nI,: c�rtt'I,F�t'h;n T�_��'II ", _LY_I_'1__1;u_11I�L_lil:�'1'!!1?I�►!?'1'c� nc�Attu c�r� lil;nt,'ril i(ETAINEI). BY Al'13I,TCAN'1' — ---- —