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Home My WebLink About0157 CRYSTAL LAKE ROAD - Health ��y/�.� �_. 1�r7 TOWN OF BARNSTABLE LOCATION \ U-V l \ C_�zhSk�� \�.\fie 5� �, SEWAGE # VILLAGE yS� e.�v.\\e ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY \S C)G t c LEACHING FACILITY:(type) (size) BUG ac�k NO. OF BEDROOMS 7" PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER Q- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No c.�• w 4 1.. i A f I 0 i t 41 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct AA or Repair an Individual Sewage Disposal System at: Owner Address Installer Address U Type of Building Size Lot:? . 320...Sq. feet 9 Septic Tank—Liquid capacityJ5.0aallons Length.] . . .... Widtl-C ..... Diameter................ Depth b...T. Z Other Distribution box Dosin tank N Percolation Test Results Performed by .. �T4 Test Pit No. 2.......Z....minutes per inch Depth of Test Pit.11�t5!_. Depth toground water K-10�j Fl- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System ifi accordance with the provisions f'I'T 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a ZVKkV c; te pf Compliance has been issued by the board of health. Date Date Application Disapproved for the following reasons:.............................................................................................................. _____ Date Permit _ Due <( No..2.7 2_�3 Fim....ZZ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _7 M.?L�J_VJ...:..........OF...... j.'.r'ft.5.Lk_ .................. Appliration for Disposal Works Tonstrurtion 1hrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 0-T ........... ...........L. .......M.M>.....1"................ %o t C ...&............................ ............1A -.51LEFE.-Aca s...CL.Pir—FLE.. Owner Address .......... ......... Installer Address Type of Building Size Lot:Z(O, _;U)._Sq. feet Dwelling—No. of Bedrooms..._...4.4...............................Expansion Attic Garbage Grinder (M)o Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures .................................................................................................. Design Flow................S.T................gallons per person w d . Total il W.- I ' Ioqns. 9Septic Tank—Liquid capacity.1-5aallons Length.f Width — .... Diameter---------------- Depth.. n .. Disposal Trench—No. .................... Width----. ....... Total Length............_._..... Total leaching area....................sq. ft. Seepage Pit No..__..Z ......... Diameter.....11........ Depth below .inlet.3 .......!R.../.. Total leaching area..S.O.Z..sq. f t. Z Other Distribution box Dosin tank i Percolation Test Results Performed by..&A' Date... Test Pit No. I.......?—....minutes per inch Depth of Test Pit...I.W Depth to ground water.1113.0.1-4E_ Test Pit No. 2......Z'....minutes per inch Depth of Test Pit..1.1-A.5... Depth to ground water I::__ 0, -------- LOA Y.k4'Y.'5L r I .................... 12- ................... 0 Description of SoiIM2...C_.O.AVU&.... ...71`2 — Z_ 0-2�' LOAN".....� 'L.............. ........... - �j X ----------)5------------- C . . ........ ............................................................... .................................................................................................................................................. ..................................................... U Nature 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 TIT � 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until Z_Vt7cate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date Applicat�i;np By... ........................................ ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date Permit No.....9.17..:i.3_3...................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... �..........OF........... ........................................ (9rdifiratr of Tontpfiattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (� or Repaired by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- at.......16ecT_.1..... e'..L,........R.4.....I.nstal.ler............................................................................................... has been installed in ac�rdance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit ........ dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .. .....DATE......................... ... 4.�_ .1.................. Inspector................��m..... .............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..2.2:21_3> ........tc'l' ........OF............. ........................7..... FEE..,7,S............. Disposal Vorks Tonstrudion "pantit Permissionis hereby granted........................................................................................................................................ to Construct or Repair an Indivi ual Sewag Disposal System ys. .. ......... .. .. .. . ........ ...... .. . atNo....... ..................................... ............................................................ Street as shown on the application for Disposal Works Construction P it No..?2.21� Dated.......................................... --------------------------------- ........... .......... DATE........... ......6.7.................................... Board of Health FORM 1255 HOE38S & WARREN. INC., PUBLISHERS ��xb v , too.ofo RIEsErwL. (_ 3 w� _\0 Xto _ - LL e SA�KG o Z-A -5 N ti- • - :�` tli oax l� r . _ O P fZr��O vE� b�GK N Z(aX6 . Z�x 7 Z7 �6 , 27 3 v 10 + T'o LI M�T o �, VEGETATEZ7 WETL,b.ND l � 03 x • Comm C 6.Vf 2�. v 2 2� �, z�.7 ZT: eG. 27,,E s: 777 _ _L WV2�f /i 25.3 -� G ZS,(cO ,��F K PAUL No-MA: W1 %7. t� / 1T� 1�/7 n1� / 5 a Vi CI.ar T��QIJI 4 L Pz ��i/S7X1 � S Y l x/,f 7-4 iti ?-,�,1 WN 1>0 //o X _ 440 PJ ST AL USE 7- - �00 07 t 7c J ��s/ /' _ y 5� .f-"? x .,2 9/8 G d'D o•K• ��L/G. �/T � 5 CLACT:/L. a CaL!-�TIC A/ "C47 /� 2—