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Home My WebLink About0245 EAST BAY ROAD - Health ays C-� SqAA rya I y _ THE COMMONWEALTH OF MASSACHUSETTS Fim BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uiipuiittl Works Towitrurtion Famit Application is hereby made for a Permit to Construct ( ) or Repair (V�an Individual Sewage Disposal System at: _ ...........01' 1�.. a ............................................ ........--------------........--------- Locati n-Address or Lot No. ................. o ...[ v� .4?............................................ ••---•• .............................................. Owner ................................Address .._.......-•--•--- Installer�----------------------------•-•-•----•- ..................................................................................................Address � � S feet d Type of Buildings Size Lot........................... q. U Dwelling d�No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type T e of Building No. of persons............................ Showers G� YP g ---------•------------------ P ( ) — Cafeteria04 ( ) 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 ( ) aPercolation Test Results Performed by........................................................................... Date--------------------------------------- a Test Pit No. 1................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........................ ---•---- •-----•-----------••--•-•--••-••-••----••-------....-•------•......................................•--=------•--•••-•-------------•-•----.....---- 0 Description of Soil-------------------.56AQ K---------------------- U ---------------•----•------•-----•----•---•-------•.....-------------•---..........•-----............--•--•-------•--•----------•-----•---•----------------........................................... UW ............................................... •••---......--------------••---•------•-----•-••--•-----•---------1--—•.� -...................................................... Nature of Repairs or Alterations—Answer when applicable............. 1e - ........................................................ --------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••••--.-- 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 t and of health. Signed ..... . ............. act.. f Application Approved ... . ................. ....................................................... ........................................ . - Dace Application Disapproved for the following reasons: ............................. .. .. .... ....................... ... .{......---------------......../---....-----....---- --....................--------------------------------..............------....--------..........---- -----....... ------------------------- Permit No. 7.... �� 1-. Issued �.�-�"'... .. '`.. t --------------------. -- .............. Dare TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE �S /e.-�, �G ASSESSOR'S MAP & LOT . INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 00 a ,S14( w 'LEACHING FACILITY:{type) �/9/U2� (size) J NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER i BUILDER OR OWNER -:�-6 H e2. DATE PERMIT ISSUED: 0 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �, s(94 a " �j , 4? = � 0 TOWN OF BARNSTABLE < � P LOCATION SEWAGE # VILLAGE "`"'�.� ASSESSOR'S MAP & LOT INSTALLER'S NAME Z PHONE NO. -SEPTIC TANK CAPACITY Q00 LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 1 PRIVATE WELL OR PUBLIC WATER ' J BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No >. (� �°', 1 � � _,,,` �9_� o II `�� ., �� ® THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE . ppliration for Disposal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( . ) or Repair (!/) an Individual Sewage Disposal System at: Location-Address or Lot No. .- - / Address Installer Address UType of Building Size Lot---------------------.._Sq. feet Dwelling NO. of Bedrooms---3...................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) Cafeteria ( ) Otherfixtures -------------------------------------------•--------------------------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. W Septic Tank—Liquid'ca.pacity.._._......_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--__-----_--------___. (T4 Test Pit No. 2-----------------minutes per inch Depth of.Test Pit----- Depth to ground water------------------------ 9 •--------------------------•-------•----------------------------------------------------•------------------------------------- _ - ODescription of Soil...................=S rl2 ----------------------------------------- ------------------------------------------------------ W ---..._----- --------------------------------------- -------------------------------•------------------ — ... ------------------------•---------------------------- U Nature of Repairs or Alterations—Answer when applicable------------ ---_---- ----------------------------------------------------------------------- --------------------•-------•------------------------------•--------------------------------------------------------------------------------------------------------•--•-------------------------------- Agreement: y 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 been iMV oard of health: Signed - -------------------- -/-d Date Application Approved B ........� •�1 �G ..._..................... -------------------------------- ----- Dare - Application Disapproved for the following reasons- ----------------------------`/-----------------------------------------.-------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- ------- No. a' • � �l� Issued� � �lre� Permit Dare r THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH _ f TOWN OF BARNSTABLE &rtiftrak of (gompltnure THUS, TO CERTIFY, Tchat the Individual Sewage Disposal System constructed ( ) or Repaired by ! j� -1----------------------------------------------------------------------------------------- `4 at --- s? l � ----------��-'i ,S ✓�,�.�r L°� _�------------�----------------------------------------------------------- -----------� --------- ------------------------------------------ has been installed in accordance with the provisions of TITLE 5APie... State-j 4 i ronmental Co as des ribed its= / the application for Disposal Works Construction Permit No. ...... ....... ......... ..................... dated -------------------------------._�------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THt' SYSTEM WILL FUNCTION SATISFACTORY. ' L 3 DATE o ............................................... -------------------------- Inspector ----------- v ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......----��f�17 FEE............Q..-..`*2L ]Disposal Vor rUrtiun f rrmit Permission is hereby granted____________ ___ j.........--.--------------------------------------- ---- ••-;--•--..........-•••----------- to Construct ( or Repair (. I5l IIndiui Sewaege Disposal .pte�n l 4 L at No........... 13 1� CF�` ----------------------mot Street i,,� as shown on the application for Disposal Works Construction Pe No._ "r+��Dated -l'�------_-� -------�� - "� --- ------------- ------------ DATE...... ............................ Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS