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Home My WebLink About0041 GINGER LANE - Health LaA e, TOWN OF BARNSTABLE LOCATION y► Q jyjc-Egz--. Ljp, .wLr'- SEWAGE # l -79, VILLAGE OS�RV r LLL ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. fflL� c cloN.tl Co.a SEPTIC TANK CAPACITY I,/0-0D LEACHING FACILITY:(type) P 1T— (size) /,o--b NO. OF BEDROOMS PRIVATE WEL OR PUBLIC WATER BUILDER O OWNE DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No a. Jk ,H , y3 q t� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN'OF BARNSTABLE Appliratiou for Disposal Works Tunutrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair QO) an Individual Sewage Disposal System at: Location-Address or Lot No. ......................__--...................................................................... -•=-------------------------•---•--••.......-----••--•----•--•...._.............................- Owner Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) 4 Other—Type T e of Building No. of ersons____________________________ Showers — Cafeteria f� yP g P (' ) ( ) P4 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit___--_-_----_-.___.. Depth to ground water........................ ....._..•_______________________•....._..............._................--........-r-......--..........-•-•-•---......--.........___.....__..........._....... 0 Description of Soil.... ). ............ cif...............2...................... f�---`''_'. .----- ............... � x W --•-•----------------------------------------------------------------------------------•-•••-••--••----••--••--••---...-------•------•-•----••-••-••------------•-•----••••••......•--••-•---•-•--...... U Nature of Repairs or Alterations—Answer when applicable-!--! --.- _____.��......�!1.._.__..c _1, 1i 4...... SY " vNS.r°. ......... �b---� '........�-=-V........./`� `��` �---------!{A a_o------. mil-------j 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 Co fiance has been issued by the board of health. Signed .....--- - .c1t��.�-:_ ---.----------------------------- ---------------------------------- Date Application Approved B ....2... .......... 13—....lf...-.#,9.�... Date Application Disapproved for the oilowing reasons- ------------------------------------------------------- -----------------------------------------------------------................ ...............----------------------------------------------------->--- ------------------------------------------------...---------------------------...----------------------------------------.... --------------------------------------- Permit No.---------- /--------{ ---------_------_---------- Issued ------------------------ .---...------....----------Date----- Date r � � No.. q�...: 7 9 ''. Fus.. !'? THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH TOWN OF BARNSTABLE A1111 iration for llispoii ai Works Tons rurtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ()p) an Individual Sewage Disposal System at: ... / G'1 a/�, (L ,gyp y L CITE f2V!....L ....•........................ ..................•... Location-Address or Lot No. ......................----......._............................................................... ..........--.................................................................................... Owner Address -�' :.....-- `v -------•-------• P, s Installer Address Type of Building Size Lot----------------------------Sq. feet V Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) �+ Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank W Disposal Trench—LiquidNo capacit ............Widthns-_---Length Total Lengthidth.............. Total leaching area__Depth'::....sq. ft. x 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......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ •-------------------------------------------------------------------------------•------••-•--•---•--......................................................... ODescription of Soil----0... ............ �-.............. ....... ----------- .4�4? ........ ......... x U Nature of Repairs or Alterations—Answer when applicable_?n' ..... -------1; l.......1,)....._.... C-!c_S-Sqczk, ••• ►' no,�s_.--------`:� �' c.+.c�0--------g-= ..........`ems- t r--------Zr 4t tt10---- •-f,•.•&7 ......?_.1......�2wL-. 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 Com liance has been issued by the board of health. Signed --------=---- --CAI .^...—�.................-------------- ........................................ Application Approved By -------- --- �" --- J [, ,�=�.-,-,�--, ---- ........ �`�- { Application Disapproved for the ollowing reasons- ------------------------(-----------------------------------------------------------------------------------.....---------------- ........................................................----------------...----pp------------------------------------------------------------------------------------------------- --------------------- ................................... PermitNo. -------- 1- f ------------------------------- Issued ---------------------- ---------- .......ate------ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CZer#ifirate of (gomplinurr i THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (/0) by.... C C yr.--------. ---------------------- -------- Installer at y ........ 13 �s - --------------------- -- ---------------------------------------------------- ........................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .... --..-. .- -�.. dated ....... .................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTI(UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / -------------------------------------------- ---------------------- Inspector ft THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C�/ TOWN OF BARNSTABLE No.!1...��; FEE ............. Biopnstt1 Worko Tun#r iron "prrmit Permission is hereby granted---- ....... !!�) :k...---��-............................................................................. to Construct ( ) or Repair an Individual Sewage Disposal(System at No. y�.........G ..'_JC _�---•--��t �.. ---•b� vtv��\ ----•-•...............................•-------------------............. Street as shown on the application for Disposal Works Construction Permit No. __-- Dated.......................................... )�•'..................................................... (�DATE........ Board of Health �= ----`� v FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS \ i