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Home My WebLink About0104 GREAT BAY ROAD - Health laq Gy-et Ge - oR3- CM r N SMEAD KEEPING YOU ORGANIZED No. 12134 2-153LGN SUSTAINABLEFORESTRY MIN.RECYCLED INITIATIVE CONTENTIO%® Certified Fiber sourcing POST-CONSUMER www.efiprcgrem.wp S"12W MADE IN USA GET ORGANIZED AT SMEAD.IM TOWN OF BARNSTABLE LOCATION �� SEWAGE # 013 Oil VILLAGE (%S' ASSESSOR'S MAP & LOT INSTALLER'S NAME 6z PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY /cS'®d Al LEACHING FACILITY:(type) '/oe s (size) NO. OF BEDROOMS PRIV TE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: '-- c3 zD DATE COMPLIANCE ISSUED:e f P.pf VARIANCE GRANTED: Yes No "` s��oe 10, No.... fi Fxs.....aZ.r>............_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1'oc n....................OF...�arrt44/e........---------------------.......----------........------ Appliratinn for DiipnsFal Works Tontrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............... c . � . . ..0 �., ��ll�.............................. ..... ._........... -- ------•••-•- -------- ---- - Location-Address or t No. •--� �•---L?..l�i.�� .fir..----... ---•----•--•----•--••- !o`�----fir_ �� _._r ...................................... Owner / �/ Address Installer eAZress Type of Building e Lot............................Sq. feet �., Dwelling—No. of Bedrooms.........I..................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria dOther 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rz Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •----------------------------------------------------------•----....--•----------------•------...---......................................................... 0 Description of Soil.......................................................................................................................................................................... ------------------------------------------------•-----------------------------------------------.... ----------- U Nat e of Repairs or Alter tions—Answer when applicable.!?g.ctQQ,•lStX?___ __ �_ ........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dispo System in accordance with the provisions of iITLi: 5 of the State Sanitary Code—The undersigned further a ees not to place the system in operation until a Certificate of Compliance has been issued by the board of health bb Signed........... -------------- 9p Date Application Approved By-----------_�.. Date Application Disapproved for the following reasons____________________________________________________•.....--_______..___-______._........._......._....._.__..._ ..---...--•--------------------------•--............-------------•------•--••-------------•--•--••------•...._......._..•••----------••-----•--•--•-••---•-••••--•----•••-----••-------•-•-------_-•-•-- Date PermitNo........... ....... .8.................... Issued.....................................................- Date _............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------...._Ci.:vY -'.. ................OF....!:. ' ; ,..< Allp iratilan for Dispaii al Works Tonstrnrtiun ' rranit Application is hereby made for a Permit to Construct ( ) or Repair (.-)4) an Individual Sewage Disposal System at: // 7 t ! ................---................................._...... = ...................... .......•••--------•--•-••----....----•-............•---•--•-----•................................. Location-Address or Lot No. ....................._.......................................................................... -----•--.......----•••----•......•----•-•-•-•=•-•-_...•--.......------......................_•.... Owner _ f Address i 1 1 1f1 r1//] �� (!ft'� ...`fft./l::r1/�l. Installer� (`Address d Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- d -- ------------------------------------------------------------------- ---------- -•------------------ 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........................................ Test Pit No. I................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---------............... v --------------------------------------------------------------------------------••-•--•-----•.---•----......-----------•--------------------------•--------- ODescription of Soil........................................................................................................................................................................ V ......•••••••-•--•••-•••••-••••••••-•-••................•••••••-•••......_....••••--•-------•-•••-•-•--•-•-••••-•••-•------•-•-----•--••••••--•----•-••••••---••-•--••---•----•---••......-•---••---•-... W r U Nature of Repairs or Alterations—Answer when applicable-n.-, .......... i-....rl `t.............. Agreement: / The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code— The undersigned further a ees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. �.». 86 Signed----- ��..� .................................................. _......� ,._ Date Application Approved BY ...... ^' ... . ..4A. ,..:.;._- c� ..................Da --- -.' .. Date ,Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- ..................•-•••••-•••-•-------...------•---•••...._.....•-••--•••----•••-••--•------•••-•---•---•••••••••....---•••••••--•--•--••--•------••--••••-----•-•-------•••-••-••--•••••••-•--•-••••--- Date PermitNo.......... ..:.._ _L.............•-.._. Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS f^ BOARD OF ttHEALTH OF... 1 .�1',rn1�•.l�{c ................ ....................... .......,................................................................. %rrfif irttte of Team liFanre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired bY......................A......�._.......��` .---.....------------------------•. Installer has been installed in accordance with the pro�3ions of TITIE .5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No............F.e_..... ram..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................�J ^..Y. ........................... Inspector............... ----------------------••-••-•...........-•--•-.... tt�✓ THE COMMONWEALTH OF MASSACHUSETTS F BOARD OF HEALTH / Pt1.r:.......................OF.... No.....8�..:.. . 5 FEE...... ..:........ Disposal Works TFUanudra ian frrutit Permission is hereby granted-------- = -- ----------- 'Y+ 1------ ----------.-----........................................................ to Construct ( ) or Repair ( n Individual Sewage Disposal Sys em at No...............LO--�'/`.......ems?_ ..-d`'.J';' f-.• _ � �l Street r• as shown on the application for Disposal Works Construction Per it No.&".. _ Dated.......................................... DATE................................................................................._..... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS