The URL can be used to link to this page

Home My WebLink About0161 HOLLINGSWORTH ROAD - Health r �1 � I 1�►�c�s�a� � �- i�o�o--� �� , 0 TOWN OF BARNSTABLE (� LOCATION L„/ y/otc� s�-a.�� -s SEWAGE # VILLAGETz icc ASSESSOR'S MAP & LOT ✓ � ,Z INSTALLER'S NAME & PHONE NO. JPJMC-DOAE ii/0�&M '7700 SEPTIC TANK CAPACITY /000 C LEACHING FACILITY:(type) "0 C�c 9%7- (size) �� 5727,e .._:.NiO.-OF BEDROOMS „PRIVATE WELL OR PUBLIC WATER Iry BUILDER OR OWNER '7)o H,4 l ,n A61 e C DATE PERMIT ISSUED: DATE :COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No i 13 .0 ,e� 7 0'f- e/ 3 � �� r aSESS©RS NAP NO: __.__t 0 No... .........._....... ... 0.... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH 0.c. --------------OF...... ApplirFation for Disposal Works Tnnstrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (A,-�an Individual Sewage Disposal System at: ..........1 L...... `' ,, sr --------0> C, -- - ... --- .... Loca' -Address ......••--•------....._......---or Lot No. G�/TvV...................................... .......... -•-•---••---------------......._...._._.----..._._-•- Owner Addre s ............... Instalier Address T d Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms----------- ...........................Expansion Attic ( ) Garbage Grinder (VO) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria. ( ) Otherfixtures -------------------------------------------•--•------------.....---•-- -------------------------•-------------------------------------------•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank id* gallo x Disposal Trench—.\To capacity`----- Widthns LengthTotal Lengthidth.............. Total leaching area_-Depth................ ft. Seepage Pit No.____-_.T._.--___-__- 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-----------------.-____. r,4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...........................-................. •---•--•---------....------------.........----.....---......................................................... ODescription of Soil...................................................................................................................................................•-•-................. x W U Nature of Repairs or Alterations—Answer when applicable--___��` C!'�G_..C ®�t Vic ¢ Z/v37,ftcl I-C_ ----------- ^' _ `mac^' Agreement:`�sc ogw,r�t�. The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of iT='Li;p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ��% t and of health. �. J Signed.. ....--`------------- •--• ................................................ ....3;4 — J Da' APPlication.Approved By.:... --------- 3 Z ---- ---------------- Date Application Disapproved for the following re s-................................................................................................................ Date Permit No. -f.C_----- Issued ..:._.__ - Date L1® I�O. - 1 f O`/� FEB....... ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH prriv5�t e= OF..... ................•---......----------------•---..._...._............._........ App ira#ion for Bi,ipuiitt1 Works Tons rn.rtion Vernat Application is hereby made for a Permit to Construct ( ) or Repair ($.-<an Individual Sewage Disposal System at: `�O[tinES(s o0TIJ (�� 2vr�<< .... _ ....-------•................. .......... Lo -Address or Lot No. frfl��c E �h.v Lot T Owner Address" W C t U'C f G!''la f.�T r�Ci/P�� ✓� y/ i/'/lJ.v lNi" Y --.., .................. Installer Address dType of Building Size Lot............................Sq. feet U ...........................Ex Expansion Attic Garbage Grinder Dwelling—No. of Bedrooms_______________ p ( ) g e ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—Nlo. .................... Width.................... Total Length.................... Total leaching area____•_-__-___------sq. ft. Seepage Pit No.---______....____--. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution )ox ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ aTest 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.............................................................................................................................................-......................... x ---------------- -----------------------------•------•--•-----------------•---•-----.....•--•--••-----•------•-•------•--•------------------------•-------•-•----------------._----------------------- 17 V Nature of Repairs or Alterations—Answer when applicable__ ------ P�G r /`arc ........ _if......?rc..�Cr � �'G /OQ� -re"' �'/T t�� a-I r T✓/a E ' NGT-F o -t_i,; f- ---• •------ r------------------'`---- - •-•--- -- •-- r7f/VSF- ;zi/'C �r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i(•1T r1 I^ of the State Sanitaryy Code''Te_undersigned further agrees not to place the system in operation until a Certificate of Compliance.,has bee µ� t x rd of health. ,.'Signed`d./�..... ..`---- ................................................... D 7... _._. Application AP roved BY-----. Q 3 .:� Date ApplicationDisapproved for the following reJns:......................;.......................................................................................---------•-------------------•----••-------.....--- w .............-------•----------------------•--------------------------•--•------------------------•------------•---••--•--•--•-•-------•-•-••--•-••--------------------•------------------------------- Date PermitNo.--------3- ----,----- ------------------• IssuedL------------------------------------------------------- Date 1 tl THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH U................................O F................. ........'"............................ T rtif iratr of Totnplianrr THIS IS T C RTIFY, T �t the Individual Sewage Disposal System constructed ( ) or Repaired at. -- -----••. . has been installed in accordance with th provisions of TIIT'!Z j of The State Sanitary Cod as elscribed in the application for Disposal Works Construction Permit No.._.._�._._....:".�_,3.___._.____. dated------ ___�---�_________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... ..:' ---�-•--• L -7...................................... Inspector.. ' THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH • ........... .....or ..------ 1NTo...Il:....... I FEE........................ Mips ork on .tr n rantit Permission is hereby granted __.._. to Construct ( ) or Repait an Indivi/1ua1 Sewage Dispo Sy tem atNo....1-61 1. . I� ��t fin, - ( --•-----.................. ..................... Street Q �' jl ��—7 as shown on the application for Disposal Works Construction Permit No. --------------- =---_Dated..:___1--..:.�..._..................... Board of Health DATE--It--r�----••--��•-.--.................................................. 0 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS- -