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Home My WebLink About0100 ICE VALLEY ROAD - Health 100 B-E VALLEY R. " V TOWN OF BARNSTABLE Ito LOCATION SEWAGE # e/ - s\G� VILLAGE �S re�v�` ASSESSOR'S MAP Sz LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.ITY:(type) (size NO. OF BEDROOMS L PRIVATE WELL OR PUBLICRR BUILDER OR OWNER -C/SG DATE PERMIT ISSUED: ! .P. DATE COLIPLIANCE ISSUED: AZ4 '� VARIANCE GRANTED: Yes No �3 k il cb )bL6SOr%b ).,A? )qU: - 1(.ea No.. - Fps... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................O F.......................................-----------------------------............._.....--- Appliration for Disposal Wor Cnnnstrurtirn Prrutit Application..is_her=eby—made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: j�l ........... �r?1 ...------.. ..................................................... a ion-Address Y�or LotNTo ,. `1 � .............................. _A .. ` 17Y3h ....--•-•-....•........................ t�-�dr".s. ......................... ...... ca ---- Installer Address C �_L3.0 UType of Building Size Lot_i. __ ------Sq. feet Dwelling—No. of Bedrooms...............--------------------------Expansion Attic (ND Garbage Grinder (q41j:5j aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................... W Design Flow....•........_._..................gallons per person per day. Total daiV flow................_--__ gallons. ------------------ P4 Septic Tank—Liquid capacity.` __gallons e Length._�0......... Width...a.._...._ Diameter________________ Depth..:4__=Z?`.. Disposal �r —No. .....�............. Width...l�,._____.__.. Total Length.....j_ ......... Total leaching area-_`�7.1-D---_sq-frejpr�. Seepage Pit No--------------------- Diameter.................... Depth below inlet.....4....._._.... Total leaching area..................sq. ft. Zttt,.Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Performed by._.... ?�.-s3 1�.V"I_�? :4J1 �_.____ Date..CL�-�j..V as Test Pit No. 1....<:�_..minutes per inch Depth of Test Pit-----l3:S Depth to ground water...._:I4o_WATM Test Pit No. 2---_< --_minutes per inch Depth of Test Pit-----A 4_!._.. Depth to ground water------P.O a, ...•-•.......................•---•----•---•--•..............---•-•------•--......_......--..._•-----........................................................ 0 Description of Soil.............. ---MV.— .�. x Uw --------------------------------------------------------------- --------------------------•---•----••--•---•-•-----------•--•-••-••-•-----------•••---•-----••-•------••......-•••--••------•-----•- 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 TTT :a. p 5 of the State Sanitary Code— The undersigned further agrees not to puce the system in operation until a Certificate of Compliance has beeeLissuy th�boof lth.Signed-------- _- - --•---•---=------•-------------- Date Application Approved By----------- ------1Q Date Application Disapproved for the following reasons---------------•-•-•----------------------•--------------------•---------------------------------------......---- ....................................................... •------•-•---•••--------..........-----••...---•-._...........-•-••••----•-•-•-••••--•--•--•-•-•••-•-----••••---•••--••-•------------•-•--------- Qqq Date Permit No...........RI-... --63- •-•.-• -------------_ Issued-....--------.....------------------ ---- Date ' Fmm.....�-5-77��" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ..........................O F.............................._........-------- Appliratiou for Bispuaaal Works Toustrnstioat Errant Application is hereby made for a Permit to Construct (C,,'�or Repair ( ) an Individual Sewage Disposal System at: .... /_. G -.,�1✓ /-�,�d ig cages CGS ---------------------------- ��j oca' n-A dress or Lot No. -------------------- ------------------------------------------ ---.......----------............------------.. W Owner Address ra .......................... --te a�- .................... ------••-•--------------.............................-. Installer Address Type of Building ��// Size Lot............................Sq. feet Dwelling—No. of Bedrooms-----------1...........................Expansion Attic 0/0 Garbage Grinder a`4 Other—T e of Building ..... No. of persons............................ Showers ` YP g ----------------------- P ( )--- Cafeteria fixtures ............................................................. ----•-•-•-----•---••-•--------......--------••-------- w Design Flow........: ............................gallons per person per day. Total daily flow-------_-%_/ '.._............._._.___gallons. x Septic Taopk—.L quid capacity .gallons Length_2 ..... Width.S.`_._..... Diameter---------------- Depth_ Disposal —No. ../.............. Width.lQ�......... Total Length_.,, .......... Total leaching area__? Seepage Pit No---------------_---- Diameter.................... Depth below inlet..1./........... Total leaching area..................Sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) '-' Percolation Test Results Performed by.._ U��SG_. fll2�ll� �t............ Date-.-,-,* ............. Test Pit No. 1--- .Z-_.minutes per inch Depth of Test Pit._Z-:' Depth to ground 44 Test Pit No. 2_c.2 -_._minutes per inch Depth of Test Pit.!�f-�.... Depth to ground a --••-----•-•-----------------••••-•••........•••-•------------•....----------•-....--------....................--------------------•---......--•-•-------••-- D Description of Soil.....C*___1'_2_1�...I.-O e-l-21 Ali.___-.... W .....•--•••-••-•-•-•-•-••---••••-------------•---•-•••--•••••••-•-•-••••------------••.......----••---•-•------•--•••-----------------•----•- . w 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 TTTT.s. 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 issu d y the bo of lth. Signed-------- .-- --- ....r:: .-r�•tel: ' } Date Application Approved By-•••--•---CJ V .-�.. �.. Date Application Disapproved for the following reasons:.............................................................................................................. - ......................................................................................................................................................................................................... c� Date PermitNo.---...... J....:__.. � ----------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... .... .......OF................. .�. .la w.:` ::'."l. %-Errtifirair of ToutpliFanrr TH-S IS—TO CERTIFY, Thy the Indivi al Sewage Disposal System constructed ( or Repaired ( ) by ��G �!sl....._. x ----✓-------•--------------------------------------------------------------------------------------------------- nstaller at za.----...�ee..(a_ �1 O� G fOGI '. ........................................................ has been installed in accordance with the provisions of TTT j 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 YHE SYSTEM WILL FUNCTION SATISFACTORY. ..�,.DATE.-. � ........ Inspector....f-.. = ............................... .................. THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ..........OF........... ✓ l..l.�.I.................................................. I�ToCI.1......:J- _.-............ FEE,,�Z_S......... .. wispo I ork Cho otrlion rrutit Permission is hereby granted . .... -•----.._ ?f4!z.-L.----._.....•-------------------•--....-----.....------..................--- to Construct) ox,.Repair ) an n avidual S wage posal s � / / at No..............1._-.6>......... � ..........�... .. ..... � street �o as shown on the application for Disposal Works Construction ermit No -l.... 2.9. Dated.......................................... ................................ r -------------------------- v DATE........!--�"--$---�•-------•----------•--•--------- ............................................. Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS d tl -. I - �.- - r-...-.-+c- -: '.." 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