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Home My WebLink About0950 MAIN STREET (OST.) - Health 960 Win 5�'�.ee.+ i No.. �• =1f 7_ Fiz$....... .CU... APPROVED THE COMMONWEALTH OF MASSACHUSETTS '�2 CwmtvationDepartmeo!BOARD OF HEALTH \� a� TOWN OF BARNSTABLE Applirttti�a� tour Disposal Works Toes ruri' n rrnti� Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Systemat: . ............................................................... .....---....••• ` .5 E ... Location-Address Q . ......................— ° --�- •. •.. .. .. ........................ ........ -� or, z"� ' .................. Owner A ces a _....0 . _ !r o s � S d. . �•��►�c� ............�..•----...---- Pq Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.............................. .....Ex Expansion Attic � g— --------- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.....................-----.. Showers ( ) — Cafeteria ( ) 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit---................. Depth to ground water.--....------.. I fs. Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ --- - ---- - x . Description of Soil--------------••--6-F- - 5- 9 f -•----- .........� ' ''''!�5 b p • --•------•••--------------•-- . ._.. •--•--................................. U -------------------------------- •------ -••--------------------------- •---------------------- ------------------------------------------------------------W UNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has en issued hy the board of health. J Signed ---------------- --------------------------------------- � �� -.......Date--- .---....- Application Approved BY - .5. --------- .......3..... Date Application Disapproved for the following reasons- -------------------------------------------------------------------------- - ------------------------------------------ - ------------------------------......................................................................................................------- ----------------------------------- ---................... ..................--------------------- Dace PermitNo. ........ -----N-7_-----------_------------ Issued ...................................... ----------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE qZ Appliration for Disposal Works Tom lrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( I,)� Individual Sewage Disposal System at D �e Location-Address or - t-No. - Owner . A dress ,•a ..............�....._.. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—a Type of Building g ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--_-_--________--------. (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •- - O Description of Soil----------------•• 2e /a .................. - t n 5 C O 4 h / V V .........-•-••...••••-••----•-••------••------------••--•••••---•-•----------------•---------------------•--------•--•----•--..................•-----................................................... 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian e ha/s b5en issued b the board of health. Signed --. --- --------------------- ---- ..........................31)� �� Date Application Approved By .... .�. -.� - 2 7- 9 2 ......... ..... .--..--.-..--.................. .-........-..-.-Da[e.......-..---.... Application Disapproved for the following reasons- .............................------------------ --------------------- ----------------------------------------------------- . . ---- --------------------- ----------------------------------- PermitNo. .--- -_l.-a........-f-'--7----------------------------- Issued ------------------------- -------------.......----..Date Da[e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE QuIelrtift.cate of (fompliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( t/) by G... ------------------------------ ----`� .. �! ..................------------...-------- -- .....--------- ........................................ �" Ins[aller has been installed in accordance with the provisions of TITLE 5 o f jhe State Environmental Code as described in the application for Disposal Works Construction Permit No. ---------.....a--....11.2........... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATW1.01 ISACTORY�� DATE.. r . :'------------------- Inspector ......... I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.............'.......7 FEE.._..................... Disposal Works Tonstriul ion Prrutit Permission is hereby granted.....A_.._��--v)4/ dV(e -I e/ �� __.-...7•-•-•-------. ---"--•-•-•--•------------------- .................................................... to Construct( ) or Repair (,)—an Individual Sewage Disposal Sy e S at No........ - ram•---- 1 /n i f 61 r o Mil h PP P street cya 11, as shown on the application for Disposal Works Construction Permit No.._...........__..... Dated.......................................... [ � Board of Health DATE....................... 7 2 FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION SEWAGE #_ VILLAGE A.SSFSSOR'S MAP & LOT-- j. CRAIG MEDEIROS INSTALLER'S NAME & PHONE NO._ ' J IRY ANNJS, MA 02601 ACITYV/ SEPTIC TANK CAP LEACHING FACILITY-.(type -� -(size) BLIC 'ATER NO. OF BEDROOMS_ ;Z� PRIVATE WELL (W--Pu- L—lc OWNER DATE PERMIT ISSUL 21 DATE C.01,1111LIANCE ISSUED. VARIANCE GRANTED: Yes No ke 13" -7 A r TOWN OF BA RNSTABIX i LOCATION � � �` SEWAGE #.�� VIL L.AGIs_�✓S �L'�� J�/� A.SS91880 i'S MAP & LOT J. CRAI.G ,MEDElR0S INSTALLER'S NAME Sr PHONE NO.�_��TTNnRN HYANNIS, MA 02601 SEPTIC TANK CAPACITY F - (size l o LEACHING FA.CIL.I'I'Y.(�yre�C.��S 5 Mv l �_ �� NO. OP BEDROOMS ?/. PRIVATE WELL PLiI3LTC 'ATUR— OWNER co, /'��_�-_ DATE PERMIT ISSUED: _�_�_iVqL � --- .DATE COMPLIANCE ISSUT'D. _��-�— VARIANCE GRANTED: Yeu_ No_.� _---- ..r v. �, �� S� .� ® / �/ �dvS� jj ✓ 3 � m `� ,�. _� ® � - � 3 �. � � 9 � � � �� :b c �� v