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Home My WebLink About0010 NECK POND ROAD - Health (2) i i S M E A D KEEPING YOU ORGANIZED No. 12134 2-153LGN 0E SUSTAINABLE MIN.RECYCLED INITIATIVE CONTENT 10% Cerofiedfi6ersomeMp POST-CONSUMER wxw.sfiprapremorp s"Im MADE IN USA } GET ORGANIZED AT SMEAD.CAM i TOWN OF BARNSTABLE SEWAGE VILLA GE O�Pirdi l�'� ASSESSOR'S MAP& LOT G ,11- 1NSTALLER'S NAME&PHONE NO. T,4 to /-)k 11P SEPTIC TANK CAPACITY LEACHING FACILITY: (type) i f (size) dew !axe � ' .NO.OF BEDROOMS 3 �UII.DER OR OWNE � S/a0 e PERMTTDATE: q 30 I-6 COMPLIANCE DATE: c l Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t a� aw 33� 33. � 5 o % L-0_ C,Ai°T,-!.Z N SEWAGE. PERMIT NO. V I L L A C E gash` U,y®& I N S T A LLER'S NAME 11, ADDRESS lAyWnS`IOA/ �9�d1r B U I L D E R OR OWNER Don rYYJ ✓"J.1 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �d�,- '� f,�� v� ,t�v vt .: . �� '� e No. ..... FR$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................................................................................... Appliration for Diopoottl Works Tonarurtion Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ••... 1 .. . .. .... ..c� ...........s wP alp ................ Locatio ddress . or Lot No. �s.�..— ......... . ... .........•-- .... 1-----_- --------- . ............. ....W Owner^ Address W Installer Address dType o Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...._tZ.................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•••----...•••••---••--•---•-•.......................•----•-------••--•-•-........----•-........._............-•--•-•-----......._...-----------•-......--- 0 Description of Soil.................................................................................. ------------•--------------..............._....•-••-•--------.............--- x w ----- -------------------------------------------------------------------------------------------------------------------------------------------------------------•--------.....-••---------------••--- VNature 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 TITI U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the board of . lth. ned. ..... ..... .......................................... ..... Application A ..... •.--- --,:. ':.._.._... �__lz_.. �........_.................................................. Date Application Disapprov or following reasons:............................................................................................................... . ...........................•-----•---...............---------............-----------....---•-•-•----•---•............----•--------------------------------------••-------------------•---••-•-----•----•- Date PermitNo......................................................... Issued........................................................ Date 3-It,, No................ ....... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................OF ....................... Appliration for Rapatial Vorkg Tontitrry.tion rrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Ut .............................................................................................. Loctpdes or Lot No N.6 J --...... a ,�d .... - w----------;, Address .............. ------------- 01•...... .. .... ..... � ................................ ...................... ........................................................ ... ........... Installer Address Type o Building Size . IZ .............................Sq. feet Dwelling—No. of Bedrooms.__...j...................... Expansion-Attic -------- Garbage Grinder aOther—Type of Building ............................ No. of p',qrsons...............:............. Showers Cafeteria Other fixtures .....................................................V .< X ................................................................................................. Design Flow............................................gallons p r person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons ength................ Width................ Diameter._.........._... Depth......._........ Disposal Trench—No_ .................... Width_.___..._1, ....... Total Length.................... Total leaching area--------------------sq. ft. > Seepage Pit No..................... Diameter._...._.._..___._. Depth below inlet_........_._..._..._ Total leaching area..................sq. f t. z Other Distribution box Dosing,taik Percolation Test Results Performed by.........I-------------------1�r-------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit__._.._............. Depth to ground water........................ 44 Test Pit.No. 2................minutes per inch Depth ofTest Pit........_.._....._._ Depth to ground water....._..._.............. 9 ................................... .............*......*------------*'"*"*------------------------*--------------........................ 0 Description of Soil.'....................................................................................................................................................................... ......................................................................................................................................................................................................... ........................................................................................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 T IT 1Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in -operation until a Certificate of Compliance has been issued b the board of ed.. ..... ..�W..................................................... Application A ........... .... t. ... ..................................................................... ......... ................ Date Application Disapprove r t following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... IssuedL........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... (Irdifiratr of Toutpliattrr T ys'em c ns r IS TO C R T!;Ia, That the Individual wage Disposal f3 t t ucted ( o-for Repaired by--------:-....'`"" ...__...fie... ........................ . . ......0.................................................... nsiali' .............. . . ........................................................ .................... at.........0.... .........1,7...*------------ 4?�� has been installed in accordance with the provisions of TI�......''" 5 of Petate Sanitary Code z Addy bed in the application for Disposal Works Construction Permit No.._ ....... ....................... dated_.e!?� .5�. .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR40 AS A GUARANTEE THAT THE SYSTEM W LL F?NCTION SATISFACTORY. DATE....__ .................................................... Inspector,/___ ,,�_ ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... ...................... FEE....................... Permission is jpeby granted....... ....... ....... ---- ------- ...........4 ........................................... ------------ to Construct �VR�epair divi(� al e Dispodtys� / . .../I Z.,..... .... ............................................0........... at No..........'. .. .... .............. ........................ Street as shown on the pplication for Disposal Works Construction Permit No..._.__. Dated.......................................... ......................... ...... ........ ......0-i ................................................ Z Board of Health DATE....... ........ .............................................................. FORM 1255 A. M. SULKIN, INC., BOSTON 5 ►NGLc- FAM►LY - BcoaooM li No GACL6AGI°, 69- NDE2. I. vA►LY FLOW A 110X 3 = 33oG•Pp �I SEPTIC. TAQK = Z30xl50% = A9rG.Po j USE- 1000 6A1r-. o►5Po5AL PI'1- vSE Ivoo C-�At_. 9 I S%DG.Y+/ALL AQ.EA I 50 5.F /O ' Art/.4)/ /37 o y _ 150 5.F X .2•5 r 375 G.Pq 1&0.6 R BOTTOM AE.Ar ., Imo S,F. ,Cd7'S /-Ii6� /7 *1 I 5� s.F x i• o A 50 &.Po' 11 --TOTA L- D ESIGN = ,4.2 5 G.P D. �f 977 99 5� I �I 'TOTAL. DAILY{ F�-ov,! - 33oG.P. o, Zc�f'•y ......... ..-.. � � T., �/'$ZG�� I i, Pa ZCO�-ATION RATE : 1"IN 2MIN oli;Z-LE�55, /OO �,2ovo I /o /oc4 ;: . •.� ; jN OF c, o 95'd. '9 c ��1N A LAN �G� .y �, RICHARD �� ]] 10rJES I' E A 7 No ''S1U0 BAXTER No.24 Q I S T E FC S lei{ T6�,T �P-Z3,4v �6._ /dam• � To P FWD=10 1 .o M �oa,y ►oov tN�• .sUc�SO�� s DIST. INS. ci I GA%-, Gy 6PT1G �•�I z IOoo INY. 0uX 979 TANK Gay . 9,3 I o' II LP Tu INY, INV. wI-ru 9 s 97 7 r I I 11�3�9•'/L II 'sip WAS1dGD GE2TIFlGD PL�-T' PLAN I , L�� P Q U F I l-.� LOG 4'T I O N U.S��✓/�--1-�-� No. SCALE SCALE 1 GEcz-r11=Y 'THAT 'fHV-- PZ0F2,55 FNr NowN �� y,� ,y/7 HE9 So►4 GoMPL`{5 IdJTN-THE 51 o6LIN / Auv 56-te%c.CK R-6Qv►R.EMENY� oF �C4�E- ,C . e, ZGCl� g 'TOWN OP �&AR�7i AP-q G ANC IS r LOGp.T WIT IIJ TNEnnG�-ooD PLNIN DATE 11 9 �e�.0 ci (; B A XT E V-c REG I ST i.Aw o 5 u zY TId15 Pl.Q1J l�j NOT (3l��jC_T� pid AN C>:5-r VILLF-- I� 1N5-T-9uMENT 5u9Vey E -Tr 4S o►=FSET5 5uouQD yy�� No-T D6 u5ETo O pE'TERJ^1►�1� L-cl,7 E�j APPLICA► /VI fr A S/.IAJA 0,OJS-T-,