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0200 PARKER ROAD - Health
200 Parker Road. osterville — - A= 116—041. --- TOWN OF BARNSTABLE 4 LC;'CATION 200 J �—k P'{' q?� SEWAGE VILLAGE Oci tP?- `l I C.. ASSESSOR'S MAP & LO' INSTALLER'S NAME & PHONE NO �/��� c. r<1 SEPTIC-TANK CAPACITY���O LEACHING FACILITY:(type) �� /1lJ�+r l�/�4�/��S(size) NO. OF BEDROOMS� PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER S 6 Lo / DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ��� i �1 r� 1 V� I _ ,V•1 TOWN OF BARN ' t STABLE LC k%CA'nON (�0 /Jr- P/-- �L�1 - SEWAGE VILLAGE � ASSESSOR'S MAP &. INSTALLER' l I S NAME & PHONE SEPTIC TANK CAPACITY SOD LEACHING FACILITY:(type) l��Qf6(size) NO. OF.BEDROOMS--,3 _PRIVATE WELL OR PUBLIC WATER. BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes r No ~ V " S /. No.............�RPF��AVED Fri$ .................... Barnstable Conservation Depart"AME COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Signed Date TOWN OF BARNSTABLE Appliratinn fur DiuVuuttl Wor1w Tomitrur#inn Prrutit Application is hereby made for a Pe mit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ?z.. . Cf. t ��,,, ocation-Addr ss or Lot No. V4f .......lZ...... t---•-------•-••----------------- ...............................................•-•----•-•-- ----•---•------ ••-- ....----... Own r Adds /►1 a � L j............................................................z............... Installer Address UType of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms-_��____________________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons____________,____-______-__ Showers ( ) — Cafeteria ( ) G4 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------•------- ----------------------------------•------...-•-•-----------------•--•-•--.......---......._............----------••......-•------•..•--•-. 0 Description of Soil...................................................................................................................................-----•----•-•--••--•---------------• W V .....---••-•••••---•----••-•-•-•••----•....-----•-------•-•----------•----•-----•-•--•--•-••-••--••-•--•-••--•-----------•--•------------•----•••----•••---•--•-----•--•----•------------•--•---------••. W UNature of Repairs or Alterations=Answer when applicable. ._,�1� w__________ _ __ " 'I__-:. .............................. 1 �! ` ................ ------------------------------------------------------------ - 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 Complie i n ued by the and of heal Signed ..... .. .... ... ---- -------------- .. ..../..../ Application Approved By ----------- -^— ----- -------------------------------------------------------------- Due "..C-. _ ITace Application Disapproved for the following reafons: .. ............................ . ....................--. ............. ..... ........ . ................................................... ....................................................... ................ ......... ............... ---------------- ------- Date Permit No- ----------q ------------------ky....... ��--------------- Issued ............... ............. .......... ... ... Dare - �- 0. © 0 No.......... •---.. FEB ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allp iratiou for Big w3al Wnr1w Towitrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (G)n Individual Sewage Disposal System at: ...... 1Location-Add r ss Lot No..... .......................................... wn r d Ac�dres ----------- ---- Installer Address d Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms--- ------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d 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............=ra_._ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter___---�'n........... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution boxy( ) "� Dosing tank ( ) Percolation Test Results Performed by...............:r._... :`::}` `f� a -•----... Date ,.a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------•------------------------••---------------------------------------------------••---•------•........................................................ Descriptionof Soil........................................................................................................................................................................ U --------------------------•-----------•-••-----------------------------------------------•---•--------------•-----------------------------------•---------------------------------......-------•-------- W x -- ------------------------------------------------------------------------------------------------------------------ ------------------- --............••-•---•-••----••-•--••-----••---•-•--------- U Nature of Repairs or Alterations—Answer when applicable.._.����=�__:,._____S�..S t°'�'l.................................... � , ; ............... ? -------��-----�----------`--- -•• = /._ ✓S 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 Compliance has been issued by the oard of health. �� \ Signed %-- �'.. �' '... ' ��^Z... --------- ., � .....: �� Dare Application Approved B .s.t - ..-./. -..'. .1.�.. PP PP Y ............. .�_�,.X ' � Dace Application Disapproved for the following reasons: ..................... ................................. . . ............................................................... ............................................................................................................................................................................................................. ........................................ Dare Permit No. ---------_i. .... >..K;?- ---- Issued .................................. Dare ————————————————--------—— ————.—————-----——.—'—'———————————————————————.————————- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifi ate of Tomplianre THE IS T CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ..... -' ,/ iCL'..............ec ... =_ �... ........................................... at . -f')�-- --------_. //!..�.h...l '-------R�------------------------------L/S ...... ..0 1..L.. £'------------------------------------------- has been installed in accordance with the provisions of TITLE 5�of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....... ----.---- ...`t�..'? .. dated .............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... /...... .. _.. ................ Inspector--^ . '' � ------------------------------------ -------------------j�-------------= THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C N TOWN OF BARNSTABLE FEE 0 Q o. Lt%_: .. J..�. •--• •. Dispapals Workii Tomitrudwia 'prrmit Permission is hereby granted_ �-f-����---- GC/% -----------------------------------------------•----.................... to Construct ( ) or Repai5 ( � IndividualSe�r ge Disposal System atNo....-`` '` - �..:�.!�--... ------- - - ------------------------------•----------------------------------------•------.-.--•--- C� I ` lr- f / V --I Street V C as shown on the application for Disposal Works Construction Permit No �_::�§:�:-__ Dated_--_--r7:.�.�:_:__.�y.._........ i f ' rd 1 f ' Board ofHealth DATE - ••-••-•-�-----••--•--••-•-•-•----...... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS •.