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Home My WebLink About0025 RAMBLER ROAD - Health as R ct-n=, bie-(Z-. 20a d ` M AP 14c) No......t:J-Ay LC5�1 192 Fxs.-.lane: u THE COMMONWEALTH OF MASSACHUSETTS ,• � � �� i BOARD OF HEALTH �J dj_ WV 1.6u1.+U�..............OF... A6 �v� c , ApplirFation for Uhip ii al Works Tomitrurtuan ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: .............[ t?.----------•--•----•------•-- --��'o�2Vli....E Location-Address _ or 11t No. .._....... . 2........................................... ...... -- 1---=A t'1-��E L....----)?........................................... V n _...----•-•-•-•-•--.....__Address Installer Address Type of Building Size Lot.. 2_0 ....Sq. feet U Dwelling—No. of Bedrooms._.____�-rt_ __=___(9..............Expansion Attic (U6 Garbage Grinder (� Other—T e of Building No. of persons---------------------------- Showers — Cafeteria Q' Other fixtures .----•-••-------•-------•----- ._. W Design Flow.....55t.M'/Q________________gallons per person per day. Total daily flow........9_4-C)......................gallons. WSeptic Tank—Liquid capacity.?Jbfk)gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. ........I........... Width.....12-.......... Total Length-----3dZ....... Total leaching area---�Z_`31G.....sq. ft. S --------•---------- epth below inlet.-•••-1--_--- Z Other Distribution box ( �S Dosing tank ( ) '~ Percolation Test Results Performed by.... ArK ...M:.(_EJ_WS.................. Date...... .......... Test Pit No. 1....Z -----minutes per inch Depth of Test Pit-----19r_......... Depth to ground water_-. - N4ac�a-tom Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------•-----------------------.._......----------------........................................................................ O Description of Soil.......b_':!l....1-odd.Nl. zUPv1_L«._:L_-. 7_____________________ x 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 Compliant s Zbn issued by the board of alth. Signed Cam'..-..........- ........... Q� ---------------------------...----- ---Date Application Approved By ................... V -----f/e,., .- 0 -------------- ii Application Disapproved for the following reasons: .................... ... . ......... ............................................... .... ..... f...........-------- ................................................................................................................................................................................................................ cr Permit No. ....---'*----"--- Issued Date -�r :2. TOWN OF BARNSTABLE LOCATION QS eaw AQ P- SEWAGE # VIL-LAGE QL(e U(1�e ASSESSOR'S MAP & LOT V0 f INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY --),00 o L' , LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER O OWNE ►JB-f�y � � PERMITDATE: COMPLIANCE DATE: 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 f within-300 feet of leaching facility) Feet Furnished by M� `1 A ` t-; t. 1 No...._.le _:. � f_.0 i 1 �� Fps..../Q.O............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 -.-.. .fir\ Z IU S t A6�-E ✓" f_r., l -------------OF - ........ .........: Applira#ion for Uiipnsai Works Tonotrudinn Famit Application is hereby made for a Permit to Construct ( t�) or Repair ( ) an Individual Sewage Disposal System at: , -y�- .....--•---...............................................•---•-••............................... _....••-•-....-•••••------••••----•-•.....-•-•---••-•-.._..................................-----•. Location-Address — or Lot No. Wa .......... �IT •....a..4 •••...................................... ..•-••f• •-....C.....�..•-+--`-!-....�...r.... i ............................................ . ... . n Address .......... ..... ............................. --.......--------------•--.....------ Installer Address r } Q Type of Building Size Lot..._�.....Lr:...... Sq. feet U Dwelling—No. of Bedrooms___...__ ..........___G..............Expansion Attic ( �), Garbage Grinder ('16)� Other—T e of Building No. of persons______________'____--__-__- Showers Cafeteria dOther fixtures -------•------------------------------------------•----------•---•-------•----------= ............................................................. Design Flow..•..`.. '.. � 'fit ---------------gallons per person per day. Total daily flow........ .`_%�-%'......................gallons. WSeptic Tank—Liquid capacity-- act-gallons Length................ Width._.._........... Diameter-----........... Depth................ x Disposal Trench—No._-__-_--1.......... Width...-_�. -.._...... Total Length....._.. ._.... Total leaching area_._ ...sq. ft. Iameter w � ---..----_.._, � See�ge'Pit No:__.....___'_ �_.�"_""Depth below inlet___________________ Total'leaching area____.._ _.:..._sq. T. Z Other Distribution box (`I )`.> Dosing tank ( ) i _ `" Percolation Test Results Performed by D-----_-�_�-:n l�'I `.. ` Date....._�....t � ` a ................................................,: ..•....------ ,� Test Pit No. I____-/ --____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........................ ----------------------------------S U I?,SO l 1" \�_ L t-/k L J ----------------------------------•-•--•-•--•-•---•------•----•-••-••-----•-•••-------•••--••-•--•----•••-•--•--•-----------------------•._.._.._•..----- x 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 Compliance s b en issued by the board of ealth. - a2 Signed ----------------- ---------------------------------------------------------------------------------------- ----------�.........---................ e � Date Application Approved BY ------------------- I� U.� -�..------,� .._.. � e Application Disapproved for the following reasons- ------------------------------------------ ---------------------------------------------------------------.......................... ........................................... . ... .... ........................................................................ f t,� Date PermitNo. !��--- ---5 ; .. .................... Issued .......................................................------------ Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH 1 - ---:._..------. OF ....... C- TPr1ifirate D Q-10m tianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( °Q or Repaired ( ) by............................. ....... ...... .. ............................ ....... ----------.--------............. -------- ------------................................................................... _ '1 Installer at .. �_ ��tiN�i€ l+t_1Z --------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 o he St to Environmental Code as described in the application for Disposal Works Construction Permit No. ........ /.�...'. .. ...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -------------------------------------------------------------------------------------................ Inspector ----------------------........................---------.................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7U-,�2 t OF.....�{.��.�.. , )\k->c..r _ ......................•......... ��D ........................................... No........................ FEE... ............ iras Permission is hereby granted- ` -••--••----------------------------••---...........--•-•.............--- to Construct (?X-) or Repair ( ) an Individual Sewage Disposal System --------...••••-•-••-•-••--•-•• ....-•.......................--••••••.. = ---•-------------•-•-••-•------••-•--•---•- tym as shown on the ap lication for Disposal Works Construction Pe ......... --- _ �3 10 Board of Heath DATE.............. -- --------...---- ............... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS q ' Y 200 , Oc, ' /oo caQS �''Assu�n�+�� TC ggs/A► J 99 � I o IoI. I i i✓ti 99 v � ,i� lo• � p�2oi�aMi„:� HatTua) � �.-; � Pee.*z ,cp -I M L�p q90 s 11J T Te r »OLC/2.;v, � '^ ate�.�ihr uar I j t,Ua i '----' a aKt� '4u5q��TArzy P,vC. y ,z"oglL a ry n 4y R .C. SEttc7L �.iVC: ,�t, us �,� r t-, ��, r��Grz.� e �V,c -11 'TLC w iTN /gas��Z.- I /al .7 SGTG�sH to FiNAsy 61LA1)6r /ol 7 la F -AJ '5cq t.ar t,I 2 0 ' Nov. 14, 119 v _ a F3se"a-> ?.y o S4-re ,� Qy(Z: 7i\1G, /c�/ 9- `f nP- �::ND - l0` 9 4 - — r La A M SO eAu�. / � j� �B 7 f PC 4¢'' ScED. 40 �.--- ��' � � ,2000 69�- I►.N. u �N�. 9`l � ,�V DIST WV INV. ' SC!'lIG 97•Z' BOVoN Toia )'Jiq, GAIa. VNi SbCI `)74 cl :A" t � o (..9 2.4 2 3A 0 ITA(ZIJ, 24 ` 4 Pv A.c - rcs w ITi i .. t M F�fL CL.c.An OUT Pia o5c ;. AT A06tjL-, Pd,ATS 4.7' Ir e LA Ili 1E too WATT.,. 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