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Home My WebLink About0571 SEA VIEW AVENUE - Health 5 71=S e'aview Avenue 4 Osterville �r A= 114 - 049 t '� o -7 No....... ••..... ......... LTH THEBOARD AOF FHEALTH TS t .� 17V- ------- OF... ......... ....... App iratiun -fur Bi,ipuuttl Works Tonmrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (J_� an Individual*3eag Disposal Syst at: /J • r fL..�-.... ....-•__..•_. .. ___ ______ _______________ -........... Location- r ss or of IGo. Owner Addres . /� a _ zl.. {'� ....................... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures Q ------------------------------------------------------------- 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. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..-__---:_.--..-.sq. it. z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by.......................................................................... Date--------------_._--_-------.------------ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-----------.---.--.----- �14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water---_------------------ ..............................------....--•••--•-•••-------- ---------------------------------------•--•••......................................................... 0 Description of Soil-.... __. _ _ _.�. x W UNature of Repairs or Alterations—Answer when applicable...1_-1�- i% --•---=----------------- -------•- t .. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary de— The undersigned fu ier agrees not to place the system in operation until a Certificate of Compliance has b en ' s by the b�d hgcth. / lf igned �- . -....__. _ Cdv, e,,�---- l.• � � Date Application Approved By.- .!----- — -------- z •- �� Date Application Disapproved for the following reasons---------------------------------•------•-------•-----......--•--•------------.............--•--•-•....-••---••-- .....................•------•----•--------•-•.--.••-••-------•-••---------•_..._.....••-••---•••-••-.......--•--•---••---•-------•--------•------.......--.-•-------------•-•-•--------------•--•--_----- Date PermitNo......................................................... Issued........................................................ Date 7� 4. '► No.----••`��/ Fxa�.�... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH M1. . ............OF.... rna .............................. Appliratiun -fur Uhipoiitt1 Workii Tnnitrurtion Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair ( /4 an Individual SeI7age Disposal System at: hd Location- d, Tess _ or Lot No. �f Owner Address a ......... v.��` 1 i z�6�2-'"�J ............ T , •------------------------------ Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures -----------------------••--------•-•------------•- ------------------------•-----------•-----•---•--------•----------------------------------•------ W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................ Width-----------.---- Diameter.......--------- Depth---------------- xDisposal Trench—No- ____________________ Width.................... Total Length-------------------- Total leaching area_.__.-_______.._____sq. ft. 3 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------------------------ LT, Test Pit No. 2................minutes.per inch Depth of Test Pit-_-______.__--_-___- Depth to ground water........................ a ---------------------- ----------------- - ---------------•---•---•--------•------......................................................... O Description of Soil ,Y ?� >__ x —-�fll� ----------------------------------------------------------------------------------- V ..-------------------------------•-------•-------------•--------•-------•------•-•-----------•-•--••-•---------------••-----•.....---------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable__1-'1.r !L�_/l f ..:_--- i ° ___________________________ ••-------------------•-••--------_..._---•--------------------------------------- ----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned fur her agrees not to place the system in operation until a Certificate of Compliance has ben '-ssu d by the boa /of'h th. Algned — ------• -----/---�--------e - ----- _/_!- _ ....... Date Application Approved BY - �✓_GG t........ .... ... . Date Application Disapproved for the following reasons: - -------------------•------------•--•----------•-------•--•------•---------•- ..................................•-------•----•-•--•--------•---•------•-••--••-•-•---••••-•---•-•----••--•-•----••--------------••-•------------------........----------------....._......-------•--- Date PermitNo......................................................... Issued........................................................ Dater„_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF.....,P�U' . ,1,64 <.......--..--.............. (Irrtif irate of (fnmpliatirr T• IS IS TO CEP, " IFY, That the Individual Sewage Disposal ystem constructed ( ) or Repaired (L) Inst Iler , ' has been installed in accordance with the provisions of A ;cl XII of/The State Sanitary Code as described in the application for Disposal Works Construction Permit No.v-----=�//--------------- dated------- ----•--•-•-•-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS �Aj�G�UARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Ins ector----- ---------��^6/��'�Ci---... - -- - --....-........... ' DATE--------------� )•---7 6 P THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH No......................... FEE,;�!:.Lj/)....... Bi-spoattlMork-4 CITunfitrurtion Vrrmit Permission is hereby granted..;f ../ P __ __ _ 1�,> !f ' 1a. fir`` _ ¢ !{'-u':................. to Construct or Repair 4�'an Individual Sewage Disposal System (- ) P ( ) g P Y at No...-,.-� � '`6 ' �- 17,4._-e---t)_! 0_!� �! CJ �tz'�D k�� l Street / -- ---- as shown on the application for Disposal Works Construction�Pe t N/_ ____./�/..___ Dated____ . __'-7 ............... :- DATE - Board of Healt - ------------------------- '---------------. . . - / — FORM 1255 HOBBS & WARREN.. INC.. PUBLISHERS LC.-5C&.T16KI 5EWWC,E PERMIT UO. VILLA ca IM5TQLLER 5 ► &L AE ADDRESS BUILDERS IJ &MF— [NDDRESS DIaTE PERNA T ISSUED - r DATE COKAPLI bJACE ISSUED ; t 1 31 1 r• d. TOWN OF BARNSTABLE LOl ATION cS 7l -��j�-1, d -v'L'- SEWAGE # VII:LAGE_ t�2✓i Llr Lo ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.y 20► ZOW 66�)-��I�SPF�f�1� SEPTIC TANK CAPACITY ESR LEACHING FACILITY:(type) T, i cq— (size) NO. OF BEDROOMS '-f PRIVATE WEL OR=PUBLICW TER -BUILDER OR OWNER—fy— �i�(C DATE PERMIT ISSUED: / P-'c�Z dAj YAL DATE COMPLIANCE ISSUED: 'VARIANCE GRANTED: Yes No 1 f,