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Home My WebLink About0034 SECOND AVENUE - Health 3 �} � �D14��KdS? u � /o� 315 - A U RI R R D ®S RVI i I I 1 5 M E AD KEEPING YOU ORGANIZED No. 12134 2-153LGN F�OURSETAJ TRY eM MOIN RECYCLED IR9TIATIVE CONTENT 1090if In" Cergfiad 5ber sourcing POST-CONSUMM vinmatiDrogramrg Skmt196 MADE W USA GET ORGANIC AT SMEAD.COM TOWN OF BARNSTABLE ,a 4 LOCATION Ve - SEWAGE # `� VILLAGE Q, ASSESSOR'S MAP & LOT&4( INSTALLER'S NAME & PHONES NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY i U� LEACHING FACILITY:(type) /� •d� f (size) _ NO.OF BEDROOMS j -PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1�! pp' r - j�... �� r � `T �►/��R® ■\ '\V S b �a -h M l e(�1 \r /� \� j'. J THE COMMONWEALTH OF MASSACHUSETTS ------BOARD OF HEALTH CIo OF..... ... .... BWMTSTABLE Appliratinn -for Uhip ial Works Towitrnrtion Vaniit Applicat' is here y made for a Permit to Construct ( ) or Repair an an Individual Sewage Disposal ystem at: �. ca _Address '------• - -+✓--- - --��.......... :. ___^ ._......-' -•-------•----•----------•--------•---'---or Lot...o-•-'----•--•-----•--•----------------•---- e ner Address w ' --'------•---------------------------------- Instals Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms------- -------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' 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........................................ a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water-----------.-_-.-_.. LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..........------------- -------------------------------------------------------------------- ................................................................................... 0 Description of Soil......................................................................................••----------------------_------_------------------I------------------------------- x V ----------------------------------------------------------------------------------------------------------------------------------------•------------------------- -••--•--•••-------•---•----••--- 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 Article \I of the State Sanitary C e—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en is ued by .he board he It Signe .. ..... -•---------------_----------- VateApplication Approved By----- -- ---- • •... ....�- � 7 Application Disapproved for the following reasons:....................... ......................................................... •--•----•-•-•--.......---•-----------------------•---••-------------------------•----•-------••----------•-•--•----•-•-----•----•---._...--•------•------...---••-. ------------------------------------ Date PermitNo.......................................................... Issued-----------------------------------------------•--•--•- Date - -.------------—________________________ ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _-.. :'°` of...................B-MLNSTABLE ................................................... Aliptirn#iun -for Uiipuiittl Workfi Cnnni#rnr#ion Vamit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at t �,1) r t _ (Location-Address or Lot No. Owner / ) � � Address / �r ./ f i `i - YA.,--/ Install r t Address dType of Building —� Size Lot............................Sq. feet Dwelling—No. of Bedrooms-_.-_-^"`"": ----------------------------Expansion Attic ( ) Garbage Grinder ( ) ALI Other—Type of Building _______________________---- No. of persons..._------------------------ Showers ( ) — Cafeteria ( ) P I Other fixtures .flow Total daily per da person per gallons n Flow -------------------•---.....-- __.g Design Flow p p py. y ___.______..__..._..__....._..._......._ W 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 ( ) 0, Percolation Test Results Performed by------ ------------------------------------------------------------------- Date---------------------------------------- 0-1 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-------_-_-_-__.-____. (i Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ----------------------------------------------------------------------------------------------.............................................................. 0 Description of Soil--------- ------------------------------------------------------------------•--....---...---- -------------------------------------------------------------------------- V -----•••---------••---•--••--------------------------------•-------•---•--•••------•••--------------•-••••--•--•--------•---••---•---• ----•-•---------- -------------------------------------------- W --------------- ----------------------- --------------------------------------------------------------------------------- = ------ VNature of Repairs or Alterations—Answer when applicable._-___, '/__f ___j ___.`-_.--_-..__ __/--_._. . -----------------------------------------------------------------------------------------------•----------------------- ---------------2--•--••------•--....... ------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in y operation until a Certificate of Compliance has been issued by the board,of,health./) Signed r:f "- '° �41 ' ra ---------- ---------------- i r r f lel � Application Approved BY vt"^ t '-�.-•----. � .�t i rt.��---- ---- - .y................. Date Application Disapproved for the following reasons:.......................................�____._. __._..... ...-•--•-••--•--•-••-----•--•-•-•---•-------•---------------------------------•-•---------•---•-----------•---••-----•--•--•----•---•------•-. --_-------•-••--------------------------------------- Date PermitNo....................... -•-•------•----------- Issued-------------------_--------.......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH BAMNS_T_ABLE .................................................................... CErr#ifirn#r of 0nmplianrr THISfIS TO _CrERCIFY, That the Individ q. Sewage Disposal System constructed ( )" or Repaired ( ) by.... --------- -�` . --------------••• •-. .................. / __ Installer f at i/. ---_-Cj.fi- -- JJJJ , � f ! 1��r ; /.-s G/f� ---.'------`� i ____. / �r._._V_ V _ _t v---_-. has been installed in accordance with the provision of ArticleXI of The State Sanitary Cod as described in the application for Disposal Works Construction Permit No----------- ------------- date d......r7, ............_.. THE ISSUANCE AP THIS CERTIFICATE SHALL NOT BE CONS UED AS A G RANTEE THAT THE SYSTEM V✓, L,JFUNCT N SATISFACTORY. DATE-------- /f . ----- Inspector---- --- - -_ - THE COMMONWEALTH OF MASSACHUSETTS ___.� BOARD OF HEALTH f ...............'� .. t. - ..OF_...........BA'R1vSTABLE........................... ..... No. �-........... FEE... ...........••----- �i��n� � , j Permissionis hereby granted---------=.------- -•----•----��`�:.�..--------------------------------------------------------------............--•----_.•---•-.... to Construct ( ) or Repair',()an Individual Sewage Disposal Syste at No..: --•----- � '2..�---� �-• rrz..G,�/ / lo street !1 as shown on the application for Disposal Works Construction P,ermit� No........'."�....... Dated....Z-------------_ - - -- - - --- ----- Bo ard of Health DATE..... _ -------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS PC No._..... ............ ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF YARMOUTH Appliration for Disposal Works Tonstrurtion jhrutit Application is hereby made for a Permit to Construct ( ) or Repair ( t4o an Individual Sewage Disposal System at / ..... ... .... •• ........................._.......... Se Ifpc�ti -Address �� or Lot No. -` ............................................ ...................... ..............---------................_..... Owner Address ........... -------------•--....--^ — Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........ ...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers W YP g ----•---•-•----------•-•-•-- P ( ) — Cafeteria ( ) Q' 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........................................ 0-1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ,a+ •---•..................... ---••-••••-----...............--•------......---.....•--............•••---......._...._.........................--_.. 0 Description of Soil............................................... U . ....................................................................•----•-••-•....._...._........-•-•----•---•-------•------•-•--.-•---•.---...........••-----•.............._.._.....-- W ---------------••-•--••••.....••-••.-•-•••-••••••-•••••-•••••••-••••••••••••••••••-•.......--•-••......-••-••......•••. ................... •.......•. .......................••--.-•-• U Nature of Repairs or Alterations—Answer wl}en a plicable_. ... .. (. .......: .. ..........I-----••-_ ._.._ l� J_t7-�- L........L .�._La Jo......( - ..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 bv the board-A health. Signed................. - M t ?L Application Approved By.............. t ..... ...--------.- --- l Date -Application Disapproved for the following reasons:..............................................................................................................-- . ...............I.; .•••••••--•-........................_.•••........•-••-•......_..._.•-•-•---••--•-_....••••---•-----••------•---••••--•-•--•-••-•............•................ .....•-••--... Date Permit No.... . .r`.. ..........................._ Issued... .7.. ......... Date 'Wi'vi� ��"�Lr` '"` "'�1��'ca�'^ < '��^�� 'tlr�+� i. r' /1 V7 -'!S':S'a•+1ir"t^. o� No. Fim THE COMMONWEALTH OF MASSACHUSETTS f = BOARD OF HEALTH TOWN OF YARMOUTH Applira ton for Bispooal Works (funstrur#tun jkrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( 4),"a�nIndividual Sewage Disposal System at: .....a_/q.-_____�).. c vr, r ' A,,.U�................. .....1��. ,�-l��.�,_...1- _..................................... Locatio -Address or Lot No. ---..:. .1C) ____....... US�4- ---------- -----------••-•••--•---------- -----••-•-••-••--••--= A.YE 4_... � Owner Address a .. �.�.n.............. ... -_ _--------------•--__-____-__--_--__--------••--•--__.--_-----------_--__------•---------------___ Installer Address Type of Building Size Lot............................Sq. feet �..� Dwelling—No. of Bedrooms_ ...... ...................._...........Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of ersons____________________________ Showers YP g ...-•-•--------------------- P ( ) — Cafeteria ( ) dOther fixtures --------------------•--...---------.._.........------.._._..---------------.._._....-----.._...........----._.....----._....-•-••__••---.._...._-•_... W Design Flow............................................gallons per person per day. Total daily flow.................................._.........gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter................ Depth................ 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........................................ 0 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (j. Test Pit No. 2................minutes per inch Depth of Test Pit________._.___...._ Depth to ground water........................ -------------------------•----------------•------....._..--•--......._._..................................................................................... 0 Description of Soil...........................................................•-•---•-------•--•------------------------.........-----------------------------------------......_........._. W W ••----------------------------- •......... _------- --••--------------------------------------------------------- -------------- -•••... _......... _•----------- -------------- -•------••-- -------------------------------------------------------------------•••-• - ---------..._._..-----------------------------------------------s-------------....._..---._...._....-----._...--------... U Nature of Repairs or Alterations-Answer when applicable__.1 � ._.�Ql <_.........k_�,.._.___..!........J�_:.__ W? ------.Ln---•• ?�__�t�.C.� ?....___. �� ? ��::c�L�--•-••-•--•---•---------•-t---•-....•-•---•-•---••-•••...----••••-••••-••••••---••••--_..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi: 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 by the board 5 health. Signed... ;�rr�r�.:_......---------•----- - :.. :./ D to Application A roved B � PP PP Y •-••--•-•-.., ....__.4. . . f..,_.... 1. 2:. "-• �� 7 Date Application Disapproved for the following reasons:........................................_////................................................................ _.._ •-----•...................•-•---•-----------•-------.._._._..-----...........----------..................._.......----------------•----.._..------•------------------......••---•-•--...•--•-••--•-_•---- Date Permit No....-__-_-_,�------r... ±._. f"�............... Issued.... ......... ......... Date -------------=------ — — — — — THE COMMONWEALTH OF MASSACHUSETTS //� -� 0 . BOARD OF HEALTH TOWN of YARMOUTH Trrttfiratr of Inutpiiunre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�)� /'�4rU - ...---- bY........................ ............... ....._.. ------------------- - Installer at..-=3_`-?�----------------- ��c�� r'- �'��`�................... ' ...._...__._.._.. has been installed in accordance with the provisions of TI 5 of The State Sanitary Code as described in the j application for Disposal Works Construction Permit No. . ..s-K. .4 ...... dated.../ THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................{ / `,!-••-•• ..� ._._...... Inspector--.._.. � d,: '1!?�......... ..... L THE COMMONWEALTH OF MASSACHUSETTS _— s �;y Y BOARD OF HEALTH. TOWN of YARMOUTH �Y`No............... ...... FEE...... Ropnoal 10orks Tonstrur#ion "prrumit Permission is hereby granted ..............-.......................................................................... to Construct (. ) or Repair 2V) an lAdividual Sewage-Disposal'System at No... �a�................).._--�f.'.. E°....---..._....... �: .��-! v Street �j as shown on the application for Disposal Works Construction Perrri� N, -�________ •--------•------ ." ' .- { —�----- ��DATE....... �--•-•..................... Board of Health