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Home My WebLink About0021 TEA LANE - Health 1 � �- !� .= �jS�v titi� ^ /� i o TOWN OF BARNSTABLE LOCATION a�. �-°.� �'�'�- SEWAGE #_ VILLAGE " e-+C fit'/C� ASSESSOR'S`MAP Cz LOT Z-y ( �� INSTALLER'S NAME & PHONE NO. ' A &'B`CANb0 `• 775-6264 SEPTIC TANK CAPACITY,. �, ��' C-4 LEACHING'FACILITY:(type) X o (size)C C' S7&sw NO. OF BEDROOMS '! . PRIVATE WELL. OR PUBLIC WATER ..A- BUILDER OR OWNER/e-;0 a DATE PERMIT:.ISSUED: DATE COMPLIANCE ISSUED: VARIANCE.GRANTED: Yes No ' L T �� E �4 ®�� uu No.. [..: Fas.......:3�....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Alip iration for Ui ipoii l Works C onfitrur#iun Famit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .... :r 1. ........ �.c�------------------------------ n et v Z&........_...........--------........---.........-------- p aiioz-Addrrs or Lot No. - ... .-t------------------------------------------ ------------------------------- --.....---.....----.................------......---- Ow ier Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms------------- ....................._..Expansion Attic ( ) Garbage Grinder ( ) C14.4 Other—Type of Building No. of persons............................ Showers — Cafeteria aOther 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. 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. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit......--_--._----_ Depth to ground water........................ 9 •------•-----•----------------------•------•--......---•--.......------------------------•--•-....--......................................................... ODescription of Soil........................................................................................................................................................................ x U .....-•----------•••----•--------------•-----------.........--------•--------•••-•--------------•----•--••---------•---•--------••-----•---------•--------------------................-----•-••-------- W ---------------------------------------------------------------------------------------------------------------------------------------•------- ...•--•-......... ............ UNat e of Repairs o} Alterations—A,nswer when applicable.- l,F �l.-...-�."'-__ ......�a��_. .._. ------- �`1.�----- ......>f1 T'-<r7--------------------------------------------•-•-------------------...------------. Ag ement-. 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 beep issued , he boar f health. Signed .................. ------- --....! .............. ............................ .� Dare Application Approved By .............. �` ... ... � �� 0Ze�( I Application Disapproved for the following reasons: ... .............. .................. . .. ........................................ ......................................... ................................................................. ..... .............. . ......................................... .......................................................... ........................................ Dace PermitNo. --- - ..'.. .- �1. ......................... Issued ................... ----- . ........... ..... ....... Dace 1•-•�:.._......,.;,„''r•.::..ir"ti�..,+t.s.—�...,._..r„�...r....,.:.o.....�..,...�,x,::..�_.,,,ri;-,7i,...J„+•,...-.......i�:.,-�s,�.:.-: era L":.....o. . _ _ +-..�,:........�t/�^—�'....,*.�.,.n,...wv! a.ai..w,[�� •: ...��:c_..�t;.....�.K....., sRh:.Tn�:K.-.s}�t-:ti.ir1�.•i4, No. y_-: cI� .......J................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Diripimal Vorkt� Tomitrnr#inn rrrmi# Application is hereby made for a Permit to Construct ( ) or Repair (>r%"an Individual Sewage Disposal System at: _ 11 L^tatinn-Addres — 6�� ,� or Lot No. J _.._..... .. .............................•.....•----- .... --•••-.. ................................................................................... (7,rnet Address a ............ . ............................................................... Installer Address V Type of Building Size Lot............................Sq. feet 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. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -------------------------------------------------------------------•---------.....-•-------...........--•---------.....---............•--.._...........--••-- 0 Description of Soil..............................................................................•-------------------------------•----•-------•---•------...•---•-•-•--•••........--••---- x UW •••--••---------------------•----••------•-•------••---•..........-••-------•---•------....---••--••----••--------------•---------•••--------•-•-. ----- ..................' Nature of Repairs or Alterations- nswer when applicable.��_Sf"g/l.____f_".:__�. .... .. 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 boar f health. Signed ................... . ....................J.......... ........./.. .' U..-`.9 T Date Application Approved By .............. �• ...��,�. _ n....'. - -g.-....`1.�y Application Disapproved for the following reasons: ................... .................. ....................................................................................... ................................... ..................... . ............................ . . . .. ......--.............................. ........................................ Date Permit No. ............................. Issued ..................... ......................................... ......... ..-... 1� Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE l �' ertifiratE of 0-11omplinurP THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �� by .............................._............... ........C'fo ..................._.....................---------..........._........... .............._.................... at ............ ..f..............._.....1�t Gt..,...._...... ..mod Q._--------_.... C ~?�F./U.[. c,... _... ............. has been installed in accordance with the provisions of TITLE 5 Qof The State Environmental Code as described in the application for Disposal Works Construction Permit No. ----.�/�. .-.,.5..%6..._..._. dated ........................ ........_._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY- ATE... /Z . .._.... ----- Ins ectol- ............................................................D THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� TOWN OF BARNSTABLE No.. FEE......-�...o••. -- Dispoal nr� �#r tuan rrmit �F; to Construct ( ) .or Repair 4)� Individual Sewage Di'- os Sy -. Permission is herebyranted............................ ....._. ....•.... . J s osal System ,�� t/ at No. - ---- l A}'1.0�...---•-------_.15.S_IIV l/t Street as shown on the application for Disposal Works Construction Permit N � �D--a�ted----- � � C/...._oQ�-:l • - ......................................... �? c :� y1----------------------- -•-------•• �� " 1�"�f l�-•--------------------••---•--•--- Bo�rd of Health DATE-------------------------•---------•----/ FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS � g r i. � 1 � '7 t