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Home My WebLink About0025 THIRD AVENUE (OST.) - Health rA c )q,cna TOWN OF BARNSTABLE LOCATIONS' SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 016-67a. INSTALLER'S NAME & PHONE NO. E6l,T"W SEPTIC TANK CAPACITY c'6'&5/>voc- LEACHING FACILITY:(type) (size) CPC/0 NO. OF BEDROOMS PRIVATE WELL ORjnUBLIC WATE BUILDER:OR OWNER /Y,4-AD.FAI DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes N � � e No-_IJ-- .`,Cl... FEB._....v. .........._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uiopnoal Works Tnnitrnrtinn f amit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at::, Locatio - ddres or Lot No. ��_�.�------.��t �- ......... .._._.. •��211 ._._.. �..................................... G� G0 Owne��s� / � dress / ...... �......... . :... Y .__��_ .w.....�1- Installer Address d Type of Building Size Lo �_�!1l .__Sq. feet a Dwelling—No. of Bedrooms............ .... ..........................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a, Other fixtures ------------- - w Design Flow................>.�� _..............gallons per person per day. Total daily flow.........._-x�_�__<D.....................gallons. W Septic 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 ( ) Percolation Test Results Performed by........................................-................................. Date........................................ Test Pit No. 1________________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........................ P4 -------------------------------------------------------------------------------------•-•-----•--•--•......................................................... 0 Description of Soil...................j1= -------C � {-.5 f----C.5.7 -------- x w U Nature of Re airs or Alterations—Answer when applicab ___C' -1 A _ 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 b en issued y the-board of health. Signed ------------- --- --------------- - - ------- - --- --- $.-- -------- -----.em s/.. Date Application Approved BY' - -- - -1...�..-h'�. -- -- - ........ ----Dare Application Disapproved for the ollowing reasons-- ----------------------------------------------------------------------------------------------------------------------- ---------- ----------------------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------ ---------------------- ---------------- Dare Permit No. .......71-- - �f--1-------- ----------- Issued -------- ........................................... ). Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrnrtinn Famit Application is hereby made for a Permit to Construct ( ) or Repair (",<) an Individual Sewage Disposal System at: Location- ddres or I of No. ...... ...... SJ/Z1� ?!! ........._.. isvl_G _......---•• Owner Address a �GIL i Dc o 1 ........?4_11-."!1--/1/X S............ Installer Address Type of Building Size Lotti��.QnLlt.._Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ................ .......... No. of persons............................ Showers ( ) — Cafeteria ( ) Ga Other fixtures -------------------------------• - WDesign Flow............... -';:S ...---.....--..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 ( ) Percolation Test Results Performed by.......................................................................... Date................................•----- aTest 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..--.................... a' ----•-•-----....-------•----•---••••--------------------------------•-.......---••.- -•-•--•-•--•--........_ ...---.....................------••-----•-••-•. O Description of Soil..................0.._ ........ ' � c.__S7 iSQ�I------^ .......1 ......... x V •--•-•-----------•••---•----•----------------------------------••------------------•-----•••----•-•--••------•-•--------._........._..---•---•••--------------------........---•----••---•-•-•--•-.----- W •------------•----•---•--•---••--•--•-•------••--•----------•---------•-••---•------------••----•--•-------•------•--•--•--•••----••-•--••-------•-----•-••-------------------•-------------•- UNature of Repairs or Alterations—Answer when applicab e...<:2/4G.)_S le 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 t system in operation until a Certificate of Compliance h s been issued by the board of health. Signed /,Y-/ - ...------. / j/ "".. ... Date Application Approved BY _ r"y 4L-b--'..... ... .......................................................................... .7. Dare Application Disapproved for the ollowinnlg reasons: ............................=---....-.......................- ----------- ------ ------------------------------------------------ - ------------------------------------------------------------------------- ------------------------------------=----------------- ------------------------------------------------------------------------- ------------------------------- -- L Date Permit No. .... " .�-..>' ...................... -Issued Date THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH TOWN OF BARNSTABLE 01-lezttft.cttte of C110myliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........................................................... c -G `U:S 1 7D Installer at ............................ . ............... ...........� ............. ....--f lJ 57" lJ/G« 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. .....7/..-..-...�/. .�.......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. .f.�1.. /-------------------------------------------- Inspector ..... 41 ; f ,-----------.................---...------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G� TOWN OF BARNSTABLE Disposal Works 'rrns rur#ilan Vvrrmi# Permission is hereby granted.................... �%� D�tS .. :...................................... to Construct ( ) or Repair (>1) an Individual Sewage Disposal System at No........................................... �1_J '4 .•................../L LF .............................. Street as shown on the application for Disposal Works Construction Permit No..9.1:a/-,_ Dated.......................................... .._...._---•-----••-----.--• �.-.. --•....................................................• U f B DATE...........................•---......-----------•----------•----.--•-- •.••-- oard of Health FORM 365oa HOBBS 6 WARREN,INC..PUBLISHERS TOWN OF BARNSTABLE UNDERGROUND �✓ > ��,v FUEL AND CHEMICAL STORAGE SY .TEMS ASSESSORS MAP NO. PARCEL NO.-o Ko ADDRESS! VILLAGE, cl Z J CONTACT PERSON {� �r _ PHONE NUMBER ° �d�O 3 LOCATION OF TANKS:, CAPACITY: TYPE OF- FUEL AGE: TYPE: LEAK OR CHEMICAL: DETECTION Lb M ;5 7wk bass a.semer^t o-sy c�u s4a' DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS oV-A PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD.