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Home My WebLink About0091 TOWER HILL ROAD - Health � � o��L _, No.... ......... Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Diti-p 3al Works Tou.itrurtion Famit Application is hereby made for a Permit to Construct ( ) or Repair (C:4) an Individual Sewage Disposal System at: ............---- -----------------••--••'-••'--...... . tio ..... -Addre ! �� 7 o. Lot Ny.. Addresst In has Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms__________________1- -------____-___---Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures "-------------".-_-__--_-.-__.. ." W Design Flow............................................gallons per person per day. Total daily flow..............0,.._� ------------------gallons. WSeptic Tank—Liquid capacity./ ...gallons o Length---------------- Width....... Diameter---------------- Depth................ x Disposal Trench—No. ---------/........ Width...... Total Length---cF__......... 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. 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........................................................................................................................................................................ x U ... •------------------------------------------------------------------------------------- .....------------------------------------------ •--------------- •---------------------- •------------------- ..... .. W . . ••••••••------------------------------------•------...-•----------............----••. -'--•• --------------------------- ••••....-•-••-............• ---••-..... UNature of Repairs or Alterations—Answer when ap 1 cable---- 1 C�4-._._.A:_.. ..... .__c _E.4 77 ` ------- w T--... Zln1 C--•.-- 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 hsbeqn iss e y t oard of health. Signed - ............................................... ....... -............... . fey � Day Application Approved B ` .. ........- Dam Application Disapproved for the following reasons: .............. .......... /--------------------...--------------------------------------------------------------- ----------------------------------------- ------------------------------------------------------------------------------------------ ...-------------------------------------- ------ ................... Permit No. ... ...... '� � � .... .............-. . Issued .. - .. ... . ..... e Dare 1 ... No.:�� Fizz........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE AppUratiott for Uiopoo l Works Tonotrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: Location-Addres or Lot No._ -----------------•- owner Address a !J/ 0c(6 I. LGiJS' �( L�J/f��L3`� (BCD �/yJ t ✓!7/I.LS IcistalIer Address UType of Building _ Size Lot............................Sq. feet Dwelling—No. of Bedrooms------------------,,�___-____-_-__-.._--_-.-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ...............................-.-.Q -------------------....-•--------------....---------- -•-•-•---•---....-.�...yam._....--•-•-------.... w Design Flow...................J r__-__-_____--gallons per person per day. Total daily flow-------------- .---__._....................gallons. WSeptic Tank—Liquid capacity,e� __-gallons i Length................ Width---.._�-------- Diameter.___.._-_-.-_.-- Depth................ x Disposal Trench—No. .........1........ Width....'............ Total Length-- ...... Total leaching area....................sq. ft. Seepage Pit No..._---_ ----_----. Diameter.................... Depth below Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 04 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........................ Pdi ---------------------------------------------------------•-•----•--------------••-••-•-•---------••-......................................................... 0 Description of Soil....................................................................................................................................................................... x w UNature of Repairs or Alterations—Answer when applicable..../N��r�4 ___-.A----....�.�----G'w----_-----S._ �<- 7/1 N. 1..........�_-C`S/_�--.........••`'�!;;� -----------V......./ 'l `9-5---•---- ........... Agreement: i 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 issue by the oard of health. Signed / - .................................................. ----- ��,/�'`��.'��.. �'' Data A lication A roved B - y,�4 i---------------------- ---------------------- - ,.�` �',< PP pp ......... . ........... Date f Application Disapproved for the following reasons: ...................... ........... -------------------------------------------------------------------------------------------------------------------------------------- -------- -------------------------------------------------------- ........................................ Date Permit No. '''. ........ Issued .._......y.... ...4;1 _ !-�..... ...... Date ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS A BOARD OF HEALTH TOWN OF BARNSTABLE QlQrtifi atr of V��TT-IIittylianve THIS IS TO CERTIFY t the.Individual Sewage Disposal System constructed ( ) or Repaired ( ) l G ; cL7 7----------C" �� .Z/,wc.ra,-j by ........... -- --------------------------------------------------------------- -�, h�t:aiet at .. _....... ...... /_..... / VG1-- (` -- c...L-----------/ ---------------------------- ✓!c --------------------- 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. . ... .1�... . dated .._:._. _. ....�. THE ISSUANCE OF THIS CERTIFICATE SHALL NO' BE ONSTRUEA AS A GUARANTEE THAT,HE SYSTEM WILL FUNCTION SATISFACTORY. �. DATE ' ------------------------ Inspector - '�-r-'` 3" . ,_— THE COMMONWEALTH OF MASSACHUSETTS /S BOARD OF HEALTH w TOWN OF BARNSTABLE 1?0 No..,��....... { FEE..............•---- , �i��no�t1 �k� �rrno�r ion �Prini� Permission is hereby granted..................... �.___..._'_ 7 C &,J`S 1,�.�/r_? % U'J - --------------- - ----------------------------------------------•------------- to Construct ( ) or Repair �) an Individual Se ge Disposi System atNo.. f f"1~ .............. ...... .............................................................rc.. Street as shown on the application for Disposal Works Construction .ermi�t�N=._�'"4.7_ Dated.,,Ii;_ .,_��.....`-�f4-�--- ................. Board of Health DATE............--------- -------. ..... ............................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 1 j TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE- ASSESSOR'S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 0 �� G�i�► y8�. ', SEPTIC TANK CAPACITY /. LEACHING FACILITYAtype) C /BLS (-s-iiz—e) ��•�8� NO. OF BEDROOMS � PRIVATE WELL O T� I IC WAT BUILDER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: " VARIANCE GRANTED: Yes No _ �- i i