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Home My WebLink About0028 APPALOOSA WAY - Healthr-�28 APPALOOSA WAY, MARSTONS MILLS l '44rFt0le TOWN BARNSTABLE c� LOCATION �/17- -"�/ZA &,j2,,j4QPSX SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ,-YeD fie*l1 fr+6 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Pel /X0 OAJ. (size) c Z NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: � �"� VARIANCE GRANTED: Yes No jv. .I lift: 3 FEB �.®..._ THE COMMONWEALTH OF MASSACHUSETTS -- BOARD OF HEALTH Appliration for Disposal Works Tonutrartiun Ilernfit Application is hereby made for a Permit to Construct (,,)4 or Repair ( ) an Individual Sewage Disposal System a ................_....—_—... •Location-Add ss // ., 00, pp ..... t No O60 es / �,/ Addrs ....................... Installer ddress /�� q Type of Building Size Lot...........................S . feet U Dwelling No. of Bedrooms....... ...................................Ex anion Attic� g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other tures --------•------------------------------ - W Design Flow............ ..l! .......... gallons per persett �f' day. Total da'y flow..........??? .................gallon WSeptic Tank—Liquid capacity. Q..gallons Length..�l�.... Width:.. Q... Diameter................ Depth,. ... ... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........ ..... Diameter......La....... Depth below inlet....... ......... Total leaching area.:?4!.7_....sq. ft. z Other Distribution box V) Dosing tank ( ) Percolation Test Results Performed by C..�f- � � ._ ��...,-._. -..... . ...-•--•---•--•-•- ----«................. Date...... ................ Test Pit No. 1.L�mmutes per inch Depth of Test Pit.... . ..._. Depth to ground water..'�'Ty . f3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 94 ....... • --- •• -- O Description of Soil............# ��l . V ............------- ..... .........------- .------------------- .........------------- -------------....... ---------------------------- ---•----------- ......---•-•- •--------- . ---------- Z ............•---------------------------•-----•------------------•---------------------......-----------•-----------------..._....---.....------..........------•-•-------••.............-•-••.......... Nature 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 5 of the State Sanitary Code— The undersigned further agrees 4nottlace the system in operation until a Certificate of Compliance has been issued by the board of 1 Signed......... .. ..: ..... �... ......_.... Date Application Approved By....... (� .. .t,e� --------•----------------•-- ----.......5. Date Application Disapproved for the following reasons:............................................................................................................ .--•-•----•...............................•--••---............------•---•---•-•------•------•-•-•-----.--•---•--................................---------.........---••----....-----....•-••-.......: g/ ) Date Permit No......1..Z.."..6._69........................ Issued.-------•-------- .......------...................... �� ,� Date YmB - HE!CO'M� MONWEALTH OP MASSACHUSETTS -- }-- _ + a .�.. BOARD OF - HEALTH _- --- ... _, .....�...,. ..... �/ST J _ r2 Appliration for Uhipoiittl Works Tonitrurtion Jrrutit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at lylLocation-Address r `"Lot No ................_....___...fz �?: ..... - A t _•-" J1 Owner • ... .. .......«........ W f---_ .../,A/..........�� ....................... .......1__ v; h Gr Gc `--re Installer Address Type of Building Size Lot./6.bZ:.�...Sq. feet .-� Dwelling—No. of Bedrooms......;....................................Expansion Attic ( ) Garbage Grinder ( ) _ Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ------------------ .................... W- Design Flow...........................................gallons per.par-son per day. Total daily flow..........�..��._.......................gallons. WSeptic Tank—Liquid capacity,/Wlq.gallons Length.k�ram.... Width:...Vie... Diameter................ Depth&........ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................'sq. ft. 3 Seepage Pit No........ ........... Diameter......�.Q........ Depth below inlet...... Total leaching area. j.....sq. ft. Z Other Distribution box V) Dosing tank Percolation Test Results Performed by._....1...p.. fftivC.�". ( ��a .:. Date L. ----••---•----......_'; Test Pit No. I_ _-..minutes per inch Depth of Test Pit....l. ...__ Depth to ground water.'JLLn0.)�.- rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Chi .... ... ...... . ..........................................•.....---•-••---.....-----•-•-••----------...--•-•-........ O Description of Soil..--.. ....#---....----..... ---------------------------------- VW .......................... ---------------------•---•------•---•--•-------------------.....----••---------------•------------_--------------------------••-------•--------••---•----------•----.....--- ' Nature 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 TITTLZ 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 of heafh) Signed..... � 4� ... Date Application Approved B ----------- -----•---- Date Application Disapproved for the following reasons--------------------------------------------------------------•----------------••-----------•---..........---- •--•-•-•-•...............................q..--•---.....----•-.....••----.......-•-------.......----•-........-------•--------.....------...........---•--•--•---••---•---•---•---... •-•...----• Date — Permit No......1..Z._-..L6if...................... Issued-....................................................... r5 - 7 eg ;z-- Date THE COMMONWEALTH OF MASSACHUSETTS V BOARD OF HEALTH ..........�19(ea&I............OF.......... .-c ................................... (Irdifiratr of Toutphatt r T,,HIS—IS T .................................. TIFY, That t Individual Sewage Disposal System constructed (� or Repaired ( ) by...✓�1. :A:....--- -- �------...... Dt`C in_..... .... .- I Installer at..... / .(.�.. .'.�. �!� 1.1� tea. f •-•---•----•---•----•---------------••---................ has been installed in accordance Tv with the provisions of TIT �� j of O e tate Sanitary Code as described in the application for Disposal Works Construction Permit No....... u-.t ..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM W,IL'' FUNNOTION SATISFACTORY. / � --_ "76 DATE.......' ............................. Ins ect�"...__._-------- ..._ .__-..-- - ----- --.------ -- T.. --- --P A.,..------_- ~- _-...,-- , -----M------...,..T_- THE COMMONWEALTH OF MASSACHUSETTS 741 2 BOARD OF HEALTH No.. ... FEE...10. Dispo l , orkii Toniprmit Permission is hereby granted— e ... .......................... to Construct ( ) or Repair ( )an Individual Sewage DispV�vstem 64 at No..�d .. *to ? U�'°�+......a l ................ r -----•-•....................................................... Street as shown on the application for Disposal Works Construction Permit No._761'-/�SDated.......................................... � . DATE. 7 // Board of Health . /; � ��,i 4��E..,-tom• l [..Jl�� f`" ��o�c,*_^ se.axa,.e-.,s 7 t l !Eli Tra-e F l�d?U►•�/ $L (rYD td KBI.� F¢D_!� = v � � � �� S o. i' �G✓'{�' Z. 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