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Home My WebLink About0366 BAXTERS NECK ROAD - Health a�5- 83� S M E A No.2-153LY UPC 12934 smead.com • Made in USA Q) . SUSTAINABLE FORESTRY INITIATIVE Certified Fiber Sourcing +wr s iprogra". o �07,"2 #S-f�366 OF LOCATION � / p SEWAGE PERMIT N0. VILLAGE INSTALLER'S NAME i ADDRESS JOHN A. AALTO BACKHOE SERME Street 'West Barnstable, Mass. 02668 BUILDER OR OWNER te vow 5e',&of C.ol;te—�4111/.v DATE PERMIT ISSUED 291 . 7F DATE COMPLIANCE ISSUED r . c 5- 1 �► C � J No.. "s._....... ..... Fns..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF:, !- E ELT ....... ..Z. Appliration for Uiipusa1 Works Tonstrurtuan Vernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................... a E9--------•--•------•------------•----------------•-•----- Location-Address - -•--••--••or Lot No. ........ ..!ll__... .o�.F------------------------------------- 1'-.._ T' ............................................ Owner Address ........................................................... ----=---------------------- ------.....---------...-------------------- Installer Address dType of Building Size Lot....1.21__.e�C°__-___Sq. feet U Dwelling—No: of Bedrooms_____'..................................Expansion Attic ( ) Garbage Grinder ( ) pa•, Other—Type of Building No. of persons..... Showers (a) — Cafeteria ( ) Q+ Other fixtures ..._.._..--••-•-••••-•-•....•••• ... -----.--- `......................... W Design Flow...................T..r._ ........gallons per person per day. Total daily flow_______'K_.`...4!........................gallons. WSeptic Tank 4-Liquid';capacity&. gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width__pr............... Total Length......__........... Total leaching area---------..........sq. ft. Seepage Pit No._2............ Diameter.......-d'-------- Depth below nlet____��.._�^._.._ Total leaching area...'.`�.�.2'.sq. ft. z Other Distribution box (�i} Dosing tank ( ) ' ® ��oaa1 5'' ��' 7,� '-' Percolation Test Results Performed by... ry -_-__-_-- .. ------•-- Date.....___........` aTest Pit No. 1..:.............minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...........°....:... ......................3...... -------------r............. ---- _.._..----•------......--•-•---• Description of Soil. '_.O_ � = - .....--•° -•-• --------------------------------------- 4„ .............. ....................................--------------------------------------------------------•--------------------------------••. 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 iITI.` 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 health. Signed ''................................ 44 G.76'-....__..._ Date - Application Approved By........ I/A;--� -....... ' Date ' ` Application Disapploved for the following reasons:................................................................................................................ -----------------••••-••-•••--•------••••••-•••••---••-•••-______.•••........._..._..._......••----•---••-••----•-•-•••-••••----•••••-•••---•---•••-•--•-••---•••-•------•-----•----• •- Date _ . Permit No......................................................... Issued....................................................... Date No................- THE COMMONWEALTH OF MASSACHUSETTS ;. . BOARD OF �ELTH idctr .......oF....... -� Appliration for Binpuaai Workri Tow4rurtion Vamit Application-is hereby made for a Permit to Constructs-('` ) or Repair ( ) an Individual Sewage Disposal System at: .�------------------'...Q.rQ.----------------------...---......_....... Location-Address or Lot No. -.--. ��.�/f�g Syr /�yy�]��'' , ................................................... ...1.[.Y_ Z"'___A.1'___........._._.... ...................................................... Owner Address Installer Address R QType of Building Size Lot... eu __ '_ ...Sq. feet Dwelling No. of Bedrooms____:"! Expansion Attic ( ) Garbage Grinder ( ) Q ._R................................. Other—Type of Building .... No. of persons..... 7................... Showers (9,) — Cafeteria ( ) . Other fixtures ------------•-- -•----••---••-••-•.............•••-•.•••••-•------••-•--=--•------------•••---•-.--•- W Design Flow.................... gallons per person per day. Total daily flow--------............._.....................gallons. WSeptic Tank I-Liquid capacityl, gallons Length................ Width_____._________. Diameter---------------- Depth................ x Disposal Trench—r�No..................... Width_ _...__._...__.__ Total Length..... Total leaching area...... ....sq. ft. Seepage Pit No.._.. »__..._._._.. Diameter.__.... . _. ._ Depth below mlet_ 4 g q. �f� �" ..... Total leaching area..'�! _ '"..s ft. Z. Other Distribution box ( Dosing t nk ( ) iG' , A *' "` r/. 7k; Percolation Test Results Performed by.... iv �. .......... .. ....�.... Date....... ..... t.`•�__f.::'.._.__. la Test Pit No. 1................minutes pet inch Depth of Test Pit.------_............ Depth:to ground water........................ Test Pit No. 2................minutes per inch. Depth of Test Pit.................... Depth to ground water........................ . ......................... . s•* �......... p '� z 11i t.._... D Descri Description of Soil V r trtl!'`a---- --- I •----.................................... .. ._�:"_ !...................._______.__.._._.._____._____._. __.______._ _ �_ _ _.___________ Nature of Repairs or Alterations—Answer`when a licable........................................................�. w W ----- --- - Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T ITIE 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 health: Sign _ 00 d�(z-A •--- f�} Application Approved By......... •--1= -- = '" - - s-- ------- s* Date Application Disapproved for the following reasons:....................................i------------------------------------------------ ......•............. ----•---------------------.............................................................................................................................................................................. Date Permit No.................................... -•---- Issued-----------------... --•-•------------------ Date............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ,!,!�! ..........OF q,�kj/,t..-.................................................. .....fo Tertifiratr of TompliFanrr T IS TO CE .TIFYtt the Individual Sewage Disposal System constructed ( or Repaired ( ) by.. .� --- -_ -" ...er V .' -has'been ind in accordance with the provisions of T' i S of The State Sanitary Code .sescribed 'in the :application for;Disposal Works Construction Permit No.__.....-- _ -�--_.---_•--____ dated__,V " .._ ._�............M:---- THE ISS ANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THEE SYSTEM VILL FUNCTION SATISFACTORY. , DATE. Inspector •- THE ` COMMONWEALTH OF MASSACHUSETTS r BOARD.::.OF HEALTH .............t�_- . ......OF............. �.gaerllkl........................................ No._ FEE...�S . im ion rranit Permissions hereby granted...r . = to Con rust ( ) or ,epair ( ) V1rgvjjual Sew Di System at No.- ... G -" ./ -2 , sue' '"` ' "° s `r,,A Street as shown on the application for Disposal Works Construction Per �Nj<........ Dated'"'_ : �► � ."_....._.. # '' i--- r Board of health` s DATE •--- 1_ l j FORM -.1255 HOBBS & WARREN. INC., PUBLISHERS it y ;r fp e[ 3 �{ /rFti�tt/.. .1i3-d ti"SN :vev4 • .�.A F"In�s To .z r r_,, „c ,Let. e 5;Z •D { ..• .i ; CsiLA� RL 6 •...�••'-•�!•� - •r,�. /t{N :"\•.'.�%'•'��". �. `/�'';t.\�f :� �\�� ' �l�w' � ��.� ire:" . 4J•S • �- f'f ui7y!!EL� :DV D !S T A N y7A6+,t J J J 1 16, /, ,��j�/l�,l�.!k �l�i_' �oTrv,•r o!• v. i j f y Z If 40 i 10 40 M 111 r / O SAS + � \ off,9 nE i'�� Y,.. Z'�e*Q �. 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