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Home My WebLink About0018 BLUEBERRY LANE - Health l g Le.�r� L�� , .. 1�a-l �3 m�►�-bTU� �``--�-5 - C TOWN OF BARNSTABLE LOCATIONIeCiPL /Y�C,/ �0�� SEWAGE # VILLAGE//'2?a ZA &I ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NOol'1,1141-1. SEPTIC TANK CAPACITY 7611?l LEACHING FACILITY:(type) (size) 6 NO. OF BEDROOMS PRIVATE WELL Olj: PU�BLIC WAT R . BUILDER OWNE DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: �� VARIANCE GRANTED: Yes No MCASvrr-d ^f1i h }a 2sJSZ G Mo`l— IRV., dP�:b� C-0 roc t' ul l h 6 R�vEli tlY I 6 3 a Fmc....� ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE . pphratiun for Diupuuttl Work.6 Tunitrnrtiun ifrrmit Application is hereby made for a Permit to Construct ( ) or Repair (j5< an Individual Sewage Disposal System at: �� L�L� --- - - � !� -yS-S-------- i1---- ---. ` ...........................................................---------G- �lo _...... c11 cSG)J f or 6 " `___' ......... . Own A r ss Installer Address UType of Building Size Lot___________________________Sq. feet Dwelling— No. of Bedrooms______________�________________.-____Expansion Attic ( ) Garbage Grinder -(--�rOJO 04 Other—Type of Building ____________________________ No. of persons._____._________________-___ Showers ( ) — Cafeteria. ( ) 44 Other fixtures _---__--_____ ---------------------- ---- W Design Flow..............___.___________gallons per person per day. Total daily flow..........��_____________.........gallons. WSeptic Tank—Liquid capacity_M%zallons Length---------------- Width________________ Diameter-----........... Depth................ x Disposal Trench--No_ ____________________ Width_______. __________ Total Length..........�_......_ Total leaching area....................sq. ft. Seepage Pit No-----------/...... Diameter.._...../4_-____- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (o _ Dosing tank ( ) Percolation Test Results Performed by------------------------------------------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water__-__-_-_-_________---_. Li. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 •--•-----------------------------------------------------•-•-----------------•-••-•---------••-••-••......................................................... 0 Description of Soil........................................................................................................................................................................ x W U Nature of Repairs or Alterations—Answer when applicable.___-1 A-1 �7x-✓�___-4- IGUo_ -5 t-__- s S 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 as b en issued by e board of health. Signed _... ........ -----r --z------.----......... ....................................... Date Application,Approved By . P....._......... ... ....... .. ........ ........... ................................... ....._........... ......----------- Date Application Disapproved for the following reafo r- ..................................................................................... ........... .... -................... ---- ---------........... ---------------------------- .................... - Permit No. ... -.................. ...........----- ----. ---.- Issued -------------- /... - .�---Date------ No. �5--.---76 FE$....��'�... ...... t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iratiun for Di-nVuuul Warks Tonmrnr#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair (p4 an Individual Sewage Disposal System at: .../ �.0 Jay != 1-s.. Location-:\ddr•ss or t No. !� t� �..L ...`� �1.------•..... �...............................11 ...t---.....xV Q�.!4!�✓1....tN....!4..-G .................................................... Owner Addr ss Installer Address Type 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 W Design Flov if!f'........�_ ...............gallons per person per day. Total daily flow.---._.___3j0._.___...______..._...gallons. W S1eptic4?nk�Liquid�capacity_4��O_.gallons Length---------------- Width................ Diameter_.__ ._.--_--- Depth................ �Dis'posal;Trench j'No t_...............1Width--__._.__--_ __-_-- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............��_....:/Ibiameter a �'�Q---.--- Depth below inlet____-_-......... Total leaching area..................sq. ft. t f-I Z Other Distribution box (.Z)_, Dosing tank ( ) F, Percolation Test Results�T -Performed by.......................................................................... Date........................................ W 1.4 Test 'Pit No. 1---.__-.-.!:____minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT4 Test Pit No. 2............ri_mrnutes per`mch Depth of Test Pit.___-_-_•_----.___-_ Depth to ground water........................ r---------- - - D Description of Soil--••----•-•-----U - r--------------•----.... .-__... ...----------....._...--•-•-•-•-•-•-•------------.....--------------------------------------------------------- x ------------•----•--•---------•-----------•••--------•...........----------------•----••------•••-•--._...-----------...._._........••-•--•.•-•--- V ..................................•••-----•••--•••••••...•----••--••••••••••....-••-----•••••••-----•-••••---------•-••••-••------------•••-----•--•-•--•--•---•-•-••-•--•......••............•-•••••... W Z. -•-•••-•----- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable____J/N_S.' __ :---------lG uu j !........... -- . < 3 ,5.... .�..................•-.•.•.. Agreement: t _ . 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 ,as b en issued by/3he board of health. Signed ......._� -- ---- `j / ...... - ------------------------ Dace Application Approved By / l L/ ----- ....n........- --- Date Application Disapproved for the following rea.ro s. ................................................................................................ .................... ............. __.._..................... -j,�...... � - --------------------------------------- - ----- ----- Dace PermitNo. .... ............... -----------------------.... Issued ---------------- . ..... .... .... ------------------- Date THE COMMONWEALTH OF MASSACHUSETTS Q{� BOARD OF HEALTH TOWN OF BARNSTABLE Q-1-ertifira te, of Compliance THIS IS TO CERTIF That the Individual Sewage Disposal System constructed ( ) or Repaired (}C ) Y - ............ - ...........----------------------------------------------------------- Installer at ... ......... .._._._............. ......../._Ir-_.....LUefG i/!/C-y---- 6e rv�'......._,....... ...' has been installed in accordance with the provisions of TITI. of The St nvironmental Code as described in the application for Disposal Works Construction Permit No. .+"- .. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. c' --- - 'DATE ...._ ......... P7 ...... -tG1....... Inspect r .... . _,-y _ — ----,—_—_—_.--_-----_—o_,__,�,_ --_-----�--_ �—� ---- et,t1l THE COMMONWEALTH OF MASSACHUSETTS loz _ 1Z3 BOARD OF HEALTH G �" TOWN OF BARNSTABLE No.. -..-- r ---.--•-••••••• FEE. G. ---.. Diu rusttl urku Tunu#rnr#ionyerrmit G/t�ii Qc_Gi/ �5�7L✓G7 7 CAIJ Permission is hereby granted •-------------------------•---.............•-•..... to Construct ( ) or Repair (PX) an Individual Sewage Disposal System atNo......................................... ••-•-• . 'L�Lu�(SF/1�LY &A('J i............................... t Street as shown on the applicati n for Disposal Works Constructio V,11�1 er�mit No._ 4�? �.�Datedd_j^1---- -�------_- .... �1 v Boar of Health DATE'-.................. = .......................... FORM 38,808 H088S A WARREN,INC..PUBLISHERS