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Home My WebLink About0178 BRIDLE PATH - Health Is. 'r TOWN OF BARNSTABLE LOCATION /76? 4,c� ga SEWAGE # VILLAGE 9 ASSESSOR'S MAP & LOTla p INSTALLER'S NAME & PHONE NO. ,�, �� 77 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) rZ- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � _ , — �� , i .e �. v�= i '� 7 ..� �,,., � _ q ,��p a ft � No......./...J�.-� ?C7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apli iratiou for Dhipuutt1 Works Tomitrurtiurt rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (4-j"an Individual Sewage Disposal System at: .........�. _ .... -- ------------------------------------- ---- ...01.----••--...-- •--.......-•................ 7aAe ion- ,lddres or Lot No. --------------------- ------------------------------•--...........-•-------•---------------•........................•--- W O erLO�� Address a °. •----------------•--- . ............. ..•---.............--------------------------•--------•--...------................................ Installer Address UType of Building Size Lot............................Sq. feet �-. Dwelling— No. of Bedrooms.--_-__--�-----------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .................Ir No.No. of ersons-__-_-----.--------___---_-_ Showers a YP g P ( ) — Cafeteria ( ) d Other fixtures -------------------------------- W Design Flow............................................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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.---.---.___-_-___--.-. �Z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t4 -----------------------------------------------------------•--------------------•---•-------•...........----------•---......--------.............••----....-- ODescription of Soil........................................................................................................................................................................ x U ---•--------------------•-----------------•----•----------------------------------------------------------------------------------------------------------------------------•-------•------------------- W ---------------------------------------------------------------------------------------------------------------- -------- ------------------------------ - ----- --- ------------------------- U Nature of Repairs or.A erat• ns--Answer hen livable.--- inn.ama �tlo�l? 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 Compliant s been issued by the board of health. Signed ............- .....- 1:...yr..q.�� Dace Application Approved BY .... .... f ----------------- ...../------- Application Disapproved for the following reasonr: ... ....................................................... . ............... -----....... -- ........ ----------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ................................ �-5, _3 L y —9S Dare PermitNo. .................... .. .... Issued ........�...-----........ . ............. . . Dare o 0 No. -/-- ----....... Ftzs.............................. THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH (� TOWN OF BARNSTABLE AVV iratiu,t for Bi-tipw3al Works Tontitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (v) an Individual Sewage Disposal System at: . ............... "` `x n Loc rtion-Address or Lot No. J O Address a .........................y° 6............. Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms------------2------------------------ ----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons----------------.-.--.-----. Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gal Ions. WSeptic Tank—Liquid capacitv------------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----------- ............................ a Test Pit No. 1................minutes per inch Depth of Test Pit--..--........---... Depth to ground water........................ fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........--..---........ a .-••---••-••-----------------------•-----•••--•--•••-•••••...-••-•••--•---•-•••••----------•-•------......................................................... 0 Description of Soil........................................................................................................................................................................ x U .......................................................... -----•--•------------•-------------••--•••--•-----••••---•--------------••-------••-......---•--......................................... x -•••-•-•....... .................•-------•.....--------------...----------------..........----•-••-•--------...•.n--------------------------.......----------=,�•••••••-----•--•---•••••-•----•----•--- Nature of Repairs P airs or Alterations—AnswerPP _ �Q when applicable .- ?_...�1,� �------U'Z�i .+ ------------ C ?•-�rx 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 been issued by the board of health. n/ Signed --- - - r..... --------------- ------ . -l--/—--- Date `APPlication Approved BY �_..._ - .............Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------- ............... . . -- -- ........................................ 5_ _ 1 _ ! J�S Date PermitNo. ....... ........................................ Issued ... �-........................................................ Dare ----.----_,_„------------------------------._.----------------_-- --------.--.�— THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALTH TOWN OF BARNSTABLE - (ITIErtif ra e of (11-omplianve x THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired by ....... � �_ �� y :--------------------------- ----- -- - ---- ---------------------- ------------._.-� ........................----------------------------- r:u r at .. l �� _../ .... Z.f ---------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code a§ described in the application for Disposal Works Construction Permit No. ...-.._.1T..5_._1..._............... dated f --/V� Y- .......... _..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY, �--r — ' �DATE...... -v _....... Inspector .......... - - .._...--- ------- ----------------------------------------------------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �i��u��1� urk� �un�tr�rtiun ��ermit Permission is hereby granted.......... rr^! o -------!� --------------•------------.........--------...--•--..........--- 7-------- to Construct ( ) or Repair (le an Individual Sewage Disposal System -------- Street as shown on the application for Disposal Works Construction //Permit No.`.5:- 3-------. Date �-----/-._5/-_J;..,5.............. /— Board of Health / U DATE............ •-----•--•--_. FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS