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Home My WebLink About0055 CAMELBACK ROAD - Health O!o ��Q �oZ �1ar5�v��5 �Y1� I Is _ _� C TOWN OF BARNSTABLE V LOCATION,OO/3 " SEWAGE # VILLAGE J/ t y. / ASSESSOR'S MAP & OT, Z{-f0 INSTALLER'S NAME & PHONE NO. � r�� //)®/ii� SEPTIC TANK CAPACITY f©0 0 LEACHING FACILITY:(type) fPZ (size) /0 y® NO. OF BEDROOMS �� PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER De-A.,,,i,s ➢�� 0 A�; DATE PERMIT ISSUED: CJ4✓: IV_ DATE COMPLIANCE ISSUED: 1t —'y VARIANCE GRANTED: Yes No .. � � �-= Q ,�jv �' d} °q � ��j 2 � � ��% �� _�-�� d�� '� 3 ��.�_� No THE COMMONWEALTH OF MASSACHUSE77S BOARD OE H EA TH � ...OF.....� ...� :. .- - r..... Appliration for Diip.us al Works Tonstrurfinn Frrutit Application is hereby-made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage DDisposal System at: Location-Address No. . % . � ......Z-%....... ..................... '. - . ................ Owner ress .r. -.... F'✓.( ....-fS.� p� ----------------------- �� -W. . . --��-------------- Installer Address U Type of Building Size Lot....30.3.11ASq. feet 1-4 Dwelling—No. of Bedrooms......_....3............................Expansion Attic ( ) Garbage Grinder ( ) p_, Other—Type of Building _ o. of persons.........4.............. Showers �) — Cafeteria ( ) a' Other fixtures Q -- Design Flow................ ....._._._._._._..gallons per person pey da Total da' fl 0................. ns. WSeptic Tank—Liquid*ca.pacity.Q gallons Length-_�..�f_ Width_//./9?._ Diameter................ Depth_.O/. x Disposal Trench—No..................... Width.................... Total gth.................... Total leaching area.._.._...___.......sq. ft. Seepage Pit No----------/-----___- Diameter........... Depth below inlet..........,b....... Total leaching area..!„,_�sq. ft. Z Other Distribution box (� ) Dosi g tank ) e r Percolation Test Results Performed by..._ .�y11/'�' / .��✓_ .... Date......'�._:'�1--." �!-.. a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.__ . _. LZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ ••••--••---•------------•--------...•---...--•-..... -- - ---------y-• --------•-----------------•--------------•---------•-------.---•-- O Description of Soil }! 1� 1 r �3-V ei..------ �� x w ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•- V 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 7"1T1 U 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 b r)f heal d- - �. •- -•- - ------ �•-- -rtsv i.-� •----�--- --•------•--Date--•--•-----•-- ApplicationApproved By.. .•----•--•--•----------•---......---•-•••................... -- --- Date Application Disapproved for the following reasons---------------••----•---•-------•--------•------------------••--------------•----------------------------•----- -----------------------................................................................................................................................................................................ Date Permit No..-..<.:.:.. _S---.0---------- Issued........................................................ Date FEs............. .........•. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tonstrnrtuan rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .....1 C'�'�'_. •�? �.�. :.r: ..: .: . Ea r7 :. , x�'J '. r'sY I l .f, a f ddress or No. " r 1 . r"Y ..!' ...i FY.r3._...d:.�' '_-.�1..._. .....{� a Owner 7 r /:Installer f/ �! x v ,--- � (� dd�e t , Type of Building Size �Lot=__ 11 S feet �-, Dwelling—No. of Bedrooms..............--------------------------Expansion Attic ( ) .��•+G rrUage Grinder ( ) Other—a Type of Building �•. . of persons..........�-............ Showers Cafeteria ( ) Otherfixtures - ... -------- Y--------------------------------------•--•----------------------•----••--------------... ------ Design Flow................... per person per day.- Total daily flow......_......,}. .._' ................gallons., WSeptic Tank—Liquid capacity..Z f�g allons Length_.__. �Width.._:._�.^- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length........ ____..__._ Total leaching area....................sq. ft. � 1 Seepage Pit No._..___.-_.J-------- Diameter.................... Depth below mlet...........f :-1.:f'_..... Total leaching area ft. z Other Distribution bol ( !) Dosing tank ( ) '-' Percolation Test Results f Performed by.....-z*.,?. '1 . ✓-....... Date...... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-___.�.!r_ 4A Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__..-_-................ a ........................................................:........................................... Description of Soil ........% : ..... �✓'t "wr ................................. U •---•----------------------------------------------•-----------•--...-•------••----••------....---...........--------------------•-••....... W x •--•••-•-•••-----------•--------------•----••-•---•••--------•------•------•-•-------•-------••-•-------•-••----•••-------•--------••--••-•---•-•---•--•--••-•--......--•-••-•----•-----•-•--....._..... V 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in P p issued Signed.... == ' = h. g ssu by the board; head a .a operation until a Certificate of Compliance has been _ •-v � �� A� ,.-�--� '' Date Application Approved By-•----•--•••-----��•--......°.1111i ;�. j E Date Application Disapproved for the following reasons---------------••------•---------------------------------------------•-----------•-------•-•-----•---•-........_ ----------•----•----------------•-•-----•--------•-----...-----------.....------••---...-------•------•-----------------•---------------------...................................... Date Permit No.... ------- >.. - - Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ♦.f (9rdifirate of ( 1intpliFanrr THIS IS TO CERTIFY, That the Indiv•d,-al Sewage Disposal Systemc�nsructed Z ) or Repaired ( ) q r772Y f !._:.._.. at e' Installer �•� ------.... �� ✓? E! ` ------. t v Z j r �3 y -•-•- has been installed in accordance with the provisions of TI T LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. �-_--__'i2R 2... dated__-.-___ n THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU T1+9 ATISFACTORY. DATE. 2 � � Inspector . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No'� ......................... FEE........................ Disposal Worko TOnstrudion rnmit ' t Permission is hereby granted------------------! -' Cl ( / - � f''1 /- C I v:__( to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ` 'Street -L'"�7 ' as shown on the application for Disposal Works Construction Permit Nd)..................�1�Dated_________ _________ rr•� ............... ------------------•--------•------•-----------------•---------•----•---•---------------------------•.•. DATE O r^� Board of Health �-I � ------------------ FORM 1255 A. M. SULKIN. INC.. BOSTON ? �t #V a, t a TO T, �+� 1 T�� (D O� "�G'� A#�Y ,�P�I f F"f�� tJ!43 L�•�i'�+�:+tx.. 1�1 % tilt-E t 7 _._- I �' t t ,T t�1Y OR �n . ,_Wes_.�___ . • j � �? F $ .• _,._ �( \)4J 41 1 5,6P7 ,rah PIS I?,/ q ,�� 6 "'lf 3�.... �� _ .. ._ ✓ TA i k"' J i�d..=`,'Y 'C� e_F t I ,P1 wY iz r i i , 1 . . 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