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0200 CAMELBACK ROAD - Health
i i TOWN OF BARNSTABLE A / .�CATION 014 04 olne � AV7 SEWAGE # VILLAGE AW3149,yS / ////3 ASSESSOR'S MAP & LOT 474 , INSTALLER'S NAME PHONE NO. J e' v .s�'� C� SEPTIC TANK CAPACITY l0 0 0 f' �- LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �A r 9c f t S P.# vs - CL DATE PERMIT ISSUED: DATE .I COZIPLIANCE ISSUED: e5- VARIANCE GRANTED: Yes No i � j _ f Q 7 Finc ... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 F HE A �T�H ......OF.... Appfiration for Bispviial Workii Tonstrurtion famit Application is hereby made for a Permit to Construct (�T or Repair an Individual Sewage Disposal system at ---- ......... --- cati d;,, Np..,, 2—49� r W T 4 jV.... ................... .. ................... Owner Address —14— .... .. .... ................ . ......................... .. ..........Zj.. 7 Installer Address Type of Building Size Lot z/..7X_�.7...Sq. feet Dwelling—No. of Bedrooms.._......3_-----------------_--------Expansion Attic Garbage Grinder P4 Other—Type of Building No. of persons.......6................ Showers (.0, ) — Cafeteria P4 Other fixtures .......................... ---------------------*-----------------------------------*------- Design Flow...........J'a --__gallons per person i I e Total ably flpw-------- s 1:4 Septic Tank—Liquid capacity/.gallons Length..�./.... Width. ../o--- Diameter................ Depth.. No. .................... Width..... ....... Total Disposal Trench 7...... Length.........._.....:.._ Total leaching area..__.... ..........sq. ft. Seepage Pit No.......I------------ Diameter.........10....... Depth below inlet_....../--------- Total leaching area.. . .7. ..sq. ft. Z, Other Distribution box Dosing tank Percolation Test Results Performed by--- P,5;7 Y_ Y�,6 A J..jV�............ Date...._.'-. .—,FT7 ----- Test Pit No. I................minutes per inch Depth of Test Pit.__............._... Depth to ground water. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit...___..........._.. Depth to ground water.wo. 04 ............ . ...... --------------/� ---------- - ------------------------------------------------------------------------------- 0 Description of Soil.................... .... �4 ---- /V............. . ...... ................................................................................ U ......................................................................................................................................................................................................... ........................................................................................................................................................................................................ U 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 TL I Ti 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 i sued b the board of� lth.I/ ----_----_------------ Application Approved By................................... . ......... ........................... .....L-121..........:ko Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Dat PermitNo................................. ...... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 :........:...... ..:.............OF................. e............-........ ............................. Applira#ion for Disp.aii al Works Towitrnrtion jinnfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r .. / Location-Address . ......... --••--••-•----•--•-•-.•-- wn 7 ! / fo{,'� ,C""f r 1 ! 'T .......T '� ��J/} A(aaT ass � "� ._..__...__•_•........................ ...................................................... Installer Address M U e of Building r-_ T YP g Size Lot.�.,__r_.%_� ......Sq. feet._,_ Dwelling—No. of Bedrooms..------4 ............................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type Type of Building f-;V1P,.7_ ,. No. of persons--...- ?................. Showers ,'� — Cafeteria ( ) Otherfixtu es ............................V........................................................................ W Design Flow..._.._...';.. ........................gallons per person-per day. Total daily flow--._... .j?.........._........._..gallons. WSeptic Tank—Liquid'capacity : gallons Length..Y..,f..... Width."'.. Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area......-----------._.sq. ft. Seepage Pit No...-. ---- Diameter......... ..... . p G ..... Total leaching area.r'._..._._....sq. ft. =------- �: Depth below inlet.....:.:...... Z Other Distribution box (f` ) Dosing tank ( ) '-' Percolation Test Results Performed by.-;�.f.: , '.., �it:':-?'_ %/l'_!A/�.•_-__-_-__ -` �:__ `t - ('" a .... Date------- -•........... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground 'water........................ 0 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-'._/(.' -' 47 ---------••-----------------•--•-------•••••....--•--- � O Description of Soil................ �._ _ .f).).S_.k)/ • :/ � x -- •---- U ------•---••--•••----- ---------•...----------••---•••......-----••-•-•-------•-••-----••...••-•-----•-•-•--•-----•••-•-•----•---•----•---••------•••. ................................................. w UNature of Repai>s 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 operation until a Certificate of Compliance has been.issued by the board of,health. ..4.:.._... ..._. ..�.`._._...1 ............................... Application Approved By........................... -C'_`� ........ . ......................................... f Date Application Disapproved for the following reasons:............................................................. --•----- ---......._._ --•-----.....-•-----•-•---•-----------------•---•--------------•-----------------•--------...-----....._.--------•------•-------•---------------------------------•------------------------------------- ( 4. Date PermitNo....... --•---••--1.0 1.-___/_.... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r f„ .r r . . lei �t OF....j.`.. .sue_ /Y F�j -r', ram ..:...........-. . ...�........j...........�.V Tntifirate of Toutplutnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed •(c`. ) or Repaired ( ) �� } nstall r has been installed in accordance with the provisions of TITs F___ of e State Sanitary Code as es riQ the application for Disposal Works Construction Permit No-------- �. _. dated. -, 1CO THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATES ...............,Z�'...�. .". .�............ Inspector..4 -----•---•-----••----••---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /. ,............... .............OF........ No.. FEE.... :........... Disposal Workii Tuno#rt uan rrutit r Permission is hereb anted..._.r... .. ! 1 t� J -7- ' —` �a t , 'to Construct O or Repair ( ) an Individual Sewage Disposal System at No..- r^"-_ �._ ;.. �:.`-----------------------------•-------•------------••------------- ---- - ' J f .-re° -• / f' f t/ r� f ; , r street` e=-Cf l ,'.G�1 f- as shown on the application for Disposal Works Construction Permit No Dated.................1.... ...._._. .. - ...... •--...------•-•---------••---•--------•------•----------------•-----•••----•--••----......---•---•------ Board of Health DATE................ -•------••------...----••--------- FORM 1255 A. M. SULKIN, INC., BOSTON .GENERA fTpS : ,d l �"�. �'ATl�J'NLS SHt�11!/IV ARE +..� A+: ;1 17 `:/ J_ A.�,.�, ,�!l�ES TQ�f1'!,� !N THE' SYS7"Er�f 5:�1.d1., Q � (D a a ,. C,45T IRON 0111� SCftEPULE 40 RvC. C7 4 .4kk 5 f TlC T-4,61�-a PISTRIBUTI:.`N OO,h E,5 - € - U /��) (/(^}�} [j(J�) 4114P �e.4CI PlTs s�lA4 4 BE AE�r6�oE P � 00 0 J - Z346 NE 'TH Tr�/E JNYE h'T �1,EYAT/+�N',� / JJ�; S4�JJ7 !?Y - III cap fTH P®FElYSR,SO ° . , /srWNiCE - 14 _ - $! .S,4NP,dNP 6R,4 t/�'fi.'.hAlINv A PE"RCOL 4TIat :�`YPICA ,. PI T IBIMON C. ' :: R4 re OF Z MINI-17,ES P6/f INCH OR 1,6,5,5 - . _ = " O4RP OF HC,41,rH fV,5— uQ N0 TO %5C.4r.E TYPICAL ZVCIVIN6 Plr ThE , JT� lv0-E' P1,57-)1?1,60r/01V 50X ANP G,44,. NOT 7-0 SC,gGE 1616' /VO Tc/E" 14H�'iV 7WE 5YSTEllY/S IVEAR OBSE904TION PITS SEPTIC ;TX IV 3Y � n "�'`PIC. �,to 0...� ,�`1.,. EP1�"/C T,�Nk' F' C7, AT/Dry' dT 2 t l,�.► t► IC..tf .Af,Lr-1?,'C4/'V P.t'�C,4ST C7r`C EPLIA�, 7 L/NLESS OTHERW15E NOTE,P,41,k a5Y,5;rr`Af / MOT a sc r COIOPOAleENT� SHA4,�, BE rNST,4I,�,EI IN 0,5SEWJ14 T'r0/vC !3 Y-j xt-i�5 1,110TE7: T1-41VA ' REI NPORC6`P T/-1,�i UUGHOU T 4000,l?`%.4NC4' WITH Tl TkZ' ,Y Or THE'Sr,,4✓Z- tvkZ 1J -FA 6i�>LS- ffOARP OF HE,4 Th' L l rl-1 E1,17CTRIC ;,Y 12,C P Ik'/r rZ7 Z4 IZ, ,J S54NI T,4,47Y COPE ANP ANY J,OCA4, e411,90 ENOIN,, "rR: ARROW E`:NCIN,:c"ER11VG /NC E.�fBE�PEP �13TEE`I, 'AFOP /N TQp�C 807"r©xf. d�'flrCfl sff1,4Y Af�l�Y. ., J i 8� CONCR_� ,.� 1 4 C C00 I 7-E,5 T C)T — NOTE'-ACC E 55 AMIVAIOLE5 TO SEPTIC TANX' A AID 4,EACH1 IO P17V5 TO 3,E BUILT UP 70 ' ? .e-F7N1.5H C-RAPE IW GRA PC Oil,` ' T,4N1,C -rINISH 6 WRE" F/N151-1 0.eAD E OV+EZ? 41 - --� '"- _ _ /4 Pr-A5TOjVE _� h. �0 o e ac�c 0 G Jr �,a(e I€? CGf yr,tzEi,f4E. 51r,4�t36 OEX dfX 1t� .:. !¢ C� (tS?__ 1c0}oe6coy ;C.: QL151_.,l:E_. D 570NE 44Y C rJ °PT► v ,' � do 7ANK . —:_.-1NY BOTTOM T - t 7"0 BE .0 VEL :STA,3,LE rt n to, TYPICAL dEWAC7F, 5V5TEM P�20)i::7 E NUT T® SCAB., Do- 4UP isEC TloN PA llf cE'I,, 4,0 T -_._M���APPh'E5S L L ,ti 'U't7tl�/rV 'J�514'/ T' Fl r�'J 71,4 ,4 'G' . C?1✓ i CRITERIA` � -P C TIO OF El, I & � NLMfeeR Or EPROOM, E T P A . `�°' T E"�'1�'T, CG7A,f TC�LlR` _.___. ___� w__._ _...v._� a�%� s,;;E��T .�'.. � �RO�O �E CONTOUR ����rREK,$llrS PER �EpRCom OASL0V6 PER PERSON PER PAY ex ,5r .5POT IEYATION 8*0 � 4CACI-ONG REQUIREPLT— 'A fl/NG f'fi4 °!PEl� 41 w? PERCC7ZATION TEST NO P/.S�PO54 04\:TERV14r10N /'IT ,4�'�'`41C. N7 : ENGINEER C oAfZ Ac_Z R!L-ry"s ' sou Orb cie AT A0 60 E F,4L4104YrH HWY •5C.414`' M rr : tSHEE"7: e7i `1 C7 ice-4-7 57 BOTT _ cry? , . c � O ,---.� _ � �, �:.•�,� t ,/dtS NC)T�"a J,.�u� ►�I 19 8� r cry" r r. aR,,4la°Y'/1/ kq Y t;"'11E"CA-CP 46Y Af p 6 Y` Ple4N MO. 5 G 41..- E..:t n r' , - '....