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Home My WebLink About0066 CARLISLE DRIVE - Health 66 Carlisle Drive Marstons Mills A = 122 138 ` APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATIO No VILLAGE des —1--j6 T-may V) xk- DATE APPLICANT FEES=�Z �s;`� (Non-refundable �v/J_ ADDRESS_3l. ��. �2 S:' ��s��, � aZ3 _TELEPHONE NO. S ENGINEER l�, !'�i 4�i _T _TELEPHONE NO._77J Dvs f DATE SCHEDULbD (Applicant' s signature . . . . . O . . O O . . . . . . . . . . . O . . . . O . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . .. . . . . . .06060000 ASSESSOR'S b11�P & LOT NO: 1�Zi3� SOIL LOG SUB-DIVISION NAME r't.1,0 -�>)-I4 7/ DATE Z - :7-e TIME EXPANSION 'ARE YES ✓ NO ENGINEER . ....y TOWN.WATER PRIVATE WELL C > �1 A BOARD OF HE4T= EXCAVATOR SKETCH.: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests locate wetlands in proximity to test holes) �z�• P P Y NOTES: 34 ° S r x�4f. . if 3 I �u c N GApL, S LE ( ✓c 44o' ' PERCOLATION RATE:_C TEST HOLE NO: / ELEVATION: TEST HOLE NO: z- ELEVATION: 2 3 3 r.. , 7 18 8 9 9 10 10 11 11 ' 12 12 AJO t. 13 13 14 14 ' 15 16 16 SUITAB'LE 'FOR .SUB-SURFACE SEWAGE: LEACHING FIELD_L/LE&CHING PITS LEACHING TRENCHES ✓✓ UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: 10TE: ;. .EkINEE'RING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION )RIGII4 :h+{ COMPLETED IN ENTIRETY BY P. E. ANA RETURNED TO BOARD OF HEALTH • y 1 7} ;OPY: .::; RETAINED BY APPLICANT / TOWN OF BARNSTABLE , SEWAGE # SIG 2 ®l VU- LAGE � t M ASSESSOR'S MAP& LOTAeg IS INSTALLER'S NAME&PHONE NO. J't"A n A. A—7 SEPTIC TANK CAPACITY C 6—a®§ LEACHING FACILITY: (type) (size) NO.OF BEDROOMS__ BUILDER OR OWNER K PERMITDATE: COMPLIANCE DATE: /e� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac bin fa di Feet Furnished by / d C � � a 71j�-e ��- i' �] 1 Yi 6 so 3 s t i No... :_ "Fee--/ - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Miqoal *pgtem Cow6truction permit Application is hereby made for a Permit to Construct( t/)or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. - Owner's Name,Address and Tel.No. 7-S YS 96 �o� C.4�d_e51 ��t✓E GAS r`� i 1�ts /C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.S'-d 9-`7 7 Z-(;a4 QOS H )9, g6a A�, ' /�W 1S47W.J*,. ¢ $/. /Vl� �i�•c .Ar A f� �A/Lbaf�� b-� 4nlrvis Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �rL S••`� 4t!� gallons per day. Calculated daily flow gallons. Plan Date - z-+-9l Number of sheets 1 Revision Date Title Description of Soil `1 -5: Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board oaepv Signed Date 0_ ?` 9 Application Approved by Application Disapproved for the following reas Permit No. Date Issued OMIO No. t � Fee j €�'rik��fiyi THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BAR-NSTABLE., MASSACHUSETTS 0(pplication for Migaal *p$tem Cottaruction Permit pplication is hereby made for a Permit to Construct( y )or Repair( )an On-site Sewage Disposal System`at: r Location Address or Lot No. 34 Owner's Name,Address and Tel.No. /7.g-95 -5-1 All, �o C,4 eLt 5 C;c .D21&,4 05Tr ZV'i LA/. )—J• Installer's N ame,Address,and Tel.No. Designer's Name,Address and Tel.No.f a 7--7 7 .11c /W 4Y q Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building PA m t L y No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow s..` gallons per day. Calculated daily flow ' r""'' ►�€3 gallons. Plan Date - Z4--9G Number of sheets / Revtslon Date Title Description of Soil T',;�.S /f/E >i u giLl Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of'the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of-Compliance has been issued by this Board o e 1 Signed Date " 76 �. R Application Approved by ; Application Disapproved for the following reas(61 Permit No. _ Aq Date Issued lr,� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-- BARNSTABLE, MASSACHUSETTS Certificate of Compliance. THIS IS TO CERTIFY,that the On-site Se*w-age Disposal System installed( Kor repaired/replaced( )on by� i for !-4 S�' as i as b n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set fo h bel•w: 0 No. / Fee P2 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS &Opogal *pgtem Cougtructiou Permit Permission is he by granted to h PA 14G � to construct(repair( )an n- •te e S m located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local rovisions or special conditions. All construction must be completed within to wo years of the date below. Date: Approved b l i { V4 I 7e� pit, j4p 8600 bZ I ' I cadr•--1 !-7's9S{. , Wit. rl Gf 1,5 Q/!/C� i o�L.Oo r i O wctiteh P-YEC'AN.�1.�P/GeC,�. r ' I -� •st9. s�z ap i 1,2 .,,ct. 38 rs t i .Cod 34 0 Xc' ;t 35 / eo I land { .: o - { N 4a� 0- - 3- t3.R14 .7 .' g S✓i to pit o� :�'cwtd tir2 (� .te ruitte;:l;q / c N 0/G .(OIt'l ccr c _ ei;�.r.. ),o4 31' cam, ilioivn on �:p.Cdvi tee= co�r�.e�lti 3y.; pa. 71. vim. cam%a 0,^ Al 3/ 1 td ..- .. _.... :.., Ceric�tro G (J TP a S 5O 1 TPI r�-.<e � 5t° Jcc%-?.e I 1'-<<0 t Jate`4-24=9G 1VU 1.ap e niu LeP�rit►uy - ad f . `94;0 Owl. r 54.4 •tcq bo- t I ca,,,�A i t !ln with owner cab0c.rt 'ao�-i.>!e7. /Vo; �cc-o e � �,_-°Jc-.i/�cbe=c✓%iu e ,i.n �r4rLt zfc✓ul, I 4 2 _�) bo,-CrzJ r P--;.�.� �: ,, .f✓ .. -_ �.. I - . ✓u�uCl►a Es,.+,:.c. •.,:a.w. r 'r�_.!'.fa,Ll+[7..¢ �`� 24•. 41 LAW 2 "Wwa :o$ 4 each, ad: 1M. -}— . ' S.. 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