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Home My WebLink About0110 CHUCKLES WAY - Health 11 0u ck �4 TOWN OF BARNSTABLE LOCATION LCI ZZ �� 5 W�f SEWAGE # VILLAGE �c5T��S �` ��5 ASSESSOR'S MAP & LOT/()/' INSTALLER'S NAME Sr PIiONB NO. SCoI( 72 L Lo` O SEPTIC TANK CAPACITY._1_s 000 (�Os LEACIHING FACILITY:(type) L2°,C,(A P, (size) cb NO. OF BEDROOMS PRIVATE WELL 0 PUBLIC WATER 2 BUILDER OR OWNER DATE PERMIT ISSUED- S 'o DATE COUPLIA NC E VARIANCE GRANTED: Yes No a �'ti1� S� �e ,� � �� Qa t.�� Z�. �� ( 9 I ^* C6 7— c;)O/ x No..lr - Fzs ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH :..............JOW!4........OF......... ----- ---------- ; 116 Appliration for Bigpusa1 Works Tnntitrnrtinn Vamit Application is hereby made for a Permit to Construct (tl/ or Repair ( ) an Individual Sewage Disposal System at: ................__....... -C.�1t� l a�'�y....... — -.....2z-..--•--...................-- Loc to -Ad ress I or t No. A -------------------- ---- ....................... ..---� ... _ 0. ................. ......�, 1 Address Installer Address Type of Building Size Lot......... [5,0.&Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (A4_) `4 Other—Type T e of Building l� �� ✓+'1i'e No. of persons............................ Showers — Cafeteria a YP g ----- -------- P ( ) ( ) a' Other fixtures .................................. W Design Flow...................:........�'�.....___gallons per person per day. Total daily flow__._..............._..___._...3.ao.._gallons. WSeptic Tank—Liquid ca.pacityAPQQgallons Length.,.............. Width................ Diameter................ Depth...._........... x Disposal Trench—No..................... Width...._............... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No............. ...... Diameter............. Depth below inlet..._..4......... Total leaching area....�P.sq. ft. Z Other Distribution box ( vY Dosing tank ( ) '—i Percolation Test Results Performed by....__'-P-i,.PXT-C-.n ._.l'_A.�$_5x......6Ni;t............ Date.......... ...- a Test Pit No. l.......z._minutes per inch Depth of Test Pit........ ...___ Depth to ground water......:�"�........ .- G%, Test Pit No. 2................minutes per inch Depth of Test Pit..._................ Depth to ground water---_.................... .......................---.................-..............................................-.........•--------................................................ O Description of Soil.....................?-t n !'m.r k -----� '----•- 5&o c�------------------•-------------------------•-•---............______.. x U •--•------------------ ••-•--------•--......----••--•----•----------------•----------.......----------------------------------..................................-...................................... ......................................................................................................................... .y_._...._____ _____...____.__.._.__._._ U Nat re of/Rep irs r Alterations—Answe when applic le..- __ ....... .- ? _ Agreement: �� The undersigned agrees to install the aforedescribed Individual Sewage Di posal Sy em in�*ac ce with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the syste n operation until a Certificate of ComphaW has been issued by the board of health. a Signed ........ .....-... .. .......................... ......0 6f t CJ. Da Application Approved B .. .... a-�--- �.� ".�f�...... pP PP Yc.5 Date Application Disapproved for the following reasons: .... ... ................ .... --..... ------------------.......................................................... ........................................ Date PermitNo. .... ....................................................... Issued ............................................................... Date r- No ••. ............ FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i N. z w ApplirFatinn for Disposal Works Tonstrnr#inn rrntit Application ig hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal System at ....•--•"�y-'--•.»__•---•-•--•� ,L --......� /.A.. ......• -••--•--•-••........................•--..� -----•. .........._...-- Loc�tio�ty.�`Address ��y or Jot No. .....»...t:.... _._»s.................taea�t�c ......".'�'L!........................ ....Y...:e'=_ -......._ __•..... ................ ner �7 Address _........................................................ ........................ . L� Installer Address of � Type of Building � Size Lot................�_____.»�.Sq. feet _, Dwelling—No. of Bedrooms.................:..........................Expansion Attic ( ) Garbage Grinder pa, Other—Type of BuildingZ - No. of persons............................ Showers ( ) — Cafeteria ( ) Q+ Other fixtures -------------------------------------------------- - W Design Flow............................ ........gallons per person per day. Total daily flow.............................3 f; ...gallons. WSeptic Tank—Liquid capacity.-9q gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------I------- Diameter-----------Y_.... Depth below inlet.......-......... Total leaching area.....gP .sq. ft. Z Other Distribution box ( !< Dosing tank ( ) '—' 11 D��l'? a - Percolation Test Results Performed by._...__-.�._.__.___ _ -__:_....._{_ ._.__.__�c: ____....... Date......... Test Pit No. L..._.__ «^"._minutes.per inch Depth of Test Pit-------- ...... Depth to ground water......"..._...._.. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••---•--•----••------------------------••-----•----...--•--------•........_•_..._......-•-•--.•---•......................................................... O Description of Soil......................5 tt�`l': ° ...•-•.t� t..................................................................................................... x U •--•--•--------------••----•••------•-----------------------•------------------------•-.......----•-----------•--•----•------•---••---•-•--••--•-••--••---------•----•--•.....-••-.....---•---•--------- W VNature of Repairs or Alterations—Answer when applicable............................................................................................... --•---------------------------•-------•------•-------------•--•---•--•----•---------..............•.-••-..--•••----•---•••••--•--•--------•-------------------•-•-------••------------••----_---_-----•• Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the p ,gf�ITLE 5 the State Environmental Code—The undersigned further agrees not to place the s ste P r i tii-d eutificate of Com lia e has been issued b the board of health. -1) � ----161 _1W4 __ G Soigne -- - Application Approved By .......... . ... ........ ....'b-�.................... .... ----------------------------------------- .................. Date--------'-------- Application Disapproved for the following reasons- ---------------------------------------- .--------------...---------. ...-- ------ -----------------............ . .. .... ....................... ... ... .. .. ............................................................ . ............................................................................. ........................................ Date PermitNo. ---------------------------------------- --- .......... Issued ............................................................... Date THE COMMONWEALTH OF MASSACHUSETTS —•-�- BOARD OF HEALTH :- OF j ........................................ . �t� � .:��( -' . ... . ....--------------------------------- Cer#ifirate of CITorttylianre ` 4IS I T O CERY, That the Individual Sewage Disposal System constructed ( X or Repaired ( ) o Installer at ........r... tom .-..... - f��eC' r -- -r ft /® + )... t ............... ..-- k ' has been installed in accordance with the provisions cat TITLEJ of The State Environmental Code as described in the application for Disposal Works Construction Permit No. L" ....,. 7s`�.......... dated -, ___. ...`7e.- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----/-d..'.".... -------IF8 Inspector .... ��........ THE COMMONWEALTH OF MASSACHUSETTS •t._ BOARD OF HEALTH 1 qqrr � 79 t u1�.J 6a,.tr� -7TaS4G_. No......................... FEE........................ Binpnp�tp nrkn "Top#rn rPermission is hereby granted....' -.4....- `�to Constr ct ( ) or Rep, 1 ( )rare ndividual Sewage Disposal S stem . at No.. .-------f......... c r:......--- t` Z... ------------------------------------- ••-•---_--.... Street as shown on the appLicatiop-for Di osal Works Construction Permit No...................... Dated.._..•......_............................. ) - l/ .........................................Boarder ea --•-•---• ---------- DATE ------------------•-----•---....---•--...---•--------------......•.........•... lll.11l FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Y zoo to GAtzanL� G2l,;.tv�1Z: • .... '.. ito -4 d G'•pt>. ITT-lC -nn, •V- = .33o, ISO % * 4§J5 6.F?D. z7pAl� 00C-.:, b � >15Po5A.L PtT - use:' loco Gp.L, , . _ � • � � sue. � I .o - 50 �.RD.• ��{j � � - _ 2, 970 TOT.&L 425 ToTA L 2Gbt_laTlOt.l tZATE ��tt.! �Lhtt1.l� 0rz LR_ss Ltd OfjB_ OF �y LJj,� g � � PATER N � 1, Rtt:HARD o SULLIVANEA BAXTER H No. 29733 r---- -I o 0 o I --_l-..___-.__.- No.2aoae 0, ISTEa � lN� sbNAL t. O w/ �� Tom_ Tor t� cfL-6-- 4-7L g8 F6=-1 I ,. 4 Y 77771, LG A.µf `lfiSpi� PPS IO�•oo IIN. 2 4r�PE 7>KT IW. GQL. c•'c: :r f -fix ! L S�nC 10 ,,•: TA►,tK (000 SrcAPFIED GAL. Gf�•2 �� . M PIT SAIJD WtTta - .. e� WASs•tED CECZ.'('tFiEv pl.o-1- PL./�ti1 Ptzo�t L_� - 1 Z U o Sc a.LC--- J WATE�- >' A l' T 11 GG' �I Ga -tF:lr tt5l.� GctPL�IS W t't'1-1 Tt-l;'= SI DC.I.t►-tom I �_-� _ JQ U t fZ E AA C uT-; O w Q c= !a! 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