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Home My WebLink About0176 CHUCKLES WAY - Health C 17(� TOWN OF BARNSTABLE F LOCATION LO� � � C SEWAGE # 9 'S 3 1-1 VILLAGE ��'C4��`S ��5 ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY 1 r�0 6145 LEACHING FACILIT'Y:(typP)_L�ta'�l vA (size) A, 00 1 NO. OF BEDRO0114S PRIVATE WELL O �PUBLICWA�TER'�- BUILDER OR OWNER �7� S/ ��d�j, (0. DATE PERMIT ISSUED: I/ 7� 9t DATE COMPLIANCE ISSUED: � 6" VARIANCE GRANTED: Yes No i '13`6 w a w V S: 4 �� L o !A r , No-1 el THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE�A/LTH �CJ i:�1 ,Qcler .........OF..............!4/ (..!q'.I/.. ........................---•---- Applira#inn for Disposal Works Tonstrnrtiun ramit 2 Application is hereby made for a Permit to Construct (L� or Repair ( ) an Individual Sewage Disposal I System at: ................__.........e�.�`f.o e!. t -.----- --------------- -.----.------------------..... ...4..----- -------------------------- ��L cation- dress or t o. . - � = ----------......................... ................... --..............._...- .. Owner a . .. . ---------------------------------------------------- ---- ------ Installer Address d Type of Building Size Lot...Z f_ e....Sq. feet U Dwelling—No. of Bedrooms.__..........3__ ______________________Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria p-' Other fixtures ...... W Desi n Flow....................... gallons per person per day. Total daily flow................_..3;�43.........gallons. g . 6 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 ( Vj Dosing tank ) '~ Percolation Test Results Performed by--------------- 44. .--_f....1'lyw.......... Date........ a Test Pit No. I.._._..Z-____minutes per inch Depth of Test Pit.......(_ ..._ Depth to ground water......:.'....... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P' ----•--------•------------•---------------•--------•------•-•-----••••--....._....._......------•---......................................................... 0 Description of Soil.................................................................. ---•--------------------------------------------------------•----------------------------------- •----m ! �............. W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature 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 TITL 5 of the State Environmental Code—The undersigned further agrees not to place the system ' eratio it a Cert.' is e of Compliance has been issued by the board of health. Sig ........ ---- -- -- ------------- ---- ------- ---....................................... ..... ...... Dgrd Application Approved By ........................ .... ............................. .-- .--.......---...... / Y / ce Application Disapproved for the following reasons- ---------------------------------- -------------------- ---------------- ----- -----.......--------......----------. -------------------- ------------ ---- ----- ................-- . --- ----- .........................-------------- ......-- .... -----...........-- -- . -- ----..-.---- -------------------------- Dare PermitNo. ��6. 3 --------------------------------------- Issued -----------------------.............................................. Dace f THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH .............. OcE 1��--..........0 F.............. �-!Z,; �y �9.4-6 ............................... Appliration for Di4pnoal Works Tonotrnr#inn Famit Application is hereby made for a Permit to Construct (�-'� or Repair ( ) an Individual Sewage Disposal System at: ................-........� r'lwrGl ...-----.i./ -` --•----------------•-----•-------� =' ....................................... ......................... 0n o �w -- ddress or Lot No. ..._. ... ._ .C!..... �= ••f-•----...---•-•.................•-------... ........................................................ wner Address ...... --------------------------- •----------- ••------------------------- Installer Address , Type of Building Size Lot____......,r....... ...Sq. feet aDwelling—No. of Bedrooms.______.____ ..........................Expansion Attic ( ) Garbage Grinder ( ) al Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -- W Design Flow_______________________ _.____._._gallons per person per day. Total daily flow.................... 3 .........gallons. WSeptic Tank—Liquid capacity� ._gallons Length................ Width................ Diameter.........._..... Depth................ x Disposal Trench—No..................... Width... ._.......... Total Length.................... Total leaching area_.__._y.._........sq. ft. Seepage Pit No............../.... Diameter-----------_.__..... Depth below inlet.......4?....... Total leaching area___ — ...sq. ft. Z Other Distribution box ( V/ Dosing tank ( ) / °'' ?�L `!?/� Date........................................l f Percolation Test Results Performed by................ _ ___ Test Pit No. 1...... -._._minutes per inch Depth of Test Pit....... _.__ Depth to ground water---------' .......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ....................................................,............•--•---------------------------------------------•------------------•••--------------------- 0 Description of Soil..................................................................... W ••--------------------------••---••------•------•-----••-•----------------•----••---•-••-••----------------•--•----•-•------------•------•--------•-------••----•-----•-•-•----••••••.................. 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 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 boy the board of health. l 12... 3�I �pSissgned -.. . r ... 1 a ApplicationApproved BY ---- - - `'-------- ---------- ---- -------------------------------------------------------------------------------- ------ /,D/y�-.. ..... 1 Dace Application Disapproved for the following reasons- ----------- --------------------------------- ------------ ----------------------------- - ------------------------------ . . --......-- ....................... ................................... .........................---....--.....---...------.......................---.........----..................... ------------------------------------- .. PermitNo. ��1 Issued ........................ . .. ... ............................. .. ...Date --.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ------------- OF .......... .........---,-------------------------- Cex#ificate of CIumplianre I IS 0 CERTI That the Individual Sewage Disposal System constructed ( [/or Repaired ( ) by 7 -- ........ --. --------------------------------------------------------------------------------------------------------------------------------------------------------- / �/ Installer at --------------�(.--.. f.--......... ... ------- ......'" " :....................... has been installed in accordance�with,t"he provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .110-757.511............... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .. ............................. .. ................ ... .. .. ........ ............ . Inspector .------ .................-------------------...---------- ....--------------...........------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !'!.�U(.`?.......OF......... 62: `C> :�? rC-' No.- �?,7�--- FEE. ................ Permissionis hereby granted -- ------•.------- -------------•---------------------•-------------..__...--•-----------------•----._....-•-•-_... to Construct (V) or Rep it ( ) an Individual Sewage.Disposal S stem at No.- & -•-------`------- '= ly 174. �r Street as shown on the application for Disposal Works Construction Permit No.�.0_�.�X Dated......2__^y_f.4Z._____._.___ ---------------•--------•--------•--•------------..................................................... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS G6¢ue WA`f c +o �Ill6t� G•�ll�l'1..`•( - .3 �31=]D1�o�vC "_ __ ��...�. _ _ _ d- -- -- -_ _ �__ _ -- - Grzi f.7C'1E: adtt_�( Flew s 1l0 -4 c � _ -�➢4.43 v, 33o,, �r7G %• �7 6^RD. _ ,. I.ai; y ti 2aP_ SA.L . htT USE-- t000 v. ✓tDE�t/�.t-1. AeE,A = t50 sF. '. I 1 i ISO -'S; ,c -Z.S s r.._ I- TO - A L T>ESIGW C ,...,.:�..,._.._- . Flaw s 33O 1?D � ' .lZC�L&TIOQ tZ� TE • �"lu 2hctu',oEz 1�55 Q� P� / c,' Rziiw�-- ,v .,SULLIVAN QISTER 29733 r, • 5.p n �.. �} � n- Tor F u �s9,S ._. LOAW �l•P 1 �� looc 1 uv, wv. S�83o�c 4,Po� a`sr iw. Gay. `z" Mv. •�X s5'(y SEIPT•IC 5�o' J K INv. GAL.. ' i 55 Z. q r WiT%4 e �.1 � _ WASi1ED � STorvE, �L=49 CCEZ.T1FtED L� I , PQo 't t_ T PL.A, of �� 1 •Gta:tZTt4=�{ -1'4.1AT _ Tt-1E. .�' p��V-�s '?"Jt�l`� Sl-lo�.vlJ �t_L>l�l R��`�cl�lG� ► F:F;Vbt.1 CCWlP _VG W I•CN TWE: 51�G.t_t►-ice ,,_. �.►Jt?;-'SCT1'��Ct< SZEQJIREA�tt.u�'y`' of 'c'►-��. 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