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Home My WebLink About0026 LAKESIDE DRIVE - Health log-- oo� - �M - rn �� LOCUTION ' - '' 5EWo6,E PERMIT QO. .a to _ — �/I LL p G E 1N► S-la✓►S Z±ir La — — — — — W5TNLLER 5 ULME 6 ADORE5S _IR ,.�. ocviuj'-! j�r CO2sT— — _ — . VOC41SAL-et_p�j� GUILDER 5 ►J &MF- 4DORE SS DUTE PERMIT 15SUED DD.TE COMPLIW.ICE ISSUED ��— 7 . C l eu— _ a � � r TOWN OF BARNSTABLE e► 1 � LOCATION SEWAGE # VILLAGE 'ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. I SEPTIC TANK CAPACITY I LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: 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 leaching facility) Feet Furnished by' ASSESSORS MAP NO. _ PARCEL N0: � No...91.---�S,:?_ -- -- Fps............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH j. A g R a t 1lb D nTOWN OF BARNSTABLE 04nstable Con ervat on Comm n Appitrati l � Di-qVviial Workii Tomil.rnrttun Errant Sj%Q9ftion is hereby mtAftJor a Permit o Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ............. ......... --•--•...............................•-••--•-------•-----•----•--••-•----•------•..............--- r?Locatio(]/}.Address or Lot No. .......... :�. R....l.[�.4uL K.:..Ik�lli.... ............................. ........ Owner Address t WW1 -•''�= ��?:�.Ga.S.tJl.l!q._........................................ ---x`•'--�-•-•—flf_.Jc,....!ZLC-&�c ......-•-•---••----•----.. Installer Address PQ Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........A............................Expansion Attic ( ) Garbage Grinder ( ) PL, Other—Type of Building ............................ No. of persons..........4_.............. Showers ( l ) — Cafeteria ( ) Q' Other fixtures .---...---•-•--••-••---••-•••-•. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..t�.gallons Length__`. ........ Width__:_e.t'_....... Diameter................ Depth._`!t:2....... x Disposal Trench—No. .................... Width.................... Total Length................... Total leaching area....................sq. ft. Seepage Pit No...YadC>------ Diameter.......1e.`..__..--- Depth below inlet---in.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date..................................... a Test Pit No. I................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........................ 04 •-------••-------------------------•--- ..................................................................................................................... 0 Description of Soil........................................................................----•----------------------------------------------•-••------------••----•----•----------_---•- x ....................-------............................................................................................................................................... U Nature of Re irs or Alterations—Answer when applicable_.... .............l:__�._. ----------------------•-------------------------------------------------------•------------------------------------------------- Agreem nt: 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 y the board of health. Signed ---------------- --------------------------------------------------------- ....... .......... .,.�-+ to Application Approved By !r� f /Dat Application Disapproved for the following reasons: .................................................................................................................................. ------------------------ -------- ---------------------------......... ---- -- --- --- --- ---- --------------------------------------------------- --------- ------------- ---- - ----------------- --------------- Date PermitNo. .... .1 .............................. Issued ........................................... Date -THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH =� TOWN OF BARNSTABLE '1 pfirationfor Uiiv.as al Works Tonstrnrtiun Vamit Application is hereby made for a Permit o Construct ( ) or Repair {x) an Individual Sewage 'Disposal System at: ..........-- �° t.k.r i�.r....�?- ........ -�-7.o..l..l. .�-V -•......................•---•-•-•-•---------------•------•-------....------------................. Location-Address - or Lot No. ...... ::.: �1?:.:._.�/Z;lr:=. ....Ff I I-•---••---....---•---•---•.......... ................... .-. .................................•............ ^� Owner Address ... '�I x�.. C�( J! j/lly + Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........e�.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------•-------------•----•------••---------------•---••-••----------.........-•--•--•......•--....... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_.irx.....gallons Length._`, ........ Width....... Diameter................ Depth................. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No... ' ...... Diameter-------!4`........ Depth below inlet...'.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fi Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ R; ---------------------------------------------------•------------------------••......---------.....-............... ---..... -------------- ----------------- .-- 0 Description of Soil............................................................................... --------------------•---------------•------------------------•--•---•-----•-----•-•••--- x W ----•--------------------------------------------------------------------------------------••-----------•---------------•----------• -- x ��, U Nature of Rep 'rs or Alterations—Answer when applicable_____ V___ _.__.._._..._�:_....._.�.....__.__..__._.__.._..__._._��':. __ �.�� 42 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 by the board of health. .. //t• /�, l Signed .................� a.. .............................................. .............----------f---/..--------=------- D6ce �_" ..-� Application Approved By r.�.-.��... - - ---- -_---------- ----------------- ------------------ ...1 D / / 13 Dar Application Disapproved for the following reasons: ...... ------------------------------------------------------------- ------------------ -------------------------- ......------ - ------------------------------------------------------------- -- ....................................... PermitNo. ...- ------�--��----y---------------------------- Issued .---------------------------- ................................... Dare Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CPz#tfirntr of Cgompltana THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b U Installer at -----------��......4 Sl. .�� -------n/1.ru'.!� ...................................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code"as,ddscribed in the application for Disposal Works Construction Permit No. ---.-�.i...�s--I— ......... dated ..........�v !�.�.�'.r!............... 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 TOWN OF BARNSTABLE No ��..... S 2 FEE........................ QJOL Permission is hereby granted ----------...................1�--•-••••-------••••-•---••---••---•---•••---•.......•••---........•---..._.......-•.•---- to Construct ( ) or Repair ( ) an Individual Sewage Dis osal System atNo...-- -�_=C'-7---•--...)_c�<�S.JC-------•-...C_t...................................." t� -----------------------------------------------------------------------------•---•... StreetJ� as shown on the application for Disposal Works Construction Permit No---------------- - Dated.........._--_..L-_.._.................. ------------------------------------------------------................................................ DATE.........1 d �! Board of Health -------•---------------•------...... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS