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Home My WebLink About0217 LAKESIDE DRIVE - Health 217 LAKESIDE 1�F�vp MARSTONS MILLS A= 102-169 i Ion TOWN OF BARNSTABLE LOCATION , lt �� t , SEWAGE # -7,3 VILLAGE , fA0% 1`S . W�`. ASSESSOR'S MAP & LOT/4,Z—/d INSTALLER'S NAME PHONE NO��er .� _®34 -g SEPTIC TANK CAPACITY ` d L Low LEACHING FACILITY:(type) �' _ �"�C'7 (sue) ®Gd �- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ®�'� &a�4e-s DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No `a 61.�,Jlf 43 ,Za I ° ' ► D No. ---....... Fas.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diopooul Worbi Tonitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (b4'*`an Individual Sewage Disposal System at: -- �?.J.1 La ties o o e �� . �= °l �, `' Locati n-Address or LQL No. �1...i.A. e Gt.......- — f�` ------------------------- A! ---- -Ke-S-a ........ _!a_q Owt r Address a �_ -Y)� Installer Address UType of Building Size Lot............................Sq. feet F. Dwelling— No. of Bedrooms...--.-.--�---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures .................................. W Design Flow--------------------------------------------gallons per person per day. Total daily flow-----------------------.....................gallons. 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 ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date.----------- -------------------------- ,� Test Pit No. I________________minutes per inch Depth of Test Pit___---____.-_--.-.-- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 �/ T ............................................................................................................................................................. O Description of Soil......................- -- 4. U ---------•----------------------------------- ......................... z-----------------------------------------------------------------------•---•---•------------------- --- -------------------------------------------------------------------------- ------------------------------------------- ---- ----- --- o t a U Nature of Repairs or Alterations—Answer when pplicable---__----�.k-.h'l_{ ____ _________�..�__--......... \C Q00 2u�-•-=----•-•--1 ��------. ,7.f......--1-"j'.0t---------------00.8 41 II 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 Comp�ce has een issued by\ e board of he the 3 —� V Signed ... ....... .. Ta �� Date Application.Approved BY . ........ .. ....��'�._.------..__----------------------------.r-.......- 3 -�a g � ........................ Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------- --------- ----- -- ------------- ------------- ------ --. ..3.....a.... y- 2� ' / Dare Permit No. :...................... - ....... Issued _..................�.....�....v�..�.^9.5 Date I QQ � 7_3c� Q�cel j Q - No.....1�....... FEB......................... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diljip gal Wor1w Ton61rur#iun Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( n Individual Sewage Disposal System at: Locatio�-:lddress or Lot No. ................................ t Own' r � Addressi ---------------••- 1 d, - •-•P --•-m4 . Installer 1 Address Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms------------ ---------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ___-.--_-- No. of ersons---------------------------- Showers — a g ------------------ P ( ) Cafeteria ( ) � Other fixtures --------------------- W Design Flow............................................gallons per person.per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv_._.__.....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. t Z Other Distribution box ( . ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 04 Test Pit No. 1-__._--._--_---minutes per inch Depth of Test Pit...---_--__--____- Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water........................ 9 ._..._..•-------------------•-----•...__.....-•'----•----••---•----•......................................................................................... D Description of Soil �� ... �, --------------- V ----------------------.--_----------•--.._._._....--------------•------ ��'.�jr�E- ....-----................................................................................................... ---- U Nature of Repairs or Alteration"s—Answer when plicable._.---.. .m__ .___.�?...... ____�.��.__...._ +5 °Cv� FOo ¢ � � � 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 operation until a Certificate of Compliance has been issued by the board of hea h. Signed ._(jaA. �t`... ......`..: {�.. ........ 3...—Y3 IS.... Dace .11cation.A roved B f ....`�4�..r1...-��....... DPP PP Y ------1'�. .. .......�..' ,-............... Dare Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- -------------- -----------------------_......--------------.....---......_._....---......--------------------------------------------------------------- ...�3..�a. .-g. ... lS / Dare Permit No. :............................... - Issued ....................�.. 7 ;� Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifirate of Complianre THIS IS TO CERTIFY, That t e Indivi ual Sewage Disposal System constructed ( ) or Repaired (-)( ) by ......- - r_\ ._L4..........CA(- ----------- ------------------- - 0 J at ------------------ ------------ .✓ � 5}- fl.� �_' - '`. ...... CA _...... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as describe in the application for Disposal Works Construction Permit No. QS.-....73.-Y- dated .. - ... r_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE, AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ---------------- .. ...... ,'.... Inspe for ' �•� . THE COMMONWEALTH OF MASSACHUSETTS � � ��-�`� e�\�v es BOARD OF HEALTH YY) 1 D 9` No. .. �3 �1 TOWN OF BARNSTABLE Q 6q r' ..�- FEE._ .!�.�.... Rnpmat nrkii TAT ivtt "rrntit f Permission is hereby granted.....t...��._ ?.w-------------....... .C_ •................................................................ to Construct ( ) or Repair ( an Individual Sewage Disposal System at No. -••-----------•-•-••---r �"1.-...i s-`- ' '�`t� -� ..� �... .0 Street as shown on the application for Disposal Works Construction Permit No�s__�3_ _ Dated ..`�c� - ...... _��. `fix .. ---------- r _ .J Board of Health r DATE ------------ --------------------------•-••-- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS