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Home My WebLink About0043 MATTHEW WAY - Health 43 M Aft H EW WAY MARSTONS MILLS A = 064 - 028-41 i Ov 41 w » i r : N � S, daA^ t syr iM1 a ti d� ^ r r g^` u� Y , 4i, y w„ a � t +S k{ y ' TOWN OF BARNSTABLE LOCATION�� i. SEWAGE #_. VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. &,V6o SEPTIC TANK CAPACITY 1d LEACHING FACILITY:(type) ,2, /&0-0 (size) NO. OF BEDROOMS C), PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER joutA (✓yam FznAg ii°ci`� DATE PERMIT ISSUED: / f DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No je a� 3� � i S6 � S�' i TOWN OF BARNSTABLE LOCATION SEWAGE # ASSESSOR'S MAP & LOT :INSTALLER'S NAME & PHONE NO. G o J7, SEPTIC TANK CAPACITY At 101, LEACHING FACILITY:(type) eL /CJBTU (size) oa' NO. OF BEDROOMS c:2 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Ja L o bl zlqo-,p DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: / n VARIANCE GRANTED: Yes No �r ° .23` w 3 o?�f 55 No..7r(-',174p ?4 l Fzs.:90..x�Q THE COMMONWEALTH OF MASSACHUSETTS 1104 BOARD OF HEALTH Appliration for llhiposal Works Tonstrnr#iun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at , . ................................... ...�z �:?-t...... Location-Addr ss o Lot No. Owner Address ©.............................................................'--... .., ®_.+tM.4 _�_.�.i..... ....if ®:........ Installer Address dType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms:`..........................._._ _._..Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type o Building .....:...................... No. of persons............................ Showers ( ) — Cafeteria ( ) Ga 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 ( ) Percolation Test Results Performed by................... •..................................................... Date........................................ 1 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........................ �+ ----•---•----------------------------------------------------------------------•--•-----------------......................................................... 0 Description of Soil........................................................................................................................................................................ W U --------•-•••-------------•--------------------•---....--------------------•------•.........--------•-•-•--•--•--•-----------------------------------•--------------------------------------------....•. W p -- '. U Nature of Repairs or Alterations—Answer when applicable.. —4.'--. c cQ .4L-•-------•---------------•---•-----..........----•---•---........-----.......----------------------------------------------------------------------------------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIME 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been Ws b. he board of health. Signed �t.:r4°:.I d.......... � Dater Application Approved By.............. " - = -------•-•� — . Date Application Disapproved for the following reasons________________________ ........................•...._. -----•-•--•-- ..................................•--•----•-•---...-----------------------...------------...---------------•--------•-•-••-----------•------••---------•-----------•--•--•--•--------------•----------- �` 1 r� Date PermitNo.........0 ?-----.vim f --------------'-• Issued....................................................... Date � t FES..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........1 OF. '— Appliration for Disposal Works Tonstrurtion Frrutit r Application is hereby made for a Permit to Construct ( ) or Repair (,, ) an Individual Sewage Disposal System at: -�A Location-Address or Lot No. ..... ...............•............---........................................ -••--•-•-•------••............................ Owner Address .................................................................................................. ....................................................:........................................... Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_______________.._.._..___________.____Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building No. of ersons____________________________ Showers f�-1 YP g --------•------------------- P ( ) — Cafeteria ( ) Q' 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 ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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 ------------------------------------•----------------------------•--•-•............................................................................ ODescription of Soil................................•---....---------------.._..----•------•---._...------------------------------------------------------------..._._......----•-------.... x U ....---•-•••-•••-••••-------•••------••--------•------•----•-••••-••-••-•••--•--•...•-----------•••••-••-------••-----•-------••---...•-••••--•-•----•-._....-•-••-••....•--•••.......................•-- w M ________________________________________________________________________________________________________________________________________________________________________________________________________ U Nature of Repairs or Alterations—Answer when applicable.._.-5____.� �_S :......`_...............................- _ - �c ..:.--�, . - -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT?,c 5 of the State Sanitary 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. Signed.__. t ,` f t .,�• Date Application Approved By............ - ----- ------.... ------- ------------------------------- Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------••-----•-- --------------------•------•-•---------------------•-------.....-•---•-••-------------...._._..-------•-•--••-•---•----------------------------..------------------------•-----------------------......_ Date Permit No........ --------------- - Issued-........... Date THE COMMONWEALTH OF MASSACHUSETTS � BOARD OF HEALTH ��J�,� ...........1.• ui!!1�`.........-OF.............. . ....... ....Q?r i ............................. dw Tntifiratr of Tompliancr THIS�S TO CERTIFY, That the Individual Sewage Disposal System constructed) or Repaired ( ) •------------------------------------•------------------_-_--------•-•-•-•-•-----------__-._.............---...._-------------------------......_ by.............•----�._ ..._...C%CAS �A Installer at---------- ---- --- 1'�--C9.� ...... ---- ----•---- ----- has beelinstalled in accordance with the provisWns of TI"' �-'' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... ^_,Z�_�._________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS'.A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. lDATE.......................................•-•-............_...--••------•-••--_._.. Inspector....--------------------------------•-------------------------------•-•-••••.....__. THE COMMONWEALTH OF MASSACHUSETTS J7/ BOARD OF HEALTH .......... .........OF...... .................. . ..... ........................................ FEE-. Permission is hereby granted____- - -_.__..�!__6___.__ to Construct`W) r Repair Individual Sewage Disposal System ....... -•--•- Street as shown on the application for Disposal Works Construction Permit No_ _ _ _. ___ Dated........................................... f Board of Health DATE_............................................................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS