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Home My WebLink About1161 OST.-W.BARN. RD - Health l ! Lk) r i I i 5 i a H E r � O �r9 p 6 Zd CM T LLJ (CAM A w {�LLI CYIA TOWN OF BARNSTABLE LOCATION I t eQdt— ld, r&&A*Ut4"SEWAGI. # yd`3 ,-?d VILLAGE &� A. ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.jJ4?1teJ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /44 0 P• 4zt (size) NO. OF BEDROOMS 3 P• I OR PUBLIC WATER r BUILDER OR OWNER , DATE PERMIT ISSUED: ' 07 DATE COMPLIANCE ISSUED: 'VARIANCE GRANTED: . No ��' � l �� j �� ., ,� .� �� Y l No...: 2.: ?..` FEB THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrnrtuan Prrmit Application hereby made for a Permit t Const�ct ( ) or, epair ( ) an Individual Sewage Disposal System at 010 le, Dfclo .�.1.. .1_ -- ... .. ...... ......................... -1*17V • .....u`�' - -•-- Loca'o A essQ or Lot No. ... ...................... ......P..... .... .............. ... ............ ..............................................._.. ................. ...... er d ss aW9 - �---- -------------------- -- Installer Address Type of Building Size Lot.___aVW4......Sq. feet Dwelling�No. of Bedrooms__��........................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building ............... No. of ersons....._.._._..........__.___. Showers — Cafeteria a YP g ------------- P ( ) ( ) Pa 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........................................ aTest 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........................ ---------- -------------------•----------------•-•----------•-------------------------.------.----- 0 Description of Soil. x W -•••-----•-•----------------•--------•---•----------------------------••-•-----••------•......-------••----•-• ------ - -- x - �� V Natur of Repairs or ter ions—Ans r when applicable..�1i _ ._. ___`_._._._ �........... ...........:................. 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 bbeep issued by t oard of health. Signed . .... -. Date Application Approved By ----------- --- ----- ---�`- BZD� - �� Application Disapproved for the following reasons- ----------------------- ---------------------------------------------------------.................................................. ......................................................------ -------------------------------------------------- ----------------------------- ...... Permit No. � ........................y ..................... Issued ...�.a......../.. Dace Date No.. - - r: Fps.. _ ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,, TOWN OF BARNSTABLE Allpliration for Diaposal Works Tnnstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Re air ( ) an Individual Sewage Disposal System at ... /:.. M&.........................., . R... .:..._..._._......__ _....._._.._..._.._..._---.............__.._..__...--.........__._.._..... Location=Addesst or Lot No. A = ------- ----------•••--••••--------------...................:...................._........................ W Owner (� t Address,e /�-� p•-._...... ............................. .9 9� � .9 �- . Installer Address Type of Building Size Lot...r__ ..-_._Sq. feet U Dwelling-1;4o. of Bedrooms..3.....................................Expansion Attic ( ) Garbage Grinder ( ) aOther —Type of Building ............................ No. of persons............................ Showers ( ) — 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_---_-_____-_______-_ rl� Test Pit No. 2..............`minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q ---------------------------------------•----•--•-----------..............--...--......--.•.........-----........-------------...•••--.......----- Description of Soil%- !_ !. . V .....•-•••--•--•-•----....••-••-••--•-----....•-------------------------------•--•-•--------•-••-----•---....-----------------•----••--•-.....-------•-•_....._....6...._......._.... . U Nature of Repairs or Iterations—Ans er when applicable..�.! A___� .....J..-_�f,19..... .. ...................... :..•--- -•---------•---•--=--••-•--•-••-•-•-...;V=-,eX�ly--------------•--•-------------------------------•----..----------------------- -----------------------•---- 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 he board of health. 01-149 Signed ..mac- --------------- .................................. .... -'2..`. Date Application Approved By .. .� V ----------------------- Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------- ......................-------------- ------------------- ...........................------------------------------------------------------------------------------------ ---------...................................... ---- --------............................... Dare Permit No. d ' ?�--------- -------- Issued .- -Z' -------- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ce>r#ifirate of Compliance THIS IS TO ER IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by ................../)...� .;.......1F 2 I(�--/ - ..------.....------ -----............................. ..... .........---..............------------------------------------------------------------- Installer at ..! W .---- -.... _............ /= �.4N. -- has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....:/ .. .��..�.2�.... 9.. dated -......s/`(-----------------_....-..--... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED" S A GUARANTEE THAT THE 'SYSTEM WILL FUNCTION SATISFACTORY. f DATE.. �... �.ly .............................. --------------------- ---------------- Inspector ----r ......----f--..._`_................... ........... ------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I __ CIA TOWN OF BARNSTABLE �j/� No..... .�........s,,..... FEES Disposal or Tu strnr#ion "Prrmit Permissionis hereby granted............�_-�----•---------..... _-----•------...---•--..............---..................................--•--- to Construct ( ) or Repair (x) an Individual Sewage Dis oral System at No................ 11/ i _ t Street as shown on the application for Disposal Works Construction Permit No..p27^3g�Dated.......................................... -•...................•--- ..;� - Board of Health DATE.................•- a FORM 36508 HOBBS&WARREN.INC..PUBLISHERS