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Home My WebLink About0266 RACE LANE - Health 266 RACE LANE Qr vns hri :1LS i r i . _ f TOWN OF BARNSTABLE LOCATION PIA C £ J_J SEWAGE # f 151- VILLAGE �I�/��%D�s /7��Il `ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY III nn LEACHING FACILITY: (type), L��G�� ifAve (size) NO.OF BEDROOMS BUILDER OR OWNER ��i��✓ `/00 '�- PERMITDATE: g 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 � a;o S ti� �l� �� ',� � f _ 6 1- _,. No.3-ti-- .l,rZ FEB ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration fur Diripuuul World, Tomitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System --at: //�� ........... `�!t ...... ..................................... ................................ ---••••--•-•....._............................................. --•-Loc•�t .n-:\d`�`s �J-I• ••--or-Lot No: �,,,L'._-_�":_�................... { -•----_•. .......................•---- O, icr Address •- Installer Address Type of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms._�___________________________.__._Lspansion Attic ( ) Garbage Grinder ( ) 0 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) —. Cafeteria ( ) dOther ures --------------------------------------------------------------------------------------- ------------------------- W Design Flow.._....S...>............................gallons per person per day. Total daily flow.. c ..__....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width.--__-____---_.. Diameter................ Depth................ x Disposal Trench—Np. .................... 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........................ (T Test Pit No. 2................minutes per inch Depth of Test Pit--------------_..... Depth to ground water........................ 0 Description of Soil------•......................•-•----....------------------------------.._...------------•---------•-------.......---------------------------------------.....•-•••___--- x U ----•-•.....•-•--••••...--••••---•--•-••--•••--••••••---•------...••••-•--•-••-••••-•--------------••-•-----•......••------•••-•-----•--•••--•----•--•-•-•-•----•-•-------•--•---.........-•-••--••--••. W x ••. ..................................................................................................................-................................................................................ V Nature of Repairs or Alterations—Answer when applicable---- lQ10___C2 -..... ._ ! •-._.--_•. ..--•--....._ ?�4�. 7 �....--` "I. ' ....�() _ ..14 --------------------------•-••--------------------------.........----......-...--•---• 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 f rther agrees not to place the system in operation until a Certificate of Compliancetha_5J�2e_,en is. hea Signed .... . .. ........ .... ........ /z�........ � ......... ............... Dace ApplicationApproved By .............. .1.......... ............................ .. ........................................ .....�Q...- .�..--e.. it Dace Application Disapproved for the following reasons: . ... ..................................... ................................................:................................... ...................................................................... . . ................. ............................ ... .. .................................... ........................................ _ Dace PermitNo. ............ ...../_ .—_. .').... .....`........ Issued .................................................................... Dace i y . � itqq cq� No...1..y'. _l.. FEs......: z ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF . HEALTH TOWN OF BARNSTABLE Appliratiutt for Diriputital Wurltu Towitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .......... n.. ....Yf. c = ---------------------- -----•--••-••---...._... --------- . .......-`----------.._...........--------•- Location- Wjr -; . ( ... or Lot.No ................... ,� �- - Oa ner Address �4 Iustaller Address d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms.-_"5...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otheri�tures ............ -- •............••••...---------•---------------------------------------- ---------•••••••--••-•-••-•--••...........-----••-•---.----•- w Design Flow......."..?............................gallons per person per day. Total daily flow__��0__......................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 Pity 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 •••••-•••••--•••••-•-••------••••-•••••---•--••------•-•-••-•••-••--------------------------------------------- --------------------------- .... .---- -... ------ ODescription of Soil...................................................................................--------------------........----•---•----.........--•--.................-----.------ x w --- -------- - - - -- ------------ ----------------- ----- U Nature of Repairs or Alterations—Answer when applicable_A4.0 Oj--.nwe-__....Y.,..11..12.._..n0.............. 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 ofhealth. Signed ------ ..( ...------ -- . ......�...�........`.....�......-...�......y�. Date Application Approved BY ................ ......................................................... ...../!..:=.. /Dare Application Disapproved for the following reasons: ...................................... .. .................. ....................... ...............------................... ........................ ... ............................................ ............................... -- . -- ........................... . ----................................ ........................................ Permit No. ..._9?' Issued ---------. ....... r................... ---........:...........Dare .............................`....... .�.�._.__�.--- - -- ..mac-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (1-Ertifiratr of 11 l!..��omplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .....:------------------------------------------------------ . .....t 4... r�- .K�t Qa-` `��?r -----------................................................................................................. at . _................ lr :(Q........ .. '_,.__ ^.► -------_------------------..-------- ....._............................................... ._ has been installed in accordance with the provisions of TITLE 5 of.The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... ..-.. 7_� _ 7v.._ dated ..._._...................._................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....�i�'-.'�....�..-------��.4'Ir-._...- - ..... lnspecto�_.�c=�„f�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..... f -��- FEE. ................. Diupuuttl Work,5 Tunutrudiun "rrmit Permission is hereby granted.......................C.-.4._4o_P...n��z Gt _•C _l./elz.r.� ................................................. to Construct ( ) or Repair ( ,�,an-Individual Sewage-Disposal Syst at No. �_ !:....•---.-� sA r ' ................. ` f Street as shown on the application for Disposal Works Construction Permit Nol.-1'=��`Dated. -� ..y....... qq DATE................. _ .....................•... Board of Health �.�.._-_..��..--.f. . . FORM 36508 HOBBS h WARREN.INC..PUBLISHERS k\ iy ,fu o 1{ RELOCATED FRENCH pJ W w (. 16'-0" DOOR �G 15'-�113/16" I IROOF WINDOWI I I ROOF WINDOW � M I Al I 00 r 4PUJ\/ i PROPOSEIY ADDITION o i `D 7'-7 7/8" o 0 5)-Q" 3'-4 1/2" o - 2'-6" in i o 0 DOUBLE MULLION 2t- WINDOW 44 �N d�