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Home My WebLink About0990 RIVER ROAD - Health r - ZOWN OF BARNSTABLE LOCATION ° o- SEWAGE VILLAGE YVA �� I ASSESSOR'S MAP & LOT® INSTALLER'S NAME PHONE NO.CQ C I�Y.1�f;C�tS. Y77- SEPTIC TANK CAPACITY / 00 0 LEACHING FACILITY:(type) ) �f (size) f NO. OF BEDROOMS P VATE WELL OR PUBLIC.WATER BUILDER OR OWNER W' � k4t YIN DATE PERMIT ISSUED: 0 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r � I 9 �\\A �o , ,�.� III o II � I�- � � �, �t �� 14��, cuss o6(. � 0 �.N�w C. Q,� �4C.S., MAPNIk PARCQ.NO:. o V ; No...7 :a�_ - Fps............._............ prl�1 Sid-e— THE COMMONWEALTH OF MASSACHUSETTS �uK�Gt{'teV �Qo do f� BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal I. Vorks Tonstrnrtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair �Individual Sewage Disposal PP Y System at� �...-•--�o - .. - 06f,. .... ..... .. ......... - oca •...... •-•- --- .. ........ ..... Location- es r Lot N o. (•`,^ .. ._� _TY 1--`�'`e-V - --- L.. r�....... ...... ` Y'�. ........---..(� .......p.......--.. c Own �j], l ` \ rflddress -- ... Installer Address Q ,Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................ ... .._-•---_-___---_Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria WOther fixtures ...................................................... 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ........................................................................................................................................................... 0 Description of Soil.............. S R(� , . G.'�' �. ram•' `(�C� W ---••••-------------------------------•----•---•-•-•----------•--•----••-•-•----•------------•••-•••-----•-••--•-----•----•••--•---•--••----•- ...... U Nature of Repairs or Alterations—Allswer when. p�ic ble________________ _._.________ .___.__ ....................................... ---------------------------------{ 4...............1............... ..S....................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environm 1 Code—The undersigned further grees not to place the system in operation until a Certificate of Complia ce h s been slued by the 4oard o healt . Signed ------------- ----- .......................-... ...... . . ........ ---- ate D �r /..... Date Application Approved BY - Date Application Disapproved for the following reasons- ------ - ------------------------------------------------------------------------------------------------------------------------ ...........................................................I..............................................................--------------..........................--...............................Date---... ---...........................---------- qr V Permit No. .........1....V-- 5------------------------- Issued Gi e 4 '0 /7/ / 5 No-7ram. tom.-. J ? I�s Fps............._.... I THE COMMONWEALTH OF MASSACHUSETTS s;� e BOARD, OF HEALTH �u�v>Kev �jyU 4�i ff , TOWN OF BARNSTABLE Appliration for Disposal Worki Tonstrnrtion Vrrmit Application is hereby made for a P it to Construct Disposal or Repair l �an Individual Sewage Dis ( ) P (�'1 g P ., System a .• 1 � ��/`e� ---•--- - -..... ... - - -. -------- - -....... ..... _ ...-o-atio•-- .. �l� l ! \ � Q Y�ocation- iiFes� �1 �1 � � - �or Lot No. v7 ~ �np .........�..__..__..._ ._._...»........ ..... .._..._...._ -- ----•---- ---- ....... -•-•---------- 1 W �� Owne�� `^� J � ` ( uAddress M OS Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms_______________ ......................Expansion'Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................'Showers a yP g P ( );— Cafeteria.(...-). Other fixtures ---------------------------------------------------------- . .. W Design Flow............................................gallons per person-perrday. .Total daily flow.............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length----------_---- Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length___--__._...-------- Total leaching area......... ----------- 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to.ground water--___-_____-_.-_---_-_-- rX4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--_______-_-.-------_--- a -- - 1,7 O Description of Soil----------- �`' - - -- -- -- -- - - - -------------------------------------------------- ... - ----------------------------------------------------------------------------------------- UW --------------------------------------------------------------------------------------•------------------------------------ Nature of Repairs or Alterations—A swer whevp1ic ible---------------� ...................... .....__..___.._._._._.___-._______.____- -----In--------------- -----------------------11----------------------------------------------------------------------------------------------------- Agreement: 4? The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environnaen�al Code—The undersigned furthe agrees not to place the system in operation until a Certificate of Co once hla�sbeeo issued by the oard 011, ealt y Signe ----� w".. ............. ----- --_- ----- Date Application Approved By ........... .t, Date .- Application Disapproved for th follouSi g rearonc: ------------------- ........---......................................I.......---......------..-..------------------------------........-.....-...-.--............................................................Date...... ........................................ - Permit No. --------/...-C'- -- ..S� Issued �.... Ca -f�--------..Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE rttftrate of Cfomplia txe THI S TO CERTI Y,,,That the Indlvldual,Sewage Disposal Syste constructed (%✓ ) or Repaired r . by----- .. .--.....Ct..'c \- `'� 1. ✓ - - -- ..`� t -5 C `'-. ------ ..�....- p t alter x r - � ;.. ;. ...J �r \ `\\ atc.................. . -------------------- .-.... -----------...... ..-..... �C '...... Y� S' has been installed in accordance with the provisions of TITLE 5 ohe State Environmental Code as described in the application for Disposal Works Construction Permit No. ......... .. .•.- �� ... dated .-----........................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED ASzA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------..q............... D Inspector ------------------------------------------------------------- 'X, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3O� D P TOWN OF BARNSTABLE No......................... Di fro ork Tonstr,ulto�t4 ernt�� Permission is hereby granted `^t .�....`..... w..----•-- ---------------- �--------r........:...---.................-------- to Construct ( ) or Repair t an I v' ui}1 SewagelDyposal System 0 11 at No.............•-...---•--------....---.......---•-....._...__.tI.. �J ----...-- r -- �- �= .........I ( f Street t, as shown on the application for Disposal Works Construction Permit No. _ _.... Dated.... "_ ZA.�0__.... Board of Health DATE- -^-------.-•------•-•--•-••---•----•----------------------------------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS J