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Home My WebLink About0060 SANTUIT-NEWTOWN ROAD - Health 4z(,v'f o ,Dn, - _ __ 73i UOS /O03 �1 ' TOWN OF BARNSTABLE � LOCATION N�&f,4J ICb SEWAGE # / VILLAGE S /LJ/LLS ASSESSOR'S MAP & LOT021-d0��--643 INSTALLER'S NAME & PHONE NO. 4FC� )V7 e4 I SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /,�O-%,S L)- (size) y /� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER /044guE DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: "`-9"' ZZ VARIANCE GRANTED: Yes No J i�� 6� �zfiz�� `` .1�► � �� ' �® �� 5 r`� '9 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applira#inn for Disposal Works Tnnitrnr#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair M an Individual Sewage Disposal S�tesn at ... - ._._ F a6LJAl �.---•------•---•---------. y�. �i S •..- Lo on- dress ................................. ........................................`/'d rA. I.....�_.............. (� ee® �/ caner�Q . 'n �/ �� d ress I _ L 5 /VJ ..... ._..s`... (..�..... `� .�sal•--•...• ............................................ Installer Address Type of Building Size Lot___ rJ.O_d_--.Sq. feet Dwelling—No. of Bedrooms...................:.,.;;_�----••-.--._-.-•Expansion Attic ( ) Garbage Grinder ( ) `PL41 Other—T e of Building No, of persons............................ Showers — Cafeteria Q, Other fixtures ------------------------------•-•--•-•-•--- ----------•------------------------------- ---------------------------------------- W Design Flow...................... �? ..........gallons per person per day. Total daily flow........_...y�rQ.....__......._....gallons. WSeptic Tank—Liquid capacity/Q4Qgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No:.................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........�-.. Diameter..__:.•... --- Depth below inlet.......1,�--------.- 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........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.------............. Depth to ground water.----.---.---------.---. W' ---------------------------------------------------•-------.........----------------------------•---......................................................... 0 Description of Soil--•------------------� --------- LSD/L.-------� ---- �f r x U ---•••-•-••-••--•-•---••••••-•-•---.......--••----------•-•-•••-•---•••-----•--•-•-•.........•--•-•-----...----•----•••-•--••-•-----••••-•---••.....--••••-•-•---•-••..........•-- w -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- __..._. V Nature of Repairs or Alterations—Answer when applicable...... ........... ........................................G .....•-•--••-•-••----•-•••--••--••••••-•----..........••-•-.........-••••••---••-•••••......-•••••-------•......---.............I........................... 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 bee issued the and of health. v Signed------ ---- ------ Application Approved By ----------- ...- --------- ----------------- ---- ..................................... Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------- --------------------------- ---------------------------------------------------------------------------------------------------------_................................................................................................... ........................................ --1... // PermitNo. ......... ---- ----------------------- Issued -------------------------------------..-..------------- -ate-------- Date No.._ �:._, Fps.. .. ti THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE -Appliration for Disposal Works Tonstrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ()<0 an Individual Sewage Disposal System at: /U&,Jiu e',JA1 Location- ddress_ o�I�t No. _.....- - - D• flF�.. '/LOAJ . ----------•--•- - ................................................ ............_...- ._._....._ Owner 4 Address --------- -----------------•••-• ........_..---.....---•••-------------•------_..a..=� .yam.....'-----� - — ------ Installer a� i Address � Type of Building Size Lot...1,� �� .-__Sq. feet U Dwelling—No. of Bedrooms......................./._.. ._.._Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers Ga YP g ----------'----------------• P ( ) — Cafeteria ( ) QI Other fixtures .----------•-......---•-------•. . W Design Flow......................:?__T...........gallons per person per day. Total daily flow............. ...................gallons. WSeptic Tank—Liquid capacity=grallons 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........................ PL Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ -----------•-•---------•---••...............•-•••---•-•--------•••••-•---•------•--------------•--•.•--•--••--•--•--•-•••-••-....----•-•--..__.....•-----••-- O Description of Soil---------------------1!.-.-2.._....../_ ✓vt ...SCJ SONG--•---` -----•- � r x ....-- ' /ll.�--`�'J� U ..............•-•---•--•---------•-------....•--•------......_........._........----------------•--•-------------------•--•----•-•-•--•--•••---•------------.....-----------._.............-----••--••- W U Nature of Repairs or Alterations—Answer when applicable_..... ........... ...... .................. ............... .------------------......-----------------•--•-•--•---...------....--------------------------------------.......----......_..--••-•-------•---•-.....-•-•---- 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 y---t-h---e-- do health. Signed ------------- �------------------.--- �--�......, . �/ 9/... �'� mare ApplicationApproved By ------------- p_ ...... ---------------------------......----------------------- Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------_..---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----................................... Date Permit No. ------- 1 - . �� ...... ............... Issued ------------------------------------ ................ ate....-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CITPrtifirate of (go ntlaCit ure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.... C'O.�ST;---------------------------------------------------------------------------------- Installer at ------------------------------------------------------------------- 10....0 ......... J`T"�l.AJ • ' 2.r...✓ / ............. 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. ... �o .-.../.. ..` ......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... -.-.-` ./...." -------------------------------------- Inspector....s... ' .. .................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE l� �•� FEE.�-.,��.� _� Disposal Works Tono#rurtion Orrmit Permission is hereby granted........................... l_L ......c. .......................................... 1 to Construct ( ) or Repair an Individual Sewage Disposal System t at No................................. 1Sa 4j..: L )�l. �--4 f ,✓J/1 --�1/I/� L ' Street as shown on the application for Disposal Works Construction Permit Nol,Z:Lr .L Dated.......................................... 1 q DATE.---••-•---L Board of Health FORM 36508 HOBBS&WARREN,INC..PUBLISHERS