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Home My WebLink About0081 TUPELO ROAD - Health 81 TUPELO R Marstons Mills �, - - A = 057 — 108 - - TOWN OF BARNSTABLE LOCATIOI,F T p z / A,�,4 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT O'Y-7 /OS( INSTALLER'S NAME 6t PHONE NO.A 2 e_H 6ws i q!� 2 SEPTIC TANK CAPACITY J o d S LEACHING FACILITY:(type), PP � C.as r (size) 4*a0e9/3 STo,yg v~ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER A 2 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t/ �'9gPG r too q 3 b r I No....gl.-. �. f F�a....... .L :. ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �.ti1.... .........oF..... 25 fL `. App iratiou for Uhipati al Workii Tomitrur.tiun Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ....... ??�-Lo.................. .... .••.---••••---- ............................................................. f..A.Le................. Location-Address or Lot No. r ....... f......... ........................................ ...........••••••---.....-••--••••-•----.........•-----.....••••••............................... a Owner Address................................{r ..... ............................................ ......................................•........................................................... Installer Address dType of Building Size Lot.AS ........... f t U Dwelling—No. of Bedrooms......AA.................................Expansion Attic ( Garbage Grinder )C '4 Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ------------------------------•• . •. W Design Flow....... .5Q1•-.._....._..gallons per person per day. Total daily rflow........�.`a.Q......................gallons WSeptic Tank—Liquid capacity.1 allons Length..�.-�!... Width-5-_-a.-__ Diameter... Depth..:_.":;;L_. x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------- Diameter......lz........ Depth below inlet_.s15.......... Total leaching area.. 90......sq. ft. Z Other Distribution box (YE�5 Dosin tank AO ' aPercolation Test Results Performed by--- �............... Date...Z`., _ ............ a Test Pit No. 1....L%?....minutes per inch Depth of Test Pit-----tt s .____ Depth to ground water_ .QT� CQf�a� G Test Pit No. 2................minutes per inch Depth of Test Pit________-.--________ Depth to ground water........................ a ••-••••-••••--------••-•••••••••••----------------------------------------- .......-•--......------------ .......r� W .............................. --••...••••--•-•••••-----------..........•••••--••••••••••-••-••-••••---•••••••••--.....--•••••-•------•••--•-•••-•••-••-•••-•••-•--•••-••••••............-••-----....... UNature 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 Compliaace has been issued y th ao of a th. Signed . - --- ---------- ------ ----- ------- ------- ------- - ----- ----- ----- ------------------- Dare Application Approved By --------------� xv ......�,�.r.�ti.,.�w. --- Da[e Application Disapproved for the following reasons: ....................... ......................................... ..... .... ........................... .......... .... .................... .................................................................... .... .... Dam Permit No. ......... -- .--5-rX- Issued Date No.... 1. .. /..�� Fim.......to..P..... THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALTH t \,J "1,.................OF.....►��..........................sal ~i 4 r Appliration for Disposal Works Tonsirnrtion rrmif Application is hereby made for a Permit to Construct ( NJ or Repair ( ) an Individual Sewage Disposal System at:77_7 u. ; ........... ............... ..................................................................................... . .......................................... .................. Location-Address - - -•------- -••••or Lot No. •____..h..-'a_I_____..._ ............................... ............ ..._^^______-^•__•••_______....................____ Owner Address W __ .__ a ---------------•-- ----.._..------------....... ---..._... ...... ... Installer Address �r Q Type of Building Size :�..A..........Sq. feet Dwelling—No. of Bedrooms.......`A.................................Expansion Attic J, Garbage Grinder (YZ)3 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) G.I Other fixtµres --•---•-------•...------•--•-••-••-••---••-•--••------•••---••--•-•---••---•-•••-•--•-----...--•-•-•--........•-•-•---•---•--••--••.................•- Q a 4-� __________.gallons per person per day. Total daily flow....... W Design Flow......... g P P P Y Y gallons •. ..... . a WSeptic Tank—Liquid capacity..!. allons Length..&-!' ... Width_`:._:-.�?.-_ Diameter_----------------- Depth._ '?..._.... x Disposal Trench—No..................... Width.................... Total Length.................. Total leaching area....................sq. ft. Seepage Pit No.__----.5 .-___.... Diameter-_____t. -._.._... Depth below inlet..'.?_.'......... Total leaching area..� _�_._...sq. ft. Z Other Distribution box (CI Dosingztank (91.)0-4 t Percolation Test Results . Performed by k _ . .. -..� ._.......".....�................ Date__.._............. -.�?...._..._..... aTest Pit No. I..... : .__.minutes per inch Depth of Test Pit-----1.4=S...... Depth to ground water_Nc= _ !. c�� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ,� O : Gra�til .� .� i CLI"� ��,t ?'fit _ Description of Soil =" ---------•-- '' -- x W -•--•---••-•---------------•-------•------------•-•••-•-••-•--------•••-••-•---•-••••••---•••-•--•-----•---•---•--------•-•-----------------•--•-------•-•••--•--•-••-------••......--•--•.....-----•••. UNature 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 Compli ce has been issuel�y th o Hof alth. Signed G�j:: ��2 / __ .f Application Approved By ------------ . .........�.� �}^,. �.e�^-�--..... ------ate "•--�� Date Application Disapproved for the following reasons- -- -- -----------v---------...---------------...-------------------.........---...... -----------.....................------ ----------.......-------------------------------------------------------------------------------------------------------- ...............------.......-......---------------------------- --..............Dace ...............' PermitNo. -------- / ...-------51--Z-----------_----_------- Issued ................ ... .. ... ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---------------------------------------------- Q eztifirate of Cgomylianre THIS IS TO CERTI�j-Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ................................. '`� -- --------.......---- --..- ---........--. -- --------.......-- . -- ...........----------- ----........---- ------------------------------------------------------------- ...utt+r '} s[ (— y f Installer ,t t i �" S 4�'.5...`'^�-'"^-4r� -.:...•!..'....b:..:.. � 5^f'........ ........ :: --.............. ..•. .. .at ........... ..�1--... M. ..Erl. 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. .........7f.,------`�-�.-.1...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. f op� DATE----_------------------------- ----------- ------------------------------------ Inspector ---- ------------- � 1 t THE COMMONWEALTH OF MASSACHUSETTS .,� BOARD OF HEALTH ........................... No..� FEE...1(2 ......... Disposal Vorks Twonsfr ion rrmit Permission is hereby granted........... to Construct ( or�Repair ( ) an Ind Ir3ua1 Sewage Dis osq System- -. 1-at No. .. Street as shown on the application for Disposal Works Construction er it No. 5_. te(h----------------------- .0... _ Board of ealth DATE.......... ----t- -••-•-•--•••............................. FORM 1255 H BBS & WARREN, INC., PUBLISHERS I Leta ATp. SNt.f=,T �o c- tio.>< 7'ae 1 O'F-r WALL + t w a' PST£ ��G•' RiCHA„� I-,SULLIVAN � `- - co BAXTEn ct� Z?r.,SF l�Oo. 29733 2 C-�?'a P 6� � r -Tom -I �, .gip 88G _ , �. 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