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Home My WebLink About0010 WATERSHED WAY - Health /y1 f� ►� S i orb y/ LDS �ry a ®p V1009— sc F T WN O BARNSTABLE � LOCATION ��, q �,{1 SEWAGE # VILLAGE_ 1p,415.e6 A✓� �il�T ASSESSOR'S MAP & LOT S O.S.. 0&1 !. INSTALLER'S NAME PHONE NO. ��'C/Cey �'h,Uf� SEPTIC TANK CAPACITY 1,67C>G LEACHING FACILITY:(type) f 2-9- CAS- (size) NO. OF BEDROOMS -3 PRIVATE WELL OR P`UUB_LI�C ,WATER BUILDER OR OWNER. a" DATE PERMIT ISSUED: y�— DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� Li 5 do Nam- / Fps ......... THE COMMONWEALTH OF MASSACHUSETTS / �( BOAR® OF HEALTH g S 4 - 4 . 13 TWA..............OF...... ................................... ApplirFation for Bispvii al Works Tnnit.rnrtinn ramit Application is hereby made for a Permit to Construct ( o r ( ) an Individual Sewage Disposal System at: ................--............. t i4c........W. �. , ...�-� ��..................................................... .. . ... Locatio -Address or Lot No. y �/ ..................... ..........r .... f.... .. ........ .........._... ......._____! !_-' /�✓rS�........G _' s� ...................... Owner Address ...................... --••----------. sty. :-`�.....f?�ll_. `3................ Installer Address UType of Building Size Lot._..-......�...............Sq. feet Dwelling—No. of Bedrooms.................3.__--_-.-_--___---------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .__- Desi n Flow___________________ P P P Y Y --------gallons. W g ��__________ gallons er erson er da Total dail flow.._.. ..__. WSeptic Tank—Liquid capacity_1.000—gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------- ------- Diameter.........1. ----- Depth below inlet........ _...... Total leaching area.... 577..sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by---__-_____ P-KT ? -.. '___I_��( .................. Date.__..._777.0..�-ta_7...._.. a -r-f Test Pit No. 1..._7� __minutes per inch Depth of Test Pit........U.- ,,,,__ Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------------•--------•---------.....---------------•••....•-•-..............---•------•---••-•--------------..._.......--.-- 0 Description of Soil............................................................ ------•-------•----• ----- -----•---•------••---•••-•------•---•••-------------................ x -------------------------- 1 ------- At,3-------63A-N. ..............--........................................... 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 een issued by the board of he Ith. Signed ----- ------------ ------- Date Application Approved BY ' Dale Application Disapprove fort e following ream f: .................... -------- ............. .. . . -------------------------------------------- ------- ----- -...--------------- Permit No. ......� t9sued ------------------------------------------------------ I aw------ Da[e C► t ; � ' THE COMMONYVEALTH OF MASSACHUSETTS BOARD OF HEALTH - ....._ .f�. .............OF......... ....... '?. ` '_ ................................. Appliratinn for Diipniittl 30orkg Tonstrnrtiun ramit Application is hereby made for a Permit to Construct (t.-I'rfRhair ( ) an Individual Sewage Disposal System at: ` !'y ................-..........--... `. Via ...... :: .`: .. ............. -: .......ml.................................................... Location-Address or Lot No. ............�...6-: ..' --An9 v....N. /.._y:'c"R'%Z.i�„f• ................. r. ......- ... •� ..r .T.. ...................... Owner Address a .......�.::�:c•.+'`!�,�;s:t�_:f.. ...............1_...,.... r. ........., ._._..qC=v'�,I.�c�.��_.:o................ Installer Address ' Q Type of Building Size Lot....._ _,_______________Sq. feet U Dwelling—No. of Bedrooms.................3-------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ... No. of persons............................ Showers — Cafeteria Q, Other fixtures - - -----•----•------------•-------•-•----------------------------------------- W Design Flow.................... ....._.......,gallons per person per day. Total daily flow..................... __......gallons. 04 Septic Tank—Liquid capacity 12 gallons Length................ Width................ Diameter-------------- - Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.............._____- Diameter---------I.L2.... Depth below inlet.............,. Total leaching area....: 7..sq. ft. Z Other Distribution box ( _� Dosing tank ( ) --� Percolation Test Results Performed by........... 4..I...............•.. Date....... ----_-. _'-✓_: l`- �1 `�a Test Pit No. 1----- •r'_'___minutes per inch Depth of Test Pit--------1.74,,.,... Depth to ground water........................ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................•....................................................---...........---.....----.... 0 Description of Soil---------------------------- ............ ---•----••-------------•-------------------------------------------------_.... W x -------------------------------------------------------------------------------•-------•-•---•-----•-•--•----••------------------•------------------•-----•------•-...--•------••-•-••-•-------•-------- 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 by the board of health. tx /9 Al Signed .................. `........ . 1 ..:. f..:... ' Date �. Application Approved B �^°,.............. ...................��. .... ----------...........------.----------- .... ]?P PP Y Application Disapproved for the�11�owlreasons: ...................... /� t rr - Permit No. C"� r Date /��... - ,V ISSUed .......................Date..--..--..---...--.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD�OF HEALTH T� O.AA.............. OF ............ -=`..�. I-�i ..........** of VQT 10 t2l=' THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( r Repaired ( ) by. --- --..C!:� "----- -: '--------------------------- Installer at - - r . . �n4 .-: �- ------. ►"�. A ? . .s -- -------.............................. 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. ...... -,.�..�....� .� ........... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT R C'Or`t9 ,D' AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE 1�---- -- ------------ .....� .................... .. Inspector .... .... ......1 t THE COMMONWEALTH OF MASSACHUSETTS --�—^� BOARD OF HEALTH c� ..Q. .............O F........... - . 9.d'"��-a.�..---........................ No...... P--6-70e FEE Uispsa4 Vorkg (Eh nitrnrtion Vanfit Permission is h .eby granted---- .::, . -ems.. `. --•.... `::= = `,r,.. •- �°?9��',".'r... . 1 to Construct ( � or Repair ( ) ate ndividual Sewage Disposal System > at !....... !!:.x` F: r:.... . Street as shown on the application for Disposal Works Construction er •t No... ...__.Dated__________________ l ------•-•••............. r / * ' �Y Board of Health DATE =l•-.rr--.- ..;.........�= FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS --T - —.. 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