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Home My WebLink About0325 WHEELER ROAD - Health 325 Wheeler Road - — A = 082—003 Marstons Mills 4 TOWN OF BAR STABLE �.� LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 09 INSTALLER'S NAME & PHONE NO. SCO �, (k 7 75 -SPiCt SEPTIC TANK CAPACITY `C) 0 G Gci LEACHING"FACILITY:(type) (size)Z"j-to/J- NO. OF BEDROOMS RIVATE WELL OR PUBLIC WATER Pr BUILDER OR OWNER9M (I DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r r - �• - ,. �S j.:� i (060� � 4 � ` ', :, y � :v �� ♦�, fT. Be + ac-rv1omoax y HE COMMONWEALTH OF MASSACHUSETTS � � Vet' BOARD OF HEALTH 8i 1(-m OWN OF BARNSTABLE Appliration for Dhi-poottl Works Tonotrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (V) an Individual Sewage Disposal System at:, 31 - :. --. .tc1 .............................................................. L atiott-[\ddress 1 or N0. ------------------------------- -_------------ . ..... ...........---..........---.... owner A ess � 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 ( ) a' Other fixtures _____________________ W 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---------------------- a --------•------------------------------------------- Date........................................ Test Pit 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........................ a ------------------------------------- - ---------------- Desc ' on of Soil b55........Las' ---------- 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 undersi ned.further agrees not to place the system in operation until a Certificate of Compliance has beW issue t e oard of health. -N Signed ....... .... .......... ........................e...............—...`...—..—............... ----- �s�- _ Date w Application Approved B -----Ve---------------------------------------/ .�.. ..............._...._ — � L G ...............-- - - .......................... Date--------------- Application Disapproved for the following reasonr- ------------------ -- . ................. . ............................. .... . .................................................... ........................... . ............ .................................................................................. ........................................ 7 Date Permit No. --------- .��c d Issued ✓`------.`. Date THE COMMONWEALTH OF MASSACHUSETTS 1`rna �3 BOARD OF HEALTH TOWN OF BARNSTABLE App iration for Bivjipoottl Wor1w Towitrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (V ) an Individual Sewage Disposal Systep� at. \ddress 3�9 W�u Y`Np r .---.---- `.. ................................... ` v ............_. S� C� avner �GJ .� d r ss W ---------------------•-•-••-•-•-•---•--•-•- •-�=°------------------------.......-•`- ----------------�--P` �`.-- .............. ller Address UType of Building 3 Size Lot............................Sq. feet ,., Dwelling— No. of Bedrooms............................_...-----......Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _------------------------- No. of persons------.--------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------- - - - W Design Flow-----------------------------------¢g allons 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........................................ Test Pit No. I----------------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........................ -- C a� = 1U � ------ .oDescf ptibn it W •-••----•-••----------------•------•---••---•-----•---------........e-----<..�--.�:=.�:.--�`.V,..7---jam- .....�------...--------•--------------------------•--------...------ VNature 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 unde .igned further agrees not to place the system in operation until a Certificate of Complia.ce, has be , issue�6�they ;oard of health. .....Signed ..... ... - ----1- ............. .. ........................................ .................D. te. - .. a Application Approved By---------` fir --...--= .'....... Date Application Disapproved for the following reasons: . ................. ................ -- ....... ....................................... -- ................. ............................................................................... ....................................... Permit No. � ..�. ------------------------ Issued ......------.�---` �..... //....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance TII1� 6CR�` That(thc��n� vtdu`a Sew ge D's osal S tern, constructed ( ) or Repaired ( v ) '' by ............ ..........`... ----- .. ................................................ '1 � ♦� Installer Ja V has been installed in accordance with the provisions of TIT 5 of The State Environmental Code as described in the application for Disposal-Works,Construction Per N ------ ------------- datedy '^•^f <c_1 ..�'��:. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT'THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----- - --- - ------- � ----------------- Inspector � - ..... ---------------- —a I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No. T.... FEE........................ Permissionis hereby grante------------------------------------------------ ....-----------------------------------------------------------•---------------- to Const tjc&(:) orWRe a ban (j1kdiZquaI Sewage Disposal System atNo..--•----------•------------••----------------•-------------------- ------------•---------------------- ---------------------------------------...----------------------------.......... Street as shown on the application for Disposal Works Construction Permit oy��'�'� � Dated..... ------------- r Board of Health / DATE................................................G/ ............................ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS