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Home My WebLink About0025 WILLINGTON AVENUE - Health c)3- aa-A - i i i� i N SMEAD KEEPING YOU ORGANIZED No. 12134 2-153LGN ASUStAIMAIKE FORESM MIN.RECYM JQ INITIATIVE CONTENT IG Cerdfled POST CONSUMER S"12W MADE IN USA GET ORGANIZED AT SMEAD.COM TOWN OF BARNSTABLE LOCATION WM � v t� AQ �SEWAGE # VILLAGE M l ASSESSOR'S MAP & LOT?��j INSTALLER'S NAME & PHONE NO. g�C; SEPTIC TANK CAPACITY LEACHING FACILITYA ype) 1 CU� (size) pl 1 NO. OF BEDROOMS PRIVATE WELL O �P6DBL1WATER \D� BUILDER OR OWNER Q0 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ��. Li 1 Lf No.9s- iz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Dhip ial Work.6 Tomitrnr#inn runfit Application is hereby made for a Permit to Construct ( ) or Repair (V� an Individual Sewage Disposal System at ..S -xl I\ ..---8v-e ............MY\---------- -------------------------------------------- Location_III or Lot No. . .�` f.......................------------• •---.......---- ---- -• w O vn Address a (.. fJ --------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms------ ------------------------------------Expansion Attic ( ) Garbage Grinder AfO a Other—Type of Building ---------------------------- No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- - - W Design Flow-------------------------------------------- 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. 3 Seepage Pit No.......-----_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '_4 Percolation Test Results Performed by------- -----------------------------------------------------------------. Date........................................ a ,.a Test Pit No. I................rninutes per inch Depth of Test Pit.................... Depth to ground water........................ LXq Test Pit No. 2................minutes per inch Depth of Test Pit..............--.--. Depth to ground water........................ ------------------------------------------------------ ---------- ------•-•----..........••--•--•--•----------•-----...... ODescription of Soil.............................................................................................------------------------------------------------------------..........---- x w --- ------------------------------------------------------------------------------------------------ -------------------------------------_------------......................-...................... UNature of Repairs or Alterations—Answer when applicabl .. [1 t ...C'JC-�` .. L ..pt).t.....jw ... 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 is e—beard-of health. I c Signed1.... ...... ...... . ......-�------------------------------------------------------------ --- Application,Approved B 2.../.G.--..f5... .. PP PP Y ...... ... ----------------- ------ Application Disapproved for the following reasons: ------------------------------------------------............-----------.......--------------------------------------------------- ------------------------------------------------------------------------------------------------- -------- ----------------------------------------------------------- Dare PermitNo. .....LP--------o2- ...................................... Issued -------------------------------......----------------------------- Dace LX No.... .. Fxs...: .4?:. ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (� TOWN OF BARNSTABLE ) Appliratinn for Dispn3Ml Morkii Tomitrnrtinrt ramit / Application is hereby made for a Permit to Construct ( ) or Repair (V) an Individual Sewage Disposal System at: .Location-address or Lot No. .�1� ....: •R1�4]. �.� 1_.r..................................... ...................................... Own • Address ` ' ....._...... e}� aq Installer Address UType of Building Size Lot............................Sq. feet .—I Dwelling—No. of Bedrooms------ -------------------------------------Expansion Attic ( ) Garbage Grinder kV() aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d 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 tankkkk�(� �) Percolation Test Results Performed by--------------I----------------I----t------------------------------------ Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit--_-----_--_--.--__ Depth to ground water........................ (Z, Test Pit No. 2................minutes per inch Depth of Test Pit-_--.-.----._-_____- Depth to ground water........................ P; ..........................•--------............---........'----•.....--••-----•-•---......----------......................................................... 0 Description of Soil...............................................------------------------•--------------------------------------------------------.----------------------•-•--------•---- U •--•-----•-••-----------•-•••------•--•----•---•---•••------------••--•----•--•---"-------"------••--•-•-•--•-----------•----•-------•---------••......---•------•=•---••... ••--•.........••----. W - UNature of Repairs or Alterations—Answer when applicabl _Qev_r^.Ce. _- 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 is oard of health. J Signedk- ---------------------------------------------- Application.Approved By ........... e ..-------.....Dace----'---------- Application Disapproved for the following reasons- ------------------------ ---------------------------------------------------------------------------------------------------------- . ------------------------------------------------------------------------------------------------ ----- ----------------------------------------- -------------------------------------------- ........................................ Date PermitNo. .....JSa.g..._........._...._....._... Issued --------------------------------------------- - ------------ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ger#tfirate of (funtpltttnce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓� by.--------ScQ G � h Incr.Jlrr at ------- �....... ,�.` \ +tv..._.. !'��j -----.1" .. —-----. -------------------------------------- ------- has been installed in acc an with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------- 5_'/ .. ... �' �S dated ..-< . ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......`-'.........V.... ------------- Inspector - -- ------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...1 ... FEE..3 Q:. Dispnuttl arks Tnnstrirtinn "rrntit Permission is hereby granted..rJ-S(--9Tt_.FYI..,zmk-{ors---------------------------------------------------------------------------•---------••----------....-- to Construct ( ) or Repair (L/'an Individual Sewage Disposal System atNo...... .�_......f ?+.�1 4 '��'�----4.c ------M ----- - - ---------------------------------------------------- - �.. ..... Street as shown on the application for Disposal Works Construction-,Permit No.9 Dated.._.___ (- p�. -------------............................. DATE.......2 h� _ 9� Board of Health r� FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS