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Home My WebLink About0307 WOODSIDE ROAD - Health t i wCQoc\ �S k TOWN OF BARNSTABLE , p LOCATION SEWAGE # VILLAGE /14, Mlt fS ASSESSOR'S MAP & LOT INSTALLERS NAME & PHONE NO. SEPTIC TANK CAPACITYO'odD 4AN ] , LEACHING FACILITY:(type) ---VtJjef.T(ct1arZS (size) qe NO. OF BEDROOMS 3 PRIVATE WELL OrPUNBLIC W—V RZ BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� o Go j 0 rj b FEB... 1 :. . ._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di-nVoottl Workg Tomitrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( (.,<an Individual Sewage Disposal System at: c .,ram .................. ILocation- dress or Lot No. ---.....�� If�. !�J 5....CS.r' 'Y --•--•-------- �o,� nOw r ( 2/'�h //� �ddre / F .............. � ustalle / .1--lldlf !_l�e �. � f/ j w r � Address U ................... Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms---- -----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type .of Building ............................ No. of persons--------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtu�rgs ------------------------------- - - w Design Flow............-5__�......................gallons per person per day. Total daily flow_- - ...........................gallons. WSeptic Tank-Z Liquid ca acity/W�_-gallons Length---9........ Widths-------------- Diameter................ Depth................ x Disposal Trench—No3.SN.P. ... Width.......F._......... Total Length---476_--...... 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. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fZ Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ RS -----------------------------------•----••-----------.-----•------------•---•-•-•--•---•--......---•......................................................... ODescription of Soil........................................................................................................................................................................ x U ----••••••••-•••--•----••-•--•--•--•--•••-••• --•--------•••------•-••••-•-----••-•-•--•.......---•-----•-•-------•••-•---•-•--••------•-•--•------•----------•-•--•--•-•--••-•---•-------•----•--•••-- w - ----------- --------................................................ U Nature of Re irs or Alterations—Ari'swer when applic bled 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 and o ealth. Signe ........... ... ------ ----- --- ......................... . d-R`t.7. Due Application Approved By .......... ............ �� f`............. . .................... ---------- Dace Application Disapproved fqr the following reasons: .................. .. .. Permit No. ........:1...... ..:^'' �� ---------- Issued ..... "' G3---- ... Dace NoY low.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iration for Biijipoml Wor1w Tonitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( (/)an Individual Sewage Disposal System at: ................ ........... ... ......�.. -..... _.. .. ........... ..............p.........._..................... Location• \ddress ( or Lot No. ...........................•• --- owper Address a •--'-•-- _I_�;n(,'.'1..: 1.=:.4 I(_ / 1.. C. PY 5: - �!'y 7(" •-•---...... . ................... Installe� ' Address Q Type of Building _ Size Lot............................Sq. feet Dwelling— No. of Bedrooms----ram.....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........................... Showers ( ) — Cafeteria ( ) 0.1 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.5_�! ! �.... 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........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ 9 ...-•-••••----------------'-•--•--••'------.._._._..--"-'.....••••--............---••--•••......---......................................................... 0 Description of Soil.................................................................................................................................................... •-••-•--•••---• x U w , UNature of Repairs or Alterations—Answer when applicdble.- ,'./ !Q.��..._(_ ___.fit .��..`.r. .C...........j'_.. rV ...... ............ ... . -_.,<_..._..............._..--•-------......_......_. _....... 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_b_y_the_board of health. t Signed ....,:.._� - `-....vr..... - Dace -:--- A Application A roved BX � - i/.K"'�� PPPP Y ---------------- ..... .......... .......... . ............................... Dare Application Disapproved for the following reasons: `...... ....... ----------....----- ------------------- ----------------------------- ---------------------------------------------------------------------- ---------------------------------------------- ---------------------------------------- / �1� j Dare Permit No. / `7 � C Issued .......f°.:.- // l�. -.... ------- ............... . Dare If ----- -------------------------------------------------------------------- -- THE COMMONWEALTH OF MASSACHUSETTS �--- BOARD OF HEALTH TOWN OF BARNSTABLE C�er#tfirate of Comlatianae THIS IS TO CERTIFY, That the Individual Sewage DisposalSystem constructed ( ) or Repaired by--------------------------------------- C-- -- -----"�---`---`--------="r` I--- ...-------------------------------- ....... �' Inuallc �� at � --` :. . . ' .. (.C,%CY�r--- (=-C�r _-- - t(.-"--�a�-'=------------------ ------------ ---... . ----------- ----- has been installed in accordance with the provisions of TITIA5 of The.State Environmental Code as described in the application for Disposal Works Construction Permit No �� XT�....... dated ._e `" . ....:..�1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEP AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE /.._1........_...... .. ... ---------- ----- Inspect r, - / ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �jj,��,{{ TOWN OF BARNSTABLE No.�...1:..`... FEE........................ Roposal Workii Tonotrnrtion �amit 1 Permission is hereby granted........ � .. ......(:.A.!^.J.__C---L� J.C. ............. ....d -(f P.. . ................ to Construct ) or-Repair (L-) an ndividual Sewage Disposal System atNo.. ....... __ (.. �'(' 'Y�E f' } ` c --/......---•-_.._.. -----'--'--•--••-•--........ S eet��/ �^+ as shown on the application for Disposal Works Construction Perr�`Nvo"_.----�� Dated____'.��...:---- DATE-------- �-•--•---------••-•---- B�rd of Heahtii7`Y_ ---------•�'----------••---------------..__.. FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS