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Home My WebLink About0039 CARLSON LANE - Health 9 Carlson : • . . r. 1 . f 31 TOWN OF BARNSTABLE 3 `� LOCATION SEWAGEOarlsd-n V�e.., l VILLAGE, ' dui 7'.4 r✓ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY ��S'�� / "C2 O _ LEACHING FACILITY:(type) ,� /� /01r0 NO. OF BEDROOMS S PRIVAT WELL R PUBLIC WATER BUILDER OR DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No X - � �� G/'Q -2 �oo` + �� F �� I ` i �_ Y 0 THE COMMONWEALTH OF MASSACHUSETTS F BOAR® OF HEALTH W � O®��// rop TOWN OF BARNSTABLE S) �� I � � Appliration for Disposal Works ons rnr#tnn ae Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: CC Sor L0214\2 \ ocation-Address c................................ Owner Address Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.......... ...........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria 44 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 ( ) aPercolation Test Results Performed bY...............................:.......................................... Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-._.------_---__-_. ----. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•----•----------------------------------------------------------------------------•-•-•-----.............................................................. 0 Description of Soil :----------------------------------•-.........----...........-•--------------------------------------------------.....---..........-------••------ x w UNature of Repairs or Alterations—Answer when applicable...�.:'. a. --i So 0 �R��oV�_S�t?T�cr._ .....--_ a........1�o -O.i_2cxc�, ?art i � ' STc n e- 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 he undersigned further agrees not to place the system in operation until a Certificate of Compliant is ued by the board of health. Si ne ... s g - ---- ----- - - ------------- ---------------------------- m ------------------ ------ ------------ - Date 0 Application Approved BY ....... qj to Application Disapproved for the following reasons- -------------------- ---- -------- ----------------------------------------------------------------------- --------------- ---- ---------------------------------_-- .. -- ----------- noDate Date Permit No. � ------------------_ Issued ------ : --------------. F $ m\� _ THE COMMONWEALTH OF MASSACHUSETTS 1t` �C._p -, ,,- BO�e RD OF HEALTH W �D-r �� TOWN OF BARNSTABLE rlutttilan furisutt1 WorksCn�atttrttttiurt Trutt Application is hereby made for a Permit to Construct ( / or Repair ( ) an Individual Sewage Disposal System at: ......::...... A.C�: So L a��... �fty��----------------------...... -- ._._._...................................--------- ............................ .................... `_ cation-Address or Lot ^ CZ,t Z C ... .............. /� nn Owner (� n Address ?...............................cy�.� O `— —! -.��F c ................................................... ..................... Installer Address � T e of Buildin Type g Size Lot----------------------------Sq. feet aDwelling—No. of Bedrooms..........................................................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria _ Other fixtures ...........................................'..r!..................................................................................................... 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............L...... 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......................... fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-__-_.---_-.-____-____- a •-•-••-----•------•••-•-•--•-••-------------•-•---•-------------------........---•-•-•--------------......................................................... ODescription of Soil......................................................................................................................................................................... x W x ---------•-••----•----------•-••----•--------------------•-----•----------•-----•-------------------------------------••-----------•----•-•------••-.......---•-----------------•--•----•--------.------ U Nature of Repairs or Alterations—Answer when applicable___...-.Ha_O--- ........ ►.-__....:C?, .....................................................��T -1-a '-5-ro n ......--•-••------••-•---•-•............................•--•---•---• 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 Complianceehhaas//,eeee ''issued by the board of health. Signed✓��.........../� n a -- �-- Dare Application Approved BY - r/,---VG- / r fl Application Disapproved for the following reasons- ----- --------.....------------ ------------------ ------------------......--------------------------------------------...... ......................................................:.........................:.........--.....--...---.........................................................................................C...........1 .............--Dare..--.---.......... Permit No. ......-./../. ..... /-- ---------------------- Issued .......-s. ./....�r�./ ------------ THE / ( ! % `Dare / �So�COMMONWEALTH OF MASSACHUSETTS r { BOARD OF HEALTH S T� TOWN OF BARNSTABLE (9elc#tttrate of (gantylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( P-1)"or Repaired ( ) by ........ Installer at .-... �' a. -..... - -R.taC 'A �� -----------..............---------- ----------------` has been installed in accordance with the provisions of TITLE 5 f,T e Stye.Environmental Code as des/ ibed in the application for Disposal Works Construction Permit No. ........` .. ...."�".-.. .... dated ....A�� .c �.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED�AS A GUARANTEE/THAT THE SYSTEM WILL FUNCTION SATISFACTORY_ . . -. Inspector --- ------.....DATE � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No........................� FEE......��. 1 � r Disposal 10orho Tonatrurtiun f rrutit Permission is hereby granted........;6.7t.B......c C A--------------------••----..........--••---•------•---•--••----••-. to Construct ( vo-y or Repair ( ) an Individual Sewage Disposal System at No....... .......0 A-(Z /,C N Lea, W: -'?AR 0 5-= p At,r / .�._.... Street /�' as shown on the application for Disposal Works Construction Pe{mi� No....... ".�2Datgd,.".__.=.�3..,_j J_.!-. 1f� ..`� Board of Healfh'�" DATE......�__�;.4.(./..�......�// t................................•------.. FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS