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Home My WebLink About0280 HIGH STREET - Health (2) YN N S M EAD KEEPING YOU ORGANIZED r No. 12134 2-153LGN SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT 10% Certified Fiber Sourcing POST-CONSUMER www.sfiprogramorg S 41M MADE IN USA GET ORGANIZED AT SMEAD.COM �- TOWN OF BARNSTABLE r LOCATION gZ&Q SEWAGE # 3 m 3, . VILLAGE -ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. - SEPTIC TANK CAPACITY12 LEACHING FACILITY:(type) I (size) q NO. OF BEDROOMS �)_PRIVATE WE OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: age DATE COMPLIANCE ISSUED: a� -"/ 3 VARIANCE GRANTED: es4!ed No v 4 a , sq / rl e i u� No....� . .,j 7 f l C� I is Fim....-- 3.;,Q.....- �i :)./ED THE COMMONWEALTH OF MASSACHUSETTS Barnstable ConservationDepattmor4 BOAR® OF HEALTH �;7/3-91TOWN OF BARNSTABLE Si ed ato Applirallo t for Uiripwi tl Wurli3 Tomitrurtivit rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: '� L ruion-:\ddress , or Lot No. LG -- - ...................:.......... ern, dd ----" .. -------•--------------------- -----�.-7 t �td� •� tstaller Address Type f Building Size Lot............................Sq. feet Dwelling No. of Bedrooms..--.3---------------------------------Expansion Attic Garbage Grinder 4 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 44 Other fixtures ------------------------------- -- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. RS Septic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter....------------ Depth................ 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 ( ) 1.4 Percolation Test Results Performed by.------------------------------•--•....................................... Date........................................ Test Pit No. 1................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........................ a ---------------------------------------------------------------------------------------------------------------••---•--•-•--.... ........................... ODescription of Soil....................................................................................................................................................................... U ........---•---•-------------------------------•----•-•----------------------------•---.......-----------•------------------------------•--•----------------------••------------••......----.........--- M ----------------------------------------------------------------------------•---------------------•----------- ............. ----- --- U Nature of Repairs or Alterations—Answer when a lica le... ....... . .. ............. . ..... ........... ................................. ,r.��d o.. _ . 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 as been i ued by th board of health. �ry Signed -... � . ................... ..... ............: l ....... a..q3. Date Application Approved BY ..-.-.. ..- .R. ................ "7.�../...Du.—.. .` .............................. Due— Disapproved for the following reafons: .................................................................................................... ................................ .................. ................................... ............................................................................... ............. ............................................... ........................................ Date Permit No. ...��-.e.� .. ...a-..7..............._ Issued - - te.. -..Y-3........ .....�,:..ti./...;v✓-`�-•vr .-.�-..-.Y.r.`.�.,r�-=� v•+-wr=...,•,,.�.�_-.-.� �..� v '� ., v lam'— v .. _.y�cr.._.. ,_ _.....- 'a_� «__ `r _ No. =- / �/ T _Fps... '�r......... THE COMMONWEALTH OF MASSACHUSETTS _ f BOARD OF HEALTH �2-/3- 9 -?TOWN OF BARNSTABLE r Appliration for Dirivwml lVorbi Towitrnrtion Vamit Application is hereby made for a `Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � - -- --.....---••-- ---._-......l. -------•-•-------------------------- ------------------------------------------------------------------ ---------- -- �Location-:\ddnss or Lot No. ............ ..._ -- ••----------------------------------------•.---_.__. a ddcc 1 ----------- - ---------------------- � � - �1:. ----------- ---- ---- �mstalter Address 11 Typ4 flBuilding Size Lot________________ q. feet a Dwelling— No. of Bedrooms._J..................................Expansion Attic ( ) Garbage Grinder ( ) QI Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 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. j Seepage Pit No--------._-----.-._ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Performed by.......................................................................... Date........................................ 14 p P P g'1 6.4 Test Pit No. l................nunutes er inch Depth of Test Pit._._.___...._... De th to ound water...._...__..........._ . 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ................................. -----------•--------------------......-------•--------._....--•----•-•--•----••----.._..-•----------........--------_..... 0 Description of Soil........................................................................................................................................................................ ` W -i•----•-- ---------------•---------- .... - ---------- ---- �' \Cxj Nature of Repairs or Alterations—Answer when a lica le.__ _.____.. l._._..-..... !?.... .......................... 1 Agreement: \ The undersigned agrees to install the aforedescribedtIndividual 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 as been is ued by th bar o lth. Signed od f hea.................. .. .......... ._.. !. � +% .............. -- ..-...� 6... 3... Date Application Approved By .................�A�. ..,�,: ... . 7.. .. .. .......3..-..`I... -..... Date Application Disapproved for the following reasons: ....... ......... . ................................................................................................. ..............` ............................................................ ............................ ...................-.......----------............................................... ........................................ Date Permit No. ........ ..-.... ... ... ................ Issued 7.....�...3. _ / ? Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C9er#ifirate of C�omplianre THIS 1 TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -------------------- --- - -----__........._. e_a� .-:�Q_�f-- -------......--------------.._--------- .. ......... -- . .......... ................................................. . 1 tnsrtuer at ...................2....�..4.......... <..C'P- (.---c. tU........... �/e ..... - ..._...--------- _............. has been installed in accordaWce with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...------7.•3_��.�..�_.... dated .... .. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. CCyyr-3......_...................................... Ins _...... — -------------------------------- ---------- -------------------DATE...................�..-J.�.......1.... Inspector . p _-_---------_,----- -------,-_--_,-----,-----_�.®�_u-- _-------- ----- j THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE N07,3o FEE.......................... Diapooal Works Tonotrurtion "rrmit Permission is hereby granted ----------- ! ---------------------------------------- -------------• -----............. to Construct ( ) or Repair. ( ) an Inc ividual Sewage Disposal System at No.............. ?..�!t- IA/_..... .s M 4- r .... ----- Street qq as shown on the application for Disposal Works Construction Permit No Dated Dated... ....................................... .....-•--..._--•-----•---.lJ (A .............................. -----------•------•------•---- ' DATE.............7 ............................ Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS