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Home My WebLink About1834 MAIN ST./RTE 6A(W.BARN.) - Health 1834 Main. St West Barnstable A= 217 - 009 e B it i TOWN OF BARNSTABLE t�� LOCATION /$3�{ S�:n g - SEWAGE # q2 ' 3 a a VILLAGE (,U � ASSESSOR'S MAP & LOTCtp INSTALLER'S NAME & PHONE NO.C4R f 1-ig4l el ,34a-- Go F SEPTIC TANK CAPACITY 1606 5j-? / LEACHING FACILITY:(type) q flvw LIYy'ejS_j P size) NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER 0Je f BUILDER OR OWNER DATE PERMIT ISSUED:— DATE COMPLIANCE ISSUED: Ig'/ VARIANCE GRANTED: Yes No �/ r � QR y r i 2 Fps.. t APPROM THE COMMONWEALTH OF MASSACHUSETTS �C01� BOARD OF HEALTH OWN OF BARNSTABLE Appliration for Disposal Works Tontrurtion rautit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......... ...... .�'..`.1....�'!......................... ........ ...................f.Q: ......t3 �► .: i..................----- , Location-Address or Lot No. .......... --- •7� t��•:�,.r................................................... .......................•...... Owner Address W a .................. . •. ----------------------------- ---.------.---------.--------------.-----.--------..------•--------•-•-----.-.-.--•--••----=...... Installer`/ Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) 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 tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a 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.---.................... 04 •------------------------------------------------ -......... -... •........ -------- -.-------. ---------------- --------------- -.-•----- ------------------------ - 0 Description of Soil........................................................................................................................................................................ x U ...............•••••--------•-----••-•-•-•••--••---••-••-•-•---•-•-•---•--•••.....--•-•-•••••••---••----••......---••---•----•---•....-•--•------------••••---------•--•••......••.................•••. w x ----•-•-------- ..................................................... --•---••-•-••---•-----•----•----•------•-•-•---•---- -••------------------•-••-----••----•-------•----•----..................... U Nature of Repairs or Alterations—Answer when applicable------------/a.0Q- -- �,Q -•-r--� rr . 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 by the board of health. Signed -------------- --------------- - ------------------------............................................. ........................................ Date Application Approved B Date Application Disapproved for the following reasons- ....................................................... ...-------------------................ ---------- ....-----....----------- - ----- - ----- ------------------------------------------------------------------------------------------- .........-----------------------.......... ----.--------.......... pDate PermitNo. ....... L- ..-. ........................... Issued -----...-------------------------- Date it — -..... - - --------..--- - --- -- - - -- - -- - -. _._.----- - ----- - - - - - - -- - - - - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�er#tfiutt#e of CITont lianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ......... L- ------------------tall- '�" - Installer at ... ..........3.-.L2......N1....a2.u2....ar....................------�(1 -A has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..........9,2 .....3.T. . dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................. .................................................... Inspector ...........................................---•................................................... N ..... ........ j, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE A#pfiration for Dhip"sal WorksZomitrurtion ramit Application is hereby made for a Permit to Construct' or Repair an Individual Sewage Disposal System at: ..............1_11�1...A.6ka'. 1_)A�..... ...................IL-1.4-AX...... ...................... Location-Address or Lot No. ............qe.,"nq.....(2�.-ai................................................... ................................................................................................ Owner Address ..............(�� ...................................................... Installer Address :?_4��---------------------------- --- Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms______________________________--------- Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons...._.........._............ Showers Cafeteria aOther fixtures Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter._._____........ Depth................ Disposal Trench—No..................... Width............._...... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No_________________--- Diameter.............__.____ Depth below inlet.................... Total leaching area..................sq. f t. 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........___._.._..._.__. (Z4 Test Pit No. 2................minutes per inch Depth of.Test Pit....__._............ Depth to ground water........................ P4 ...*.....*---------------------------------------*.........*............*.......*-----------------"-----------------*------------*...*-------------"", 0 Description of Soil........................................................................................................................................................................ U ......................................................................................................................................................................................................... ...........................................................................................................................11.......................................................................... U Nature of Repairs or Alterations—Answer when applicable............ ...........................................................................................................6 .. ...... .............. 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 by the board of health. Signed ....__-------------:.................11................... ....... ................................. -1...................................... Date - Application Approved By -------------- ........................ ........ _:......9._..4._7... — il��------------------------------ ...6;le Application Disapproved for the following reasons: ..................................................................................................................................... ........................................... .............................................................................................................................. .................. ....................... Permit No- ---------- ------------_-------- Issued .......................................................Date- ............ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifir ate of (fumplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.........................<f,t Installer ;13.X........................................................------__....................................................................................... r ............................ at ................... 3 !7i /* G-. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ............ ---a_�O dated _............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........................................................__.......................................... Inspector .................................................... ...................... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ?ZZ:3.6e TOWN OF BARNSTABLE No.... FEE.....�d(2...... ------- --System--------------------------------------------------------------------- Permission is hereby granted............. to Construct ,\,4 or Repair ( an Individual Sewage�spos at No------_-----4.5 F�.,>..K C----tom..-_ .............. .. ....................................................................... ..................( Street as shown on the application for Disposal Works Construction Permit No.. ..... ' ........;)Dated.......................................... ................................ ................................................................... DATE.................57--_6......./��................................ Board of Health FORM 365oa HOBBS&WARREN.INC.,PUBLISHERS