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Home My WebLink About0857 MAIN STREET (OST.) - Health (2) ��- � ► � - I �'=} USA-�� I� Pq—1d q LOCATION SEWAGE - PERMIT NO.' VILLAGE _ n �� I N S T A LLER'S NAME i ADDRESS e U 1 L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� / i I �� / � � \�� '� _ � � �� . �� - f� _ L. ,�. �� .a �.., Poo LS 75 - 2, 000 t f $ X10 16,7 N Poop TYOFO)'e4 1 �5 - 851 MhiN STreEET . ' i OSTE2vIL 026S$ CS r— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH lllla_..-........OF....... M. A. .... Appliration for Dhipnoal Works Tnnitrnrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair (01"'an Individual Sewage Disposal Sys em at: , e - 0-A--P_..I.AY1 e. ... 1...1_41�...! ..................................................................................... L`gcation Address or Lot No. .^ .................................................. caner .� Address aInstaller Address 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 Q' Other fixtures ---------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ 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........................................ 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........................ a --- xDescription of Soil.......L, J1Z ..., _.__.e,�4!/ . -•--•---------------------------------------------------------------•-•---------- V --------------------------------------------------------------- .....--------------------- ---------------------- -------- ------------ .-.----------------- •--------- W •--------------•---------------••---•-------.........----•------------------------------••---••.....__...----- ...................-•g- .... ----.••-• ---------------•-.-•--- VNature of Repairs or Alterations—Answer when applicable_._ ''�DA�______h ._� 1....... i $_ ..... ------------------------------------------•--------•--...----------•------•--------......--•-----•-----......-------------•-------------------------------------------------------------•--••---....._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the b rd of ealth. - Z ned .. . . . -•-----=--- ........./ F - -� — Date ApplicationApproved By.......... -•-- ------•...........................•-----------------•--..................•.... Date Application Disapproved for 1�e ollowing reasons-------------------------------------•------------------•----•-------------------•---....._...---•----------•-- -•----•--••-------------------------•-----------•-------••-••----•----•-•--------...--•--•-•----•---...•.------•-------...••••---••-------••----•----------•-•------------------•-••----------...-•----. Date PermitNo......................................................... Issued....................................................... Date } THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH jo Appliratiun for Bisposal Works Tonstrurtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (=`I) an Individual Sewage Disposal S s em at Y r s ..! :..A'f'•! .-_...=:F. `l!�1f 5..t::.. ... ''.-..c......cF"�✓ �x-..�. .. f.................................................................................... �. LDcation-Address or Lot No. JiDpwner y� .Address F-1 ._.... ..� tf J J'-;f•A.............3.': .................. ......... _ ..................................._..•........_.............•_..................... Installer Address Type of Building Size Lot............................Sq. feet U Dwellin •�'No. of Bedrooms.........................:...................Ex ansion Attic gp ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) Otherfixtures ----------- -----•-------------------...--••--------.-••--••-------•-•...._..-------------••--------•-•----•... 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 ( ) 0-4 Percolation Test Results Performed by........................................-•••-----•-• ..................... Date........................................ 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ DDescription of Soil �... y"+'. �......................................................................................................-- ----- - x V -------------------------------------- -------------------------------------- ------- ...........................••-----......_.-.----_---.__..----...___.._._.__..___...._.._..._.__...____._ , rX-1' A7 U Nature of Repairs or Alterations—Answer when applicable. >.._//'d ....... ....... !' --------------------------------•---•-•---•----------------•---......-----..•..:_...........-•-•-------•---•------------------------------------------------------------------------•----•--••....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance as beqp issued b the ard0of health -------------------------- Date�, Application Approved B _ Date Application Disapproved f •t following reasons-----------------------------•---------------------------------••----------------•-----•-•-•--•-----•-•......---- .......--••-•-•-----•.....................•---------------•-•--------•----------------.....----------••--•---•---••----•--•--------•-------••--•----•••-••••------•••••---•---•••-----------••....--•--- Date Permit No.................. - -_ Issued_ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEALTH -11 <,a'• �'... " .....� ,r`�d'T� ...........oF. E ......... . .......................... 10.1rdifirat of Tuntpliunrr T IS . TO CERTIFY, Tat the Ind vhd 1 Sewage 1Jslsposal System constructed ( or Repaired ( - by_ --- ......-� .....................x" ..................: d p ..... s..............••-----•-----••-- `d ...... � taller �' .. �- has been installed in accordance with the provisions of TI . 5 �1e State Sanitary Code as described in the application for Disposal Works Construction Permit No......................--------------------- . dated-._.._.__...._.___..._.__...._........_........ .19.fO!' TIME ISSUANCE OF THIS CERTIFICATE"SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM e �N TION SATISFACTORY. DATE..... ... .. {................................................. Inspector..._ THE COMMONWEALTH OF MASSACHUSETTS BOARD O,Fj HEALT lJ / fJ .......... ......OF........� ..�:.t •- ' ` . ,�.. No................./.. ............... �a FEE ........... ..... tuuu u dunriiriun ernti drr� �!9-p� �"Permission is hereby granted----. �---=----------•� .-----�--... -•---••-------•-•--- - ......------•---••-•--•---....-•---.... to Constr or R Ir%( an Ih)dhv d 1 Sew e Dispo�11 S •..--•- ----- Street as shown on/theacatio or Disposal Works Construction Bel ...............:.. Dated........._..:__............_.............. ------•... -- -- ----•-.. .........•---------••--------------••----••-----•-......_...._..••..--••- Board of Health DATE •------•-•-----•-------•-- FORM 1255 A. M. SULKIN, INC., BOSTON i" TOWN OF BARNSTABLE LOCATION SEWAGE # VIL:.AGE � I ��. IJ 1�L-� ASSESSOR'S MAP &LOT //7 —I® INSTALLER'S NME&PHONE NO. SEPTIC TANK C�PACTTY �,u �D LEACHING FAr-II-TTY: (type) (size) NO. OF-BEDROOMS Z 779 1L BUILDER aR.OWNER S PERMTTDATE: COMPLIANCE DATE: Separatuf Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility .Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ti o