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Home My WebLink About0010 CINDERELLA TERRACE - Health T-err yC TOWN OF BARNSTABLE LOCATION . is 11,04TOIG, r— n EWAGE # VILLAGE �nLA 2"> �A A(S ASSESSOR'S MAP & LOT6 ,- INSTALLER'S NAME & PHONE NO. 2 M SEPTIC TANK CAPACITY `D00 yc L- D JTO K LEACHING FACILITYA ype) l Pt (size) W ((//�� NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER Pt IUk4 BUILDER OR OWNER �� {eC lw c�NYJ �l��J DATE. PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No rio-I A-tO 4o V bur Lex V �f ASSESSORS MAP[1@:®_6 9 THE COMMONVikALoTT�F MA-SSA-C--H-t 9T'S- BOARD OF HEALTH TOWN OF BARNSTABLE , ppUratiun for Diripwial Workw Tomitrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( V J an Individual .Sewage Disposal y .System at•Or i Location-:\ddn s or Lot o. Owner Address < Installer Address Type of Building Size Lot............................Sq. feet �. Dwelling— No. of Bedrooms......_..._1_______________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther 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 ( ) 1.4 . 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.............._......... P+ •-•••---••-•-----•.............•-•........-•----•-•----•......••-•---•--...........----••••--...............--•-•-•--..........---•-•---••.....--•-•---•--•-• ODescription of Soil........................................................................................................................................................................ W ---•-----------------------------------------------------------------------------------•-•------------------ U Nature of Repairs or Alterations—Answer when applicable........... ... �__._ 1C1�4Al"__._.Q �...... .� b... sA.l, t c.;.. ..C .e?� .. '.--�,/-- _ a-t---cam^ .. -t✓-CrF.. --��.,...... 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 boar health. Signed ............ ................. Application Approved By ....: - ..................... ..... --------- ----- :.....................................•---- ---.............Dace.......----- Application Disapproved for the following reasons: ..................................... ' ......... ............. .............. ....................."-'...... ......... .............. .................................................................................. ................................. ............................................................... ........................................ Dare Permit No. .......................... .... Issued ..... .................C...........`....�,� ... Dace ','J•�•..^-r'�..�i��..`.-��.:'-.� r•,�.,1'�,•�;j'�tiy...-... �.�..`.•i,�,. ^.Jv.... .. ., _. _ .,,_.,.e�.vc-.�._ ..- .._.,,•......� �•L.�-�.� .. �-- v•»--. .. . c. 7 No................ 1 / Fps ��✓ -..f- m THE COMMONWEALTH OF MASSACHL SETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripwml Worbi Cnomitrnr#inn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( V/ an Individual Sewage Disposal System at:0e' 10 /..f1... '..C..s �._r.. .11 f'e .- --------- -- ---------------------------------------1 --- ---------- Location- W I s or Lot No. :........... _ c - ----------------------------- O-ner Address !!L- ----------------------------------------------- ....... -pv.nc-{- "7 -k /c�,.ti .� -- .... Installer Address Type of Building Size Lot............................Sq. feet .� Dwelling— No, of Bedrooms...........\-------------------------------Expansion Attic ( ) Garbage,Grinder ( ) Other—Type T e of Building No. of persons............................ Showers a YP g ----•---•---------•--------- P ( ) — Cafeteria ( ) Other fixtures ....................................•-•--••----- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_!QPPgalIons 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---•------------------•--•-- a ••-•-••-•••--•-----•------•--•-------••---••-- Date....................................... Test Pit No. 1................tninutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------------------------- -..------------•---...........------- ---------------------- •........ ........................... 0• Description of Soil........................................................................................................................................................................ x c., w _ ----•--•------------------------------------------------------------------------------------------- ----------�j ------....... U Nature of Repairs or Alterations—Answer when applicable._.__. Q lGt ?.... X.h4 -Q - -_-_.G '�5 4L 1-...,_. — 1 greeent: u.-l-. -• ��4 -- -----Pt4----W..�..�t!.� ..S-�Ci ,T 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 b of health. Signed .......� ... ..... ....... .... �oard ------.--------------- a s ...l 7--S Due Application Approved B am.- "....j� ... ............ .......................... .........o....... �....'......... Dace Application Disapproved for the following reasons: .....................................d....................... ....................................................................: ... ............... .. ... . ......................... ......--............................ ..... ................................. ....................................... Dare Permit No. may, /- y / -- -----.._.. Issued .. ram+° .................�' r...��. ��'... Dace THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH <TOWN OF BARNSTABLE , 01-e r#ifictt#e of C�nmplian.ce 4 THIS IS TO CERTIFY, That the Individual Sewage Disposal System co,nstructed ( ) or Repaired ( �/ ) by .......... .SC,c�. '1.-... `....-... �'t l t-............................... ............. ....... .......... ......... ................... ....................................... Installer at ...... .........+-.(�'�----------- ►--1`^-------- ... ............... .. ................... ........... . ..--...................--... has been installed in accordance with the provisions of TITLE 5 of Theme State Environmental Code as described in____ the application for Disposal Works Construction Permit No. .?E�CCONST�RUED l�.......�� dated ��-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOTS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_ �'� ...............-.. Inspect r^..... ..� ...... ........ _...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.. .. TOWN OF BARNSTABLE f- ... Miposal Workii Tnnntrudion "anti# Permission is hereby granted........... I--------------------•---•-------....--------•-----...--•---..................... to Construct ( ) or Repair ( �an Individual Sewage Disposal System Street L� as shown on the application for Disposal Works Construction Permit IV�o._ __ �� _. (� •- Board of ealth - FORM 36508 HOBBS&WARREN.INC..PUBLISHERS