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Home My WebLink About0072 HARTFORD AVENUE - Health (2) `t o? tt�d 2r7 v-e I � c�r�s7Jo n I r "< v TOWN OF BARNSTABLE LOCATION �w r) Asi e- SEWAGE # 2Q1ff>5W4 VILLAGE )Q&tr, A L Qls ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.Q e,6, A Bmtoia sm-&nO-yS3& SEPTIC TANK CAPACITY" LEACHING FACILITY: (type) 1nel (size) WK 30 NO. OF BEDROOMS BUILDER OR OWNER —P*,Ajn� PERMITDATE: 7"//"05 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility sm� Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) &--f P.64i Feet Edge of Wetland and Leaching Facility(If any wetland_s exist within 300 feet of leaching facility) e— P60 Feet Furnished by y 0- h&sSGtu ,44 c.9AG•/ a r., _ r � per_ �r/�-,;�-.• � �y�dw �Lt' 5 7k.: J i •, TOWN OF BARNSTABLE LOCATION_ 7_a 14R2l Fc, ,o $ - SEWAGE # i 417 VILLAGE I`'1 125 ;,,5 0� �.� S ASSESSOR'S MAP & LOT/119-f INSTALLER'S NAME & PHONE NO. S 3,toS_ SEPTIC TANK CAPACITY ( s�� LEACHING FACILITY:(type) 1— (size) ( od c� NO. OF BEDROOMS nF' PRIVATE WELL OR PUBLIC WATER Pu6w— BUILDER OR OWNER DATE PERMIT ISSUED: 7— " DATE COMPLIANCE ISSUED: �',ANCE GRANTED: Yes No fig o W rc -- M . a ' J 1 No Fss THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripotiul Works Tonfitrur ion rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at I it;, r Lot n �00,/op ! ...._ .rO.. .__.!.�.C.'/,!•!f::!- - ddJr Ad es ,�.. ---------------- ------. . ....... Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._...........��-----------------------_-.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons...........----------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - d ------------------••.......... ......._.. 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. 3 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a 0 Description of Soil...........................-............................................................................................................................................ x W ••••-•-••--------------------------•----•--••---••--------------------------------•----••••-••-•--••---•------.........-----------•---- ,.�- -- UNature of Repairs or Alterations—Answer when applicable.-Z�e72" ,-..- Y..e.....: ,_.. .,.. _ ••- '1. / ........................••---------------------------------...----------------•-------------------.............---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enyironm ode—The undersigned further agrees not to place the system in operation until a Certificate of 1' as been issued b the d of health. Signed ...... ........... . .. --- ------ xx r�. ApplicationApproved By . ... ..... ............. :. - ........ .... .... .. ....................... .. 1 --........ ce Application Disapproved for the following rear . ..... ...... ............... ........................................................................................ ........................... . ... .. ............... ............. ......... . ............................................ .......... .. .................... Permit No. r.... ... ..... .... Issued ........ .. ... Dace..... ............. Dace }"."�F�,d'r''°'ti.:J�3+'.Si!k./r wa..�:«r?'t�k.+a:.::.eh�;o:.-.-.a:.1:,Fn��:''.-wok...:---....r,j;;.,-.f-l....•1+::.r,.,,,....�..�-.�..y`�:�+:J'.w..,r',J�„r•........^�.q,stir'tit+-^....:rw�+'O.ii�.��'b.t�++:Tki.�.�-..�kst�+;...w,w..—.—.:*"�,,,-+.,:.i.C�e}..sti:f� No.�� r- � _ � � . -•----_------- F�s............._......�....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripnsul Wi orlio Tomitrurtion runtit Application is hereby made for a Permit to Construct ( ) or Repair (/an Individual Sewage Disposal System at ---V..... ;14;� zt.-o4-2141...... .M,v......... .......... .._.. Location Ad rrsa Or LOY O. Address Installer Address / Type of Building Size Lot............................Sq. feet ,.., Dwelling— No. of Bedrooms-------------------------------------.......Expansion Attic ( ) Garbage Grinder ( ) NV 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 ( ) aPercolation Test Results Performed by..............................•---•------------------------------------... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------------------------------------•----------•----•-•--........-•-•--•---..........................................0-........----•--- 0 Description of Soil........................•------------------••--•--•-•-=•----•-•------r-.------------------. ------------------------------------------..._....................---..--•- x , W ----••-•••--•------------- --------•-•------•-••----•---•-----........_.._..._.....--•-----......--------•-------------......---------------- x U Nature of Repairs e aits r Alterations lterations--v Answer�'� when applicable..� �---- ......_rz. .... --------•-----•----••------------------------------------------------ ............................................. Agreement: v The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmen a•1'Code—The undersigned further agrees not to place the system in operation until a Certificate of 'mplia�nc-as been issued b the of health.' Signed �...........r. .,.- a ...r.. ! Dace Application Approved B �� .: .... �- �! �. }- / Iv -...9 ........................ ...... .. e`..i/ ...'I PP PP Y Application Disapproved for the following reaso� .................................. .... . -- --- ..-- .. ............................................. ............................'o'y.�. ._--'--........../---i 7--..._........_..---.............._......---------................................_... ............�. Dace Permit No. !... r r �------------------------ Issued .. 75. ..{...�---------- ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifi ate of Tontyliartce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ....... L�l� _f..... - 4 ------��-------- ------_..-----------------.------..............--------------... . ............................... ,...h,tallu ac .......... ......... °7`./� �..�✓.. !' tt/k.-- /�/1 .l�'vn:_:t--��i�./ .. ..................................................... has been installed in accordance with the provisions of TITLE......of T /he Sta E wironmental Code as described in the application for Disposal Works Construction Permit No. ..._"'.. ef.-.. .. dated ...._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... -`..- r_..._....... .......__------........----..._ Inspector ._._ ....� ........ � THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH TOWN OF BARNSTABLE �-- No.. FEE..........J.:....... �io�oottl orko �>an,�tr�xtion �rrmit Permission is hereby granted..._. �� .. 1r ��• d-----------------------------------------------•----------•----.-......... ( ) p •r ( an Individual Sewage Disposal System a� No Construct � or R _. 1/Z........................ ............................ ti . ..: Street as shown on the application for Disposal Works Construction Per it Wo.�_L/f''�.,. Dated-_---_--..................11...�_...... �. . Q Board of calth`. l/ .- ------ DATE...............�.-•/Ill-)..-•--:--.�..,.�,.�•."_.- 1J/ % If FORM 36508 HOBBS 6 WARREN;INC..PUBLISHERS