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Home My WebLink About0195 LAKE SHORE DRIVE - Health Shove-,� , ®-)2olozz No.._._.1. .,5-d (-/ Fis.........1 G?..C?.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinit for Bi_npn!3tt1 Wnrkai Tomitrnr#inn Prrmit Application is her y made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: /.1715 ..!-:�'--Ufa.-..1.A. _.` -.' ._.__._... / + 1rn f Location-_Address or Lot No. .------•------------•-•----•-- -•---•----••-----------•----•-•----------•---------... Owner - Address a �� -41... -- ......................... -----------=----------------------------------------------------------------------------•-------- - histaller Address Type of Building 3 Size Lot___2L.2'.2...Sq. feet UDwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons..................._-------. Showers ( ) — Cafeteria ( ) dOther fixtures . -- ---------------------------- --------- - -----------------------------------•-----------_---•_-•••--•- W Design Flow........ A.10___................---gallons gallons per person per day. Total daily flow_____________3_--5._(P_._.___._.___gallons. I $, �,r t u W Septic Tank—.I Iquid-capacity gallons Length._-__... .... Width_-_4..J0}__ Diameter__ ____________ Depth.js'___a-. x Disposal Trench No Width__ - __, __ Total Length.................... Total leaching area....................sq. ft. Seepage Pit .No ►-� ..p>ameter ..-_ .Depth..below inlet_._____r ....... Total leaching areal-4�M.!__sq. ft. Z Other Distribution box ( ts Dosing-tankJ. ( ) Percolation Test Results Performed by ��. Date....................................... (i, Test Pit No 2 �L___unutes per; filch. D�tlh of Test P..it____....13�_____ Depth to ground water........................ -- - -------------- ----------------------- O Description of SoI ?►-� tt_ �____I :el-_C,#L .Ar-?. x v ► f . `- . Asa-A-- . ----- ------------------------------------------------------- U Nature.of Repairs ar Alterations—.' Answer when applicable--------------------------------------------------------------------------------------•--_----- --------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------................ 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 Com Lance een issued b rd of health. Signed . `3f Date Application Approved B ------------- --------_-----.---------- -------.------. PP PP y .:...........! Application Disapproved for the following reasons- -----------------------------..-----------------------------------------------------------------------te------------------ ---------------------------- ------------------------ ---------------------- ----------- --------------------- ---------------------------------------------- -------------------------- ---------------------------------------- Date Permit.No. ;_:.. L� ---------------------------- P ... ....�-.��?. � - Issued . .. ................... ... - .... .. -, Dare -� ® - TOWN OF BARNSTABLE Y LOCATION SEWAGE # 961- She/ VILLAGE ASSESSOR'S MAP & LOT6.10, iS 22� INSTALLER'S NAME & PHONE NO. 6,¢e SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) /boa �+ NO. OF BEDROOMS 3 PRIVATE WELL ORS U L1C WATER BUILDER OR OWNER � �.2T ®�/1� DATE PERMIT ISSUED: ff // DATE COMPLIANCE ISSUED:' VARIANCE GRANTED: Yes No 4 -BLr a� 14ovS l� 3 v THE COMMONWEALTH OF MASSACHUSETTS P BOARD OF HEALTH TOWN OF BARNSTABLE Apli iration for Did n!3tti Wnrkg Towitrnrtion ramit Application is hereby made for a Permit to Construct (V-) or Repair ( ) an Individual Sewage Disposal System at: ;�^r- ---'------•----------------------------•-------'---------•-- Location-Address or Lot No. "��•...� ------------------------------- -. Owner Address a � .......... -------------------------------- Installer Address U Type of Building E� ansion Attic Size Lot__G��.binderq feet Dwelling—No. of Bedrooms.............. ."p" ( ) g ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) a d Other fixtures ---------------- ---------------------------------------------------------------------- ----------------------------------------•------------••-•---" w Design Flow................U.�.�7.- ga llons llons per person per day. Total daily flow..............^-a.�-�___ ............gallons. WSeptic Tank—Liquid capacity_(1'y .gallons Length-$�_Gz'_I-_ Width...�_f�_�`.. Diameter........- Depth.�"�`��'�. x Disposal Trench—No- -------------------- Width-------------------- Total Length.................... Total leaching area-----------_........sq. ft. Seepage Pit No._r°? � ... Diameter....._5` ......... Depth below inlet-----�`....... Total leaching area :n..sq. ft. Z Other Distribution box (--I Dosing tank ( ) '~ Percolation Test Results Performed by... '- � C�.............................. Date... ' _ ........r�........... es Pit No. 1--__`�._--minutes er inch Depth of Test Pit------- Depth to ground water........................ Test k� P P e P LL, Test Pit No. 2........�-_"_minutes per inch Depth of Test Pit------- _-..... Depth to ground water.......... "........ 9 .......................•--•--•-"-------..._.._.......-•--•-•----.........-•-•-•-•------•------------......................................................... 0 Description of S oil ' =E-a�...lr�� .. A i t ¢--- �'tea i R h-?.G;-cJ�-E-�F. �-�ak ?E ....... x w VNature of Repairs or Alterations—Answer when applicable............................................................................................... ----•--••-•------------------------------------------------•------•------------------------------------------------------------------•------•--•----------------------------------------.............--- 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 Comp ial n e'°as�been issued by-the-board of health. Signed ......._....... x-t' ......................................... ... ......_ �s'// �l �..�- Dace Application Approved By ------- - L -------?...... -.... .. Application Disapproved for the following reasons: ..................... ----------------- --------------------------------- ------------------------------------------- ------ -------------------------------------------- ----------------...........-----... ....................................... Da Permit No. -------- v------------------ Issued .-----------------_--- ....................................... Daace,e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cextifirate of Cgomyliance THIS FS-TO CERTIF '~`Ihat the Individual Sewage Disposal System constructed (fir ) or Repaired ( ) by ----------:_. .}-:,... r � ;�`r, -�t�-�•��c cam;/ ------- at o.-- --6......W....._ .t--�---->�} �!-! -----------��er-<----- -------------f'f r ��f}�-------------------- ..--------------------------------------------- has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. _._ .-------�..0..4f--- dated ._..._--------------.._----------------_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ^L�... ..f..:...... ------------------------------ Inspector .....- .:'v---------- ----------.f.......... ...... O THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G TOWN OF BARNSTABLE 1. )LFEE �t��rn�n1-� �ark� Cnu ��r�trtuan hermit Permission is hereby granted.... ...........---'' =`''`'r'c'c'z-•---------------•----------•----•-•--------------------••-•"..... to Construct ( or Repair ( ) an IndividualSewage Disposal System at No.------. �'�� .'�? ? -' . n.�._� '_Efe .........Ii.--<'. !!=M ...... Street 2 c, as shown on the application for Disposal Works Construction Permit No --------- Dated....___: .✓./ .......... ............................. - :- �J Board of Health DATE. 1 3./ 'h�------------------------------------ FORM 36508 HOBBS R WARREN.INC..PUBLISHERS I s '77777777"77�-- 4 -J-'11"�;�'1:1- 0 % 10 (D a4 rLi M 3,pig -44-. w IC -a IT to" ID E7 T&I Lf. O A-zC0 V74A CooCS 7 1 Lf- V, Lv CiT Ll&�-16 e, bLS Fvel 7�_rj t> t 11.4 Lj 17 Ty 0 bj,��F� 'Ito: .4q .70 QL 1.01 't6 LA V St.1 IC �4 JT 0 M'&;4