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Home My WebLink About0706 MISTIC DRIVE - Health cl --off - -7 r- 3 FEB....... � .... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Diti-pniial Eorkii Tnnitrnr#ion Vamit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: _�%� ..ZD ... ---- ...............•....... --7-�------- L ti dress (� r Lot No. /..........._........ ....... ... ..._...- W ; j er `.Jj� Address c- /�j/( Installer Address Type of Building Size Lot_. .7i'-_._._...._. d YP g S U..Sq. feet U Dwelling— No. of BedroonJs'.J....... . . _... •-__----_---_ _ -.-- .-._Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building v- --_ o. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures -_............ .............. . . �/ W Design Flow................ l•U----_-___ gallons per per day. Total daily flow.._____T�� gallons. 0: Septic Tank—Liquid capacitv/�-----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 t nk ( Percolation Test Results Per Yformed b Z�f� &...%-......!r -------------------- Date__... �1.7-- 1•------.. aTest Pit No. I_ -------minutes per inch Depth of Test Pit.................... Depth to ground water........................ G% Test Pit No. 2-•--------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 04 ----------- Description of Soil....... x � � . C<v! V ------------------- •------------------------------------------------------------------------------------------------------------------------------------------------- ------------•------ 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 Compii ce has eeq s ed by the boar of health. Signed � � �� /�0�7" g . I °.............. . ..... ................�.e.... Application.Approved By ----------- -�-,. �---------------------- --------------_-------------------------------- ----- Application Disapproved for the following rearonf: . .............. ........ ............. .........................f...........-------- . .......... .............. .............. ........ ...................... . ....------- ...-----......---------------------------------- ..................................... Permit No. -----...��---'... �i. .........._ Issued j t .S-_....D�e...... Dare No...••.. F�s..........r�r7.. ..._ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH TOWN OF BARNSTABLE N Apliliratiou for Diryuuul Ourk.6 Towitrurtiurt Famit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: wd4 far ' --------•--------------------------•---.---.---------••- LoFti u-Address or Lot No. `';ry Address 1�...:.Gy✓• Installer Address Type of Building Size Lot..7 7,..fa a._Sq. feet �-, Dwelling— No. of Bedrooms__________________________ _ _ ___-_-__Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building- _No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QIOther fixtures --------------•---------------- - --- ---------------------- -------------- Design Flow................. __________________._____gallons per pPsa> per day. y gallons. W 1/ U e�- Total daily flow-------�___...,--------------------------------------- W Septic Tank—Liquid capacity ��g ll?ns Length________________ Width____-___-___.. Diameter.--_--_-________ Depth............... . x Disposal Trench—No .... WJdtl ,s_ .... ------ Total Length-------------------- Total leaching area--------------------sq. ft Other Distribution bo f Diameter______ ___________ Depth below inlet.................... Total leaching area........_._._.....sq. ft. See a'e Pit No._______1..--:--___ { Z Percolation Test'Results ) Dosing t nk (4 ) 1 Performed by.--:. v"`� -'- --•- e— _.. Date-----/�---•-•• _l•� ��7 W minutes per inch Depth of Test Pit____________________ Depth to ground water______-__-__________----Test Pit No. 1_��-_.. _ . , GL, Test Pit No.2.._..�.'._;...nunu•Yes per inch Depth of Test Pit____________________ Depth to ground water........................ /'---- .......................------------•--------•-----••---•••••--------••••-•-•-•••-•-•••--••-•......................................................... Descriptionof Soil ,�, ../ ..... 7..... '------------------------------------------------------------------------------------------------------------------------ V --•-----------------------------------•---••---•-•-----•------•-•-----•--•----------•---------•--_--_____-•-•---______------------___--•-•-•--•-----______---••--•-------------•-•-••••-- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature 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 Complia ce has ee 's ed by the boar of health. Signed _ T---------------- r' Date Application.Approved By ..--....... . -:. ..�., ,, ............................ 1" ` ..-..,/-.n-..-.1 .: .,�..................... :1f Cate i Application Disapproved for the following reasons: --------------------------------------------------'------------------ ---------------------------------------------------- i t - -.........-1 ` ........ ......._-----__-- ------------------------------------------------------_.--.. --.._--.-___--.-...---.-..-.--..----._ } �.-._-....--f,( .-..._. ...Date.O... --_.-----...-..Date...........-...... 1 t --j..-....., -� ............................................ 3 Permit No. - :... '� f -Issued . 1 _----- ----..,-.v,.��_��,�. ®_._,®� �,�,•------•-.--- --�--�,^�,_------- THE COMMONWEALTH OF MASSACHUSETTS I , . I d/ BOARD OF HEALTH , TOWN OF BARNSTABLE' Ter#ifirate of Toiiipli.anre T IS TO CERTIFY',Zhat the ndiyijuual Sewage Disposal;System constructed+(V ) or Repaired ( ) T� b _ .._-�-------------------------- - " - -- Y ---- - �,!Jy( s at .. - has been installed in accordance with the provisions of TITLEt5 of The'State Environmental Code as described in the application for Disposal Works Construction Permit No. _.��5.1 � ��_.._. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........//.........,G ..-- .....� J............................. Inspec e-,.. ----- ------ ... ----- 17 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1, TOWN OF BARNSTABLE ,.ermi u i PermissionY herebygranted...... ..---------•----------------------•-- -- -- ---_..-- --•-------•-••-----........... g to Construct or Repair ( ) an Individual Sewage Disposal System at No...--••- • 7 1 � C__..- .�'�--- Street as shown on the appli io/fo Disposal Works Construction P No. �'�?:__.__ D d_____��_ __._._._......._._._.._.••--••. .- •--•- -• -•---•••--•. _------- - ---�� •••. •••---••••.--•.../ Board o ealth DATE•--------------(-- 6 �. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 4, 7� TOWN OF BARNSTABLE LOCATION �! lsT,LC SEWAGE# To VILLAGE ASSESSOR MAP&L T INSTALLER'S NAME&PHONE NO.- SEPTIC TANK CAPACITY /SOP 61faal-) LEACHING FACILITY: (type) I�CC/11�� ' X`�G�>1 (size) Age NO.OF BEDROOMS ` BUILDER OR OWNER PERMTTDATE: - ----COMPLIANCE DATE: 4 " ZZ 7" Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /�L, +ITL'� 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 /n /oZ3 � VA T-A OF SIIJkZ FAAAI :bMzoo'`s �0 G AqB as Go► tez f -t:I,iL� PLow 4xIIo-A4o P-r-> Lar -12 S�,,rG TAWIL 440x0�;D`7o-660 L�aG►4�N r,. G4u..s15 4 _4x.d- �� STD Mq 7-bAl S M I�.LS Snos xu- Awz4= l9z SF jq z Sr � -2,r= 4�z mm MAP �9 Pa �s P5oT rDM A ZZA = I 0 s1' 145 5F X Jo = l'm�,&Q a -rorAL Dtsl�►J * Coo 8 (,P� 'TOTAL. -MILy �IXQ I� A4o PQ.COLAT►D�I fZArB 14'LAAIN/W Ao ; tN of OF A, 4"Fo o PETF.IR �c% A. SUI.1.4'AN VA 4 SAXTS vo 2iou $ NC.�.::,s3 � 4 � CIVIL .. IZ I O rF= s Il11-7 4,LVAW � to Z 4• RST' /G S�PTIL (,MULL -'4 ud 6AU.lES w , S /✓/�M-I�f,M �v. wA 5' ,FL= 57 GaaJ• PPwr R-Ao eW1tSFs C of QEc02a •Df1To� Z'Z�•9S -4-o Snug " M NPTE 7'NE 7t&wo Le" qr'S aUb REPLACS T�4�t I.v IT$l d.-GALL&-YS j �3 E.L; REy�SE�U SUE Rietm rr 95-3&3 ,L6G.47/O.C/ A•�T�S ��t45 / E•2 y T ,4 , ,Sf/oGt/it/h�E.QEO.C/�OMOL YS k//7H .SCA L SO OATS 9S- �'-,4��,5"/OE,C/.VE ANo SETBA r./G IOC14 A"V .�Ec�v�.eE�!E�/y7-vw.V c7F 3��Is7'�-►3C.�' A.c./� /s �✓d7- ,fir-- •7 Z. �27 &— OA TE ,BA XT.E,2�it/YE /NC. Tf//S P.CA.t//S .t/aT BA.SEO dv.4�f/ REG/STE.2E� !,44/,20�> SU.e/i6}2�e� � /NST,2U�1E�t/T,$'!/•eYEY f TfiE G1SJ"'�.�.2Y/.Gl...�a �'J.4SS. 0.�.45'E'T.S Sfi��L✓�Y 5,�,lDVL� V207- U.s�1� 7'� OET�,P�f/.t/E ,�>T�/NES. ,CYO• S/lib �Oc�lC.lj/d/G 40 r y �WL � �A�51DE;�JI lA4(� Co y ' I S�v•va � I i Isso 11'24 91; 68 7'4'IwrrN\z' srrvs ' � 1 loll if \ � r c L4' "1,7,sot) 0� • �H Of OF PETER 0c►uar SULLIVAN A. NO.'M33 y, CIVIL �►O Fss�Ohl.• �\ � It •Z..l ,9s