The URL can be used to link to this page

Home My WebLink About0504 MAIN ST./RTE 6A(W.BARN.) - Health r' ., �P _ l��,� � p V47OV NTRY N T NST 110 - - 004 S M E A No.2-153LY UPC 12934 smaad.com • Made in USA ,&YC(1 SUSTAINABLE FORESTRY INITIATIVE Certified Fiber Sourcing wwvasfiprogramorg TOWN OF BARNSTABLE WCATION 14 1/1 .S� SEWAGE # VILLAGE ZIL/,� , tsnt�Q�� ASSESSOR'S MAP & LOT" 6-0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Vie.. (size) 73 NO. OF BEDROOMS m3 - BUILDER.OR OWNER PERMTTDATE: COMPLIANCE DATE: �c Separation Distance Between the: ti Maximum Adjusted Groundwater Table to the 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 i I%I� vIdl al��Il4t ,1' TOWN OF BLRNSTAALE pe�7,' LOCATION`/off C'o�A/e,� SEWAGE # IMLAGE ASSESSOR'S MAP & LOT #ecwTv� t a "T• INSTALLER'S NAME & PHONE NO.Wi�1171� dO*e /y- v01 SCla sic Ta �.9a/�TT�" SEPTIC TANK CAPACITY /)dy �A "1621 7/-,0.4/ x�s7:.�� •LEACHING FACILITY:(type) 2 sbo 0 (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 10W1,e 7a rV DATE PERMIT ISSUED: —/X---f DATE COMPLIANCE ISSUED: r r VARIANCE GRANTED: Yes No � �/®f�.�� L/'?�/G %i9/d/� To �f3�iL'�'��T� ��rz//�'X��>�%�s-�✓ pk--fir �.� No..2,61.......... Finc 2: .............. THE COMMONWEALTH OF MASSACHUSETTS 11OARD OF HEALTH - &J A)- .......oF........ /_�'OL——----------------------Applirativit for Uhiposal Rlorkii Tonstrurtion Prrinit Applica%0 Mihopby made for a Permit to Construct (VIror Repair an Individual Sewage Disposal ystem at: #04........... ....................................................................................... Locario';-A5nss ��r Lot Own Address A . ................. ............. . ....... ..... ...... . Installer Address Type of Building Size Lot.39,Zff .....Sq. feet U Dwelling—No. of Bedrooms..............3........................Expansion Attic Garbage Grinder fl-15— a d Other—Type of Building A)D.jC7 Dl-,.... No. of persons.....7................... Sho rs Cafeteria Other fixtures ........ rs. 44rSAC .< W Design Flow................ .. ....................gallons per person per day. Total daily flow.......... ................gallons. 04 Septic Tank—Liquid capacity/-gallons Length................ Width....___--_...... Diameter....____........Depth................ Disposal Trench—No. .................... Width.................... Total Length........__._....._.. Total leaching area....................sq. f t. Seepage Pit No-----1497".. Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box Dosing tank ( ) Percolation Test Result Performed by.......................................................................... Date........................................ Test Pit No. L..�.......7m inutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 41 Test Pit No. 2................minutes per inch Depth of Test Pit.._.........__...... Depth to ground water_.__.____._............. 04 ............................................................................................................................................................. 0 Description of Al.,b................................................ ............................................................................................. �4 U ....................................................................................................................................................................................................... W ........................................................................................................................................................................................................ 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been . tied by the boa of, h 1,�yalth... . ... . ... . . .... 2_7 Signed_ . ... ......... ..... .. -at t a' ------------ ...... --------------...................... Application Approved BYP.(?&. ---1-e�v 17. r the fol_:� ate Application Disapproved for I _n�greasons:------------ .................................................................................a .............. ...................................................................... ................................................................................................................................. Date PermitNo......................................................... Issued........................................................ Date .......... FIZIC !f7E................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -- .......... OF........ . LA=...................... Apphrativit for Uitipmal Marko Tonstrurtiou Prratit Application is hereby made for a Permit to Construct v4"or Repair an Individual Sewage Disposal System at: �R-xi�dk,�....44.1 lf)i' ........................................................................................... LocaFto*nXddress or Lot No. vl Owner Address el/e......../'&/1 .......... ....... .. ..........Mi4,;_z..... in'staller Addfcss Type of Building Size Lot, .....Sq. feet Dwelling—No. of Bedrooms....... Expansion Attic )E Garbage Grinder Other—Type of Building .14j(�_o ..... No. of persons ..��S�howers Cafeteria Other fixtures .......... 4 .................. Design Flow......_ t&��---- ............gallons per person per day. Total daily flow.............. ................gallons. Septic Tank—Liquid capacity #M)gallons Length................ Width.........__..... Diameter................ Depth.__..........._. Disposal Trench—No...................... Width.................... Total Length........._.......... Total leaching area....................sq. ft. Seepage Pit No...._/t 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_.....__..._....._-____. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_____................_.. 1:4 .......... ............................................................................................................................................. 0 Description of Soil.... ---------------------------------------------------------------------------------------------------------------------------------------------- ......................................................................................................................................................................................................... U W Z .................................... ................................................................................................................................................................. 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 Article XT of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ued by the boaT,4 of he alth Signed.- _W.. .....?..'t Y .......... ate Application Approved By .......................... ....... 4... ---e-t-Y---/... Application Disapproved for the following reasons:....._. ........... ........................................................................................... ........................................................................................................I..................... ......................................................................... Date PermitNo......................................................... Issued............................... ........................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ............................... (Irdifiratr of Toutphatta TH�,.S.LSTQ CERTIFY,",Vhat the Individual Sewage Disposal System constructed ( 4<0r Repaired by............... ..... ...... ................................................................. 7........... f .' e -7............. 71� iel .............. "K. ------� ..............at....�/'�,' i........&o k t), tv-4 has been installed...in accordance with the provisions of Article XI of The St'a'te Sanita7r '�Cfode'a's"`de`scr16ed in the application for Disposal Works Construction Permit No----------------------------------------- dated.--_-_..._........_._._.....__..__....____...... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................................................................I.... Inspector....... ........ THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH ....... .. . ............OF.........../, ....................... No......r- �.......... • FEE........................ Disposal jUarks Tia-ustrudivit Vrrufit ....... ......... Permission is hereby granted...... .. ...................................................................................... to Construct o an Individual Sewage Disposal S teen/ at N Y's C ................................... .. r Repair........... ........ ...... Street as shown on the application for Disposal Works Construction Permit No....-................... Dated____ .............. ................ ............ ..........&.'�........................................ Board of 1-1(/dltli' DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS