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Home My WebLink About0756 MAIN ST./RTE 6A(W.BARN.) - Health CSC, `Yh�-�,K St/� G�, l�►� �/cry?, � — — — --- � .. -; A- THE COMMONWEALTH OF MASSACHUSETTS OAR® OF HEALTH /----._... �^e OF............. 5 Appliration for Elhyaa al Works Tomitrurtilaat Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - _ Location-Address or Lot No. e— -------•-- ---------- r --- -- ---S-..- .........C'-----•--•-.._..._..----------------- ----•-................---•------------.....----- ......._......•._.._._.._...---------..__----- Wne Address ----• nOstal. Address•--•-------------------------------- ------------ ••--•...._._... :_..._... es ._. a�.----- I a Type of BuildingSize Lot GQ �............................Sq. feet Dwelling—No. of Bedrooms...____.�_____________________________•Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) —Cafeteria ( ) d Other fixtures ---------------------------------------••--•••---•-•-- W Design Flow__________________ _______________________gallons per person per day. Total daily flow............................................gallons. G4 Septic Tank—Liquid capacity gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width_____r.__.________ Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------)L--------- Diameter.......46......... Depth below inlet____________________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation 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.-------------- _........ Ix -•--•-•--••-----------•--•.......................•-•---•-•--••••-•--••--.........-------------------...............Z�............................. Description of Soil.......• •- ---•-- -------.....•---••-•••- x - _.. - q •••---•- --••••--••-------•----•---•- ----.-b-----••-•---•••••. w --- - UNature 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'THE x of the State Sanitary de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ab�eissu5e4board oY Sign •-•=- -----•---- ------ ----------•-•-Date Application Approved By--ram - --- --_-___..----•---------------- 9i�--------______-- Date Application Disapproved for the folio - g reasons----------------------------•--••-•--------------------------•------------------•--------------••--•-••-•----••- .....•-•-•-----•---•--•--•---•----------•.._.__.....••••-------•-•-•----•-...--•••-----------•----••-•-----•...............•-•-•-•--••----------•-•---••--•--••---•------•---•----------••-•------•----- .dam _..--••-------Date PermitNo....... -•-- •------•- --• ----•................. Issued.......---......------------- --.._..._.. Date No.--V .....-... •- Fxs........... ?.v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... .. -r............ OF......... ....U.....!!� !>............................................. Aplifiration for Uiiposal Works Tontrnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......�.--.�._-------et�..------.6- ............................................... --•----........._...........---------------------------------------------...-----•-•------ CLocation-Address or Lot No. W ----•............. / .. ...... ...... Own r / CJ Address /p Ins'aLe Address 3 0.C.r e s Type of Building Size Lot............................Sq. feet v Dwelling—No. of Bedrooms___..__ _ .__..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other fixtures .........................•---•• . W Design Flow................................ ..........gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacit/S OD__gallons Length................ Width................ Diameter---------------- Depth................ 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 ( ) �-' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------•--•-••. -•••--------••---•-•-•-••-------•••••.......................•------------••........---'-•--•-••--••---•--•---------------••-•. Description of Soil... = :.. ------------------------ -- -•--. . •-•---••--••---••--------------••--............-- - . ........ :.. W --••-•-•••---------------------•-..........................------. ............................................................ ------•-----•---•-•----•------•----•-•---••--•----•------------------- UNature 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 j of the State Sanitary, ode— The undersigned further agrees not to place the system in operation until a Certificate of Complianceab� issu board of lth. Sig --- --•-•_. .. -- •• -•------------•- Date Application Approved By---��'�- 1 .. ..........................•-- ...... ---- -----_---•------�, Date Application Disapproved for the follo ng reasons:................... •--••--•--••----•-------------------------•----•--•-••-•---•--•-•-•--- •-------------- ..................-:.................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......... �`.L�............................................. Trrtifiratr of Tomplianrr THIS IS TO CER�IFY, That tte Individual �ewage Disposal System constructed ( ) or Repaired ( ) bf ............... --•..................•--•-----•----.............---...----...-----...•-•--•--•-------••••- atti� .......................... .� !_ r-------------------- '1�- -—------ L=-'---:--------.................... has been installed in accordance with the provisions of TITS j ' The State Sanitaryas described in the application for Disposal Works Construction Permit No��.._�-_�'.. .................. dated__..�/ANTEE�_1.�__�-_-___-__-______•_. Th9E ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A G THAT '!HE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... Inspector ---------------------------••---•-•----- -------•--•------•----- 1 t7 y �6 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...........-_. y 1... ........................................ L No......................... FEE �i��o�� for .� �on�r�rtion rrutit Permission is hereby granted............. .......... ..................__ to Construct ( ) or Repair ( ) an -ndivi�ul Se, , ge Dispos �Sysyem, / — j f{ at 1'0.- 7G r �- r �ti, ...... Street as shown on the application for Disposal Works Construction ermit Nd.7_ __. Dated�� ._3 _.:'�.. ................. Board ift H alth DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION SEWAGE # — . VILLAGE —ASSESSOR'S MAP 6z LOT INSTALLER'S NAME Si PHONE NO. SEPTIC TANK CAPAATY LEACHING FACILITY:(type) ,' (size)41 NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER C DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: `� VARIANCE GRANTED: Yes � � sq j6 �� 3 r � � , °� I F07 0 pouse Fealit d5� II I o i 0 I D , i fo f 0 I< ao �-�