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Home My WebLink About0058 CAPE COD LANE - Health D . III e TOWN OF BARNSTABLE , LOCATION G1 SEWAGE # VILLAGE = �►�w�`r� ASSESSOR'S MAP & LOT )-7T 6l � INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) �.LA NO. OF BEDROOMS �� PRIVATE WELL O 1C WA F_ BUILDER OR OWNER_�,L/lA DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� c r � y` -7-7— Di ` N 0 Y, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVE® TOWN OF B A R N ST A B L E earnstable Conservation D"nment Alirttti�it f nr1iltu� i urltl Cnngtlrr IIQNow Oats Application is hereby made for a Permit to Construct ( ) or Repair (L,41an Individual Sewage Disposal System at: Location-Atidrcss or Lot No. .................. :. =- - ��- Owner1.4 ddress 9Q Installer Address UType of Building Size Lot............................Sq. feet .., Dwelling— No. of Bedrooms._----------------------------------_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons___-___.____.__-____-__._._. Showers ( ) — Cafeteria ( ) dOther fixture ------------------------------------------------------------------------ -------------- ----------- ...................--•----••-------------------• W Design Flow............. . ......................gallons per person r 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 ( ) Percolation 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........................ ------------------------- ------- •--•-----------•-----....-----•-•--------•--•-••••••......................................................... 0 Description of Soil........................................................................................................................................................................ W V ..................................••. ....... ---------------------------------------.......................__........--------------........._....-----•----------------•----•--...........•---........ W UNature of Repairs or Alterations—Answer when ap licable... STAB___ k.................... &�-........� /G� ..... �T.L .f.. . _.--------------------------.-------•-- /,jl� 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 Compliance has bee sued by the bo . d of ealth. Signed ............... �:..' ....... re Application Approved B .:_..... ... = � , !"—V ....................... ....... Application Disapproved for the following reasons: ............................................. . .............................. .................................................. ... . . . ....... . ......................................................... Permit N . ............o .... ��. .:..::�/.. ....... - .. Issued ..........................................�""6......0 Date No. �_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iration for Diripniul Wor1wC�n�t rttrf un, rrtn•#t 1.3 Application is hereby made for a Permit to Construct ( ) or Repair (L.,)°'an Individual Sewage Disposal System at: . � �W 17 c_''_!.?1t.........-.....sz=---------- 1 ... `` .Location-Address or Lot No. h< Cc ;n! C t .................................................................•... --•---.................------•---•----...........--••-----•-•---................................. Owner Address ------------------- 1._.. ..... - Y Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._-= ------------------------------------Expansion Attic ( ) Garbage Grinder ( � aOther—Type of Building ____________________________ No. of persons.................. Showers ( ) Cafeteria dOther fixtures -----------------------------------------------------------•--------------------------- ---------------------------------•-•--•------................ w Design Flow............. .................gallons per person per day. Total daily flow..-�_"St..............................gallons. WSeptic Tank-1 Liquid capacity Z '.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........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to ground water........................ t? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......... .--.---..--_--. 9 ......•..................................................................................................................................•----- ........... • 0 Description of Soil................................-----------•-•-------.............-----------------------------------------------------•---------------------------•---•-•..........--- x U ................•--•......••... w UNature of Repairs or Alterations—Answer when applicable-------. &-`7/1/ .__ ?�.- Lr........ .............................. ......................... ............... _ ........................ 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 Compliance has beenlissued b the board of health. Y P P , ' Y Sig;OPOned ..................... .1,-�-...:�.--�: �... -------------------- .. �a - �,,... ,lam .. .. Dare Application Approved l3)&r_......... - .-- ...... - - Dare� Application Disapproved for the following reasons: -----------------------------. ..............:.°: ......................_................................................ .....................................................A ............... ....-------------------------------------------------------------- --------------- ........ .------------'.. . ......................................... Date � Permit No. ...................` .. - - Issued ..........................................! ....: Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (IT Elompliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � bto N-. L_ [ .................. ..... ....... --• ........... ... ..... ... Y .........__.................................._,............ _.-............ Insrdlcr at ... ........................._..............._`�..P.._.1..0.C-.I'. .< .....1--.t---I..t::: 1....has been installed in accordance with the provisions of TITLEj of The State nvironmentaI C de as described in the application for Disposal Works Construction Permit No. ._. ... ......._._..._ dated 7^. THE ISSUANCE OF THIS CERTIFICATE SHALL Nor BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN1CTIONc SATISFACTORY. DATE................ v' ✓ _.........._--------- ----------_.......... Inspector ..................... ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - � .- TOWN OF BARNSTABLE� ��n�t�#r�r#Uan �rrutit 41'-� � t�l._.. �s'I�t - Permission is hereby granted--_----_-----.-_--� V .._..•--------------•---------•------..........•---............. to Construct ( ) or Repair (Van Individual Sewage Disposal System atNo-------------------------------••-----•---------••-------�---�-- ----- � '..t!..�... .---- ................� " �`'� .................... Street .� ^" � as shown on the application for Disposal Works Construction Permit Nog?.7711,—/Dated_-_1;.... �j.... ...... oo Board of Hcaltlz DATE-•--- --------------------------------------••-----•----••••-... FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS