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Home My WebLink About0012 COBBLE STONE ROAD - Health �a � � . �t� os3 TOWN WN OF BARNSTABLE � ` C LOCATION GCZ� Cvr3,c�L� 5 /ZD SEWAGE #5� - 3 7/ VILLAGE 13,9,2/yS-�011 G ASSESSOR'S MAP & LOT 31&, 0,53 INSTALLERS NAME of PHONE NO._�LL1s ! eos SEPTIC TANK CAPACITY /5-G Q LEACHING FACILITY:(tgpe) �U�� i'i2cC�s� (SizeD �o r�� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER /'o'061G BUILDER OR OWNER C -J ,l rIe6)4el I/ q ; DATE,PERMIT ISSUED: �- DATE COMPLIANCE ISSUED: 3-- VARIANCE GRANTED: Yes No Ov, l 1 l t 34 N0..,? 0.,91 THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH Barnstable Coeservatimt wpcmaoa Np.GVI�...... 0F.......9. f 5TA8 --------- ApplirFa#ion for Uhipoii ai Vorkg Tnnilrnrtiun refmit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at 14 T 52- C� Location;- ddress or Lot No. ..6al�Af�tl►� ! ........... 11- !�a =..........------A--go. _ Owner Address a ............ !'� .... 11 il „---•-------•----------------------------------------- ------l..�il3.9!�!k a..j. ••--•• ti- Installer Add es� s d 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 ( ) Q' Other fixtures_----------------------------------------------------------------------------------------------------------------- W Design Flow..........................35r....._....gallons per person per day. Total daily flow...............................f.- -..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.•-_____--2__----�iameter_______�d------ Depth below inlet....._6.......... Total leaching area..... sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by-_•______________�-A1(T ....+-.--lE....]�-.... Date............ �« e . ,aa Test Pit No. I....... ..minutes per inch Depth of Test Pit------ ......... Depth to ground water..... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••-••----•--------•---•----.......••-•-•-•-----••--------•................................................................................................. 0 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 5 of the State Environ nt I Code—The undersigned further agrees not to place the system in operation until a Certificate of Cola asre ' rby the board of health. / Sig ------------_-- Dare. q Application Approved By ..- ..... .... _ Dme Application Disapproved for the following reasons: .................. ... .. ........ .................... .................... ------ Permit No. ........ ..- qq b� j -�d.�-------------- Issued ................. .. - Dare THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IM ^�L DATA `;j►, r! No..»............»- -•- Fps............._............... THE COMMONWEALTH OF MASSACHUSETTS .� BOARD OF HEALTH �E)G.JI,k..................OF........:..i11 4�7.K'S.St:&'-............................................. Appliratinn for Disposal Works Tnnstrnr#inn vrrmit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: �...._._ .. :1� I PJ(:> C!d..........:PJ�.-�.� t ��rCi Lp Location•Address or Lot No. • ...................--........................................................................ ............................................................•..............................»..... Owner Address W ................. ...................................-.............................................................. Installer Address dType of Building Size Lot...... 3'7__�" / ..Sq. feet U Dwelling—No. of Bedrooms............... __......................Expansion Attic ( ) Garbage Grinder ( ) 44 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures W Design Flow...................................,»._.___gallons per person per day. Total daily flow...............................K....J ..gallons. WSeptic Tank—L:iquid capacity-6 _.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No .................... Width.................... Total Length........ ......... Total leaching area....................sq. ft. Seepage Pit No..........�____�Diameter-------�U_------ Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank (_y) -- Percolation Test Results / Performed bY----------- ------• -•---•._.........---•.._.._--••--......--••-•-•••_.._. Date............................--......... aTest Pit No. 1....... ___minutes per inch Depth of Test Pit------1_1......... Depth to ground water____________ _______ Test Pit No. 2................minutes per inch Depth of Test Pit............_....... Depth to ground water........................ ._..••--•--------------•--••••-••-•-•-•-•-••--------...-•---------•-•--......-••---------------.............................................................. O Description of Sail - -----_--- x --k�t t � - -----iL_c---------•--•-----_----iJ�--._._.--•------------------- ---------••---- 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 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ssued�by the board of health. Sign 1/j` �• j --'.'------------------''� ... t! + .--... L g'T Application Approved BY ............�.-- . ."'�J......"..... Date Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------------------------------- .. -- -------------------------------------- -- --------------------------------------- - -------------- -------------------------------------------------- ---- ----- ......---------------- �./f�' � Permit No. ........................`� ................. Issued ---- .................. ......r---------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH_ -- .........................f�1tUl.. OF ........8/`t/j-5 .�----- - C11ertifirate of (ETampCianre 44 TPLI-k- S TO CERT1Er,-,,That the Individual Sewage Disposal System constructed ( or Repaired ( ) i- j by ........... E...... ; Installer,, '� ,i •�"-• ,,.• 1 r Installe ! "era.• r--/ � at -....................... ............................................................................................. ................... ...----- . - ------------------------------------ has been installed in accordance with the provisions of TITLE 5.of.The State Environmental Co& as described*,in the application for Disposal Works Construction Permit No. ....'!. ............ dated .-. _'! ------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------- --..-1..�n..- ... Inspector �.,..LJ. THE COMMONWEALTH OF MASSACHUSETTS --- BOARD OF HEALTH �!�!�>�......0F..... h! j: /:' L. .......................................... No......................... FEE...................... f . Dispos af- na`kp Tannstra rtinn Wrmit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System r� f at No r , .. ............................................................•--••--•--•---•--------------------•-•--•-------•-------......-----•--••--••-••-••••-•-----.............. n t F J • F Street as shown on the application for Disposal Works Construction Permit No._.................Dated.__.__._._..____.___._......._.. —N -•••••--.....•---•--•-•----•-••.••••-•......••-•--------•----••••--•........_•--••------•-----••--.....» Board of Health DATE..............................................-•-•--•--•--•-•-•-•-•---•-• FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -PATE - '',Stt��'�:F�ItLY7- ;. � �:",(�o; . 6A1zF�QC.E G(zIIJT7ETt . 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