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0160 COBBLE STONE ROAD - Health
�. a Cobble Stone • • • 064 :i11 �f TOWN OF BARNSTABLE ' a LOCATION <ac � -(2�.C`�51�_9, SEWAGE ## VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NA,bIE & PHONE NO. q R 0-5?6C u SEPTIC-TANK cIi`I'ACITY t s o o q". t- ,f r LEACHING FACILITY:(type) ZI wsc 3 ,�(size) rpNO. OF BEDROOMS PRIVATE WELL PUBLIC WATE BUILDER OR OWNER DATE. PERMIT ISSUED: 1 Y g ha 7 DATE .C011PLIANCE ISSUED: I VARIANCE GRANTED: Yes No � s 15�o l 'O � �., o , i42 �— 7 ' rl , r t • 1 7 1 � i No..;�....... Fzz........................ THE COMMONWEALTH OF MASSACHUSETTS I�0� ' BOARD OF HEALTH %�+► mwo....OF........1.�t'T. .Z� `-' ...................... Appliration for Uigpaaal Works, Tonstrnrtion jJprmit Application is hereby made fora Permit to Construct ) or Repair ( ) an Individual Sewage Disposal system at: ti ......_. 1.4 0 A 1 L�C9�:7.1 Aa__� 1,� N ?v VV ...»or Lot No. .................».....».».».»..... l //��Oy+ Address a ... .......1:,/._ r .. .:........ ................................................... Installer Address r Type of Building Size Lot...�.�. 69 _Sq. feet Dwelling—No. of Bedrooms....................... ...................Expansion Attic ( ) Garba a Grinder ( ) a Other—Type of.Building ............................ No. of persons............................ Showers ( ) — Cafeteria O. ( ) Other fixtures ...................................... W Design Flow.............. gallons per r Frtday. Total daily Pow..............�3..0.._...... lon# WSeptic Tank—Liquid capacity gallons Length. �..... Width..j._l�... Diameter................ Depth..{�.. x Disposal Trench—No..................... Width....... Total Length......... Total leaching area....................sq. ft. 3 Seepage Pit No.__.....-(........... Diameter...... Depth below inlet............. Total leaching areas _Isq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Result Performed by.... .: tcc� - .A'.:.....:.......... Date...... .. � ......... Test Pit No. e �-. minutes per inch Depth of Test Pit.... .... .. ... Depth to ground wa er...... 44 Test Pit No._5.... ..._... iinutes per inch Depth of Test Pit....I.. ......... Depth to ground water..... . . . �i ----•---------.."-.----_ ......................................., • tt O Description of Soil#.u�....X4!m .05. 1i.. _�OQ�� ?.�S1�K? �1 .. �.� as � ...24u...... . .. ..,N.c a .+...1 P � UW .......................... ................•--------•----••---•-----------------------•••----------•----•--------•---------•--................------.........-----...........----- •..... 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.I i U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued the board of health, w ` Signed..........!.'.5.. ......1.............. -........./...._.... Iv Dat JO Application Approved By-..... . .... ......... ...... ...• �..._.............................._ Date Application Disapproved for the following asons: :.............................:..............•--•----......................_...._•--•-........_.. Y Permit No.. ..............•----•--•_.... Issued....... ............ Date No.A...... t_ THE COMMONWEALTH OF MASSACHUSETTS - �_/�� _ BOARD OF HEALTH z - ` wti t-ya .....OF........ .t . 4 w ..............�::-•-:.. Applirtttion for Bhipasttl Yorks (Iiiniiruddilt rrrmi#_ f Application is hereby made•for a Permit to Construct �O or Repair ( ) an Individual Sewage Disposal system at: � ................__...._— = i !' f3i3 `:__ k:. .Q -- ,�^� Location Address ,, ................, _ .a 1✓ A k ba�j .. �N V V_.... .................. ...or Lot No........................................... W /r��/ lr Owner ---•-------•-• --Address...... .................................._.. "„� •----•-• ------- - .......-- --/- i -YZ' •:...•-•-r ..- .................... Iastaller // �" Address •/• • Type of Building V � Size Lot_...�"�..:�::v��:.sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ...._.._.:.................. No. of persons._..._____.___________._.___ Showers ( ) — Cafeteriafixtures ..................................... a-- Design Flow_____________A _ erson �)----.._._........___-__.gallons per p per iday. Total d yilylflow.:____•______...._----_•---- .........gallons:W WSeptic Tank—Liquid capacity I lrmgallons Length_��_ .... Width:C_4,.:_.. Diameter:............... Depth... xDisposal Trench—No..................... Width..................:_ Total Length.................... Total leaching area..-....___..........sq. ft. 3 Seepage Pit No.........1........... Diameter.....1.._�_... _. Depth below inlet.__ � �...- Total leaching area. (_2,0rsq. ft. Z Other Distribution box (; ), Dosing tank ( ) Percolation Test Results Performed b l��-'�A; -:1 �.................. a y.-..-a-----•..........:....,.... rt Date........r.1. :.... a Test Pit No.9:_2-Z_minutes per inch Depth of Test Pit.._� __.-__ Depth to ground water... (� Test Pit No. .__.e__.�niinutes per inch Depth of Test Pit._-- ? __. Depth to ground water... .................CG ;;...:. ---.•... ... ....................................... 0 # 2�"tT�)Pt��l�a1�1a'`�1, caAt- Description of Soil---:...............................................�-•------._.,.............._.,.-----••-•---•----------• V PA c UP, ��ll - '� ram-AND`/HP is��.� ` - 144' _mil E_A►1 C©aZ� t R - ----------•••-- - ------- --- _. ........ ......••-, V.` o .............................•.............................................. ------._...-•---------•----...-•-----.._-.:-....-:----....----•---•--..................................................... 0 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 TITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. s Signed........ � ....................................... ...... Application Approved By.......,_-_a"Y\ � f .. Date Date Application Disapproved for the following reasons:............................................................................................................ ... ---•-•---•.......................•---•-.......---•-••----.-.......---------•-----....---...---•-----•••-•......-•-•-•--•--..........---•---•----.._.........------••-•-••-•---...._..........--•-....... Date Permit No.. �= . .._...... .................•--•------._ � Issued..........1 � " J . ...� -............ THE COMMONWEALTH OF MASSACHUSETTS �1 {� fV� .. BOARD OF HEALTH -N� ... . ......................................................... .- f�rr�if utter of f�uut�rlittnrr THIS IS T,0 CERTIFY; That the Individual Sewage Disposal System constructed ) or Repaired ( ) by..............�/� ,I ............�`Z� ................................................ -•-.........-•-•-............................................ - •� (�� t �) Installer 1• r at......... 't, ..... .._3ri .............`AJ ?'� ram..�._..._.. _s.._..__/ � 'lfvkl% .............................. r has been installed in accordance with the provisions of T TLC 5.of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-. _�_-_r.t_�'-_. �._____..___. dated........ ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCTION SATISA0CTORY. DATE.................... ................ Inspector Inspector........--- .. _Y................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... - -..... ...----.-....--... —7 c� No........................ FFz........................ Mo rn I,� l rk T o sstru lion Ve�i# Permission is hereby granted...... ................. _..__..... ................................................. to Construct ( ),or Repair (� ) an Individual Sewage Disposal System atNo......_� :.... .`� ! ! � ,��-�'-�-- K, _ ....e........................................................................ •; � Strcet � // as shown on the application for Disposal Works Construction Permit No ^.(.1.$,Dated:_-__ / --�... 4....... F ................ ................ ....................... Board of Health DATE............ .... " "._z.............._._...._.........