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Home My WebLink About0266 INDIAN TRAIL - Health 266 INDIAN TRAIL, CUMMAQUID A= 337-023 0 F - ASSESSORSMAP!!� -3 � � 1 c� 1 � � PARCB... No. ._..,... - Fss ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativit for Diinipwial Workii Towitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: _ 6 2'n�� .4/V ��4 e/ Cam I,- ^^A �,%� 4 .........................•---........•-•----•-•-....__......----•-'-•-----•--------••-------... ' -------------•------•----------------•---------••--••--•••...-•-••-•----•---- n Location- lddr, s .......................! C�'s.s��✓ 4 � S 5` P612r (!:%A:^.c_ .........................................o ' 02 -------- O��mer Address a ----------- -------mac�`rt----------- - s� ---------------•------------------------- �t� 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.....................................,------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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I________________minutes per inch Depth of Test Pit_----------------- Depth to ground water_.____._.____________._. 01 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------------------- P4 ----------------------------------------------- •---------------------------------------------------- ------------- •------------------------- •-•-.............. 0 Description of Soil............................................--------•---------•--------------------•--------•--------•--------•---•--•-•--------------.-.---------------••--•--....... k U ----•-•----•-••----•--------•-•--•---•------•--•-••••------•------•-------•------•------•---•--•-•-•--•-•---•--------•--------------•-------------------•--------------••-•-••-•-••-•--••••••••••--••••. W ---- ---------------------------------------------- ---------------------------------------------------- V Nature of Repairg or Alterat s—Answer when applicable._.__ -.._.C O-• i f=FvS '1 --------- - C-1- --1 D - -- ----- --- 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 undersigneo further agrees. not to place the system in operation until a Certificate of Compliance has been is ued .... % by � bo e .. .......Signe . C � . .... Application. ----------------------- Approved By .............. Date Application Disapproved for the following reasons: - - .... ...................... ............. . ...... . .. .. .......... ..-- ............................................... ------------------------------------------- _ Permit No. ._.1.. Issued ----------- ------- -- -------`'...��' Dace ------ ,92 ...•. w F>�s .................. THE COMMONWEALTH OF MASSACHUSETTS, ' .BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Diinpnittl Wnrlai Tonstrnr#inn rumit Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal System at: r r ................-................................................••--••-••---•---••-- ------------ Location-Add s y� �A�",-f /G�A�t�/ }�S /q"t 1-1.0>( �� rlO /C?/�T orrd ot/No. Owner //yam Address / Installer Address UType of Building Size Lot............................Sq. feet .. Dwelling—No. of Bedrooms------------_____________________________-_Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building ............................ No. of ersons---___-__--___-_______--_-__ Showers a YP g P ( ) — Cafeteria ( ) Otherfixtures . .._.. =- ------------•-------•------•••-- .......... w Design Flow............................................gallons per person per 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. 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........................ fZ4 Test Pit No. 2................minutes per inch ,Depth of Test Pit-___-_______--_____ Depth to ground water........................ 04 •. Description of Soil ............................... x U w •'- - --••-•-----•-------------- --------------------------------------------------------------------------------------- __A ____ � ___ ��. l.�FvS¢ `U Nature of Repairs or Alterati ns—Answer when applicable_ t ----------------------•_.. 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 lace the.- " system in operation until a Certificate of Compliance has been is�Iled by t -e bo r3 6,L,14 ea_ -g P Sigr�edi ....... -- ------------- ---- a---7------s....----- S— Application.Approved BY -? -......"--- -.-... '------ .................. x () Dace Application Disapproved for the following reasons- ---------------------------------------- ----- ------------------- ..... ........... ....----------------------- --------------- ..................-- .----......-.............------------.....------- ------ Permit No. �,.... '°�.... Issued ............oe. .'.... +...��`... � Dace THE COMMONWEALTH OF MASSACHUSE175 BOARD OF HEALTH TOWN OF BARNSTABLE Ter#tf rate of C�ompltttnce r THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (`i ) by ... -------.. _,�� `sr �- / hstauer at ........a�:. ..._. _Z�24 Cc,�. 1-- ----------------------�c'.y`' `' - --------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of he State Environmental rode as described in_ the application for Disposal Works Construction Permit No. .. datedC "`.�'.. ....� 7. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ATISFACTORY. DATE ...............1. ._:. --........�,1................. Inspector ------..... ' - - ------------------------------. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No � , TOWN OF BARNSTABLE FE ..•••••:•--- Rnpnnal Workii Tnntrudinrt "Vrrntit Permission is hereby granted........�2 e_N_ e-a ST --------------- ------- to Construct ( ) or Repair (G� n individual Sewage Disposal System r atNo...............7_ ...__.,Ld!!-9w..__ i � ...................................................... as shown on the application for Disposal Works Construction Pe �a `.o. _ ��_ Dated_. J .....__ _.. .__. . __.�- , Board of Health DATE ............•-----1 ------•-•--- FORM 38508 HOBBS Ai WARREN.INC..PUBLISHERS I_ • .. - - [r /' fir{ I .S -. - � - c :aa. V 'ZI 4. `ZZ jV PI Ar JL pbpr 5 �G - ".. :` • r 4 I -. 4t�� _ � } , aREa�cov`r: y.. r } f. 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