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Home My WebLink About3755 MAIN ST./RTE 6A(BARN.) - Health (2) 37 Sf �!� TOWN OF BARNSTABLE LOCATION 375 S k t 6 A SEWAGE# VILLAGE ��}�5��,+, ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK-CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER �F AViC'S PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) Feet. - Edge of Wetland and Leaching Facility(If any wetlands exist i� within 300 feet of leaching facility) Feet FURNISHED BY 3 a 1600CgA�o� e f � l trrJv C3�c. k /ty 044 OF I —� o OWN OF BARNSTABLE � D. LOrATION 317b 5 SEWAGE fi�"`.5 U VILLAGE_ ' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ram, �Q&V (size),/� �di NO. OF BEDROOMS PRIVATE WELL ORCPUBLIC BUILDER OR OWNER _. ' DATE PERMIT ISSUED:''/ DATE COMPLIANCE ISSUED__ VARIANCE GRANTED: Yes No �- _ _ � � � � __ �� _ � Q _ �. �® � ' a i _ -- AMA No.,?._ _....... Flm ........... THE COMMONWEALTH OF MASSACHUSETTS BOA OF HEALTH �� D uak)... ---.....O F.26W".. j,/..A4.919-/r-•--------------------------- Appliration for RapatiFal Varkii Tonfitrnrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair X an Individual Sewage Disposal System at ......... .� .....� , ,. . . ,.. .....--- - s............... a i Address r Lot . ......... ,r- �� f ------------------------ --------------------------------�' °c1-.-��-- ........................................ Owner Address a ..............--- • ------• �C ztu..0�!-��................ .......... - � Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )U Other—Type T e of Building ............. No. of ersons...._._.........._...._.._.. Showers Pa YP g ---•----------- P ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------•----•--........ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid ca.pacity............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. 1................minutes per i ch Depth of Test Pit.................... Depth to ground water-__-.-----___-___-___-._ rj, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. •---------------------------------•-----------------------•---......--------•--.._.........---------...................................................... 0 Description of Soil............................................................................................................................ x .............................................. V ................--•--- ••--•-••---•---------------•-•••-------------------------------•--....-•---------...----••-----------------------•-•---------••--••---••-•-•-•-•••-------•----••--••----•-----... ---••-•---------------------•---•-•---•----••-----•-•-----•---------•-•-------------••--------•-........ I-------- ••••-----•• - ------------------------ u U N4ure of Answer when applicable_pairs or Alterations—Ans R� ?............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I.I 5 of the State Sanitary Cod The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ss ed b t oar4ohealth Signed-•-•- •--••----....... --.... . .................... ...Q-1! D Application Approved By--•-----< � _1 Date Application Disapproved for the following reasons:................................................................................................................ ....................................................... -•-----------•---------------........------•-••------------------------------••-------------------••---------•---•-----•------•-•--•-----•----•- Date PermitNo. _-k &.e------------------------ Issued....................................................... Date F� _�...... THE COMMONWEALTH OF MASSACHUSETTS BOAOF HEALTH d...t ............o F..w S. s�1/ . ............................. Appliration for M-4puiiFal 10orkri Tomitrurtiuu 11muff Application is hereby made for a Permit to Construct ( ) or Repair X an Individual Sewage Disposal System at: ... _ .-.-- R A_P.1V--- -------------7.�::�. ---.--...---..............-•---- ..... ..__.. Lo i A/d�drEs n �A --....... �.1�.�....... ! ... a............................................................... Owner r-� Address Installer Address PQ Q Type of Building Size Lot----------------------------Sq. feet U DwellingNo. of Bedrooms.............................. .....Ex Expansion Attic — --------- p ( ) Garbage Grinder ( ) aOther Other—Type of Building ............................ No. of persons..........----.............. Showers ( ) — Cafeteria 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.-.-------------....... r-T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....---------._..-..-... -•------•-•-••----•-•--•---•----•-----------------••---•----------••--------....'---••-•---•......--'-•'•---••-'---•••---•---•-•............------•-•-----•-- 0 Description of Soil............................................................................---------------------•----------•-----------••-------------------......................... x V ..........................-••-•••-••--••---•--••--•.....---•---•-••'•••-••-----•----..........----••"-••••--•------•••••-•---•...----•--•-------•---••-•-----•-•••••--------------•----_............... W ----•----------------------- --•-----------------------•-------------------- ......................... -•-••-•--•--..... V Kure of Repairs or Altera ions—Answer when applicable _ �� S f � �'_c•�.Lb.... _er w -°� .le0.6,,,,��` /��,�`��'---- --•------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'i T=. p 5 of the State Sanitary Code'= The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been�ss ed bgth - oard o health ,nSigned------------•-•-------• •-•= ,-•c-=�--••.............•-• 7° �D Application Approved By.......... '-°'-=."j...._��_s'- �. -- = j T... �a'r y , Date Application Disapproved for the following reasons:................................................................................................................ .................•-••---••-...•••-•'._..---•-•-••--•---•----•----•--••-••--------•...._..•-----••----•--......-••--••---•--•••--•--------•----•-••-------••-••••-••-•--•••......---•••-••----••-•-••••. Date . . Permit No. ----- ...........-•............... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS . BO D OF HEALTH ..............oF. l /2ff�� ..................................... Turtifiratr of fauutplitttta THIS IS TO CERTMY, t the IAdividual Sewage Disposal System constructed ( ) or Repaired s � �:�------•-'••••-•--••••------•-----.....-'••'---....--•...............................••'---•--••--- by--------------------------------------- --•- Install has been installed in accordance with the provisions of TITS 5 of The State Sanitary Co e as described in the application for Disposal Works Construction Permit No...... _ _'.��' .... dated.._. / ...�. .................. THE ISSUANCE OF TINS CERTIFICATE SHALL NOT BE CONSTRUED AS A U ANTEE THAT THE SYSTEM ffl FUNCTION SATISFACTORY. DATE......//---------- ................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS --� BOA } OF HEALTH NO. .......... FEE... .............. -�iu�u��l� ur u °'�_�;ttutr_�rtUan rrntit Permission is hereb rant d-•--.--••• 4(1- .u_ SIA G' Y g ......... to Constr. t ( ) or Rep an Indiv _ l Sewage Disposal ,System u �------------•--------------------------------• -----_------------------ at N --- -•-'- Street as shown on the application for Disposal Works Construction Permit No.00��...��Dated__.._ . ....�...................... � ........................•'••••••••-•_� - ' ��---•••. ------•-•--.........-•-. r/t�DATE..................•------�-°�---'-------------••---------••-----..._..-------- Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - ��.