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Home My WebLink About4042 MAIN ST./RTE 6A(BARN.) - Health 4042 Main Street Barnstable A= 336— 072-OOB } P OF BARNSTABLE LOC T /o � U 6 ION �� SEWAGE # 1"k"P',fib3A-07,2-oo 5 VILLAGE L�� ASSE SOR'S LOT INSTALLER'S NAME & PHONE NO. /yA & B CANCO�� 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) de (S ) NO. OF BEDROOMS PRIVATE-WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 9` No VARIANCE GRANTED: Yes --- A� 9 ti D1r C f AP � T lY ti � ASSESSORS MAP NO: No..... .�[�$ PARCEL NO: - .� Fxs.....o�o.............. THE COMMONWEALTH OF MAS ACHUSETTS F HEALTH BOARD OF j G r ...............................................�� ft App iration for Mipaiiaf Murkg Cnnnitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (•J.) an Individual Sewage Disposal OSystem at: A �cM1 �9 - ....... a•-•-- U ---•------------------•-------•-------- Location-Address or Lot N .0 poRT �2� -s .-... ..yoy _-!?«� .6.R. cum aca 191,04... .... ........ ----------- Owner ' ' Addre 4Vo--- A,fAW-A)u1�[V Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No,. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building .. No. of persons............................ Showers — Cafeteria a Other fixtures -------------------------------•-----••--•---- W Design Flow........................................:...gallons per person per day. Total daily flow-------------------- ........................gallons. W Septic Tank—Liquid capacity.............gallons Length................ Width................ Diameter................ Depth................ 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R4 ...........................................................-............................................._._._... -----..................----.----- 0 Description of Soil--------------------------•------••--••---....---•----..........--------•--•---------------------------------------------------••-------.._....---------------.....-•-•- U --••-----•-••-----••-------•----------------•••-....------••----.._....I..------------........-----•-----------••-------------•-----•-------•-•-•---------------•.•----................----------....._. W ----•-•----•-----------------•--------------...------. ---------------------......----------------------------------------...-------------------------- ------------------------------------------ UNature of Repairs or Alterations—Answer when applicable..Zn s9. :..1liC�o_�s ... f o x�j....�v.�-1�.�Z�._..ZZ" ..rQ�t tea------------------------------- ----- ......------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage DisTg6Nt ystem in accordance with the provisions of iIT ,�. 5 of the State Sanitary Code—The undersigned furtherrot to place the system in operation until a Certificate of Compliance een issu he bo- Signed ----------•-------- •--------------- ------ s3_-.�r-2'�$....._... ' Da trfi Application Approved B "J'...-�'..............••-----------.......------ [_.� •--.... PP PP By Application Disapproved for the following reasons:----•--•----------------••-------•---•-•---•---•----------------•-----•-----•---•---------......•••--......._._ .............................•...............................---------•---•-•-•--.........--•••---•----------•----•-.............................................•...-------•--...ae-------------- [ + ....................Permit No._..... 5 ` ......•---.._...... Issued �� j . Date r - No.... ��.».:.i I� Fxs............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............:.........................._OF.....-................................................................................. Appliration for Uwvooal Works Tontrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (;' ) an Individual Sewage Disposal System at: r f I Ul . Location-Address or Lot No. ........... .................... ...........%i'h Owner ' Address r. Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a Other 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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water•--_•_-_-____.____--._-. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•----•-••---•----------------•----•-----•---•......--•-•-•---•--•-•-------•-•-............................................................................. 0 Description of Soil.................-...................................................................................................................-.................................. x U --•------•-•----------------------•--......---••----------•---•----------------....---••--•------------•---•---•-------------------------------------...---•----•--•------------......----------...._.. w •-----•--•------•-----------•----------------•-•--------•--------------------------•-•----••-•-----•---------•----------•-----------•---•----------------- ------....... 0 Nature of Repairs or Alterations—Answer when applicable._'_____________;_.._.._________,c__!�______ __ .._._.._.__._...__....._...._....___________. 1 ----------------------------------------------'••--------•--•-•--•....---...............-----:...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITTIE 5 of the State Sanitary Code—The undersigned furtTagof to place the system in operation until a Certificate of Compliance een is d bv�oar Signed._....... -----•----- . --•--•----•-•--•-•-• •----- .._•--•-•. DA lication A roved B "'PP PP y--•- - --- _ `±_.f ...................•-.......--• •----— 7. ------.Date Application Disapproved for the following reasons-----------------------•-------------------------- -------------------------•------........._ --------------------------------------------•--•-••------------------.......----._....---.....---.....---•-----•---------•-----••----•----------•--------•----•-----•-•--------•------••-----•--------- Date `i ---------••--••••• Issued----••--•-••�' Permit No...... ..................•-- - -------•-•------- Date THE COMMONWEALTH OF MASSACHUSETTS /y BOARD OF HEALTH ..................O F.............r......... ....................... ................................................................ %untifirtttr of Tomphanrr THIS,�,,S_XD CEETIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ••.....~~=:�............... ... , 0.0.r\................................................................................................................... by.. t "y _ Installer , at -�---•-----•----- --..------•--•--•-------------••-- -�----•-•-_-------- ----------_---_-------------------------------------•--.-_.-._---------------------- has been installed in accordance with the provisions of TIi T E j of The State Sanitary Code as de cribed in the application for Disposal Works Construction Permit No......!_.C__--':__�.1 ...... dated-__.-__ .�_,__ ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. d ..................... Inspector................ ................................. r � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... FEE........................ Uiop000l York Touts ion pamit , Permission is hereby granted.......-_�� - . ... -------�------------•--- to Construe ( `) or Repair_(._ ) an Individual Sewage Disposal System i L - - q.at No............ ....�. ..........°�.::`....: t --.... ti1:.:?.p C v - -'- ----- - -- -----------------•--- Street as shown on the application for Disposal Works Construction Permit No..................... Dated-------''J 171 ------------- � Board of Health �. DATE................. _-.:�..................... -------•--- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS `` YL folopho,lc. 'W-0530 ROBERT . '6, OUR CO. IN cissl�cx», I3U11.1)1Nr - c r'ANlf%'c S Or TYPE DIGC1NC.' GREAT WESTERN RD. ' S. N. 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