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Home My WebLink About4429 MAIN ST./RTE 6A(BARN.) - Health (2) 4 4*kq rh4A)l/9". L_ AJ�iTOWN OF BAA��J,,!/izRNSTABLE LOCA N '1'� I aft, C& �EWAGE # S-' o,57 . VILLAGE $ lJ5L/3siI__E ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.-I c In ay,,C) SEPTIC TANK CAPACITY / LEACHING FACILITY: (type) WO 000 6'0L�c%�+/ /%size) fCCXi4,.,o 'S&5ne NO.OF BEDROOMS ff_' BUILDER OR OWNER t�V r r 40 kr+O M PERMITDATE: o S' 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) — WIA—WI Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility. ) Feet Furnished by 1 C t '�_ mil•. LOCATION � (� SEWAGE PERMIT NO. � _s C U OA1 CD i , ��NSTrn�C7`� j /ti—e VILLAGE INSTALLLEER'Sn NAME A AAD-DRESgSS B UILDER OR ( OWNER ,o (\� I DATE PERMIT ISSUED DATE COMPLIANCE ISSUED L - - - Poo y , W� 0yvv1 S`tdIt, e O a tip' S3 i 1 TOWN OF BARNSTABLE LOCA770N SEWAGE # 7-/79 VII.,LAGE e--�yy/ ��A�� ASSESSOR MAP & LOT INSTALLER'S NAME & PHONE NO. .5to i SEPTIC: TANK CAPACITY Cev) STp-u�_ C-�SSt�a L CUS J LEACHING FACILITY:(type)_(2-e/40 Plle—e-)d '! (size) NO, OF BEDROOMS —25 PRIVATE WELL O UIfUB®Vl►ATE BUILDER OR OWNER _mom DATE PERMIT ISSUED:_ DATE COMPLIANCE ISSUED: e VARIANCE GRANTED: Yes No �. �,, �, '` �. ` � � '��' c .. � _ �.", -.� W �V � ti No._s :..1—Zfs. ' 'Z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF ��Y, La�-------------- ,� lirtt uan for .11isposal arks C��an,�trurtiun Frrnnit Application is hereby made for�a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... !.Y. 9......11l .r.W,.al......J( ......c�k.&......... ........ Location-Address or Lot No. ..........Zrn-SAXWOU....' 1�G. .a�xt, `�,�_......._... .............. ..... ----- - •-----......-------......•...----•--- Address Owner W ` ,.a " ............. ...... �n4�------ r ------------ ---------- ........ ....................... Installer Address U Type of Building Size Lot.............................Sq• feet aDwelling—No. of Bedrooms.... ....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .............. No. of ersons..............__._........._•Showers Oa. YP g -------------• P ( ) — Cafeteria ( ) dOther fixtures -•--- -- ---- --------- -•- ---------. . ------- - ---------------•--- WW 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 Depth below inlet....(a. g........._. Total leaching area..................s Seepage Pit No...___.�..:.._____.. Diameter.._.ja.`... p t q- ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by..................................... -.----------•••------------•----- ---. Date....................................... Test Pit No. 1................minute's 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.............. f a . 0 Description of Soil.........:........... ...........:_.._.... W :.......................... ---------.-•-• -------•-•••-•- -----•-------------------- ................................................ . •----•-------- ----------------------------•-•-••-----•-••----•-••---•. ...----•-••••-••••-•--•-••---•----•••------•-------••...-•••-•-•--•••--- U Nature of Repairs or Alterations—Answer when applicable.....AAO1p_...� -.. .`e._._]r-� _.p------ ... 1rt�- .• �._.�` Zllc- .�. .i 5u11 CAS- iJ '-----•------------------- Agreemen IThe undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions.of LIIP 5 of the State Sanitary Code—The undersigned further agrees not to place the system in L Operation until a Certificate of Compliance has been issued by the board of he th. Signed- -- -••--•------ . -•----- --------............. r...................... ---- -`� .-K ______________ E _ 1 Date Application Approved By..................� ............................ --------- V V Date Application Disapproved for the following reasons:....................................................................................-............................. ....-•-----------•..............•-•---•-------........-----------........--------------•-•-----........--••-•--------•------------------------------------------------------------••-•-•-•---•........ Date PermitNo.........a-1....._. .................... Issued........................................................ Date Oar..,r::A*f.. ^...� .a�-i•��w--i:.. .i_1•�E...1„i, . . �7i'a. .e - ',M'}1♦' ii'r.'�..' "�+ -.� r .•x� a+�.v-. .. vex.. .�..•-.....,.yyip�5,ri.o.! °x►��+•. �`�.. r 3 S, (a- c) aA - �? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........77Q --..OFF Y .v ,a.x4� _.... ., pphration for Disposal Works Tonstrnrtinn runtit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _._..___.`?!y 9.......1.1 t.: _. . - '��•- =-----:... ..,�,r?.cv---S r ...P ......!t!_Im m- au Location-Address or Lot No I ............................... Owner a ...................... �-kg l!' .. '��O�i�c 1_bb.l.._P_� ..4= ..�:�!!.Scx 7 4-. Q ...- .._..... --_.... Installer a Address 1d Type of Building Size Lot............................Sq. feet V DwellingNo. of Bedrooms____ ____________________________________Ex Expansion Attic — p ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d' Other fixtures --------------- -•---•-_----_.1.....--------------•-.-••---------•-•--•--•-•--• -••------------•----....•----..._..---•-------•---•----....--_----•• WW Design Flow........_6�<........................gallons per person per day. Total daily flow............ ....................gallons. WSeptic Tank—Liquid capacity............gallons, ;f Length________________ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.___.'i............ Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.......1............ Diameter.._.Ja.v...... Depth below inlet___.Ccs-(--------- Total leaching area..................sq. ft. z - Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Perfor med�''�y--------------•---•---.......---...--------------...-----•----•-------.... Date............_:.......................... Test Pit No. 1....... ..........mmutes�per inch' Depth of Test'Pit_.____._____________ Depth to ground water' __....__.____.___-_-. (z, Test Pit No. 2________________mmutes:per�inch Depth of Test Pit_ h___!_ .___ Depth to ground water........................ f , > �. Description of Soil::.. _... -- ----- ••-•---_. _.....-• -•--.......-•-•-•--••-•••--_-•--• V ...-•-----•-------•-- ---- - -- i •-------------------------------•---•-•- ^--y•------- U Nature of Repairs or Alterations—, Answer when applicable R4Q � ._1 ?_ ._... �,r- -_. � _.._.. b, - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code—The•undersigned fir ther agrees not to place the system in - operation-until a Certificate;.of Compliance has been Issued by the,boal d of health. 1.' � . I � a ,� l pp, i �, Si ned _� . lic �' i IcatlonrA roved'B c PP Y --_------ Appllcation Disa roved, or the f of �' Date PP { PP f lowing reasons: = .` �.� i � R 1 1 Date r Permit Issued- No.. F ti 1 �1 i . Date THE COMMONWEALTH OF MASSACF USETTS BOARD OF HEALTH r� ` w...........OF,7-757Y 121!.... (..�.. '.f6� ........................... (9rdifirttte Of plittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( t_)- by - ......... 't,4� -►A�.�!`O_.._..5 ��-.._ .................. Installer at----------A-1 �`�:---•---�'2 fQ--�-:.........r/��-z.� _- =-- ..... .................} ..... has been installed in accordance with the provisions of TI T LEE, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---_____ __ ... dated__4___________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM hL FACTORY.,F�1.NCTIOSA„a15 DATE... Inspector.....:.._ r ------------=----------------- _ THE COMMONWEALTH OF MASSACHUSETTS s �— BOARD OF HEALTH �' -- O F , P 4S No._� 7. FEE. . �in�rrrntti nrk� ��an��ririn �trrntit , - Permission is hereby granted-------- �f -��'l4!M C��"� d ........................................................................ to Construct ( ) or Repair ( x)an Individual Sewage Disposal System at No............ ....... ---=- UN%ti?2 j �1 j:�'' --=----- ............................................ Street , as shown on the application for Disposal Works Construction Permit No-_-__:_03__ Dated.......................................... �' oard of flealtli DATE-----------•---• Pl v c t r C = O -410 � �r A 7 r r C $ v 'O - � m 0 v N v � N p. Aj L v � II J �� o i � �/ ''�1 -�i 1 �' .`+ .. �cz5 1 .� � ,� -� � � k [i i .p `