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0205 OLD JAIL LANE - Health
�. T205-Old .fail I a.g A= 278—002 -005 Barnstable LO TOWN OF BARNSTABLE LOCATION S SEWAGE VILLAGE /�CQ r&,g 1 (Q ASSESSOR'S MAP & LOT -00 INSTALLER'S NAME & PHONE NO. _0-k _t d S 3 -2 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) C S' size) .NO. OF BEDROOMS LO PRIVATE WELL O :U:B:LICWATERBUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: - VARIANCE GRANTED: Yes No iP p- r. 6 _ 1 1 f LP _ THE COMMONWEALTH OF MASSACHUSETTS VF......./0 .......... 7,7 � BOAR® OF HEALTH TOWN OF BARNSTABLE - ,���Iir�t#i�an fnx �i��n��1 �xk� Cn�a�.��xAz�c�tIt1T P�IItt� y d Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal �ystPlri � C �' .� A✓�^1 NI.G h �� ��� .. ...... ...�.......... .. ....g ... ...... ---•••------------- ............ �_ o io Addres or ItN7 ~a W l iV Owne G (��{� 1 _ d s ` ,v u Ins ler Ad r Type of Building Size L t............................Sq. feet U Dwelling_No. of Bedrooms........... ----------------------------- Attic ( ) Garbage Grinder Other—T e of Building 'pi yp g .ela!re ................. No. of persons.......... _........_______ Showers ( ) — Cafeteria ( ) a Design Flow-.. ... . yes ....................allons per person per day. Total daily flow........................................gallons. P q P g g -•7-•-_.. Diameter-------------•-. Depth................ W WSeptic Tank—Liquid uid ca actt, ... . ..gallons men th._8...�...__:... Width.. p x Disposal Trench—No. .................... Width.....1............ Total Length____3.0.... Total leaching area.....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing, k i-t Percolation Test Results Performed by._.`. �>. 1!�..Y. .................. Date.... Test Pit No. 1................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........................ 0 Description of Soil...... . �� e •-----.�,, :'° ...-•----••----... . ..........................- -- W c., .....---•---- x ------•-•--••-- ---------- --------------------- ............................................................. -- ---- ---- ------•-•- i-------- . U Nature of Repairs or Alterations—Answer when applicable.--__ - ----: --------� Cf .- /�. �% ,.'V...._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental de—The undersign rther agrees not to place th system in operation until a Certificate of Complia ce n issue�d /e. a o ealth. 1' Signed .... ... .. ..... ................... ... ... .......... ..................... ApplicationApproved By ------------ Re ...-� �.or, 4 ,�---------------------- --------------------...................... --------�® /.b..-..P/ Application Disapproved for the following reasons- ------------------------------------------------------------------------------------- ------ ------------------------------------- qr *� Permit No. --------.11...v......0'`y;�..................... Issued ........................................ Date .... .--..... ate.----- Date THE COMMONWEALTH OF MASSACHUSETTS 17 BOARD OF HEALTH TOWN OF BARNSTABLE - . 1 1. Appliratiou for Dhip o ii al Vork,5 Tonstrudiou rawit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal 1 System at: -� ......;,7- � ....... ..Q.:.:::.....: .rn ......................................... Location-Ad res .4 r s Imo, S. �IGI W Owne / ddress i Ins ller A � Type of Building SizerLL t____________________________S . feet U q 1—t Dwelling—No. of Bedrooms.........i . ...................Expansion Attic ( ) Garbage Grinder p, Other—Type of Building tV __________ No. of persons.._.__._L�__._......_..._ Showers ( ) — Cafeteria ( ) G.I Other fixtures -------------------------------------------------------•------•-•---------•-••••--.................................................................. W Design Flow....... .<�. 0......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit .gallons Length_/---E.......... Width...."-_-__-- Diameter__--____•-_-:._• Depth................ x Disposal Trench—No. .................... Width....----_.- Total Length____.<V..... 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--- ,t _ .Yze_-.................... Date...s W Test 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........................ P4 •---•--••--------•--••-•--•--------•. --•-- ---------------•--•--......... O Description of Soil ?FiP f ��� �'f r /-1 .. . ..............` r-•�. x ...... W x -------------------------------------------------------------------------------------------------------------------------................ ---- ------ ................................ U Nature of Repairs or Altera /- --/tions—Answer when applicable._._-- -P_cC✓--------- --------------------------•--•---••-----•---•-••--•--•------•--•••---•-•-•--•---•--•----.....__-•••••-•-•----•-•......---------------------------------------------------------------•----•-----•_------ 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 undersigne urther agrees not to pl ce th system in operation until a Certificate of Compliance h een issued b e < a of e /© Signed .. ----- ......- Date i Application Approved By -------- ..------ -----------------�- '---- -- A Dare Application Disapproved for the following rearons- --------------- ------------------------------------------------------------------- -------------------- --------. ------------------------------------------------- .......--------............-------....-----..-..------.................---......--------------------------------------------------------------......... . --.... ------------................ Date Permit No. / . 0_ Y. �................... Issued ------------......: - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifirate of Comylizi cce Gj T IS IS TO CER�T7F , That e I livid al S �a Dispos�1 System c strutted ( ) o Repaired ( ) by-- — G� rt .. 'Y,.30..... �� j��,.5.......: ------------------------ .............. at ..... -:...S7.... 69- -c..r.. ................( -cl W/ ' �../.'�--------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 ofbegt F','Vnvironmental Code as described in the application for.Disposal Works Construction Permit No. ................................................ dated -.......-....................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFA ORY. w /;;�_'c �` �DATE --- ....:�........................... ........ Inspector ..------..... ...--........................,.................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �l. 6 TOWN OF BARNSTABLE �d d No......................... FEE........................ Irart'� Permission is hereby granted...... . / ...�?`.. ...............................: to Construct ( P/or Repair ( ) an Individual Sewage Disposal System' . `jav� / .....���� _� Iat No.---------� - ,1_ . .. � ...................................................... Street as shown on the application for Disposal Works Construction Permit No.._.0?/-�:.��/6F)ated.......................................... ------------------------------- =- ....................................................... DATE .............. Board of Health FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS P f 4. L _} — j 1 11 i P�,�j' ��r�-5,Ky6i�:�Tty' ! I L _ _ I i ^Ii� - I , , Y ----'---'---------- . .:., � � 1� •j _._.....-.__. �r-+-- Ili ,i--�— "'�—', !r I I F. - iF �' (ln%'PGL'iw�{' :1�_ JI ' \\/\\\1 i� f•.. ,f l ' _ � oii �' ,i If 4—�A�s�I•>��.e�.-. --G�I MBP�IDIOIK-YA1 m-uII e f �1; —1 tkrrITwF ,-•e-2L a � ':ticw,tw-uCfE 0 6v„I�1/a-v ro� _ r 7 a(�� r aI� e�v h � 0 -00 SOUHELEVATION &dva" A IIµI ,5p9t(M&t3ucu F (611K " ASHWORTH RSIDENCE DESIGN aT cwh d4_e1 71 ARCHITECTS p DRAWING SurAl i - 705 OLD JAM LANE Q •I Tf LE ISSUE IVAN BE"CKI ASSOCIATES,INC. HARNSTAHP F,W ,�,, :I• � a f II ti I I ,i ar..I � I II I I I i. i � � ril r:?r I I I Ii. yp T1 "11 11 GG r" t., ! � I I I — — --- —— —— ------ _..... € 4 I I: ff 1 ry 1 , 1 `Y� .. ( Jam.• �:98. �Y I •e.,}T � ._ .. � y }'?'---"��,"'.--��.,_ .-fir � w �+�:� ,.. .. `Y�Ci6Vi t � f. F14t�¢dt ,I ..s✓f /�,.--3 n - ;,i.' _ - �`a+',�trr� tC sr� - I Mt}�'�fi to - ._i: t, ,-lj- ._ ,• ��' ! - �$ ).'-� _t r�=-2�. _ � � �k ,�i-t g _ �L• �" .1 1� ':5 f °.Ih I :.#„�,k, CZ 'C It t? t. 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