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Home My WebLink About0190 PIN OAKS DRIVE - Health 190 Pin�.Oaks Drive Barnstable A= 280 - 053 No..D. .. � * R Flcs.... .... 4 THE COMMONWEALTH OF MASSACHUSETTS4. f. BOAR® QF HE T.........OF.......... w rz` 0 lw . /isposali Application fnr Uispos al orks Tonstrnrttnn �eruti# Application is hereby made for a Permit to Construct ) or Repair ( an' Individual Sew System at: ..P.in...0alcs._IIr._...Parnstrabla......Mass.............. ..........#1..................................:......... ----------•---•------------------- Location-Address or Lot No. ..Cha.x].P.a..I..Heath---------•-----------------------••------------- .43...LQ.wi s---B Bay R .,.._Uy...................................._ Owner Address ,.� ,.... _...... �"� h_........ � 11;�11�U '�� :....... Installer Address Type of Building Size Lof.2 O,x 0 0 0 Sq. f t U Dwelling—No. of Bedroom .............................................Expansion Attic ( ) Garbage Grinder ( 6) Other—Type of Building t+tr ..... No. of persons............�............. Showers (� ) — Cafeteria ( ) Q' Other fixtures ......................... d ---------------------------------------------------•---------------- Desi n Flow............' allons er erson per day. Total daily flow............ ..2. ..................gallons. W g �----------- -- ----- P P P Y• Y - -- 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 i et..:................ Total leaching area.A_d.j...sq. ft. llrr- 7� Z Other Distribution box ( ) Dosin a ( ) -- ®/ �� 7 7. a Percolation Test Results Performed by .......... Date.....:....li gl......7_7-.... Test Pit No. I........L. minutes per inch Depth of Test Pit................... Depth to ground water-_---___.._-_-__---_-__- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -- / 7� f� .........--- �r r .........- •:-/............. '-.......1-�................. xDescri tion of Foil ---------- .......... p --..............1.40.................................................................... W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: 'The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance-with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. I ate Application Approved BY------ --- ------ ------ --�-----.------- ---{ Date Application Disapproved for the following reasons:............................................................................................................... .............••-----••-------•-•----------...---....------......-----------•-----------........--•----•------..__....._..-•---------------------•------------•---•--•--------------------------••------. -� te Permit No.--------•------•.. ._.... Issued-- 2 -a----•------------------------� -Date L ct No...................... ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD ............... ..... .. .................OF.....:..............al.g�......................... ..... ................................. ..... Appliration for llhivasal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System;A: ............... --------3'3'0n'j_-49. .................. .................................................................... Location-Addoess or Lot No. .... - .... .......... ............................ ......Ir 7 ............... ---------- ...di rq ---------Owner 'dress ................... ............................. ............ . ........ n I Ileo Her Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............../..........................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons..........tl.............. Showers Cafeteria ( ) Otheres -------------------------------------------------------------------------------------------------------- ............................... Design Flow/............................ gallons per person per day. Total daily flow............................................gallons. —Liquid capacit ............gallons Lerigth................ Width__............._ Diameter________.__._... Depth____._.__ . 9 Septic Tang I . ....... Disposal Trench—N --- ------- WidtjLj:!!............. Total Length___---V**.......... Total leaching ----sq. ft. I- -- --------- 1W -_ Seepage Pit No..................... Diameter.._......__ .._ Depth Belo �l To k ..................sq. ft. 16 I f Azplit;w Z `-Oiher Distribution box Dosil '11-V %477 Percolation Test' Results49�*OPerfor:med by.................................... ........... Date.................................... Test Pit No. I...............minutes per inch Depth Test Pit.................... Depth to ground water.......... ------- j Test Pit No. 2........... imute r iouChorDep*i�q Test P Dept t0VrVndj#ater' .... _/----------- "St ;2*4..................................... ........ .............. 7;0" 7-------------------------.......10... ...... ..... . 0 Descri ... .................................................................. ............................................................ .................................................. U - ---------------....................................................................... ....................................................................................................................................................................................................... ----------- U Nature of Repairs or. Alterations—Answer when applicable- --------------- ------------------------------------------------ ------ .......I...... - ...........................................................-7...............7...........-------------------------------------------------------------------------------------------------------------- Agreement: The 'undersigned agrees to install the aforedescribed Individual Sewage Disposal-System in accordance with the provisiods of T I T YIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of om ce has issu by the board of health. ..................... . ...... Application Approved By............................ . -. -- Date Application Disapproved for the following reasons:................................................................................................................. ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued................................................... Date THE COMMONWEALTH OF :ACHUSETTS BOARD OF H ........................... .............OF.................................................................................... ffirate jaf Toutpliatta 0 nd;vidual Sewag D�isp6sal S ucted or Repaired AA, ...... ----- ....A/Ore. m 0.....co ..I.;--- by ......................... at...... ------------- ---------- nce with the provisions c ��O/ 667cyge_( in,the ----------- ----------------------------------------*---------------has been installed in accoida tol he State Sanitary % 05A application for Disppsal,Works Construction Permit No......................................... dated_--.._-_._._._. ___--:____._____•-_•_-_-___;--- THE ISSUANCE'PF THIS CERTIFICATE SHALLAOT BE CONSTRUED AS A GUARANTEE THAT.THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... .................................................................... Inspector......................... ....................................................... THE COMMONWEALTH MASSACHUSETTS BOARD ..........................................OF................--.............................. .................................. No......................... FEE.........._._.:. 712 Pe 4S 1;�efc ab � nted....... .... .... ......... ........... ..... ... ------ vil* Sy n to Conz", �&dq$T Sew st at No Z'.w7l- ........................................................................................................... ........ ..;.. ...... ...................... ........7.............. reet as shown on the application for Disposal Works Constructi 0— .. .................................. -9 .............................................................. ........................ ............. Board of H 7 DATE.... ..... .,�7......... 1 ...................................................... FORM 1255 HOE38S & WARREN. INC.. PUBLISHERS LOCATION ..�:.'t� 11ttt) fSl:ltVIJ l,ll APPLICANT No. ADDRESS 0e, .�'-.c�.2— ( FEE/�, o�• ENGINEER TELEPHONE NO. (Non-r�fundabl e DATE SCHEDULED TELEPHONE NO. �2 .r P WAN Appl can t l d nature 1. z L0, 0a SUB-.DIVISION NAME . EXPANSION AREA YLS�NO DATE -��-- TIME TOWN WATER 4PRIVATE WELL '— - ENGINEER 3� BOARD OF HEALTH SKETCH: (Street name etc. "XCAVAT011 ,dimensions of lot hercolation' tesls loca , exact locatio of lest: holes all(l , te wetlandH in proximity n imity to feet ':NOT8N= holes) 0Q L)I� • 151 LOT s PERCOLATION RATHt Now 'l'F.ST fhi,E N0; ELEVATION; `1' .`iIV HOLE ELEVATION: 2F- tops jP 1 ELEVATION; 3 'Z 2 tt 4 w aft 7 7 9 q r 0' 10 9 `l'y !-�Z� 10 ^/lots Sol/r,7o7�nr 12 IL 11 0�JSt� cQ � l8 yV /N�� 13 SA-�v� 5aic 5�iW� 12 Sir f4Gc 14 l3 A A✓+Lys/s 13 ' 14 15 1 16 5 V21v Sl1I7AQI,E FOR SlIn 16 -SURFACE; SEWAGE: I,EACIIIN(I _ LEAC1111J(1 I,J:ACIIINc3 `1'IiI:NCIIE UNSUITAB1,E FOR SUR—SURFACE SEWAGE. REASONS, _�2 2 11I)'!'E: ; t:tlUlNEO11INC1 !'CANS MUST SHOW tllllilll It AS;17cI1l1:U (,tJ t'l:ltc '1'li:;'I' AI'!'I.I�'A'I'I�,f! „ItI�IItIAI,: C(1Ml'I�F"1'h:J) TIi_� ----------------.. . --•--- Nllli �" _LY_!'.�_li..�1�d11_liG'1'!l1111JL_'1'(! llc)nicu c)1' i1J:n1,'rIl I(t:v'n1NF:uiIY nl'1'1,1c`AN'r --- ----- -- -------- - z PERCOLATION FORM (APPLICATION FOR PERCOLATION TEST AND OBSERVATION HOLES) r LOCATION loin P//✓ PERC. # TOWN 3132,L I TS r,— FEE: VILLAGE ,AT�n,-7q �3LC DATE: APPLICANT H LA LH ADDRESS l3ax 9CY 4- ENGINEER DATE rA;u Q 9 o s ASSESSORS MAP — Sa PARCEL S S SUBDIVISION LOT # C r c c NAME: M TIE /� TOWN WATER: ,,- WELL: ENGINEER: BOARD OF HEALTH: ET), AT�42 E 71MI EXCAVATOR: R nn,^e-o 77 TEST HOLE LOG DATA: ivP -tN/p v yam_ rJt.D. Fff,�c_ A 17c D F='ti"E r 5,L, �Fi2hh c ) LTY/. I)6N i Si�7l' 0017 E I ri^'c T,Ey; shn � I /2 I 13 -.•h7ci�. JJ n � /i r Tl ,' AID li SUITABLE FOR SUBSURFACE SEWAGE: YES ENO REASON De Si Fti.. ^%< LlA/ SKETCH: (STREET NAME, DIMENSIONS OF LOT, EXACT LOCATION OF TEST HOLES AND PERCOLATION TESTS;--`JJETI_AIQD LOCATION IN PROXIMT� TO TEST HOES) -F1 V 0/T 1.-S 0 Now ENGINEER' ' DATE N! ar eoe-see-•,W a 2 to hoe 392-OW L. 0 down cape engineering, inc. Cr'VIL ENGINEERS ` LAND SURNTEYORS i FORM MUST BE COMPLETED IN INdTIRETY BY 939 main st. yarmouth, ma P.E. AND RETURNED TO THE BOARD OF HEALTH JOB NUMBER ` `'-2= -- — L1 CA. I O M �+ , t' ry... ,..,,,:, ..y°; ..t rL ' ..,w .•� { ,; si x.'. , - •tee � ERMIT 4j( =mama �}ryv� f/J i�S` A4LLEER 5 �I&NIE . A►D®REST ® ® ® _ PER SSI.e ® J. AD& COR�Pl.I�f CE ISSUE® s, ` t � r1c,�....►—ram., y - _ -. ��r�s'cr.� �i�- ,.- Pl2 w p"A ` 1 � (i t "i I! «.�-.;.y ::tS L\M l L Z T�E-U �Z_rj H 3 Nn &PJEA= ICU sF I e-3 7- t4 A, f A-, 0 0&0 aq L40 - -re-Z5 116.0 10 7, le)7. 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