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Home My WebLink About0032 TISQUANTUM ROAD - Health 32 Tisquantum Road �. /1 l TOWN OF BARNSTABLE 3`5 U LOCATION U AN " LA-1 ge SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: /(I—Li - 9 d VARIANCE GRANTED: Yes No �,/' 1 � � i i ACK �I !� PW C) . .._ ®DI THE COMMONWEALTH OF MASSACHUSETTS d� BOARD OF HEALTH �5 ....................OF 9✓.�� •...�3 ..;----...--•-----------................ Appliratiun for Disposal arks- Tons�i-�tr#' n rr mi# Application is hereby made for a Permit to Construct ( ) or Repair (' an Individual Sewage Disposal System at- ............ _l �c..�f... N=rv ... . ... .......... ...- --.... .. ._...._....-----..._.........- . Location- dd ess pr Lot No. .. --•---�. J '_..... .. N �.� r �(. eJ...................................... wner Address Installer Address Type 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 04 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. 3 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........................ L� Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ 0 -Description of Soil......................•-•--.......-•---------------------...............---•---------------------=----------•.• ---.--•--•--................-•.••--............ V .............. .....................•--•-•-•--•-•-•--•-------•---•-•------------•-•-•-•----•--------...---------------•--..•.. -----------....----•---.....-----•------.....•----•....------------ W ---------------------------•-------------------•-------------------------------------------------- ------------------ ------ UNature of Repairs or Alterations—Answer when applicab e. --------------------------------------------------------------------•--..........__......---------------•-•----------- ---------------------...... -----------------.---------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I'U 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 t boar f health. Signed- ------- ............... •--------- Date ... Application Approved By...... ... ,............................. Date Application Disapproved for the following reasons---- --------------------------------•----------------....-•-------------------------------.........---•••..... ---------------•----•------------------------------•---------...-----------------......-----------------•-•-•-------------------•---------------...---•--------.................-•---------•--•••-•-•--- Date Permit No........... - - r G.......... Issued...................................................... ...............•••......_.. Da . � 4 S -6 I P r,) THE COMMONWEALTH OF MASSACHUSETTS BOA�ffjD OF HEALTH l 11 ..................... ......:. oF.. ...........................................-................................ ,� Applutttiun for 13W 1,9 ad) iark� Tonfitruutinn jlrrmit Application is hereby made for,a Permit to Construct--(�, or ReIF4" (,�%� Individual Sewage Disposal _ System at: 1 t 6 !S G5 v N 7`vM ............................................................Location iNAess No � N/V........_.... _..... .. NZJ _ ................._.caner Ad a .........�... -) ... ....................1/, �e ress .. ram!c q .......... ,... - y� . Installer / Address Type of Building f J SGi� z �ot...../` _! ..__ . ....._.. U Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( GVrb-wr4Grinder._( ) `4 Other—Type of Building No. of persons...................�_._�Showers — Cafeteria a' Other fixtures ................................................ -:.............••-•------••MV...........................-•--•-••----...................._� 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 ( ) aPercolation Test Results Performed by....... .................. Date........................................ ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GY4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ {Y, ...................•••••••............................•------•-•-•.............................-----......................................................... 0 Description of Soil.................................•--.._.............------•----------.._..._.........-- .....-----•--• ...--•-•----------•------•--••--•--•-•-•-•••---••..............••----.......---••-•-- ---- .-:. • --- . ------. ...---•------•.---- ......••. U Nature'of Repairs or Alterations—Answer when applicab e._.__�_ ?Ae__....11..�:.7 r'p..-re- (�U�'4/ � .:............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITA 1E 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 th boar f health. Signed.......... .................... Date Application Approved BY................ �� '�1 =--------------------•-•----- Date Application Disapproved for the following reasons:-------•------------------------------------•---•--...-----•----------------•---•---•--.._.................--- -•--.........-•-•-•-•---••---•--•-•.................•--•---------•-------..:----...-•---•------------•------------------.------------------------------------•------•--..._.....-•-••- ................. Date Permit No.......... q �............:.....<--�---•---..__. Issued....................................................... Date _ THE COMMONWEALTH OF MA SS ACHUSETTS BOARD OF HEE�ALLTH/� ..........................................OF��.!d!,&S:1..X.Rk........ .................. Trrfif iratr of Tomphanrr THIS IS TO CERTIFY,,T at the Individual Sewage Disposal System constructed ( ) or Repaired (/,.� te� C......... -•------------•-•--•.................................•-----•-................-----............ - Install �at-----..... .��....._.�..�.:��_�i�..�>._. . ---- ...................7..... .................................... has been installed in accordance with the provisions of TIT LP I of he State Sanitary Code as described in the application for Disposal Works Construction Permit No........... ... 9o._.. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 4 DATE................•..-.._)n--^.y---& - •• ..._.. Inspector- ................................................. .r --- .. p ( T THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o.. �.' �J.. ........................................... N OF.../� ., - .................. FE .... .... �i��rnsttl- ur�� urt�tr�r#uun �rruttt Permission is hereby granted....�� - � ..` ...-•...:............••--------......------.....---•••............................ to Construct( ) or epair ( an Ind_�io'lual Sewage Disposal System at No.:..t j 1-•�- _.. .. dU !�..--•- Del1/ � 1 / 1 ..................... Street as shown on the application for Disposal Works Construction Permit No. . . .'.'.)--• Dated.......................................... dd qc� Moard of'Health DATE................... O r ••-•----••-----•- 0. 4� THE COMMONWEALTH OF MASSACHUSETTS BOARD I-!EA LT I-I ............OF... .......... ..'G .... App iration for Disposal Workii C onstrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair (k,<an Individual Sewage Disposal System at: - -�_• ��1'� n-Addre s or Lot No. er Addre F Installer. / Address Type of Building Size Lot-------------_..............Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers — � YP g -------•-•---•-•------------ P --(----)•------Cafeteria ( ) dOther 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 ( ) I Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_---.---___-__---_---. 444 Test Pit No. 2................minutes per inch - Depth of Test Pit.................... Depth to ground water........................ a •---••-------------------------------------------••------------•--••---------..........-••-----•_.......................................................... 0 Description of Soil.......................................................................................................................................................................... 0 Na Repair or Alterations—A-swer when applicable._ o . r _ Via_..:-.._ "`._"� . Agreement: The undersigned agrees to install the aforedescribedrInd' idual Sewage Disposal System in accordance with the provisions of TITi U 5 of the State Sanitary Code—.,* de Signed rther gre of to place the system in operation until a Certificate of Compliance has been is e th oar Date ApplicationApproved By............. .... ....... ---- -------- ---- ....................................... ........................................ Date Application Disapproved for oflowing reasons----------------------------•---------------------------•-------------------- -----------------------...••------ .............••-----•--------•----------••••-•••--•••--•-•••.•-•- Date PermitNo......................................................... Issued....................................................... Date 14 No. .. `'. F�sO. THE COMMONWEALTH OF MASSACHUSETTS BOAR® � HEALTH ...........OF................ AplilirFatiou for Diipnsal Works Tonstrurtinra an it Application is hereby made for a Permit to Construct ( ) or Repair (k< an Individual Sewage Disposal System at• i Lo Addres or Lot No. rYer Addr..V---?,� ------------- e W F 1 Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers � yP g -•--•-•-•-----------•------- P ( ) Cafeteria ( ) � Other fixtures ----------------•----------------------•---------------••-••......-•-•---•••••......••. ............................................................. 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........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --•--------------•--•------•----------•--------•---..........------.......--•---•------•-------.........---.....-------•--•------.....--•••••••............. E 0 Description of Soil........................................................................................................................................................................ x U ••••--••-•-•----•-•••--••-•-•--•••••••••-•---•-••-••••••••••---•---•••••-•--•••••-•-•--•••-•••-•---•••......••••---•••-••••••••••••-••--•••-•-•-•••••--•••••••••••••••••-••-•-••......••••..........••. W •••••• -•-•------ ---------•-------•-----------•••-----••-•-------•••--•-••••----•---•••••......•••-- U Nature f Repairs.or Alterations—A swer when applicable__ _____________�__._._____._._. -__..CS/'% 2'.__.___.._ ___._ . ------------------------•---•--------------------...........•- Agreement: The undersigned agrees to install the aforedescribed Ixidpvidual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code Th undergiIgned rther agrees not to place the system in operation until a Certificate of Compliance has been is ued the l�oar, kh Signed ".. �.......................G�3 G' Date Application Approved By ••• == `• .........:.:. Application Disapproved for a owing reasons:--------'----------- ---- 1....-------•----------------------------------•---••-••--•Date----.......... -------------------•---------•---------------------------------------------...... Date PermitNo............................----------- -------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUTSETTS �J. r F BOARD 0 H�E/ALTHfi, ...... OF.... � �L!....:.2, �'�. .......................... rtttr ,af f�u�a��i�aat�r THIN�r CERTIFY; a `e`Inu vi ew3ge isposal System constructed ( ) or Repaired -. ••-- - at.•••s Insta — �� / J �,�-...,fir�.�---------- ............................................. has been installed in accordance with the provisions of TI`IZ 5 f The State Sanitary Code as d cribed in the application for Disposal Works Construction Permit No... .. _. ,y''s�.,_._------- da.ted_.... _' ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CONSTPAD AS A GUARANTEE THAT THE SYSTEM �,1A/4 NCTION SATISFACTORY. DATE....l./7.j!.......................................................... Inspector - ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD 9fz/H5ALTH 1 /�G!/�.........OF_..,.. ................. No. ' FEE.�-, ,. ... 'Disposal r g Tan i.vat �er ff �� Permission is hereby granted..------� --= -� L:�✓--------------•----..._....------------•-•--------.....----...............----- to Construct Repair ( Wan Ind Adual Se vyx Disposal Syste� atNo.._Z?.�1.. ..._.l7S </A. * f...................................................... --�^ '1 ..Glib%-----...-----------------•-------------- -- Street as shown o/thea licatio for Disposal Works Construction Permit No............. .�..1 ated.. .. ___Board of Health DATE_ _ _.. -- •---------------------------------------------•• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS `'