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Home My WebLink About0000 YARMOUTH-BARN. TOWN LINE - HAZMAT �G-�� 1 t�l '" i-�'C�VV� Il�lt��1 �..IYI� T3a.,�►� s-��I-� _ _ _�- - - - `�� i00� ---- - 1 Jd:�m0 APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITSV/ LOCATION � VILLAGE _ C DATE t.✓ `��z� APPLICANT FEE_e � ADDRESS 2 M"(, nr• IPGU. 4 kkA TELEPHONE NO. (Non-refundable) ENGINEER TELE N 0._95 1 ?b 15 DATE SCHEDULED :2 �' � ppl, can signature I'- ; • .. • • • • o 0 0 0 0 • o i o 0 0 0 0 • • o o • •.• o 0 0 • o 0 0 • • • • • • o • • • o • o • • • • o 0 0 • • • • • • • o • o • • • o o • o • • • • • • ASSESSOR'S MAP & LOT NO: SOIL LOG '3 SUB-DIVISION NAME G • 62 DATE '' � TIME EXPANSION AREA: YES NO — _ENGINEER TOWN WATER X PRIVATE WELL r'd t2QM.Ca BOARD OF HEALTH D EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) ° NOTES: CND Av4 . PERCOLATION RATE: �� TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: a--g lbyp- 2 i' -� !oG""�1 �� Dylz bl� 3 4 ZS'I_may G 2._s y ��b 5 6 bolt 11 GZ ! (owe Z•5 y �2 7 9 9 10 10 11 11 12 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD X LEACHING PITS—_ LEACHING TRENCHES X UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P.—E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT 4 . cam Z y - cot r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE App iration for Bhip aal 10orkii Tnnitrnrtinn Urrmit Application is hereby made for a Permit to Construct ( ) or Repair (,.,�an Individual Sewage Disposal System at:, / q . .7.... 1!�l�!?S�?.. .... .✓_. ....... 41?#MRsl-44...j�&-, ----- �°Ko✓yJe�S ✓ Location-Address J or Lot No. 6i �o'y C Lofl E _! '�.. r!��.�..Alk"(mil. A.ssle�._...� Owner q n Address�J ------------------------------------------- 1.=`....d.<?a1 SI�OE1- -..�1r2-i...1 Installer Address d Type of Building Size Lot............................S q. feet U Dwelling—No. of Bedrooms.................9........................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons............................ Showers YP g --------•------------------- P ( ---)--- Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------------------------•---- ......_... W Design Flow...............M a....................__gallons per person per day. Total daily flow__-_-_--..--33D....................gallons. WSeptic Tank—Liquid capacity.�.O.A®_.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........................ rx, Test Pit No. 2................minutes per inch Depth of.Test Pit..._................ Depth to ground water........................ W -•-•-•-••••---•-----•••••••••-------•-------------••-•••....-----•--......---------•-•-•--••......--......................................................... 0 Description of Soil...............................................................................--••--------------------------•------------•-----------------••----•-•••---.........._.. x W U Nature of Repairs or Alterations—Answer when applicable---jZW.f . 1T!�_... fys� ......../ �r'Pao___G . ...'011l.'".d04.----lO.�Q-.-ra G l...._.�S!Af.4 Z„ _�Q.aL ..J/9,/e�d�i.Jeyl._...•---•----......--•-••................................................... 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the and of health. Signed ...... .......�':../. ---------- ------- - -- - Dail Application Approved By -------- ..-�,t.e-.,.r, ~`� ...................... ----- �1. �..�. Dace Application Disapproved for the following reasons: .. . .......................................................... ................................ ......................... ------------------------------------------------ ---------- ------------------------- ---------------........--------- -- Dace PermitNo. ....... --jL--__6.Y6............................. Issued ... --------------------------------------- ........-------- Dare Fzs... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE - Allp ira#ion for Bhiposal Works Tonstrnriinn "pumit Application is hereby made for a Permit to Construct ( ) or Repair (L,--ran Individual Sewage Disposal System at:. : ...1,4,.r Y 4,1?,w_, - _ �A�!a ... �d✓ f.�s /✓a<��,ar<:- ,o ,r____....._.__..._ n Location-Address or Lot No. ................................ --G-----cLo,a,rQ Owner Ad-d Q -mg F —aJ. . ------------------•...._....--........._ _ ,. ..a :Insta/ler Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.................9--------____ _Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building No. of persons--------------_-__-_--____ Showers — Cafeteria Aa Other fixtures -------------------------------- - wDesign Flow..............l/.q.....................gallons per person per day. Total daily flow..........____.3 A---------•--------_gallons. WSeptic Tank—Liquid'capacity.Zdf!4___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 ( ) 1.4 Percolation Test Results Performed by..........................................-----------------------•------- Date........................................ ,.a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (it Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_-------------------- P4 --------•----------------------••---•--•-••--------------•-•••-••-•......---•--......-------•---••--......................................................... 0 Description of Soil...............................................................................----------- x c, w U Nature of Repairs or Alterations—Answer when applicable----0��-�A�<�.4% Sus ��c-►____._._��1___r_s�' fir'- lO�n -' � t .. ,• T�'= < f �s�l• ----- 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. / Signed ......... >titer dI C:- �'t - =�' ------------ -------1� �r---- Application Approved By .......... ............................ ----------- Date- Date Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------- ------------------------------ ---------------------------------------- Date PermitNo. ------7_---`�--Y6--- --------- Issued --------------------------------------------------_----------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (C.er#ifira a of (gontyliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �' by ---------------- - -------- �� .� t t 1 C-.....s-- . : . T_ ____________ -_-------.--..-.._.___-...__. - ' p Installer S, sue_ AaFE �, _ �Juwl s- has been installed in axordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..__...0 s�..-_..�`�.. _( ___. dated ................................._-______..___ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE '-'----'-- --�--------------�--------------------------- Inspector --------------------- 1------ ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE f o� No..�r :�U.... FF� . AS?............ Disposal World To/nstrnr#iun amit Permission is hereby granted __ .d.:Ss..... ---------------------------------------------------------------------- to Construct ( ) or Repair ( an Individual Sewage Disposal System at No....................... -`_� .-i..-t�r,,, - �- 7-7 O --�","#C> C'f1 r ._ '.R::� J r 5- --------- - ----. .. -------- ----- •--•---................ - Street r�� as shown on the application for Disposal Works Construction Permit No.--•-_•----I-------- Dated.......................................... ................................... ..................................................... I q Board of Health DATE.............. /- ....../ ..................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS