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Home My WebLink About0055 ASHLEY DRIVE - Health 5 5 Ashley Drive Centerville , A. 172 —078 d UPC 12534 ' No.2-153LOR HASTINGS,MN , THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for 13ispaual Works Tonstrnrtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (✓)�an Individual Sewage Disposal System at: ----•---------- _.....yov_$ 1_24.` RIU.'�----------------------- .................... ........................................ Location-Ad r ss or Lot No. O ner Add�re�s a _y-�4w _ _....�4............................. . ............... Pa Installer Address d Type of Building Size Lot...........................Sq. feet U Dwelling No. of Bedrooms___..�.1__.._._ .....Ex Expansion Attic�-+ ng— ------------------------ p ( ) Garbage Grinder ( ) a'4 Other—T e of Building ............... No. of ersons._..._.__.__..._._.......... Showers YP g ------------- P ( ) — Cafeteria ( ) Otherfixtures -------------------------------•----------------------.-------------------------------------------------•-------------------.....-----•--............. 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------a-------------- Diameter----\X1......... Depth below inlet....6........... 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-___---.-_--_-__•--___-. fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R; ---------------------------------------------------------- •---------- •---------------------------------------------- -------------------------- ---------- -.... 0 Description of Soil........................................................................................................................................................................ x U -----------------------•--•-----------------------------------------------------•--------•.....-----•------------------•----------------•-------------------•--------------------••.................... w x --------------------------------------------------------------------------------------------••--•-- --------------- --------------------------•--•---------•-•--•- - U Nature of Repairs or Alterations—Answer when applicable_:____I�:0....___QY�-�-_____�a�.�C1._..____�T_..W..ca._......._.. TO. ------.-- _...,c �s. -�� ................................................................................. 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 boar4 of health. 7:77- Signed ......... ................ _ Date ApplicationApproved By ---------- . [Gzyu.. ------------------------------------------------------------------------------- -- ti e-.,� Dare Application Disapproved for the following reasons- --------------------------------...---------------...-----------------.--- ----------------------------------------.---------- -------.....I------------------------------------- ------------ -- -----------------------------------------------------------..................................................... ------------- -------------------------------------- 69 Permit No. ........... Q.------K- L .......................... Issued ........................ -----------------.....----- Date Date !. r No ..... r� 4,r Fps........:. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration fni Disposal Works Tonstrnrtion Uprrutit Application is hereby made for a Permit to Construct ( ) or Repair (, 0-an Individual Sewage Disposal System at Location-Add re s or Lot No. --•- ---•••--•-.Ca e..... ------------------ ........................... 7 t;n°� ................................................... Owner Address ! ................................... Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling No. of Bedrooms________ _Expansion Attic Garbage Grinder py Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a4Other fixtures -----_---_---................................... ------------------------------------------•-------•-----------------------•------------------- W Design Flow.........::;;T ___________________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-------I............. Diameter___.1_O!........ Depth below inlet.....(p.'_......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T Test Pit No. 2................minutes per inch Depth of Test Pit-_--_-______________ Depth to ground water........................ a --••-------------------------•------•------------------- - --------•--••••-----------------------------------------••--------------------------------- 0 Description of Soil--------------------------•---•---------------------------------•----------------------------------------------------------------------------•-••••---•..._...._...__.. x U .._..--•--------•----------------•----_.....•-----•--••-•---•-------------------------__...------------------------------------•----------------•----•---••-•-••-•-.----------------••----•-•-••-•-•••--. x U Nature of Repairs or Alterations—Answer when applicable-.__._.A;_0, ------- ...... _ �_�......... Agreement: 4 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 � �' " Application Approved By ---------- -<N- ----------------------------- ----------------------- -------- / ... Application Disapproved for the folloiNng reasons: ..................... --- ------------------------------------------------------------ ---- -- -- ---- ---------------------------------------------------------- -- ---------------------------------------=- ------------------- ----------- Date Permit No. -----------�� - if-- .............................. Issued ` Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ; Textifirate of (gumpCtttnce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ......................0 4...57.-*.�.A*..'\D.......�.4..'k�1�4-------.Installer...............------------............................................................................................. e at ............................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. --..--- ��.�..1...�- ---------- dated ................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY. � DATE...-... -------------- ..._�,----........................................... Inspector ......��.�---. .....-.......�---------------.---- -�, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.. Q-r FEE. ..�—.. j U x� Disposal sal Works Twnng#rudion fautit Permission is hereby granted...........L-,A4K .................................................................... to Construct ( ) or Repair (,..4.-an Individual Sewage Disposal System atNo............... .....✓1_S .le! ....� �t,sC. � -------------------------------------•-------- ------------ Street C� as shown on the application for Disposal Works Construction Permit N�f�____�_� Dated.......................................... .. �B ar of Health DATE ...........ql+ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION C¢ 1 }`� � � SEWAGE # VILLAGE &7rC-�&i1 ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. GK4 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (��jd tt,) (size)( ct- G-)' NO. OF BEDROOMS PRIVATE WELL O UBLIC WAT J�-- BUILDER OR OWNER ��U DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No et �� F e � � ��o--J�-��..-'. THE COMMONWEALTH orMAssAc*ussrrs �� HEALTH ��==""" ~ ~~ " " " .............lJ-- ...................OF-��. � -' � � Disposal� ��n��lur«*twwuu �xu� Works Toumw4rurtion Prru4tut � Application is hereby e for a Permit to Construct or Repair an Individual Sewage Disposal ,wner Address Other—Type of Building ............................ No. ofyec000a-------.-----. Showers ( ) -- Cafeteria ( ) � Other 6�o�� .� . ---.-_------..-----------------_-.--._-.-_-------.--'-_-------------_ Design Flow............................................ person per day. Total daily 8mr--.--.----'---------- . Septic Tank—Liquid capacity............gallons Leocth-----.--. Width................ Diameter................ Depth................ Disposal Treocb--No. .................... Wiidz---------. Total I.cootb--------- Total leaching area.-._..............sq. f t. Seepage Pit No.-------- Diameter.................... Depth below inlet.................... Total leaching area..................ml. ft. Z Other Distribution box ( ) Dosing tank ~~ Percolation Iout Results Performed by.......................................................................... Date........................................ Test Pit No. l-------roinotcuyerinck Depth of Test P6-------'- Depth to 87ouo0 water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth toground water........................ _ ............................... .. -_-_--.-. - ___--'----_--------'-_----- �� nf5�L--_-__--__--'- _-'-''_-------'_--------------' + _---'--_-_''--'___'_-__--___-_-_-__'------_----_----'-_-_--_-'-'------------_---'-----.. '------------'-----'--------'-- | U N '-----'--------'------'----'''--'------- /*grcemeoz: The undersigned agrees to install, the uforedescribe6 Individual Sewage Disposal System in accordance with He provisionsof OL'ITiU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ............ Date Application'Approved B]�------'~' 'J�� -------- --��.�..^��r--- , �^ »*= Application Disapproved for the follo 'ng reasons:................................................................................................................ � -------_-----'---'-------------'-----_---_-----'----------------_----------_-----_.----_-------- � /�- 7 lyq LOCATION 1 N�i, % z SEWAGE PlRM1 N0. CAN VI L E I N S T A LE 'S NA & ADDRESS B U I'C D E R OW ER A DATE PERMIT I S S U E D � � DAT E COMPLIANCE ISSUED d - S- - 07 } i � �� O pj Iw l � No FEB THE CJ�ONWEALTH OF MASSACHUSETTS .......... BOARD ,OF HEALTH .............. ------------I........OF..... ..................................................... Applitation for Dh4posal Works Tonstrurtion rumit Application is er h eby made for a Permit to Construct or Repair an Individual Sewage Disposal t ystem a - - ----------------- 7, ------7------------7--- h- ------------------------------------ 6' ;,d r.esi ............ or Lot No. .............. .. . .................... .. .... ................................................................... ............................. -ner Address ...... ........ -------------:7�7*......7.................. .. . ....................... ............... ..... . Installer Address T e-bf Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........�3.................... ....Ex�ansion Attic Garbage Grinder ( ) ther—Type of Building ............................... No. of persons............................ Showers Cafeteria ( ) Other fixtures ........... ................................................I.......................................0............................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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........................................I.................................. Date........................................ Test Pit No. I................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 '' - -a---r-- �-�--- ----------------------------------------------------------------------- Descriptionof Soil............................... . .. .. .......................................................0.......... ................................................................................;..................... --------------------------------------------------------------------------------------- Natu o f R e irs ions—Answer when applicable..... . ........ .......... ...... ... .. . ...................... ......... ............... .......................... ......................................................................................................................... Agreement: The ufiat the,a;fc��described Individual Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State,Sanitary Code—The undersigned further agrees not to place the system in qjperation until a Certificate of Compliance has beoissued by the board of healL11. -- --- ------ ---------------------------------------- ........ ..................... Ag Da 411 -"77 ................ ....f Application Approved By............... . ......... . ..........f.................. Date Application Disapproved for the following reasons:.............................................................................................................. ............................................................................................. -------------------------------------------------------------------------------------------------------- Date P11 Permit No. ........................ Issued_........................................................ -------------- Date .01 THE COMMONWEALT-H-OF MASSACHUSETTS 4 BOARD F HEAL�TH 4444 ................... OF..... . ........... ...........:......9...................................................... lertifiratr of /.000- I is TO 9�rR_Tl` at the Individual Sewage Disposal System constructed or Repaired by-------- - !L.................1. ......................... ....................7- ............ . _�*---------------------- .......... .................... s/ial/r 'y -- -------------------- -- at.."... ?r has been instdillel in accordance with:the provisions of' e��6.)5'of The State Sanitary as,described in the a plication fo' Disposal Works Construction Permit No.-- .......wil.......... dated p --------------Y�_7.7.............. THE IStUANCE' OF THIS CERTIFICATE -SHAL I.I.NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIL,VfUNCTION S TISFACTORY. .. ............; DATE...... ... .......... .............................................. insp��ctor.... .......................----------------------........ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0.� HEALTH 4 OF..........A'>.41..... . . .................................... ...................... Ni .......... FEE... ..................... �'Dispos ork o . trurtion "amit Permissio�)�'is hereby grante ... ... .......I....Mo .................. .... ..... - --------------- ------------------- ..... ...........------- ��,�j t( �pair a In d*, i u a,age/Dis t Constru or pos A, ... ........ ......... ...... ----- ..........a .................. ....... ............ . ... .... at No..' Y.. ............... Street as shown on the application,for Disposal Works Construction e i XtZ..efe ....4Z.... Dated.A0�V-77 ...................................... ... ..... ... ....................... W a - ----- .... e—_ j/- -7 71 -I ATE................... .................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS