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Home My WebLink About1259 CRAIGVILLE BEACH ROAD - Health 1259 CRAIGVILLE BEACH RD. CENTERVILLE A = 206 055 II!! pECYC(F00 II 111 � UPC 12534 No. 2 1� 533LOR HASTINQS, MN 0 1 N ,. Fee THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zippticatton for 30i.5po!6at *pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade.( )Abandon( ) O Complete System F individual Components Location Address or Lot No. /92x7 �"� y ` Owner's Name,Address and Tel.No. / 7 "O oY ' IQ s9 C'2A f�,1/�BCACA✓Co/, ffe / T Assessor's Map/Parcel CE yTre+J// Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 13r'vCC tvLeall:3-1Cr 19-t P'."S T OSTcs: .r1� 40- Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 1 ku Description of Soil Nature of Repairs or Alterations(Answer when applicable) Move ,4 V1 o w (N 1 k a w Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oazd of h. Signed a ate OC7-d 5-O B Application Approved by Date Application Disapproved or the following reasons Permit No. A Date Issued TOWN OF B ST LE LOCATION 10Z5 9 C 4 l .g , SEWAGE # 0()C ~� y� c/ VILLAGE Xr7��/� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /%A[v9/,6 J'F-— SEPTIC TANK.CAPACITY 40-0 D i. LEACHING FACILITY: (type) i it,.��L�' (size) CZ rx NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet iPrivate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by . Q5, �J kph i g. 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .,� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Mizpo!5al *p.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System tU'individual Components Location Address or Lot No. 7 Owner's Name,Address and Tel.No. � �% e,0.0y �� Jr 9 �2rN S✓,) N c-,grA A/ Assessor's Map/Parcel CE/irr2ci//c r �c�J^S (^k',�/G(ii// fr"7��r l� 0• 5, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3� �cc (tic cc_ r o, S`I Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures V' Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Titlg Size,of Septic Tank Type of S.A.S. ,Description of Soil Nature of Repairs or Alterations(Answer when applicable) Moue Q V1ow Date last inspected: Agreement: y The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. SigneAorthe �r. C 1 o ate OC;1j�-06 Application Approved by r fr Date Application Disapprovedollowing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS R BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( br)Upgraded( ) Abandoned( )by at 1)-5 q C r A-c, ;��r "s e ra c A. Y��r C��i e^� . e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. � f Ii) da ed Installer"R;v c e `lc—,_Co c\e. Designer / / _ :h , The issuance of this ermit sh-Il not be construed as a guarantee that the system will function as d�igned� Date Inspector ��,�/f l --- / — —i---------------------------/-- No. C/�--'' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpooar *pgtem Construction 3permit Permission.is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at 1_1.5 Ct C C and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. A Provided:Construction m "st be co�pleted within three years of the date of this pe Date: Approved by r� TOWN OF BAtRNST LE Ck LOCATION c 0 r SEWAGE #e 2006 VILLAGE � '�r��yr /� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. S=r&A, CA1/`!;7e F— %2R-550 q SEPTIC TANK CAPACITY 40-0 D LEACHING FACILITY: (type) A ��J 3.�y��f (size)c r f NO.OF BEDROOMS / BUILDER OR OWNER ;,,61 PERMIT DATE: 6r%-y2 y® COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by e e 18 C o2C� //e •� C 36 ` /Q ► so No....... FiS....ld...:........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF.........................................------•---------.............................--- Appliration for Diipniittl Works Tomitrnrtinn amit Application is hereby made for a Permit to Constru ( ) or Repair ( ) an Individual Sewage Disposal System at: / .. F ... •-•- .-. .....-•---... ------------------••----...-•-----••-•----• ---•-------------... .................. Address or Lot No. ........... . .:._.... ......... .............................................. _..........---........----------•.......`...................• •---•-........................... C wner Address (T] -- •-•----•-• I`...... nstaller Address Type of Building Size Lot............................Sq. feet Dwelling—N . of Bedrooms.....3..................................Expansion Attic ( ) Garbage Grinder (Al aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q+ fixtures --------- d - 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....-----_-r....... 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..................... 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 terations—Answer when applicabl - .. 1.- ®/Jl_! - �.__lam-. ! K......._.. 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 u dersigned fuffher agrees not to place the system in operation until a Certificate of Compliance has been issued e h :.. XD ........ Si d------ • --- Application Approved By.... . .. .......��. ...... �................•--•--......-------•-------------•----•- Date Application Disapprove or following reasons-................................................................................................................ •---------•--------------------------•---•--•--------------.....-•-------....................-----------•.....--------•----------------------'-----•--------- ........................................... Date PermitNo......................................................... Issued.................. ..-----•--......_.............: Dattee No..................fl e, FEs....��............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.....................................-.-.......----............ .-..._..... Applirttfiun for Diiipuiittl Works Tonutrur#inn rrmit Application is hereby made for a Permit to Construct' ( ) or Repair ( ) an Individual Sewage Disposal System at: .... ..........f•:; ,!Re�.�'L!� 4:4 ................. ...................•----...-•-•------....... .....------.......--------................ i •Address or Lot No. .....................•..._..--•.........-- - f ' wrier Address �}' C..!d.� !l.................................................. --•---•-••--.._..._..---.......---•-------._........................_..............-------•--•-•-- nstaller Address Type of Building Size Lot............................Sq. feet U Dwelling—N of Bedrooms......_____..........._.....................Expansion Attic ( ) Garbage Grinder (Al"P, aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' 0 fixtures _...••-•-••---- ------------- W Design Flow...Ra____a_____________________________gal lons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/l:�_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. l................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 124 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------•---...-------•--------------...----...---•---.._....--•--.........•-••-•--•-•-..................................... _....... ••.......... ODescription of Soil........................................................................................................................................................................ U ----•-••••••-••---•-----------•---------•-•-•--•--•--••-•-•-••.•-•------------•------•........•------•--..... -------------- --....................... .,�». U Nature of Repairs or terations—An when applicabl -/-'—_ Z��/� f___ � ?._ 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 bx- bb rd��- Beal Sid - -- ..._ .. �•• ....ram- - ........ . Application Approved B �� ..............................................................�" 0 D s PP PP y-•-==•-_•-• - Date Application Disapproved or I following reasons:__..---••-----•-•-•---•---••---•-------•-••--------•-------------------•----•-•---------- - ---••-...._ --•-•-•-•-•---••-•--••--•-----•-•------•-----•-••-----••..............•----•--•-••-------------------•---•---------•------•----•-•-•-•-•--••-----•-•-----•-----•--•-•-•-.....------•- -....-----._..... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... Trrtif iratr of Tumpliaurr THI /PS�O.' RTIF !That the Individual Sewage Disposal Syst m constructed ( ) or Repaired by •.. ............. .._.... rl. • - .............. ------•.....:....................................................... �,; --- � _ Installe - - at. - . -- -- - __-________ -------------------------------------------------- -•-• -_________________ has been installed i ac rdanc with the provisions of TITLW 5 0he State Sanitary Cod as d ribed in the application for Disposal NU rk Construction Permit No.- ............ dated_- ,a_...... _._._..._...._... THE ISSUANCE OF HIS CERTIFICATE SHALL NOT BE CONSTRUE A GUARANTEE THAT THE SYSTEM W L UNCTION SATISFACTORY. DATE.... .. ,, -------------------------------••- Inspector_.... 1 THE COMMONWEALTH OF MASSACHUSETTS /��` BOARD OF HEALTH ,Z , 1e�v s'�,��r�,�Jo�� -5 FEE....................... t Noll-'ell;., ...... �nu�r�r#iun ��ermit Permission is herebyranted_ fl '�..---..._.. -'- to Construct ) or Repai 'i ndivi_rl al Se ge Di osal System at No...--•---•..A. ----- "�.±.., r ._._...�' - t ...... ``� � .............. ' Street as shown on the a licati for D sal Works Construction Permit No.__.___.... �''Datedf ..__�r I %` --------------------------------------•--•----••------ fll<:,p --__ Board of Health DATE f - -- FORM 1255 A. M. SULKIN, INC., BOSTON L0C-AT ION SEWAGE PERMIT NO. V-t L L_A G E_ INSTALLER'S NAME i ADDRESS SUULDiR OR O--WNEA- DATE PERMIT ISSUED 4;Z3 DATE CO-MPLIA-NCE ISSUED r �� 9