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HomeMy WebLinkAbout0155 ELIJAH CHILDS LANE - Health LIaAfL CfLILDS LN, CENMRVILLE P7,44=7171-242 . No. 42101/3 OR a In &19 0 sn ESSELTE 10% 0 0 0 0 . -� �- t7 / 1 �- No. ©A& Fee THE COMMONWEALTH OF MASSACHUSETTS 230 Y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Tkq;pool *pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(>()an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Map �7 n�� 242 s� � Q v✓ 7B C 4ILDs L A v / S S E L I T 0 6i1/1-49 I-R-NE Installer's Name,Address,and Tel/No. Designer's Name,Address and Tel.No. G��o�2c� E I�/pr/ ho oR/4/Av /4& n�� R7, x /A),C 6110 Lf Type of Building: X Dwelling No.of Bedrooms 3 Garbage Grinder(10) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 O gallons per day. Calculated daily flow 42!5 c-7 gallons. Plan Date Number of sheets Revision Date G / / Title G�/2T F/�-7� L-v 213,LA� L b? 01 / L, 1govK 3 4 3 1 0 Description of Soil O— 2- v/j 5 0 /L —12 ReIV EL — Nature of Repairs or Alterations(Answer when applicable) �/V-5 �itL� E3�✓LV� Ig/LEI o2E N LIDS /N Date last inspected: U�j K Agreement: The undersigned agrees to ensure the const ct'on and main nance of the afore described on-site sewage disposal system in accordance with the provisions o Environment Co e and not to place the system in operation unti a Certifii-- cate of Compliance has been issue by th' ovrd of Health. Signed Date Application Approved by Application Disapproved for the fo wi a ons Permit No. / ��— � Date Issued S„•rn.:1u..'-w .1,�,a /1y,ZL f-••y�,� F p� �`� - rr 1. .. a ., s - •.. i n .. .r .. n p .. n w .. No. " �7 Fee--� THE COMMONWEALTH OF MASSACHUSETTS ,. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppYica`tton for Zigogai *pe;tem Conttruction Permit Application is hereby made fora Permit to Construct( )or Repair an On-site Sewag�Disposal System at: Location Address or Lot No. Owner's Name,Address and TelAo. 7"qx M/9,0 l7/.F4y 242 ._ C / Sp e V✓ 8AC-)� Ey L.t 3 A N C H I LV 5. L AND _. � !; Y C L_ 1 T#H C A/1C R,j /-ANE Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. g p r/ ,�, o o e �, /v P/ �ti /3 3 A T - /,t) C 6 i8 '/ Type of Building: X Dwelling No.of Bedrooms 3 Garbage Grinder Oc>) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 o gallons per day. Calculated daily flow 1425 C 0 gallons. Plan Date to /d' �'/ N umber of sheets / Revision Date . 6 / Title G T F/�� �L v� %�� r/ L y j '3 4 3 L.o w � Description of Soil l O — Z v UV n 7-L A N C Nature of Repairs or Alterations(Answer when applicable) `".5 T 14 e- t=Y? V� ND E UAL E 4X )S'/N 5 5 T t_. p ! �5 G FLUSH/N Lam, /6 7--) P, P � S Date last inspected: U k Agreement: The undersigned agrees to ensure the conseEnv ction and main nance of the afore described on-site sewage disposal system in accordance with the provisions o ironmen C de and not to place the system in operation unt a Certifi- x cate of Compliance has been issue by th' oard of Health. // Signed Date Application Approved by r - Application Disapproved for the fo wing ea ons Permit No. ! — 1�fS Date Issued I f � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Certificate of (Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replacedqC)on by C E__D ►2 !7 c_ V,oP v/ ►7 v for E L 13 Yq H 5 L 4-tJE— as T_A Y, Z has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below: No. C)©te ! Fee` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS M,5pogar *pgtem Congtruction Permit Permission is hereby granted to D 12 c,6 b1l 2 ,ru D to construct( )repair(X,)an On-site Sewage System located at L !,T q 1 E -5) 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. All construction must be completed within two years of the date below.. Date: �� -- t� "70 Approved by s >�•A�f<��q' � l�v�yr� s too .c 3 , - � 4�P•b• �: '''T A T u 5 1®�cz C-►t4 L _D_•il-Pa-sALI Pif I et0 �'aC7 :~S=. r t .cl Sh G.Y D. To^r*AC- "D��16W = 425 ToT&L. 5xA t-'�-( F'L.nw = t�Cf.�GUI.�,l'lG�t.l QQTI✓ ��.t�s 2kt�u 02 t b• /o Q 1p V ij �;,` N:; ?•.AFL" Y :.' � •�' ti k f•-1ot_'F-"- IZ-Z3 u0 �G77. .. �y .%. TOP F-4 7717`''� 4 PEE T� 1w:1 Gay, ,5s.2 z tax y 5s.o �Fs--Ic ,o It►�v. f 1 � Tn,.�K 4' SQvI?� logo r•3,5 `'WV uN , Pc (-�a✓� Gr.t.. 7d.o �54Z LcncK W,-rw. e' - 5r�,..,� tile. /o� � o _.,_I �� e--------------------- _ _....__.--- SAND CC--zTtV- PZ0F t L� • �z LhU T'lni� C E PWIi_�LI; do wc.76r� t Gl..11T117-1 Tt-(AT- T14G6 Pt_AQ Rimer-EC-'e .IC_i- G(:n.\r'L%(G W 1T1-2 TN`: h.u c� r:'r 1�.,~.C.t� t:G l� t C.M�:.►.�T; O -t-a C� L U T ► � 'rg(. Pt_ , 0►C. 343 PG. r:;; Mir �� � *TO WU NS-V 242 '.1HI hc_AW I; QOT L'A;C'J vt.a Aa.l o>zc�:vtus o A 1W-IF t'Q:J 0 C: 0r-t=:r--r.1, J La i LO C A T ION S E / G E PE RMIT MO. VILLAGE ` I N S T A LLER'S NAME & ADDRESS - ' �ll/Lcl�c•C' /T1 w i U I L D E It OR OWN ER DATE. PERMIT - ISSUED I DAT E C 0 M P L I A N C E ISSUED j i NN C't' I7c►zrN r `r Yv �v 0 9C M 17l T i TOWN OF BARNSTABLE LOCATION ,4,f C6lZd,- AoOV SEWAGE # ' VILLAGE Co.;�. �-ti1 '� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. gztzju V, SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes No j A 01, A .4.? 6,._. A `/ /Ty ��'F� THE COMMONWEALTH OF MASSACHUSETTS BOAR® HEA TH )IC..............OF......... ... . ............................................. Appliratiun for Disposal Works Tonstrnr#iun thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S esn at , --• - .. ..... ....... .. .......... ... ........ Location- d s or Lo Qwner • Address a •••• •........ .d.._.........•------•-••---•-•---•- .............. . •.................................................................•--- Installer Address ��--- Type of Building Size Lot._�c?y Q�`d..Sq. feet U .Dwelling—No. of Bedrooms.................. ...................Expansion Attic Garbage Grindera aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -- ----•--•-------------------------------------------------------------------------------------------------------------- d y W Design Flow.... .. .........gallons per person per day. Total daily flow_-__----.`-i.7_._C)...--....._gallons. WSeptic Tank—Liquid'capacit ...... Ions Length................ Width................ Diameter-_______.._--.-- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area.................... 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........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .................................................. •---------- ------------------------------ -------- •.............. --_------------------------------- 0 Description of Soil...................................................•--...-----.....-----•---------•--------------------------------------.......--------.............................. W .----------------------------------------------------•---------------------.........--------....---------...---------------------.................................................................... w UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewa Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code—The undersi ned rther agrees not to place the s ste in operation until a Certificate of Compliance has been ' e y the of ealth. 7 Signed--- - -----------•------.---_. .... _... / ---- -------• --•---.1-. Application Approved By_ i. ....�.. _ e Date Application Disapproved for the following reasons:...........................................................................------------------------------•-•--- ••........................•......•-•••-....--•-------------...-----------•...•----------•....---------••------------------------------------------------------------------------------------------..... Date PermitNo......................................................... Issued....................................................... Date N -boll No­42/)3.6-,z� % RmB 3A)............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH —07 �.0­4%44...............OF.....A. ..... ................. Aplifirativit for fi11Wpagal Workii Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at,:* A ....................... ......... ............. ......................Location- dd, 7........w...... ....... ....... -" or Lot Owner Address ............I... ... .... - ----------------------------------- ....... /&----------------------------------------------------------------------------------- Installer Address U Type of Building Size Lot../ ---4��..Sq. feet ?Dwelling—No. of Bedrooms..................I..........................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures.............................................................................................................;;�w.................................... Design Flow.... .......Z.........gallons per'person per day. Total daily flow........ ­n..............gallons. Ix Septic Tank—Liquid capacit allons Length................ Width.........._..... Diameter--._-____-_----- Depth_._............. W 0--—611741 Disposal Trench—No....................Width.._.._.............. Total Length:................... Total leaching area...................sq. f t. Seepage Pit No________ ___________ Diameter......._._.......... Depth below inlet................... Total leaching area..................sq. f t. Z r 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....................... f14 Test Pit No. 2................minutes per inch Depth of Test Pit.............._..... Depth to ground water.................t 04 .......................................*------------------------*---------------- 0 Description of Soil..................................................................................................................................... �4 ..................................... U ...................................................................................................................................................................................................... .................................................................................... .....................................................................................�7........................... U Nature of Repairs or Alterations—Answer when applicable.................................................................................................. ......................................................................................................................................................................................................-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewagl Disposal System in accordance with the provisions of TLITIZ 5 of the State Sanitary Code— The undersignedyrther agrees not to place/thhe te in operation until a Certificate of Compliance has been 14 y the Im"57di of kalth. Signed. ............. .............. . .... ................................... ....... ...................... Application Approved By-------- ..... ... ............. ... .......................... ....� ..... Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........Z.071...................OF..................................................................................... Trrtifiratr jaf TI-Impliattrr THIS IS TO CERTIFY, That he Individual Sewage Disposal System constructed K) or Repaired by................. r4 .................. . ...........................I.......................................I.................................................................... ILI,,_/,Installer.............. .. ........!�,� at. ... . . ......................................................................................................................................... has been installed in accordance with the provisions of _TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.--..(V.1.241=................ dated.._.._.___._..._.........__.____:............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................. ................................. Inspector...... ............................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .............OF... ............................... No.o. FEE..�� 0 Raposal orkg Tons-trurtiou 'upamit ................. Permissionis hereby granted......-- 0261, -a,................................................................................................................................ to Construct or Repair �an In ivid Uve d at No. ....... ?L . ..... v.............. . ........................... ......!poeft ...................................................... Street as shown on the application for Disposal Works Construction F=9-ift No--------- --------I Dated.......................................... ✓ !��..................... ----------------------------------------- roard of Health DATE...... ........................................ FORM 1255 HOBBS 8i WARREN. INC., PUBLISHERS ,LOCATION ` S GE PERMIT N0. i VILLAGE I N S T A LLER'S NAME R ADDRESS I u �u�• T BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� � � � � � `sue r�l�.Y�tt c•n.nnl�`! - '3 'Fsr�t<;�oM ` ~ T�I�I�� F pow s tad �� • '33o G.p.t7 w W `t\r(,1 # '.'.F:F'l�lc� `f"A+�11.:. = 3`3o,r IciG % • L��j6.P.D.• , 1 u" 1,ood 6aL. D " - Z/ i �.Pvc S N _- _PIT - uSC- logo G&A— �C�WAt.L Av—A - 14�0 S.F. ' fiesT-T-bm 0=EA a So v-, 6 P v. TcrrAt_ T>eS16W c 426 G.RD. 'rOTA 1_ vat L I� t=L ow . 3w 66.P'D. I 12f w Vm_-rec 7t.&,'1 toll 04-re : t"Iu SMiQ'otz L" NHS �`� ,; F'`!D ,o. U' ' -- a i IV * LO jk For I 1. OAXTV k. P-G 3 i - G a 5� -•r Top 1:N 12.234- _-- cunt 55.5 Sult�O/t. 4�PPF DIST lu✓. G�a�. 55.2 Z 'Box 55. 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