HomeMy WebLinkAbout0065 GREEN DUNES DRIVE - Health Y.
l4' 65 Green.Dunes,.Dr.ive"! 1
Centery i lle
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0CATION �` SEWAGE PERMIT NO.
9 7- Gy of t,y,Ps �G
VILLAGE
I N S T A L L E 1114 NA 6E i ADDRESS
OR OWN ER
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DATE PERMIT ISSUED 7P-
DATE COMPLIANCE ISSUED
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No..29� V/Fmc. ........................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH APPROVED
TOWN OF BARNSTABLE Barnstable CongMati=
Appliration for Biipniial
Application is hereby made for a Permit to Construct ( ) or Repair (y, -"an Individual Sewage Disposal
\ System a : �bo PE S ---ew ................................
.........."--------".......... --------------- ..
Location-Address or Lot No..
....M-..] R ........ nl .•-•-•---------•............. .................................................................................................
a � Owne ` 7Address
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................. ___C.. �R_ A c.b... - :...�?`Y?2AITINQU.T.14....................
Installer Address
UType of Building Size Lot............0...............Sq. feet
.t Dwelling—No. of Bedrooms....3.....................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures -------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow..............................._._.__...__..gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- &pt'�................
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........................
0-4
G>r, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water------------------------
04 ...................................
-.......................
•..............
----------
----------------
- •----------------------•-•------------------------
0 Description of Soil........................................................................................................................................................................
x
V .....--•---------------------------------------------------------------------------------------------•-••----------------------------------------------------------------------------------------._....--
W -------------------------------------------------------------------------------------------------------- ------- .......................;S
Nature of Repairs or Alterations—Ans er when applicabl --_-_ ---/��o..� __��Z. "....
..�`�'----w --�----- .........................................................--------------- ----- - -------
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— he undersigned further agrees not to place the
system in operation until a Certificate of Co Tian has been is e by the board of health.
Signed1 .`�� -Qom'--.
--- ..................................................
r Date
ApplicationApproved BY ----- -------- - -----` % . . ................. --..............................................
Date
Application Disapproved for the following reasons: ...... ------------------------------------- .......---------------------.---.................
------ ------------------------- ------- - ----------------------------- ---------------------------------------------------
- Date
Permit No. � -
---- -- -------- -- -- --- --------- Issued ..--------------------�--
Date
No...9r-. VFmc.3A..............._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Dtipuiia1 Workii Cnnnitrnr vI n� rrmit s-:-
r
Application is hereby made for a Permit to Construct ( ) or Repair (y.-an Individual Sewage Disposal
\ System at:
`'-''-�-�------3--�v-- -- ...
• ...................
Location-Address or Lot No.
......... "--------"•-----"---•------- ..........--......................................................................................
Owner Address
a .._. '!�b_ <A..!�.4'.�?.................................................... - "9 �� -U .:..1/b(Z yhc���Tl. ...........-----.._.
PQ Installer Address
UType of Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms....3_............................_-------Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
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.
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........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................
9 _.___•--••-••-•--•------------••-----•_______________••______._________.____.......____...•----.._........------•---___________....___.------------------
...
0 Description of Soil..............................................................................................-""-""-"---""--"-"---""-"----••-•"--"-----_________.
x
W -"------------- ................................................................................ - :__•••. _
.........................
U Nature of Repairs or Alterations—Answer when applicab - "_
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 Compllanc has been issued by the board of health.
Signed . \ �" "------------------------------------------------------------------ -----`. ----------------------------
Date
Application Approved By ... ...... ...... �'---------------------- ----------------- ---L� --.
Date
Application Disapproved for the following reasons- -------- ------------------------- ..------------........................................................................
-- .........................................- ------------- ----------------------- V.............................................- ---------------------------- -----
` Date
Permit No. `'' / ^-
.................. ................................ Issued --------. �-..----- ----�.,.................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Tertifirate of CTamylianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓)
by--..A. ..... -► ---- -- - ------------------------------------- -- ------------------------------------------.................................. .....................................................
Installer
at ........ 7--------C_fz. 1. -t .tJ. 5.........� -I-.v..F� ............... cal .T-'....
has been installed in accordance with the provisions of TITLE 5 gf The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .... dated ..-. - 7,1. .... .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT RE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................................��..-.--�-�.. " f - Inspector ---- ..-...
11
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C� / TOWN OF BARNSTABLE
„/ ,�"/ FEE....,3Q.—
�i��r���1 nrk� ��an�trnrtilan �erntit
Permission is hereby granted-"-"""- ----"" -lr Rl•C b-"-------"----"-""--"-"-"-"--"""-"" -""""---•"-......................................
to Construct ( ) or Repair ( &,4**`an Individual Sewage Disposal System _
at No.- - --...: 2 fJ "- v U.�t= �. . ..........._t -1 l Doti'JV S 0 2 l
DisposalJ Street ���d'
as shown on the application for Works Construction Permit Nod__ ___`__., _A Dated
.�...
•:�:5.�.______
�----
DATE---•-s"�-_--"'----,�"•.-�'e?................................ '&ard_o'f"H'ea'1th_ ---------7------------
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS
LOCQTIOt-11 SEW&C-xE PERMIT UO.
IMSTDLLER 5 U&ME .DDWE j5-5
-
bU1LDER 5 Q,&V F- ADDRESS
Dt.\TE PERNAI-T 155UED -
D ATE COMPLI &&ICE ISSUED :
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No.----. FRS. _✓
THE COMMONWEALTH OF MASSACHUSETTS
EOARD F HEALTH
Appliration -fur Bi-sposal Workp Tomitrnrtion Vrrniit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
D
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System a �- a / 7
--•--- - -- -----••-- 7
�\JJLo��cation•A ress or No.
4f r!!�{,
Owner ddre
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Installer Address ______________________ ______________
Q Type of Building Size Lot____________________________Sq. feet
V Dwelling I—�No. of Bedrooms______________________________—�_____________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures _-_-_ -------------------
W Design Flow......................... _"������1ons per pet-son per day. Total daily flow-------------- ------ ----....gallons.
WSeptic Tank---Liquid capacityl _____g Ions Length---------------- Width................ Diamet r___._......._-__ Deptll___-.---.--._..
xDisposal Trench— o_____________________ Width_.__...._._..... . T 1 th___ _____ ota ping area--------------------sq. ft.
Seepage Pit No---- --------- Diameter- ep •--- ---- . ot'''''''a""llllllleaching ar sq. ft.
et t
Z Other Distribution box ( ) Dosing tank ( ) ��
aPercolation Test Results Performed by-------------------------------------------------------------------------- Date------------- ------------ -----------..
a 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 T�esl?it---___-_____________ Depth to ground water........................
n+ --------
ODescription of Soil--------- ---•-------------------------------------- p
x
x --------------------------:--------------------------------------------•--------•----------•-------•. -------------------------:------------------------------------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable----------------------------____._._____.-.._____--.--__..------.----:---------------------
----------------------------- .__..
---------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee .•ssue y th oard health.
St d --- 7
Date
f
Application Approved By--------------- -•-•-• ---- -• -- d - _3
to
_._ Application Disapproved for the following reasons___________________________________________________________ _______________________•._.__.....__________________
..................................................................................................................................................
/-�-----------------7�----
Date
PermitNo......................................................... Issued........ ----------/---------_-_-
Date
- -z
No.. �__� _ r Fly$..
r THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
Appliratiott -fur II-qV gal Workii Tonstrurttott Vrrulft
r Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
•------
Locati+Aressor L No.
W Owner dre
---- -------------------- -----
Installer Address
UType of Build* Size Lot__________________________Sq. feet
Dwelling—No. of Bedrooms________________ -----._-------Expansion Attic ( ) Garbage Grinder ( )
per, Other--Type of Building ____________________________ No. of persons__-----_.-.___•__:......... 'Showers ( ) — Cafeteria ( )
w
d Other fixtures .. --------------
W Design Flow___..•__________________� _ ons per person per day. Total daily. flow_-__-_--______�,.. _ganons.
USeptic "Tank-Liquid capacity ._ .__g Ions Length________________ Width---------------- Diamet r__._:_--.-.--__ Depth-_:....--_.._-.-
xDisposal Trench— o_____________________ Width_______._____. _ T l gth _ __. tac�hing area_._......_..___...sq. ft.
Seepage Pit No __ _..________ Diameter____ pt I /__�.__ __.__. ottaa lle-aching ar _ _.__--_-.-----sq. ft. r
V: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....-_-_:.._.._._..._.- J
f14 Test Pit No. 2.......___......minutes per inch Depth of AePit.-........_____._.__ Depth to ground water___...______--.-_--__--
=----------- --- --- ----------------- -•-•- _ ---------- -----------•-----.._ ..
D Description of Soil----"---------------------------------------------•-- ---------- -•-- ------ 2 n° =. ..°�.4..:y. ti...
V Nature of Repairs or Alterations—Answer when_applicable._-___----------------------------------------------------------_._`.c -- __:___._.__.__:__-.
•---•"-----------•-•"---------------•----------------------•------------_-............................:-----•--"------------------------------------------•----•--- -----
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code-The undersigned further agrees'.not to place the system in
operation until a Certificate of Compliance has bee sste " y th ardoa ulieaitYh
L
"3
::{•. :. • - -----------
ate
Application Approved By----- -- / ..,�.I - 7...�?
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Application. Disapproved for the following reasons_________________ _______._____---- _____.__._.._______________...___._____________.____
--•--•--•-----•-•-•"-------------------------------------- -----------•----------------- -------------------------------------------------------------------•---------------------•---"--------------
Date
PermitNo. --------............................... _:.:r Issued........................................................
'.'. Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... ....
�rrtifiratr. of f�nutItttttrr
THIS IS ERTIF' hat the Individual*Sewage .Disposal System constructed or Repaired ( )
by - � --=- - - - ,--- ------- -
nsta -------------- ..................................... ............................
y Iller J
t+� ,�j
at--- -- --•- -- --l ..?--------------------
CIA
has been installed in accordance with the provisions-of Article XI of The-State Sanitary Cod s desc Abed in the '
application for Disposal Works Construction Permit No"_____________________________________ dated........ . ... �'.._........._.___.____.
Y
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARAN EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
-DATE r t Rm,y y tq X a tv rxa 6 { rt RtlnSpeCtoruar sri 1 t s t
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t THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ' �" r 7 r
..... .. OF..........Z.44,*4..............................................
No.... FEE---
�i����tt1 Cn� r�trti,�tt �rrmit
Permission by granted_._. '"�� _...
to Const t or Repair an Individy a age Disposal Sys
at N ------ .
eet
o.
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.,:•„ .. fr+X.r+rc .4 °t �:S r yr
as shown on the application for Disposal Works Copstruc n1P t No._ _ ____ _ ___- ted=_-_[__.!' _._ -
PP P t�
' ram ----=
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Board of ��/I�,,-.�.-,�
7 B Health
DATE...... ...........................................
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FORM 1255 HOBes & WA REN. INC.. PUBLISHERS ,
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