HomeMy WebLinkAbout0031 BLUEBERRY HILL ROAD - Health 3 181 ve berry t-li 112d
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5 M E A D
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
OFOR AIWLE ES W MIN.RECYCLED
INITIATIVE CID ENT joy
Certified Flier Sourcing POST-CONSUMER
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GET ORGANIZED AT SMEAD.COY
L TOWN OF BARNSTABLE
LOCATIONS 1'8I(le 4- tI � SEWAGE
VILLAGE (?n_ t ��' ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NORAo IU L
SEPTIC TANK CAPACITY /,
LEACHING FACILITY:(type) �' (size)
NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER
BUILDER OWNS A d ed scy"
DATE PERMIT ISSUED:
DATE. COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes rNo
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loN
THE COMMONWEALTH OF MASS.ACHUSETTS
APPROVED BOARD OF HEALTH
BarnmWo Cons y0 n DOPaltment
_STOWN OF BARNSTABLE
lm&d ImpliFatifWfor Diripmial '.Forks ( omitrnrtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (3�J_an Individual Sewage Disposal
System at:
Location•A 11 s f or Lot No.
........��..°hs.{ -----..���i�� ----•---- �rJ Gas7,
owner _ nadress
W �GG LCT� Gl3n f�S� �LoJ /�4J � ,,1 .�.1. / �i�h.� JILTS
Installer Address
UType of Building Size Lot............................Sq. feet
►� Dwelling— No. of Bedrooms..................�--_.._-.--_.-.--.-_EXpansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ---------------------------- No. of persons._.--_----_--_----_-- -.- Showers ( ) — Cafeteria ( )
Q' Other fixtures ------------------------------- - -
---- -------------- -----------------------------------------------
Design Flow..................._ ......._gallons per person per day. Total daily flow------------- --......__.........__gallons.
WSeptic Tank—Liquid capacity/ 9..gallons Length---------------- Width---------------- Diameter................ Depth................
p ,�..._.. Width........... ........ Total Length._.!�'7�Total leaching area....................sq. ft.
x Disposal Trench--No. ..._____. .. 7
3 Seepage Pit No------------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) IDosing tank ( )
0.4 Percolation Test Results Performed by---------- --------------•-------•-------.------ ----------------- Date
Test Pit No. I................minutes per inch Depth of Test --------------
Depth to ground water........................
f14 Test Pit No. 2................niinutes per inch Depth of Test Pit--.__-__.-_-____-_ Depth to ground water........................
a ---....--•-•-------------------••-............._.. SY.o� _....----•-....._......---•--.. ........................................................
-•-----•........---------•.-••-
O Description of Soil................. � 644.14 � .SUJ 4_ D
x ------------- .........................................'
W
UNature of Repairs or Alterations—Answer when applicable..____ . .___._/Q.PF� :... ._ ....7'�
. ....
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 issue the lZoard of health.
Signed .............../.. ......... .. ' ........_ ------ ......�.,X...
Date
Application Approved By .........
....�.—�•-
.................Dace..................
Application Disapproved for the following reasons: ..................... ... ' ...............................' -' . . ................. .. ................
........................ ........................................................................................ ' . ............................................................ ..................................
Dace
PermitNo. ....... v...-.... .y-.6-------------- -------- Issued ........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate cate of C omplianee
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
b ............................................----------------------- _.. - _
at .................................. _................. � .... �'�i l G ..!V.. :.........�:.......�1,� --�c.�l-c/---- --"�--------...........
has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ... .- W. dated .................-...........................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..........._............C...1.._'...41....../._ ........ ..._................-........... Inspector ........ =?.2.--.....
THE COMMONWEALTH OF MASSACHUSETTS /l U-77
BOARD OF HEALTH
G' TOWN OF BARNSTABLE
No..!_ ...��/� FEE....+:��..: ...
4. . _--_-_
Permission .is hereby granted... Gfl.tV 5 /�✓ ...............................(J
to Construct ( ) or Repair (_'y)'_an In ividlual Sekrage Disposal System
atNo. � _.. /��I� 1'4- -= QS.T__c/i/•.--..-........-----•--------------•--.............
Street
as shown on the application for Disposal Works Construction Permit No �--69 Dated...........................................
R.. ..o..�� ��-•--•• -- - ------
DATE. R _• ..................................... Board of Hcalth
-zJ
FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS
No..l._�?-...��✓ /FR x...� ...............
THE COMMONWEALTH OF MASSACHUSETTS , f
BOARD OF HEALTH V/
r' TOWN OF BARNSTABLE
Appliration for Uiripooul Worltg (nogtotrnr#inn Permit
Application is hereby made for a Permit to Construct ( ) or Repair (s4,an Individual Sewage Disposal
System at:
//�3
••...............•----•----•-•---...-..--•--•----------------------------------•-•----•-••........ .------•-•----------•-------•-----•-•---•••-•----•---...•--•••••-..-...........-•--•-....-•-•-•••.
Location-Ad 1 s or Lot No.
...............S/ �i_.. ................................ -------------------l 1 ----(.157=..-----.......----..........--•---
_..
Owner Address
W �G�G� G �/ Ll..•..Si---------7lo w ,�,
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling No. of Bedrooms..................-�...-- Expansion Attic g— : ...---.._. p• ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---.---.--.----------------- Showers ( ) — Cafeteria ( )
dOther fixtures --------------- --------------- ------------------------------------------------------ ----------------------------••--••-••-----•--•--•------------
W Design Flow...................... .: ...........gallons per person per day. Total daily flow............-3.•3d...................gallons.
WSeptic Tank—Liquid capacity/ q--gallons Lengtli--.--_---.--.- Width---------------- Diameter--- ............ Depth................
x Disposal Trench--No. -----------/...... Width..........:----- Total Length... '-7IF7Total 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........................................
a
Test Pit No. l................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..........------ � 1 ,�'I �S�SO)1_ ---"` /�-•' f/ 1ID
x •----- ••---• .........
U ----------------•-------•-------------......--------------------------------------...----•------------------------------•---------------••--------------••-•------------•--------...--..---------•------
W
x ••• -• ---------------------------------•- ---•-•-----•-----------•---.....-----------•••••----------•------------- --....-------------•••----------------••••••-•--•••••••--•......--•----.........
U Nature of Repairs or Alterations—Answer when applicable------ �!L.------�1 � �,. •-,•. : / :./C_•--.7 ti/ %i.
.-5.7..;= U ---/.......... `'-•K /. / /C �r�i� 7T/41 ....W r- / i . <...............................................
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 issue by the board of health.
Signed ...............:-�C ------' �I. ...-.,\—.. -------- .....C� �L`�/C._ .....
Dace
Application Approved By .........3k�
Dace
Application Disapproved for the following reasons: ..... .. ...... ...... . .... .................... ...... . ............... ................
................................................. ----------------------------------------
Permit No. .......��. Dace
- ..`Y.6-..... - ...... Issued.. ............ .........,.....................................---...--- ......
Dace
9
No. FEE.........`r....�..�...
THE COMMONWEALTH OF MASSACHUSETTS
APPROVED BOAR® OF HEALTH
®omatcabb Ovation DepartmerTOW N OF B A R N ST A B L E
!74reby
�ateteVzgigsApp Ication made for a Permit to Construct ( ) or Repair N an Individual Sewage Disposal
System at* '
,?/ i � , -r b rut
----------------------------------- ........................................... - -----•••-----------------•---•--• ••.
...................:......................:......... .................... ------
O 11 Address
. C.er r..kS.. 7(mS. Gf34 J/ �d0 MiJ - ..... -:
Installer Address
Type of Building Size Lot............................Sq. feet
�.. Dwelling—No. of Bedrooms..............�__..__.____._• _---Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ._._ ...
------------ --- -
W Design Flow------------------- ._...._.._._..__gallons per person per day. Total daily flow...........� o.............._.__...gallons.
WSeptic Tank—Liquid capacity -gallons Length................ Width....-.---------- Diameter---------------- Depth................
x Disposal Trench--No. .................... Width-----_.............. Total Length-_____-_--_...... Total leaching area....................sq. ft.
f f
Seepage Pit No............ ..... Diameter-----/0......... Depth below inlet..__.CP........... 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.........................
Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ............................................-1--------------------••-------------.-.---•-------------_._---..---•---------•-----------.--..--..---•-------.-.
ODescription of Soil...................................................................................... -----........-------------------•---....._...----••--------------•-•....._.......
V
W
UNature of Repairs or Alterations—Answer when a,�plicable._ _. �l '_. - %APO.._.. . .. cS:'�T1<......
f ---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental ode—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance s bee issued th�ard of health_ c`
Signed ,•f �S
- ----------------------------------------------------- --------- -------- .-...
Dace
Application Approved By ............ �v�•,, .-... .... .......F.- ..-. .hS
Application Disapproved for the following reasons: ....... . ........ ....................... .............. .............................. ...................................
......................... .....................................................:......... .............................................--.._......... . ................. ........-- . ......................
Permit No. ......7 ..-...l1.. r)............................ Issued .--------------
- ...........................................te......
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
V Eitifira e of Zo ttp ianre
THIS IS TO CERTIFY, That-the Individual Sewage Disposal System constructed ( ) or Repaired ( A )
. .................................. U �6L vca-,0. ..._......
-
Insrdlcr
�.... ..........
at ............ ............... ............ .. . ...._... _...... �� U�Of -.- `/d L.......'. c -1� :........
...........
i has been installed in accordance with the provisions of TITI.E 5 qof The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .._l .f.._y ............ dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
Y
DATE............................. _ ?...-... _.._?..................-........_- Inspector .....-- _...........__..... ..
..... ..
.`....fit'.......................................
THE COMMONWEALTH OF MASSACHUSETTS 693
BOARD OF HEALTH
TOWN OF BARNSTABLE
FEE............
%plaiinl Worb Tuni#rur#inn Errant
Permission is hereby granted-------------------- --.._ASS - I ,--------------C'�... Ll�/�'7Q��
to Construct ( ) or Repair (>Z�- an Individual Sewage Disposal System
atNo...............................................
Street
as shown on the application for Disposal Works Construction Permit NO. �.__ Dated_._.._._.F...�.Ta ........
-•-_. --------------------------------------•-•. --•--•--•--
q Board of Health
DATE.-----._.../. � y
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS
r s 6 1
f3 �37
No.. = 4 - Fas......`......................
THE COMMONWEALTH OF MASSACHUSETT5
BOAR® OF HEALTH
TOWN OF BARNSTABLE
"" iration for Diripasal Wurk,i C omitrnrtiun rnmit
App ication is hereby made for a Permit to Construct ( ) or Repair N an Individual Sewage Disposal
System at: � n
..--•--....�.---........�G[..--•-•--------------•-• ---------•--------.L_...........--••- -•----------------------•--------------- = ....................................—XII
'`U} -t• ' %``AV Q/J ?/ or IAt No. L /
.......... ...............................••----•....-----••--•••......--------------r-_---•----- ...................
�L.... 'l121`n...owner Address
fa .................... .......�.... ' .5- -�... Address................................................. .`....... ................................................
Installer
UType of Building Size Lot............................Sq. feet
►� Dwelling—No, of Bedrooms.............. ---.----------:--------Expansion Attic ( ) Garbage Grinder ( )
.a Other—Type T e of Building
--------------------- ------ No. of persons..................... Showers —
�,, yp g - p ( ) Cafeteria04 ( )
Design Flow.Other fixtures fi ._-.-:-___gallons per person per day. T ot d al aily flow.--.._..-, - 0....................gallons.
W J
WSeptic Tank—Liquid capacity./00-gallons Length---------------- Width----.--.-------- Diameter_------------- Depth................
x Disposal Trench--No. .................... Width.........--.---..... .Total Length......--.....�..... Total leaching area....................sq. ft.
3 Seepage Pit No............ ..... Diameter-----/V...-,-... Depth below inlet-----1p........... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
' 4 Percolation Test Results Performed by.......................................................................... Date.----...--- ............................
Test Pit No. I................minutes per inch Depth of Test Pit..---......--....... Depth to ground water..................
L% Test Pit No. 2................minutes per inch Depth of Test Pit.............---.--. Depth to ground water......--.............--.
P4 -•-•---••---------------------•----•----•---:....................................................................................................
.......
.....
0 Description of Soil............................................................................................................. ..........................................................
x
V ....•----------••---•-•----•••••-••-•----•...........•-•••----------------•-•-•••-••-----..........---...-••---------••••••••-••-•••-----••--••••-------•----••-••-•••••-•-•-----..............--•---••.
W
UNature of Repairs or Alterations—Answer when applicable.----7- Q.-..c 'f !4.......
ifs /L..:.-.... /-ST �sG x•--•-A.......Z406 (ZY..................................... �s-?�s.....��.%'Z?c`�
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/beeig issued y th oard of health.
Signed --........../<:.. 'L .%/.............. G� ! �, ....
' Dace
Application Approved By .-.......... �:<�•<, .,. -- --.._..............................._................................ ....... - e
Application Disapproved for the following reasons: --.... ....... . . ...................... . . .......................... ....................
................................... ..... ............................................................................................ ................ .. .................................... ...............................
Permit No. .......c. 7. .... ..L/�'? Issued............................ ssue .---------------
�... .----Dace-----------.-..........