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HomeMy WebLinkAbout0133 HARBOR HILLS ROAD - Health 133 Harbor Hills Road Centerville A = 227 060 A ;OrdNO. 1521/3 R _ oA -7- a No. Fee ✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for ]Die;pogaY bpgtem Cungtruction Permit Application for a Permit to Construct( )Repair N )Upgrade( )Abandon( ) ❑Complete System WIndividual Components Location Address or Lot No. /0-3 Vw Or_ >1 S Owner's Name,Address and Tel.No. Assessor's Map/Parcel of 2 7 ob D Name,Address, Tel.No. IJ Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_ 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. X6/9, � Description of Soil Nature of Repairs or Alterations(Answer when applicable — 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 is ed b this Board H alth. Signe Date Application Approved by , /W. Date 6`3—0 2 Application Disapproved for a following reasons Permit No. 9=tJ I Date Issued(n—3 —U Lno.2 - of 3 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(ppYicatiott for Migogal *pgtem Cottgtructiott Permit Application for a Permit to Construct( )Repair 4upgrade( )Abandon( ) ❑Complete System Wiindividual Components Location Address or Lot No. /;3 '. yr it1j S W Owner's Name,Address and Tel.No. Assessor's Map/Parcel a-`;7 Ob O � C^ tall s Name,Address,r Tel.No. Designer's Name,Address and Tel.No. 5 f`z'v'`C'r�a SST`+s �,t/. �✓ .vt' Type of Building: t . i0welling VA No.of Bedrdorris 7 Lot Size sq.ft. Garbage Grinder( ) Other TypMf 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. Description of Soil Nature of Repairs or Alterations(Answer when applicable) � 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 iss ed by this Board o Health r� Signed / 0 Daie ©L,_.., Application Approved by Date `3-U 7 Application Disapproved for Ge following reasons Y. f Permit No. 1ud;t- a3( A, Date Issued J, ----- •_v THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-sit�.Seacca a isposal System Constructed( )Repaired(Xupgraded( ) Abandoned( )by \ r� r at -33 c,1�iW_ has been constructed in accordance Y with the provisions of Title 5 and gCfogisposal System Construction Permit No. �t rl d -:?3 1 dated b- -0 2 Installer (lrv► L/I.I f!✓11 Designer The issuance of t 's p ' it shall not be construed as a guarantee that the syste ill fp ?�tiop as designed. Date Inspector /M �✓ ,� --------------------------------------- No. �)U 0 2 2 3/ Fee _;V i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ig ogaY ip�tettt Cjmztruction Permit Permission is hereby granted to Construct( )Repair( )U grade( )Abandon( ) System located at � 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. Provided:Construction must be completed within three years of the date of this permit.© Date:_ 3/0 2 Approved by ntif' �- TOWN OF BARNSTABLE fO LOCATION �33 ( oor ��+� SEWAGE # - a VILLAGE ASSESSOR'S MAP & LOT —0 D INSTALLER'S NAME&PHONE NO.�J C✓Vcc-� SEPTIC TANK CAPACITY ��-✓S�f�?r -S LEACHING FACILITY: (type) (size) i NO.OF BEDROOMS BUILDER OR.OWNER PERMIT DATE: J-3-ca COMPLIANCE DATE: ,6-S'U 2 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 41 . I . I K. f a e 3°1 TOWN OF BARNSTABLE fc LOCA"1ION 33 SEWAGE # - a VILLAGE !r-a4 ASSESSOR'S MAP & LOT -0 D INSTALLER'S NAME&PHONE N07-� ���-/-e y I SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ��i�✓`_ (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: ,6"S'U 2 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 Y ' A I a P No........7Y FE:s.:....�f ...`............ THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE TH ---------------.OF....... ••--------------- .gyp#firation for Riip oal Works Tonsfrurtion PrrrAit Application is hereby made f r a Permit to Cwgj r Repair ( ) an Individual Sewage Disposal System at � � �. VX = ` ��1v� `-t--- ati n-A ress `�,y Lot No. 133 ... ....-�........................... .•----•----- ...�J'---------- Address........................................ ��� ------------------------------------------- nstaller Address / d Type of Buildi g Size Lot._ �)__.L .-2---lSq. feet V Dwelling�No. of Bedrooms.._...._.... __________________Expansion Attic ( ) G2rbage Grinder ( ) �-+ p`4., Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' 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— o..................... Width.......... otal Length............ Total leaching area--------------------sq. ft. Seepage Pit No-----y/_'-------------- Diameter./L." ____. epth-below inlet.......... Total leaching area_ __Uq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY--------- -••--------•------------••-•----••-•----••-•------•------------- Date---------------------------------- ----- 1.4 a Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water_____________-_-__..__.- G4 Test Pit No. 2----------------:iin�utesr inch Depth of Test Pit_.........._........ Depth to ground water_....._._:_.._..__.._-_- P4 ------• ------------------ 0 Description of Soil.................. x W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U 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 XI of the State Sanitary Co —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by the board o li ` Signe .... -....... •/v Date Application Approved BY - ' -/�� Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------t---------------- ...--•----------------------------------------------------------------------------------------------•----I-------------------------------------------------------------------------------------------•--- Date PermitNo......................................................... Issued........................................................ Date ,. rd;' f No---- - .------ Fxiz.... ................. THE*COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f OF....... ...`.. r. / % jy Apjiftrdfiv `fur Disposes-1, darks Cnonstrurtion ramit Application is hereby made for a Permit to Construct ( ). or Repair ( ) an Individual Sewage Disposal System at f {�— //��;+ : .......... .� ' 'kb� v` _.� __. .... •: R.._._. "E _.�^ .........................,. tI. atiGn-Address Lot No. ' - � - wne ess G ._ .T'Y- ' r .. -';�vs'•'i '- . i:--.°°.............................. .................................... ...................................................... nstaller. Address , d Type of Building ! ' ; Size Lot.. ii°'r* !Sq. feet U Dwellin .Ex Expansion Attic b*ba e .Grinder g `No. of Bedrooms P ( ) g ( ) Pk Other=Type of Building ----------:...........c-.... No. of-persons.-__---_-____.-______-____ Showers ( ) - Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow............... 1.......... -•-..gallons per person per day. Total daily flow...... " 2 --------gallons. WSeptic Tank—Liquid capacity/_ -.gallons Length................ Width--_._.._--_--- Diameter::--. -;�Depth---.-_--..---_- x Disposal Trench—No- ___________........ Width-. ��otal Length_______. _-.- Total leaching area_-_ ___sq. ft. Seepage Pit No..-.'y.............. Diameter yi' .. ` 1Jeptli'below inlet....... I4------ Total leaching area_. _tr._ sq. ft. z Other Distribution box ( ) Dosing.tank ( ) aPercolation Test Results Performed by--------------------------------------------------------•---•--•-------•• Date------------------------------------- Test Pit No. I................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-----__----------------- a' ------------------------------------------------------ =-------------------------------------=-----••--•-•---- Q Description of Soil_______________________ U -----------------------------------------•--------•------......----•----------------- =---------------------------------------------------------------------------------------._..._......._. -•-----•------------------------------------------------------------------------•----•-•--•-••-•-•----------•--•------------------------------•-....-•-----•-•......---------------------------•-------- U 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 XI of the State Sanitary Code—The.undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of h th. Stgned�-- A�--== ------- =---- .r�e•�°�.� ''.,� a�'�,�.�..Q �'=a-- �---- `�---- g.,.�� Date Application Approved By--- /. ...A � '- -----•- ;?7_,e J$. .. Application Disapproved for the following reasons . =.................................................. -------------•----------•---......-----•--•---•----....---------------•-•-----------=-•--•-•------------------•------------------------•-------------•-------------••----------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD/ ,F HEALTH OF... /� �f� f�prfif iratr x of-Clutphatirt'. T. IS 0 ERT Y, That the Individual Sewage Disposal System constructed ( or Repaired y .......................... ( ) b .'•. ..._- -� ..... -. ------------------•----------------. ...... -- ---------------- ----------------- has een instal le7lin.accor�ance with,the provisions o Article XI of. The,State S �tary Code as,described in the application for Disposal Works'Construction -Permit'No..................... �__� ......_._ '. dated--__-_- ��� �__..... THE ISSUANCE OF€THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. ` at DATE--- -•-•••. -- -------��-----•----------------------- Inspector.--------------------...........................•=-................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . , .a.....®F... ... _ ,�+*�I FEE i t r No....... -Al....... r ............... Permission is hereby gran _ __ ............ ... _ _. (f •----- ------- ---•------------- •--•-•------•-•••------••-------•.•---- �t to ConsttAr ct (ts1) or,Repair'( ) n Ind v1dual Sew i osal System ted.... at NA �------� ........ F. ................... . y �"y Street Y PP P ° .. Dateet K'` ._-.._ .. ._ .. .... w - as shown on the a lication for'Dis oral Works Construction Permit N 7 J a ) aY¢ f eI�e ,A -. -- r DATE-- ---- --- --------- -----��.-----------------------.....--- FORM 1255 HOB & ARREN•,INC.. PUBLISHERS • _ i _ t,,