The URL can be used to link to this page

Home My WebLink About0065 HILLSIDE DRIVE - Health 6S N�tiJ;de br E M E A KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCm INITIATIVE CONTENTIG% CordfiedR6erSoeroin0 POST-CONSUMER® wvwAprommarp $Rolm MADE IN USA GET ORGANIZED AT SUE AIM ASSESSORS MAP N0: 2 =< y , No �� - PARCEL NO.: a Fss... ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................OF.....-.......... � � ............................ Appliratiun for Uispuuttl Works Tunutrurtiun rumit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal S stem at: n �1a' "^ .................................... `�-----•----d_.. .._.�.. �: _ d; 6�ar.�....... Location ddress _/ port No. / ................................. . ..7/.:c 2=t.k.6,-.b e ri�Ae`.�aZ.r _�}_._..t 4:2"�lluL�r1K"...........--- W Owner Ad, s ................................................ R,,�- c r+ Installer Address C,T UType of Building �- _ Size Lot.... ....Sq. feet Dwelling—No. of Bedrooms.__..1 _I A. ___________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of ersons____________________________ Showers a g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures ------------------------------------•------•--------......-------•------•----._...-•-----•---._...._...----•------.....-•---._.....---............---• W Design Flow................................,..___gallons per person per day. Total daily flow.. . 4..........................gallons. WSeptic Tank—Liquid capacity_F lNnh__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,><r Dosing tank ( ) aPercolation 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........................ a ........................ .•-•-•----•--•----•--- --------------- •-------- •-----------•-----------•------- ----------- •••------- •-••••-------- •-.._...... 0 Description of Soil........................................................................................................................................................................ W UNature 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 iIHE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be ed y the b and of health Signed--- � '1�. f-'-c%_._...---- __________ ______ „Y. .... ate *Application Approved BY................................... ---•--- ..............•. ---•--_-- - bate Application Disapproved for the following reasons: -------------------<-� -------------------------------------------------- --••-•••---------•---•---•••-------•--•-••-•-•-•••---••-----•--•--•---•----------------•---•--------....-•---•----=----....-----••----------•--------•----••••--•------------•-----------•--•--••-----•- //-��ii Date Permit No.._ 4Q2S.............. Issued....................................................... Date No. ..64Z r FIZIM ../... ��..�✓ .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a_ ....................OF................. ::��-...,c/.: f� �.,. Appliratiun for Disposal Warks Tonutrurtion Vrrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: 1 / ....5 i:',;{ter f/:Ic%-_,...!./:�........---•--•------------------•--•-----..... -----••--•---f..r.� ........ r_.:�= - "•--!:.i .`.. ...... Location-/Address _ / ` or Lot No. - 1 .............•--•-.........•... / .%.. `:...1'�A 1,r�_�t�<;/ ... __: {_., _l Glsl......_----- ( Owner 1/,Address le, Installer Address d Type of Building Size Lot..... �> .-:`.I/....Sq. feet Dwelling—No. of Bedrooms....--1-.E-�-:...................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------•--------------......----------------------------------------•---•---...........-------•---._........._.......... WDesign Flow.................................: .:: gallons per person per day. Total daily flow... ?? .._....._.__._.....______.gallons. WSeptic Tank—Liquid capacity..!t°r.-P.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__!`_41�_ '_.__.. Diameter.....f............. Depth below inlet....k.1......... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) Percolation 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 •-•-•••••-••---------•-•••--••---•...••••...•••••••--•••.....•••••.....-•-•••......--•---••----.............................................................. 0 Description of Soil........................................................................................................................................................................ W U -•••-••••••••-•-••-••-•••-•••••••--•-•-••-•••-•-•••.....---•••-•--------•••-•--•...............•-••-••••••-......-•••••-•--••......----••-••••••--•--•••••-•-•-•-••--••••............-•..........----•- 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 TITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been--ssued by the board of health. �'G%1/ '� '`�f G Signed---- { .,:.,j1. .-� � ! ..r 11...i„= :._. '�rw.... r� r .=t ` ate Ilcation Approved B ` '=I �� r Zs PP PP Y••--•- - ........ 1 .. �'-~`_1--`.1—`__ ate Application Disapproved for the following reasons: ................. _ ....................•---•-----..........-----•----------•----•-------------------•------.................._...........--•------------------•-----...-----------------•--•--------------------......._.... Date Permit No..... :.....-_�-� �� //�l.1. - Issued_....................................................... Date OIv THE COMMONWEALTH OF MASSACHUSETTS A BOARD OF HEALTH .... ................. ... .................................... Trrtifiratle of Toutplinurr TH�S IS TO CERTI-FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by 51• __(\�_�_:=� .... L A, ............ • =- - ..... ...... f J Installer ato(_ r- f- ==i ......_.-....................e.....---•---------•-----------...---.................----------------......•.........------ ..•....------------. has been installed in accordance with the provisions of TITLE 5 of, The State Sanitary Code as de cribed in the application for Disposal Works Construction Permit No....... .. ..... t...r�..._..._._. dated............ ?�...t.U�' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION ATI'SFACTORY. 1.._7_�� f . DATE............... Inspector.................................................................................... t OMMONWEALTH OF MASSACHUSETTS [ BOARD OF HEALTH f r /. . ! r ':..:.::....................OF........... �_.*t...... ......... .:..................... No.:,.:..:�_......:..:.r` FEE...••................... Disposal Works Tonotrortion ;ermit Permission is hereby granted.......:.1_.}.r a to Construct S ) or Repair, ( ) an Individual Sewage Disposal System ��, Street as shown on the application for Disposal Works Construction Permit No�&_ �!'. . Dated...:. ! C� .... 21. _ ............................. DATE...... .......... - f rZ�---- t Board of Health f ...--••••••• •...........••.... FORM 1255 A. M. SULKIN, INC., BOSTON 1 S�L-�-�- _ IC 330 -IF Z �' OFIl Pc i : . . - �3��P .:a -� 3 30 SULLIVAN .+. ci No..,29733 .ems 'QFc�. �� •. FSS/ONAL l • — 7-i N L. ljf-\ I(_._Y F(--U\e1 n o ► ;t�, �1�c5�c�a�.l t�tL.C•q��;AtTOt�,I ��T >"�7+�.U� 1►.�► ZMtU�. � v��,�.-''.'"�=:`;`,,� , i RICHAR0 f 1 A' NaAXT�/�E��Rpp '� 21l/7p }� NO s-fkU.: _ i::� - P. SOU--i✓ya>J i-�,` . ' �- -J- oisr. Coo /Hr/ Box ` I'l 81'3 d N t s i:• 13' //Vv //Vv.. <'` '✓ �.-7 3 G'.E2T/F/EO GOT _5 _ `�7`t LET 1-1 ,4TRG i et,-tZ --- ,5'GdL� / CEeri� PLNR &WOK Y TN,QT'TNE Fwivr>�r� S.yew.v .yE�Ea.v G'oMP�Y.S lti/�' /TiyE' ,4,vo,SE'7'.Q/1C` .2�4CJ/.eEH1�NrS o�' 7-,y� AEG/ST�,P.�=fJ,C�INO.S!/,21/Eyp,P� L ocQrE.o wiryis/ T/�E .CL aOvvL,Q/�V. :. CJ , . - �/tilEtir-.Sv e�/Ey'41VO S�l1/�/h�E.e�oiV Sfs/a!/G 1J�pT!E Ta ES�1 G/S/•� Lc�T�y�s USEp P�ZN OF MA PE:TER o SULLIVAN `- No. 29733 i ' ICHARD BAXTER c� et LCDT 1 0 ''Pba _ f , sa a10 CrL Jr, C�tATMCtV!u..F-MNov" TOWN OF BARNSTABLE ° LOCATION J SEWAGE # '' o VILLAGE , ASSESSOR'S MAP & LOT o®INSTALLER'S NAME & PHONE NOagd WJ4 � C� EPTIC TANK CAPACITY / o- P°LEACHING FACILITY:(type) (size) 4::: 'NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER OBUILDER OR anvil_ 2.� DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: J;z o VARIANCE GRANTED: Yes No ,,-�— .----- /y � l� �' c�� f i ��