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HomeMy WebLinkAbout0098 KENNESAW AVENUE - Health 98 KENNESAW AVE., CENTERVMLE A=249.023 1 TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY f� ' !�rS ota§ , ��- . '� (see"Orders") 5.Retail Stores yy�� 6.Fuel Suppliers ADDRESS �3`� �4r ,�� ilcr' r�bass: 7.Miscellaneous ,QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors) MAJOR MATERIALS Case lots Dq-ums Above Tanks Underground Tanks IN OUT IN OUT IN OUT I#&gallons IAge Test Fuels: Gasoline Jet Fuel (A) W r7 Heavy Oils: waste motor oil (C) new motor oil(C) is Synthetic Organics: Miscellaneous: _ DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.jVpter Supply O Town Sewer 'ublic n-site OPrivate 3.Indoor Floor Drains YES NO Y O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO LA ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product Licensed? 2. Person(s) Interv)6wed6 Inspector Date No. ! / 7I ..�.� i _ Fee a 5�2 Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for !Di!5potal *p5tem Conttructiott permit Application for a Permit to Construct( )Repair( )Upgrade( . )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. A hA V i cc ,Owner's Name,Address and Tel.No. � ,5 /60 g Assessor's Map/Parcel a L/ ' © 1 G� 16 00c r Aj El y 3 71ler's Na e,Add Address,and Tel.No. `S 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. •• Description of Soil l Nature of Re airs orAlte ns(Answer when applicable) IV,!!;,U�• S�f-��//< 1A4 'y � 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 issu by t 's Board of Health. Signed '� Date �J� Application Approved by Date 1 4 — Application Disapproved for tfil following reasons Permit No. � 7 q Date Issued 1 No. 90 ' / / D +- Fee 0 1 THE COMMONWEALTH OF MAS ETTS Entered in computer: j Yes l PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Di-4po5ar *pttem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. LfeAl/U 'A i Owner's Name,Address and Tel.No. �J5 /80 c/ Assessor's Map/Parcel a L/C, O a3 Installer's Installerls Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: 2 Dwelling No.of Bedrooms 3 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 j Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Ale ns(Answer when applicable) /WD U� s��y/ 1A A J4 n IdYX Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordanc$,with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu Board of Health. ��aa Signed Date Application Approved by Date Application Disapproved forte following reasons Permit No. �/$ ? �/ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( Jl)Repaired ( )Upgraded( ) Aband ed )by at A w Cr ivrr has been constructed in accordance with the pro vis ons of T' e 5 and;bjor Disposal System Construction Permit No. - dated Installer 'Designer A . A The issuan of this permit s/h�all not be construed as a guarantee that the s st'm/ wax-11 flu?yctio asp eSigne'cr�. Date /`� Inspector / l J/V 0 - 1� o No. ��- { Y� -----Fee � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Oiopozal *pgtem Construction Permit Permission is hereby ant d to/C nstruct(,}Repair( )Upgrade( )Abandon System located at r v LJ` ti N S,a �U� ('Z N�t[,j 11.0 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:- Approved by r b TOWN OF BARNSTABLE Cc qq LOCATION (`�f,iv N L S�-1 h p SEWAGE # _f 6- !2 VII.LAG r w- , �FS� ASSESSOR'S MAP & LOT E C+•r h� .'R�.�, INSTALLER'S NAME&PHONE NO._ 2L1,2;2 1 AS W 2 6" SEPTIC TANK CAPACITY f�' LEACHING FACILITY: (type) I RLCA`r htAGIN R'f (size) 67 X NO.OF BEDROOMS 3 BUILDER OR OWNER UC` c iu PERMITDATE: -/ b COMPLIANCE DATE: d _ 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 m -In rb _-` C 4 Q 0 / TOWN OF BARNSTABLE LOCATION qe Il . S N►`�► U SEWAGE # CI 6 %g VILLf ZE Cs rvTs'A Q'I L I TZ. ASSESSOR'S MAP &LOT 3 INSTALLER'S NAME&PHONE NO. 4/m2 9°-6' 'V 0 SEPTIC TANK CAPACITY FO®6 LEACHING FACELITY: (type) l�Rr;�As h€',kG� �i (size) NO.OF BEDROOMS ` BUILDER OR OWNER DUCAaluty PERMITDATE: A A/ g COMPLIANCE DATE: 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 r _ N 1� 0 b jgl6 buy LOCATION SEWAGE PERMIT - NO. 1-,& c INSTALLER'S NAME & ADDRESS oel- 8 UtLDE R OR OWNER DATE PERMIT ISSUED _ 22: DATE COMPLIANCE ISSUED � � � � t. Jes��^ l V `/" �. �— l-O-C A T ION _ SEWAGE PERMIT NO. V1L',LAGE GrloTF-R ViI- LIZ /yl/l .557. INSTALLER'S NAME i ADDRESS J" C911/ G MEP El go s e U I L D E R OR OWNER o/L6p P Dys C, DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �i /00 A�L— Ho 4; XI>r/►Vo� r � V No.. ). 4!"_------ F��.... . t THE COMMONWEALTH OF MASSACHUSETTS E®A R D H E> .T �L--.....OF........ :..... .. ApplirFa#inn for Disposal Worko Cnnni#rVan ion Trani# Application is hereby made for a Permit to-Construct ( ) or Repair ( Individu 1 Sewage Disposal System at: s ` � ----.Lo t--n-Addres / r •or Lot o. --- -----------•------- a ......... ------ Insta er A dress UType of Built Size Lot............................Sq. feet Dwellin No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ............................ No. of persons__..._._____....__.......... Showers ( ) — Cafeteria fixtures ---•-----•- ••---•-•---------------••-••-•-••-•--------------••••---------------- ---------------•----•-•-•-•••---------------•••--------•---•------. W Design Flow............................................gallons per person per day. Total daily flow---------------------------------------------gallons. WSeptic Tank—Liquid capacity-----_-_____gallons Length................ Width___._._.-__-_. Diameter................ Deptli---------------- 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._--__-_-_____..____-_ (� Test Pit No. 2................minutes per inch Depth of Test Pit_______..-------____ Depth to ground water------------------------ P ----------------------------•---•------•-----------••-•------------------.---- -- ------------------- ----------------------------------------- 0 Description of Soil............................................. ---- ...---••'--•-•--•------------..- L --------------------------------------- x --------------------•-------- ------------------•-- -�-- �� -- 4 W ................ .-.----_--.-____---__________ _.................__.._._...................._.___... ___ ... .._ __._s--_-. -. •-____/-__ ___ ___ .____._.___.___ __ tU Nature of Repairs or Alterations—Ans r when applicable._-__--___ ______________ ------ _____ ------- --------- -. ___ - -•------------- ----------------------•------- ----•------ ----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System'in accordan e with the provisions of Article YI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned----- ----------------------------•----------•---------------------------------•----- --------------•----------------- ate Application Approved By------- Date Application Disapproved for the following reasons----------------------------------=------------------------------------------------------------------------------ --- --------------- ----------------------------- - � Date Permit No...........•-•-•--'•-------------------------------••--- Issued--- •. -- Date No.__ . '"...... Fug.... :...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH .......OF.......'. - ----:s-----------�-----•-- ----------- o 4 , pplirtttion for Uiopusttl Worko Towi#r�anlndividu it itgrnttt Application is hereby made for a Permit to Construct ( ) or Repair ( 1 Sewage Disposal System at: L on-Addres 6.✓ ��"} or Lot No. ""'�'�---•---, a6 r_ ':..ate_ ' !± ;'---`------ =- ------------------------------------- � � es ns a er A ress Q Type of Building Size Lot............................Sq. feet U DwellmgV No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------•--•----------------------•----••-----------------------------•----------------------------------------------------------- W Design Flow.............................................gallons per person per day. Total daily flow.........................................---gallons. P4 Septic Tank—Liquid capacity_-_----__-_-gallons Length---------------- Width----------- .... Diameter________________ Depth---------------- Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area---:----------------sq. ft. 3 Seepage Pit No......:............. Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. 2 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_-.-___--.--_------_---. f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-----_--_---___--_-_.._. a --------------------------------•-•-...-•-•-••----•------------------------•.------------------------------................................................ 0 Description of Soil---------------------------------------------------••-•---•------•-----------------------------..------------------------------------------------------------ x = -- -------- r --------------;f--- V Nature of Repairs or-Alterations—Ans er when applicable._.__.... ............. ._... .__: __ _ -------------------------------------------------- --------------4 -----t.......----- 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 been issued by the board of health. PP PP Y i ned ate Application Approved B �,,.. �, - ": -_-•-- _- ,��,%�, .----_-, Date Application Disapproved for the following reasons:_...---•-••----•----------------•--•---•.---•-.......•-----•-•-------------.....•----•------------•--•----------- --••-----••--•-----------•---•-••---------------------------------------•-----•--------...---_--------------------------.....---------•----- -- ----- -----•------------ -•............... Da;,e ---•••------------------------- Issued l � Permit No. �i Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ...................OF... .:..:. AT r ifirtt le of Cut ftttnxr THIS IS T CE ,Y, the icJp ,S aqe D- posall System constructed ( r Repaired ( ) by - (/ � s --------------------------••-------------- ��✓✓ Insta at1.?i� 1i1?YL -- •------- -' ? ''fit �._.. ----------------------------------- ------------------------- has been installed in accordance with the provisions of Article XI of The State Sanitary Code a desc bed in the application for Disposal Works Construction Permit No............................. dated_.__ _ .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A G ARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------------------------ Inspector.zn................................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Mpg O F..... ................ .. - .. '"." .".•.'.�_". �... "..`.:.. .......... 4 AR-spulittf gor �Cntt n �it mi s Permission is reby granted a ...... � d:) to Constr ct ( or Repair ( ) -an Individual-S age ispos I ystem . ,'y l� at No --&....! s ._. _ ....-•-•-------•- � 2 ---� -- -- - Street' as shown on the application for Disposal Works Construction Pe. ''t To...l. .. :_................ f �- ated.. /� '1 �._.>--------•-----.-----•-•- ----- Board of ealth DATE---•�------ -- ----- ---,.J FORM 1255 HOBBS WARREN. INC., PUBLISHERS '