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HomeMy WebLinkAbout0255 PRINCE HINCKLEY ROAD - Health i TOWN OF BARNSTABLE LOCATION .`�. SEWAGE # Y7 I, VILLAGE ASSESSOR'S MAP & LOT - I INSTALLER'S NAME & PHONE NO. ;� SEPTIC TANK CAPACITY 160c> LEACHING FACILITY:(type) JVL Ic t45T (size) -3'^ NO. OF BEDROOMS PRIVATE WELL Ot FIC�WAT� BUILDER OR OWNER �A YvV S,3�� k DATE PERMIT ISSUED: ~- DATE C011PLIANCE ISSUED: VARIANCE GRANTED: Yes No_�% t , 9 �00 i r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ._.__�...... ... -----..OF ... � .r�� .%�- ?�4�.1. ................................ Appl ration for Disposal Works Tonstrurtiun f rrmit Application is hereby made for a Permit to Construct ( ) or Repair (man-Individual Sewage Disposal System at: --.....fa 2 � t -cam . --........_..........__- �� oc_. -Address or Lot No. .....----- ___..._......� �_. _ ..._.... :......................•-•••- .......................................................... • _.........._................ Owner Address C a C. �i... '.� ............................................... Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms.._..2�J.................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ...--•----------•-------••-•-••-••................ • - - WW 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. 3 Seepage Pit No....../------------ Diameter.....1_a r___. Depth below inlet....../L`�........ 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........................ 04 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ----------------•--------------------------- ---------------- _....---------.................................................................. 0 Description of Soil.........................•--•------•------------------...............__...-•------•-•----.•.----.....-•---••--•--•---•--•---•---._.....-------.....__...-••-•-----•--••- ^� x --•---------••----------•----••--•••-•-•.................•---••-------•-•-•••---••••-•--•--•---------- --- -------- -••• -----------••-•----------------...••• --•------•-••--•---------- -- U Nature of Repairs or Alterations—Answer when applicable________e!i�_11.��______luvs i4 i.: w Z........ S I.- v'c„J v I/!J u� r ✓ .K:c.�L C.L,.:}... ��.S is :.:..... Agreement: J The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITAU 5 of the'State Sanitary Code—The undersigned further-agrees not to place the system in operation until a Certificate of Complianc en issued by the b• rd o heal . Signed-- ----— - •-•- -----_._._......_._..._..._ - / Date Application Approved By....... (� _ .......... Date Application Disapproved for the f ollort4ng reasons:---•--••-•-------------------------•--=-•--------•-••--•----.....--•---....---..........._.........________.__ ..............................•--.......--•-•---....---•--•-----••----------•---............_.............._.....-------.._..----------------=---._.........---------._.._......--------...----••---••-. Date PermitNo.------ ,7.:.._ f............._._. Issued...............................------------------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :2l.rt..W\..,.........OF....�?,o vyl_S'rc, ` ............................... Appliratinn for Disposal Works Tonstrnrtinn rrrutit Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: ........................................... Location-Address or Lot No. •----...:.,:�..M....... LE.L_5 r:f.�:............................. ......................5 �!"^ ��.... ..............--------...----......._........ Owner r GAddress wj ...................... . --•-•-.............. - ... ------.....-•----•-•.. ............. .. ( i..K.: '..J...._........ - ---•-------- 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 ( ) Otherfixtures -------------------•----•••••---------.................--•---...............--•----•------...........-----••-------.....----•-•-----.............._... WW Design Flow..--.....--5.6 ......................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. 3 Seepage Pit No______ ____________ Diameter.....L, �.... Depth below inlet...... _�.._... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a 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....................... x - ------------------•---------------... 0 Description of Soil...........------------------•-----....----------------------.......----•--------•-•------ .. U .-------------•---......................----------------------------------•---••--•---- - .. .- . . --•----••-...-•-••-------••----•-•-.•. -------.. . .. --. ..... ....------. ...... ...-------- W U Nature of Repairs or Alterations—Answer when applicable.........tl�.K.6......Q_! ... r Q_ 4 .l.�._. .1...... Agreement: .. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has-b_een issued by the b-ard o,health. a, 4 Signed..... - _.- % —�" - _4 /.-.�. 7 - ----.... ` Date Application Approved BY............... .� � .-.,�, r .... Date Application Disapproved for the following reasons:...............:..........................................................................................--- ...............................••-----••••-•-•--........•---•---•-•-•--•-------•---......---------••-••--..••---...----------••-••------•-•--•--...................................•. •.......... Date .. Permit No........ 5-ZI/...........__._. Issued----------------------------------•-----.............. Date ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ft 'i _ ...........!!`-'......OF........R.O�6.ljel�- ................................ Trr#ifiratr of Toutphaurr t> t THIS � Q) CERTLEY_j That the Individual Sewage Disposal System constructs ( ) or Repaired (�--- by...........-•---..._....�.. •--•-•---- ....-•------•-•--•............................................•--------•----------.........---------•--.._.-----•.. t w Installer ��' ,�✓c. may-,tip- cI _ h s been installedinin acco dance with the provisions of TITLE 5 of he State Sanitary Code as describe in the 1 application for Disposal Works Construction Permit No.._....5S . .-__25Z�i_._._..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE a SYSTEM WILL FUNCTION SATISFACTORY. DATE...................R----2,U- -4. •• ................... Inspector----------`_- ---- -- ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .C"'Gw'�v.....0F..........1.�.�YL w�?c ��+� No...l�__7- /a/, .......... ....................... FEE. 1-2 ..-- Disposal arks Tnntrurtinn f rrutit Permission is hereby granted............... _ ......... -----•---••.............................•-•--..........----.......... to Construct ( ) or Repair ( �) an dividual Sewage Disposal System e— Street f as shown on the application for Disposa�V forks Construction Permit No.?__Z,%, ..// Dated.......................................... ,. .. . ..__..� -.1 ,. .._,._........_....g.....-•----------•--•-...... i.; Board of Health DATE................ �^.�. v LOCATION SEWAGE PERMIT& NO• VILLAGE r I N S T A LLER'S NAME i ADDRESS z? • C � t U I L D E R OR OWNER G DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r 34 1 . o Y7 l d N.-C_8) THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEA LA T ,"'* ..�'....-....OF......... ---------------------------------------. Atip iration for Disvoa al arks' Tnnitrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at . - ------- X. ...... ........7 .---- ............... - - ation-Add ... . ...... ---------••-------- ------••-- No..........._..--------................... caner �V W Address 0 ,.a .-�-------------- --------------••-. . .... .................................................. Installer �__ • Address ' UType of Building Z— Size Lot.,Z� ......Sq. feet Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder (40) 4 Other—T e of Building No. of ersons____________________________ Showers a YP g P ( ) — Cafeteria ( ) Other fixtures . W Design Flow._...___"! allons per person per day. Total daily flow-------- .__ ��..................gallons. WSeptic Tank=Liquid capacity .____gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench— o__ _______________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....� ___ __ p g q Diameter____________________ Depth below >nlet___._______...._.._. Total leaching area._...__.___.__....s ft. Z Other Distribution box ( ) Dosing tank ( ) / Percolation Test Results Performed by...... __________________________________ Date..... ____________. Test Pit No. 1_L L.....minutes per inch Depth of Test Pit..../.L.......... Depth to ground water....l'V.D_!v_A:._.__. rzq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---•-•••-----•--------------••-----••-- •-•-------------•------....---•--------•--..................._._...----•---•-------------------•---------•••-•_---- xDescription of Soil........C?_^ ..'.. ........... ��-� �s' ----------------------------------------•-------•--•------- c.� ..............................................---------•---•••---•-•----•-•---------••........--•----•--•---•-•-•-------•-••-----•---------•--...-•------••-...........---------•-----•---...---------- W x -----••-------------------------•------•---•-•--•--••----------------•--------------•------•-••---•-----------•----------------------•-------•----•---•---------.._....--•---•--•••-----------...------ 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 I I'= 5 of the State Sanitary Code—The undersigned fVrther agrees not to place the system in operation until a Certificate of Compliance has been issued by the bird of ealth. ed_ ------------------------------•.......... ................ Application Approved B Dl� PP PP Y f ............... Date Application Disapproved for the following reasons----------------------------------•---------------------------------------------..------•---------•...••-•------- ......................I...•---------•-•----------------------------------------------------------------...---...__._.. Date n �_/Permit No Issued: ---------------•- ..--- - Date ,. . ^. No. U- ..��5 Figs ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ...................... v . vOiration for Phqvviial Vvrk Tiamitrurtion _rMit 1, ;Application is hereby made for a Permit to Construct ( ) or Repair ( ) an,-Individual Sewage Disposal . System at_ �r ��� f� .... � of e `. . ............................................................. f F ` io Locatn Address- + ' or Lot No. d '__: L�'f fL A f----- C1� � -------- ..... ........ ............. ... ____.........-......._....---..--..__. W ...................................ner 'e -�.............. �r^.'� .... Address Installer Address Ra - y UType of Building Size Lot_: �_a _"________Sq. feet Dwelling—No. of Bedrooms """ ................Expansion Attic ( ) Garbage Grinder (Npl Other-Type. of Building No. of persons............................. Showers — �. a YP g P ( ) Cafeteria ( ) w d Other fixtures ----•- •••. • -•••---- --•• ----------------•-• ------------ W,. Design Flow.........- .. _._.._ sallons per person per day. Total daily flow..___..7�_._._ . ...................gallons. Septic Tank—Liquid capacity / gallons Length ______________ Width Diameter................ Depth ._.__....... Disposal'Trench—No. _.....___ Width.................... Total Length ______... Total leaching area ...sq. ft. Seep g .i►�r f Diameter..........:......... Depth below inlet.................... Total leaching area..................sq. ft. a e_Pit No..______-:'..--. _ ' Z Other Distribution box ( ) Dosing tank (- ) Percolation Test Results Performed-b ...... . Date...../.:Z aTest Pit No. l- _Z"'__.__minutes per inch Depth of Test Pit_.. _1_! __ Depth to ground water_-_.hj,�K,4:.__._ 44 Test Pit No. 2................minutes'per inch Depth of Test Pit ...___._______. Depth to ground water ._-_....._._:_ ------•--••• •--- ............................................ O Description of:Soil......©�Z; ...... 1.5--••--•-- ------------------------------------------------------------ �Z U -•••••••.........................•---_... � W __________________________________________________________________________________________ ________ ____ f - U Nature of Repairs or Alterations—Answer when applicable _____ ______ _ _ _____________________________________________________________________ ff -------------------------------------------------------------------------------------•--•----•--------------------------....._....-----------------------------------------------------.......-•--•••••. p Agreement The undersigned agrees to install the aforedescribed Individual,;Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary-<Code— The undersigned fjarther agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health ' - Date Application Approved B ........ • . .............. -------- Date Application Disapproved for the following reasons:................................................................................................................ ..• •••--••••-•-••---•--- -• ....... ------------------••--- Date Permit No....... ---------------------------------- Issued...` 4:---1/ ------- --------•---- Date .., THE COMMONWEALTH OF MASSACHUSETTS -BOARD OF HEALTH'4 D tv /✓ ...... .................. %rr#ifiratr �f fP� Itr� THIS S TO CFR,TCIFY That the o vir 1 Sewage Disposal System construttedY ) or Repaired ( ) ' by . � .._.._. x JC at. ..... .................................................... ----- . -- - ------ -- l ;. has been installed-in accordance with the provisions of j of The State Sanitary Code as escribfA, ,i the a 'lication for: Disposal Works-Construction.,Perrnit i _ GJJ PP P 78 dated l'.t ' THE ISSUAN. E OF THIS,,CERTIFICATE SHALL-.NOT.B:E CONSTRUE® AS;A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I, i DATE._ l.................... .....•. . •..--•- --_..... Inspector ••• � . ,,.. t uytT v. Si , w THE COMMONWEALTH�OF MASSACHUSETTS BQARD OF HEALT 411 H U w ...................... . ..OF.......��.2ti s ,q �3tc............. ` FEE_ .. ..-•...... • ...... s I Irk � rUa it , Permissi s hereby granted•--"' .--- .......................................................... to Constrt ) r jRepair� an,Individual Sewage Disposal System C �f at No 0 rg /N C'1C L s a E .................... n1( , .`-- �wt w ..street . - '' as sho. n on the application for Disposal Worl.§ Constructio Permit No._ ��I Dat d._::._ __ � . lx +/ r �.... ...... rd of Health l FORm'fi11255 HOBBS & WARREN, INC .PUBLISHERS nu .uu.ro,a.lF.t.`.o-L�'^'� .i .. + -i :o-CPO 4 '� Ito <-.Arz-� Ar.,� c7rcl+.rr��sc J Mat t.--C FLow _ i t0 ,c = 3304 (tic Flo = 4�� 6.�c�. �s fra r" 9&�•. uSia- LOOP GAL.. 9G•ci .-_._._ 1�.� St= �c 'Z.c�• _ �'7S G.P.D. ,. 1 Nx� MiN. CEO s►5='. t .cam E>c> c::i>.PD. TOTAL .4'L5 — I 6.F'D. Pr4" . Dtlrlr—vtrC�TtvL1 2ATF A-qq Pe I oca 0 1 kv-zj,.M, CL= 179 6oAK4 mot) -.�... :. {1.i�/. 97.O 4~Ylr7a� txty. T��u. to GAL.-+ 1 96.7- �7 `f , 1) i ii ., I _. s a 1cn.�i✓- SCA— Y - a L � � �l�T%=: I! Zr By 1 Gt,t;TtP TI-4A,7 T!- G— t7ovgDA-rioaJ 5t-lc,4ja.l PLl�l.1 Rif=C�C:►�ic C--_ t-lE t_t�r�t,i l�c_vVtt�t-`•�5 ��.' t1't i Tt-A` �I DE t_is-lE- 1 A:.ltJ `>i '1"l ,�Cl! `:�1,} -►l::t=.�✓t�.u;-� oP T"C�- �T � ► 1 'TCa btl� G:= �A 2�J�TA 3 r� MT i THI-S 17 t_At 1 LIO t';�;C C7 Ut.} 464 OS-t 6�v1t LC o /VCr~.S i� ! ++.!�(-L-'J:�t��t.l i iC)�=�f t:�' ;�. '"(•t1w:� %�F=r'�r-C-�j �L{!�ZaJLD 1•:�r [' t' [1 if_•i> i'i', �:��:{i tit;'�Il- I At..Ir.. Oe- 1