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HomeMy WebLinkAbout0353 PRINCE HINCKLEY ROAD - Health �.'_f�',Po' ' � �f �" ��� .y TOWN OF BARNSTABLE LOCATIONJ:3 5-3 &,-� W4 F%-, SEWAGE VILLAGE [' ,-� z ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. tt� SEPTIC TANK CAPACITY i 5 7 LEACHING FACILITY:(type) �/ Jt-' (size) G®� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER V�� DATE PERMIT ISSUED: — g L DATE COMPLIANCE ISSUED: L/ VARIANCE GRANTED: Yes No ✓ l� q> ��. r� No... '._ ' ,.7 Fes$...................°........ THE COMMONWEALTH OF MASSACHUSETTS ----� BOAR® OF HEALTH Appliration for Disposal Works Cnnnt_rnrtion rrmif Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal systt. I Location- dress or voftV ,. - _ _ . . Owner / Add ss W ....... ?� . ._ P��...1 �F',I ..a _ i1/ -�----- tp ' M Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a` q 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—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 ( ) ►-' Percolation Test Results Performed by.......................................................................... Date........................................ a a 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-------..__•--__-______. P4 •-•-•-----•------•---••--••-----•---•--•--•------•-----••-•••-••--•---•--•----•-•---...-•---•--•--...--•------•••••••---•-•••-•--••-----••----•---•-----•-•. 0 Description of Soil..............................•-----------------------------------------------------------•---•------------------•-•--•---------•----•------------------•-•-•-••-•--• x V •-•--------------------------------•------------•----------- ----------------------------------------: -------------- . U Nature Repairs or Alterations— wer when applicable...__ _.. _. __. v-......... ---.. -� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with TT+'1 i• the provisions of 'T;Ia 5 of the State Sanitary Code— The ndersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed th�bd o1 1 h! �p'Signed.. :_ Date Application Approved By............. --- $- y Date Application Disapproved for the following reasons--------------------------------------------------------•-----------------------•-----------••-•---•••-.......... -----------------•---•-•---------------•-------------------...-•-------------------•-----------------------•-•--•--.....-•-----•••••••••-••-•-••----------•••••-•----•--••---•-•-•----•---......-•-•--. Date PermitNo........... •-�-� ------------------ Issued....................................................... Date 1 b No... cam.:. 'a. Fx$.............rJ.... THE COMMONWEALTH OF MASSACHUSETTS -~-� BOARD OF HEALTH Applira#iata for Uhapaii al Works Tomitrurtion Pumit Application is hereby mace for a Permit to Construct ( ) or Repair {i/) an Individual Sewage Disposal • Location- r�/Dress Add ss - - J Installer Address U Type of Building Size Lot....................._--- __Sq. feet 15 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers Aa YP g -•----•-•------------•-•---- P ( ) — Cafeteria ( ) Q' Other fixtures ..................... W Design Flow............................................gallons per person per day. Total daily flow.............................._.............gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ 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 ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_--__-_---_-_..__-_--. 4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_____-..-_---__-_-__--. a -------- •------------------------------- -.... •----------------- •-•------ •-•------------------------- ------ •--------------------------------- ----------- ...... 0 Description of Soil........................................................................................................................................................................ x V •----------------------- -- ------ --- -- W ------------------------ --------------------------------------------------------------•---------------------- ------ ------ U Nature ReQ1'rs or Alteratio s—/Answer when applicable.... "��. � } _____ � .�......... ALaI .....G%/fL't _........ 'a' .... „� ..'✓!---.. ._r_ _...rJ/V --•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TILE 5 of the State Sanitary Code—The dersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed th b rd o iexl h Signed ... . ......................................... Date Application Approved By.............. _ k -... ,5-------------------------------- ----•--------?- Date Application Disapproved for the following reasons-----------------------------•-••----•---•---•----------------•--•--------------•----------------------•--------- ••••-••-----••••-•••--••-•-......._...•••••----•-----•-•••-••-••----------------•------------•-•---•-------••-•-•-•----------•-•-•-••-----•••----••-••-•-•-----•--•--•---------••••••-••............... Date PermitNo...........Zl-q.?-=---- ................. Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS --�•—•" `"^ BOARD HEAL H ...............OF....... ...� 1 .. ..... ................................................ ulertifirtt Of WITUtplitttta THI � EER , That the ividual a > posal System constructed ( ) or Repaired by fir'�'- ...... !✓ . o ----.... ........ .................................................... _�tom, , ,l� !�,(�.. �- � 1'----- has been installed in accordance with the provisions of ITIEp 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__.._.. _-.__ !.'to- :.... dated-----------------------____--__-------_-_•___.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................... . ...I-L_---- ............................ Inspector.......................4--�.......................................... THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALT ..................O F... ... �........ FEE........................ t pa a1 � ftlitrudwrrmit ...... � Permission is hereby granted . .................................................... to Construct ( ) or Repair ( an Individual Sewage Disposal ystem f at No. -�'3 -' � �.1 rL� ' � '� � �- ------ '-................................. Street as shown on the application for Disposal Works Construction Permit No��'`�/��`]�_._ Dated.......................................... ........................... ...... ....2>--------------_-...-_....................................... p / /............................. Board of Health DATE-------_--------_- .�..._.P..b- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t., No. ... Fim........fa....... THE COMMONWEALTH OF MASSACHUSETTS BOARD F I-i EALTH -.....O F........................................................... Appliration for Ditipoottl Workii Tonitrnrtion Itunfit Application is hereby �hhereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ...---em at: ...�� .... ................... .. ...........•. ......•• --•--•-----------•................ o:at' -Address ^O et-2lTA. ........ ........................................................... Owner n Address ................ ..... .4-!-r� -- ---------------•--•-•--..... ..----•-----.._.......------- //yr-9 y; Installer Address Q Type of Building Size Lot....Z�.. .P�.Sq. feet U Dwelling—No. of Bedrooms..............�.........._.............Expansion Attic ( ) Garbage Grinder ( Other—Type e of Building No. of persons............................ Showers a YP g --------•---------•--------- P ( ) — Cafeteria ( ) Otherfixture-----------• ••--•--•.......-•••.....-•---•-•-----..........•-•----------------------..---•-•---•-.... W Design Flow..........=/ .................gallons per person per day. Total daily flow.......... _�'5.....©..............gallons. 94 Septic Tank—Liquid capacity/&.,C4-�gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No... ..�0'z�... Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft. Z -Other Distributio> box ( ) Dosing tank ( ) Percolation 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........................ P4 ----...•---•--------•--•----••---•-••..............................................••---•--••••..••......................................................... 0 Description of Soil........................................................................................................................................................................ X V ----------.---------------------------------------••-•--------------.....--•----•---......-----•------......-•-------------............---.....--•-•-----•------------..............-•-•-•............--- W =•--...--•-••---•----••-••-••------•---•--•-•----••-•-----•-•-•-•...---•••-•---•••---•---•-•--•-•--•-......••--_•--•- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------•••--•-••----•-----••••-•---•-•--•-•----••-•--•--••-...-••-•••-•--•-•.......•-•---•-----•-----•--•••---•..............--------•-••-•--••--•------••......---....---•- Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with t e provisioi of TIT 5 of the State Sanitary Code—The undersigns further agrees not to place the system in pera o" til er ate of Compliance has been i sued by the board Health. gned- - ---...-• ; ... ............... ................. •-- --- ..... ..... ApI tion Approved B ---•-- .---•--...-----•-••....................................•-=•-•...................-- --••-. •/l(---••- ................. Date PPlication Disapproved r th ollowing reasons:................................................. ................. ------•-•-----------------------------------------------------------------•--------------•-----------._.........-•----•--•--•-••-• PermitNo......................................................... " No i�..- . Fes$... THE COMMONWEALTH of MASSACHUSETTS . : BOARD 4 'F :ALTH ,, y,..y � + .: a� ,ate. r�a.�t'�,_, r `•«� OF M1 ............ . ....... ..... a A,llpliration for Uhiva. is hereby made for a Permit to Construct. ( ), or Repair ( ) an Individual Sewage Disposal Application �-0 ystem at r r �,d mLocationi Address , / � i rrLot No f y o ........... r . .....................................................`�......t + .!,.............................. 64 / + Owner t Address Installer Address �d Type of Building x,"` Size.Lot _. Sq feet" d ' { ) Gartage GrinderDwelling— No. of Bedrooms............ `--? _-.-- Esion Attic ( '�= �a Other—Type of Building ........................ ... No of ersons= ................ K. pShowers ( ) Cafeteria. ( � "' QI - Other fixtures ;,..- ---------•----- ----- •-•'---- •----- Design Flow ......gal,lons per person-per day Total daily, flow .. '_ ' �-' gallons. :_. �€ Septic Tank—Liquid capacrtyl`r .gallons` Length ._....,. Width:...:. ....... Diameter . Depth...._:. .....__.' t d W' Disposal Trencir'=N0. __. Width...._:. .. . ..'Total_Len nth p g`V.- Total leaching area sq.'ft Seepage Pit No. ! " .:., Di J'' ter... .............. Deptli below inlet ................. Total leaching area._... q. a Z Other Distribution box (` ) Dosing tank. s .� Percolation,Test Results rformed by.'- .•-•-. ........................................ Date Pe - a, Test I?it No. I__....... minutes.per mcli Deptli,off�Te'st Pit'__ Depth to;ground.water,....................... . - f=, Test Pit No. 2................minutes per inch Depth of Test Prt# .............. Depth to ground`'wateer`'.. r ` -•-....................................................... Oa,. Description of Soil U # .............. - ... . .. .--•••-• ---•-••. -- ----•••. •- V' Nature of Repairs or Alterations—Answer when applicable ....___.. ----• .. ------. ---- ...--- ... ... 1R Agreement k The, undersigned agrees to install the aforedescnbed,,Individual•Sewage Disposal-System in accordance will, ' t e prop is of .of,:ITS 5 of f he State Sanitary Code—`The,und'ersigne�,further agrees'ilot to,place the system in era o "'' it f e4 ate of Compliance has been issued by the boa>d of health. `. g ` �9 f Se y • A S // p` ion Appi oved B ry Datejt pp1;catlon Disapproved r�th olloivang reasons ' ... • --••••-- ----• ... Date PermitNo.......................................................... Issued:................................... ------------------ ' Date t` • THE COMMONWEALTH,OF MASS'ACHUSETTS BOARD OFt HEALTH Tirfif`iratp, of� nMigItttlttrr T S Plus TO CERTIFY, That the Ind v>dual Sewage Dlsp sal S tem constructed ( ) or Repaired' ( )" Installer /�(�lr ��.`ice{' .•.... •---- -- t at.... rr`'(! ._..s .. -- 1 has been installed In accordance with the prof t 1s of T LS jof The.State Sanitary Co °has ertbed in the r b " application for Disposal Works ConstrucUo m>t ,ivo 'lf:k dlted:.�d � . 1 THE ISSUANCE,OF TIi15 CERTIFI ✓1'sTE SHALL,NOT BECONSTRIIE, A GUARANTEE`THAT THE H - �s SYSTEM WILYFUN ION SATISFACTORY DATE...:�J .. 1°�.. ------. ---..... .-•---•--••--•.... Inspector:. THE COMMONWEALTH OF MASSHUSETTS '1 BOARD OF E"A�LTH h / �siG.I ......... a ......................... O F ((JJ - .. � , / NO�....�.t...-- EE.,! ..... ........ ' Permission is relit'granted '._ 'p --•- to Construct or_R i , I1c" gP (` �)` n lv], ge Dtsp �cSystem �... as shown on the application for Disposal Works Construction P o.-----_-__------__ Dated........ Board of Health- A- 1 DATE P(_...a I-r1 FORM 1255 A. M. SULKIN, INC., BOSTON �. O-C AT ION (' SEWAGE PERMIT NO. 68 Prince Hinckley Rd. 84-48 :, ILLAGE Centerville, Mass. I N S T A LLER'S NAME & ADDRESS Robert B. Our Co. Inc. Great Western Rd. North Harwich S UILDE R OR OWNER Alan Small DA T E P ERMIT ISSUE D DAT E COMPLIANCE ISSUED y r A c��K sG- y2- 3a � � ,� 43 A. 151 J6tS= FAMILY ,I W P GAQBAGtE (�R�►JDE2 f �` it Dn.Ii.Y . FLoW a 110 x 3 = �I SEPTIG T?�K = 33ox15o"/• '-49rG.PQ %000 GAS-. ,I 015PDbAL. Prr v5E 10o0 GAL. 5►J)SWALL APZ.Ea - 150 6.1 15o 6-P. X BOTTOM AREA= J 4.. 50 5.F x I• 0 = 50 G.P.o• `� /sir II "TOTAL. DS51GN * 425 II I T >TA� DA11-Y FLOW = 33oG•I?o I� Povl` o U _j c PEIZcoLLIT1oIJ RATE r I''IN 2MIN OV-L 55 I . �� �� lSt �• + �� lit " .�'��+ �- V014 C)A Troa1 ttl p ✓I S , k OF lRS., ti ; RiCHAARD �(, /off P.L.Ar1 I. o BAXTER n w. " f I(1 I• � ' No.24048 �GNCS "i I'1 1f M ZS I I t PoD Stil3��o ` 1 '"'�� i j i,i1• y .4 TE`�T P-U44 ��G`57 TOP FNm-* S&1000 fi. +. III SV3tdG �., p►6�'. INV. GAL. 2. BuX S4' TANK ID � ,� I G A o LEAC e H ~ 40 / PIT INV. INV. I z W I T LI S¢ Z s'¢' f I� I/3/�I•I/z. 4 • I WASNGD 1 /16'(3t�. •.y�l C E 2T 1 F 1 G D P t-oT P L-A w SAiJ7 PRvFIL� F-L •�3 d. N p' -�q- Irr E ZEN C.E. GE RTIF Y 'THAT THE -1;V►SDIXTl00 SNobYN 4 ►NE.2EoTa Comp A. 111►TN"CHE �,Io6LIN �- A.WC S6T5ACK 9.6Q019-eMEN1,15, of Zµ� 7o w N o 2r15-rAr �,,Nv 1 S Aar I.OGP.TED •WITNI O D P AIN AIL.- Sob PL • 'L•J DATE --IZ BAXTE2e WIM INC. REG t S'T EQ6'D'1-A►•1 D 5 u eY E`1'o1zS ' Tu►S PLo.►•i 1 N�1' 4n5Fp o►d AW vSTGe.VILLC- jl luS-t-R,uMENT Sv2.VeY tr-TNE v1=F,5ET5 6uou� ; NoT D�_VSEOTd t7ETER!^IPlrc L.cT' l_INE�j f1PPLICANT �LA � S