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HomeMy WebLinkAbout0392 PRINCE HINCKLEY ROAD - Health � _ � II No. CPO 6 ®� ! Fee /25c THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for MispOsal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(_�'Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3c,D_ Fr1s0t2 141kjC4L2-i 2C- Owner's Name,Address,and Tel.No. A r-C L PrIAKe- 1jVj r_ uk j iW Assessor's Map/Parcel j ( '�1 N fi Ce rJ'je r y ® G3 Instal is Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ,06e,c-4 [�. (3v r C 0 a:aC: Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title �+, Size of Septic Tank /'C)00 Type of S.A.S. Le jy_jA 'f i Y Description of Soil Nature of Repairs or Alterations(Answer when applicable) 01 A C-e- l X , F'//I O c Q q i T Ty a e_CP % 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 Certificate of Compliance has been issued by this Board of Health. Signed ® Date C3 mjd Application Approved by Date 3 Application Disapproved by Date for the following reasons .Permit No. Pam/ 7 Date Issued ` .i. . �. •� .�r.�Y+ter•....:,n. -r..,,.. ..,,+'ryr'x'...r..r'w. r ..;' _ .%,�. "S No. t/a'f ©L� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for MispoBal 6pstem Construction permit Application for a Permit to Construct( ) Repair O Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot NO3CI'a,.rr voct Hwc4L" R4 Owner's Name,Address,and Tel.No. AN t�L 3-R a Pri,o ce. R1 u cK� 'i �P Assessor's Map/Parcel j '� (,,M N tN/ G2 u T-e rU611-G,AA D Insta}er's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1FO�j��r Q-Bvr" CO r p CS • � ! . Z Lvt� � 0 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( F),Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd '°""""' Plan Date Number of sheets Revision Date Title Size of Septic Tank /p 00 Type of S.A.S. . LiePic-1A Pt-r i Description of Soil J Naturesn of Repairs or Alterations(Answer when applicable) Rep I AC-e5111 O C Q 1 2e i 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 Certificate of Compliance has been issued by this Board of Health. pp Signed Roo Q O Date C31,2011 Application Approved by DateEY Application Disapproved by Date for the following reasons Permit No. ''r -2 "'"' 6 Date Issued 3 cad 0 -2 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ), Repaired(✓ ) Upgraded( ) Abandoned( )by R Uhl c-r" Q, Cox 'Co at-�r�-(aL. ?rWGe.: Hllu r VL• ,:�i f2CP, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N 7 66 0' dated 3/c0// Installer Designer #bedrooms Approved design flow gpd The issuance oft s pe it sha no be construed as a guarantee that the system wil/ l�fiancti n�/s esigned. Date , � � Inspector ` i - .. ---/- ------------ No. C.�' `� 06 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(vj Upgrade( ) Abandon( ) System located at 3 q a 1 C'11J c-Q., H e j CK L k- , Rd and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 ^j v //1 Approved byl— f TOWN OF BARNSTABLE _ LOCATION PC e Le— Q SEWAGE# I `✓LLAGE � ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. r^ SEPTIC TANK CAPACITY`j:20/0 �G2e- d/�0� 01rJ Pao &2eLi �A Pt"f" LEACHING FACILITY: (type) N00 6,e j. 6AD 0"�p(f (size) NO.OF BEDROOMS BUILDER OR OWNER ���L Cava � PERMTTDATE: ///J!T A'5 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility &Ae Q i4eet Private Water Supply Well and Leaching Facility (If any wells exist / on site or within 200 feet of leaching facility) /V A Feet Edge of Wetland and Leaching Facility(If any wetlands exist A/r� within 300 feeta'leaching facility) 4�1 Feet Furnished by 4-o S,t L-4S� -4v R-6 41 u40 : LL r% , 0--�o D o x 3 �ik No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pp r tion for Mt!9poq;o1 *p5tem Construction Permit Application is hereby made for a Permit to Construct( )or Repair( V�an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Lco+ 36al., Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ,1 Dwelling . No.of Bedrooms �- 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 c Description of Soil sG.S,<jv Nature of Repairs or Alterations(Answer when appli able) AA l AUV h\-Su^,o L_ (, x& P 14` G1 a TwZ .� � - ram-- , 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 issued b this Boarj of ealt r-.1 Signed ~ Date .�U 1 el J Application Approved by r-9� Application Disapproved for the fo lowing reasons Permit No. 7 Date Issued � 7I IT? No. d Fee THE COMMONWEALTH OF MASSACHUSETTS .=PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicatiou for Migpogat *pgtem Cougtrurtiou 3permit Application is hereby made for a Permit to Construct( )or Repair( Vn On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. to Installer's Name,Address,and Tel.No.. Designer's Name,Address and Tel,.No. Type of Building: Dwelling No.of Bedrooms �- Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) t Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title c ' Description of Soil JcLc)y ,� c'u>,_�L, Nature of Repairs or Alterations(Answer when appli able)-rc k A3c)�Vk u( ,cL_ x& /- 1 " Date last inspected: Agreement: i 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 issued by this Boarj of Bealt Signed '1 Date U �l J Application Approved by Zs- Application Disapproved for the fo owing reasons Permit No. - "� d Date Issued � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( }or repaired/rep]aced(✓)on p by for % C_r A r Iry� l has been co structed in ac ordance with the provisions of Title 5 and the for Disposa ystem Construction Permit No. - 'D dated Use of this system is conditioned on compliance with the provisions set forth below: 1 v � v No. — �� Fee '. D THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS i Migogar bpgtem Cougtructiou Vermit Permission is hereby granted to to construct( )X�VC(k,4 an On-site Sewage System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to f comply with Title 5 and the following local provisions or special conditions. ' All construction must be completed within two years of the date below. Date: /- .Gc��� Approved by v -f 1 d 1 DES/G/V �2A 7`A '"S/NGL E F�t�I/L Y -- 3 BEo�2ooM � /t/O GAQ-B,AGE OA/L Y ,-'1--0►.r/ - //D X 3 = -73e SEPT/4 7,, ,VK = 334X/Soo = ely�'G.PO �fS.E /,OUO G�1L. � �t�0�GO • ais.�so.� .sir.—UsE• �aao �s-,4� . 56 — ,s/vEGr/,d A,e,,t Qlp .So G.�?O. P� — �.tlPK. Par- Tim, 303 ToT,4L. 1J.4/LY�LoW= .33DG.Po OES/G� �.�'�COL4T/a�V.2�1T�• 4 . (aOFM r 'H O F ..�'� ��'P� Ass9 PETER - g� RICHAARD SULLIVAN E;AXTER i� N;`v No. 29733 - - - � C ��►/^. �O�f c STEP ,{ ..._• Al . t . . y ,,.� _. .1...�.__._......... ..............................._...._..... ....... .. V/'WSJ TEST'f/aL.E P- 245/ adz- ter�jG FG• _ .S�G,O �,,. /'- � 10A+M Y ��` PAL.) s , ✓ • 508toi L /,voO ( sue" Oisr, 1AA1 6.aG. /,yj/ BOX /N✓. GAL. S�P - SAUo V � a air.• 53,v ^3'�" S.EPr�'G Y r t .�o tZ-47 /N�. �,� o.��.� LoGQTioy ���t1r�.•�/�uc� �I S43 La T 3oz- / GE2r/,Cy TNr4T T Zell n-t v.,4.4a i��4LA,cJ�S UP ,yE�Eav coMP�Ys wir//T,yE S�OE�,/,vE B•4X72Fre€,V,yE/.mac. AMP.SE Q/aG&- .2E4v/�'EM�NrS.o,4' 7;-14 ,2,Ecsisr�ec�G��vo slievEyS Tox%v of 23A/2Al STD BG 4.r A,vp ,4,R�G ica vT- L ra/.1 !�rr► i L L I�C1 A--":PT rA. 9 V,4,V Y.ST,e- -t/.yJE,yr'.Sv.2r/.CYsJ�O Ta ES?�ZQL 1XIV LaT !_/NHS ETOsLOCATI e 39z- SEWAGE PERMIT `77 'J VILLAGE l INSTALLER'S NAME&ADDRESS d, . BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �a - 10 y�,j 3o ti I a 35' , a Fps C,`, ........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® QF HEALTH -yL OF..... ........ . .... ns ..._................... Appliratiun for Disposal Works Towitrurtiun Prrutif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t: � . -•.•••..A1.4.1 --------------••-- _....... �... 40.0.0.rl............ '--.. a - .------- Location A ress --or. N -- ..... -- ...... ...--• ............................................ ...... .. •----- ---•--•--....---•'- fd yhie I _ Ad&es Installer Address Type of Building Size Lot.. �.�Sq. feet U Dwelling—No. of Bedrooms...........'-3........... .....Expansion Attic ( ) Garbage Grinder ( ) ~ Other—Type T e of Building ............................ No. of persons --_______.__..___•__-__-_ Showers — p., yp g p ( ) Cafeteria ( ) aOther res --------------- - ----- --- -------------------------------------------------------------- ----------- w Design Flow....................................... ...gallons per person per day. Total daily flow------ .............................gallons. WSeptic Tank—Liquid capacitgo.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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................ •-••---•--- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...................... .- (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -•--•-•----•-----------------•••-•••--•----•----....---•••-•-•--•-••••-••'•---•-•-•-•...-•-••-............................................................... 0 Description of Soil........................................................................................................................................................................ x U •-••--•--•------•--------------------•-------•-•-•--•-•--•-•---.........••-••--••••-._......•-•••••----•-•••••••---••••---•-----••---------•••••--••---•-•---•-------••-------...............••--•-••-• w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ............................................................ ----------------------'------------------------------------------------------------------------------------------'•--•--•-------- . Agreement: T dersigned agrees to install the aforedescribed Individual S age Disposal System in accordance with the p ovi o is of IT of th tate Sanitary Code— The undersig further agrees not to place the system in OP ati unt- t mom liance has been ' d by the rd f health. Sned--- • ... -••••-••------••-- -••••-... ..................................... .........................._._.. Date Appl' ati Approved By.....--••-•••-- ---••-- •.... . .. `� f-�---------------- Date App tion Disapproved for the following reasons---------------------•-•----------------------------------------------------------------.._...---••--•-•._...••-- ................••-•'-•--••-•-•-•-•--••-••--•-•------•••-•-•••------•-•-•-••••----•---••••...-•-----•-••- Date PermitNo.--& ....../4101.................... Issued-....................................................... Date u..�-- — -- -- —­—­...............^ Fmc ... ............ THE COMMONWEALTH OF MASSACHUSETTS r. BOARD OF HEALTH r i ) t. _a 1_ •cam {` r , kvvfiention for Disposal Works Tongtrnrtinn Fumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemlat: r g ✓ ..........................................� 1� i ��/T t�t.'r''�......... ......mow•---!/'..._..�.....t�..............---.. .......... .._.__.._......... _ Location-Addressr ror Lot No., t ............................................ /. f... f.... .. mil' ..'f t F --- 4 . Owner / Address ................... a ............. . .5. .....ti r......... t 4 p,k•-.t_ e 7 Installer Address UType of Building Size Lot-_'f--!_ .............Sq. feet Dwelling—No. of Bedrooms............:r-'_............._..........Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building No. of persons............................ Showers YP g --••---...-----•------------ P ( ) — Cafeteria ( ) P4Oth`er efixtures ................................ --••••............•••••••----••••••••-•••---•------•------•-••--••:---- -----1 e a w Design Flow....... ...... .....................gallons per person per day. Total daily flow.......... - ............... 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 ( ) aPercolation Test Results Performed bY..................................................................... Date........................................ Test Pit No. I................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........................ 0+ .............•••••......••••••••••••••••••-•-•••---••••••••........-•-•---•••-•---••-----••......•--......................................................... 0 Description of Soil.....................................................................................................-------------•------------------------•-•-•-••••••..............-- x U ..............................................••-•-••••••••••••'•••••._......---••••.........._..•••••••••-••-----•••--•••--•-••-••-•-•-•-•••--••---•••-••-••••••••-••••-......--•---•-••••............. w UNature of Repairs or Alterations—Answer when applicable................................................................................................ .-•--------------•---------------•-----•-------------------------•--•-------•-------------------------------------------••-•- Agreeme T ndersigned agrees to install the aforedescribed Individual Se'v, age Disposal System in accordance with the ovi ous o IT of t tate Sanitary Code—The undersigned further agrees not to place the system in op ad un . a liance has beenn.irtssued by the board of health.,/' f Signed .._: . ..--••• .................................. ..........•.Date--'••......... __ p Y APPlati APProved By.....�_r., �z;�� Mesa. .�. :..... ��1`2 ! rr c�-'" ,. 2 j Date ......•--------- App ' tion Disapproved for the following reasons__________________________________________________ ..-•-----------------------------•--•---...--•----•------•--•-----------.....--------...........---------'--------...........----•--------------------------------•------------------------•-•••••....... Date Permit -----•-•--•--------- Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Tontlifitturr THIS IS TO C RTIF , That the Individual Sewage Disposal System constructed ( >6 or Repaired ( ) by-•-•--.sue`: t-.A_2.....-----•----...-----•---•--•--•----•------------------------------------------------------•----............----...----•---------•--.... Installer at............ .3.Q'7k R..j. .......... 4_rs-TCR.0 1 h Le--------------------------- has been installed in-accordance with the provisions of TITLE 5,o The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-CS ._/0 ----------- dated---------- _ _�'-?._._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... •-- Inspector........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F N .......� "►7y. ...............OF.. S..�<�1'fX.�-'.e...........--------•-----•--•. .•--•----... G FE ..................... Disposat orkg no notion amit Permission' is hereby granted.......... •-•••n--- .......... - �•�"'"....................................................................--.... to Construct ( ) or Repair ( ) an Individual Sewage Disposal,System_/ ,_..... '"� .............................................. at No -- treet as shown on the application for Disposal '�orks Construction .,�Permit No Dated_.__�___. ...�-'�...�`".' ____.... Board of Health DATE.... l• ----------•---------------•-------------------- FORM 1255 A. M. SULKIN, INC., BOSTON S/NGLE F.4iy/L Y -- 3 BE0�2aoN1 , � Alo (5A•eB4GE OA/LY SLOW - //D X 3 3340 •SEf?T/C T,dc/�f = 33oX/Soo =�9y'G.P..v. -�� _l/.SE /,OUO GAG. (C>O•dO ao2 ,So G.pd.17Z2�3 G.P o. 0 Pc�z T303 414, . OE,S/G•S/ �.E.2COL4T/a�S/.2.4T�'' . _. Q lit QF kS PETER RICHARD SULLIVAN M A. ,>y ti -koo crs . � BAXTER l��. N0.29733 - - - - � Pde.24(348 -L .e �Q p cis r0% p- 245/ /.t/K. Box Sn pl L EdcLi sir 53, U SEPr�G pv W'/ 4:o- E.2T/F/EO �G OT PG.4.✓ OGQiI/ .QE�E.2�.VO� Y 43 /3 Zo r / GE2r/may Tiy.4T THE l'GVAJ0Ar1l)V S1-1oW.v. Z-eA)rk:,LV.'"& �lr/�LA 4)IDS AAvp jSFr:66AeoL- T,'-'✓4 ,2EGisrEec=l�arvo slievEya,�S LOG•Qy�.O (�i//T.y/ii�; �".�/,E �LaaoOL.4/iv /� A,�Gica,cr-. �L✓-1IJ J mAL-L._ I�(9L aAl 4IV�iYST,2- S �•j/it/yE.e�4N.S.�4UG I��aT!E USEp