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HomeMy WebLinkAbout0040 RIVERVIEW LANE - Health 40 Riverview Lane Centerville A=228-097 No. 4210 1/3 ORA Pendatlex l 10% t o-7e. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE o2o"?g 09 Appliration for Disposal Works Tnnstrnrtiou rumit Application is hereby made for a Permit to Construct ( ) or Repair (L-)--an Individual Sewage Disposal System at: ............. a l-1 e ..�.....e ..._..--•- -----•--.....�emu! ?��___���'__- .............................................. to.cation Addre s or Lot No. .......... - `¢`, •- . � _V�........... Ali's.!�'��.......................................................... .-•------------- Owner ........Ad_ �..� ........... ...r_. _�__�. �HCSC.`:'!.l.._._._.Y.Z.'.. `1.4—____.............. ......._•______ 4 �_.. vV� .............................•..--. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-------_-----••---.__•__-___.-•_-__------Expansion Attic ( ) Garbage Grinder ( ) per, Other=Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures -----------------••-----------•. W Design Flow...... ......................gallons per person per day. Total daily flow....__._—'� .0....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. t Seepage Pit No------I------------- Diameter.....-�D--------- Depth below inlet.._..(Q-_.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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........................ P -............................................................................................................................................................. 0 Description of Soil........................................................................................................................................................................ W U .........................................................---------------•----------•---........---------••-•-----------------•----•-•---------------••--••-•........................................... W x ------------•...............•--------------•----•••-----------------•----------------•••-••••-•--•---••---------------------------------•--•--•-----•-•--•---- •------------------ t--------- U Nature of Repairs or Alterations Answer when ______d _._�Al . ............ ..... ............ . ---... ----•--------------------•--------•---.-.--------.-----.--.---.--.---.---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Corn nce has b en ' d by th board of health. Signed ..----................... ----- \ -------- --- ..................................... .....Z) 3 Date Application Approved BY = ------ ....�:' --".�..d..---- --------- ---------------- ----....---............----------------------..-- Date Application Disapproved for the following reasons- ----------------------------------------------------------------- --------------------- ...................................... -----------------------------------------------------------------------------------------------------------------------------------------------------------------------................................... ----------------- ------------------ C" Date PermitNo. ........../�--- �. ..y------------------ Issued ---------------------------------................. Date THE COMMONWEALTH OF MASSACHUSETTS + BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ................... .�OV.0---U.Yk -. .. .....----..........----.......-......------------------------------------------------.....------------------..-...------------------------------ Installer at .............................�.0.......... . .................... ...........................................-.................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......��fa..-. _.'.-�±'......... ated -..: 1�. 21�................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR UED AS A,GUARANTEE`THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �� DATE-------.....3. /. ............................................................... Inspector ........----................................. .rah./ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..Ih TOWN OF BARNSTABLE FEE..:`�.,.��-.-..- .............. Disposal Works Tonstrnxtion "prrntit Permission is hereby granted........ 2............................................................... to Construct ( ) or Repair ('L)-a-n Individual Sewage Disposal System at No............... ;l?......Q.1.� :.�.....��1. -C.L-:----.�... -c`......-------- -"!�4 ..................................... .............. Street as shown on the application for Disposal Works Construction Permit No..'?e �J... Dated.......................................... Board of FIealth DATE....................... ..:...:�...... ....... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS Fss. .� ..�>. ' .. THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE r Appliratinn for Dwpasal Works Ql anotrnrtilan rami# Application is hereby made for a Permit to Construct ( ) or Repair ( Q)`an Individual Sewage Disposal System at: V'r..qz-_...\.�e u... 1.�,�.-e - �n`tc-' �� --- - ...----•........................ /-� /�,/� Leeation-Adddr�e/ss� ,, n or Lot No. Owner n Add res Installer Address 1 UType of Building :' { �Size;L#Ctl _.-:_?.:-__.Sq:-feet Dwelling—No. of Bedrooms._.____4_______________________________Expansion Attic (` ) / Garbage Grinder ( ) �`4 Other—Type T e of Building _.__. No. of persons............................ Showers YP g --------•---�--------- 0 P ��:G+-.' � . ti'� ��y= Cafeteria.,(-_.-) dOther fixtures --------------•---------•-•----------------••-. =......-----------•---------•--•--•-•----.....-•••..-.. ..... •----•-------------- W Design Flow.....S.' ........................gallons per person per day. Total daily flow..... ..`..`.......4f�galldns. WSeptic Tank—Liquid capacity..__.__....gallons - Length.................Width......._i...... Diam'eter............--._ Depth...._._._....... x Disposal Trench—No..................... Width.................... Total-Length.................... Total leaching area..__......._...___.sq. ft. Seepage Pit No.___.. m 3I............. Diaeter..... D..__......Depth below inlet....(Q.1.._t4.<To"tal',leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) °` f �_4.. Percolation Test Results Performed by........................................................................... ! /7................................. 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........................ Q+' -------------•--------------•-•------•---••-•-••-••--------.........•-•--------------•......-•_...-•........................................................ 0 Description of Soil...............................................................................---------------------------------...................................................... W U ------------------------------------------ •----------------------------------------------- •--------------------------- •-------------- •----------------------------------------- --------------- Wx c4 S m � - ;� . - U NatureRep or Alterations en applicablc - �A t 7.Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by the board of health. Signed .................... ...... ......- ... ApplicationApproved By ............ 1: - CCst ,---------------------------------------------------------------------------------- ---m--'-o.......� ...... Application Disapproved for the following reasons: ............--- ----------------------------------------------------------------------------------------------------------------- .................................................................---------I........---------------'--........................................................................................................ ................Da ................. Permit No. / �......... y------------_...... Issued -----------............................................Date- to------ Date Zo-S /S* 11 '-3T — / — LOCATION : SEWo,CtE PERMIT UO. 101 J( ® Ll vim VILLAGE IMST&LLER 5 U&ME F, ADDRESS bU1LDER5 Q &VAE A DRESS _ DNTE PERMIT 155UED -7 —` D ATE COMPLI &MCE ISSUED : — _ — - _ .,, �l 3 �a `� �o --�_ r; No........lit....--••_. Flan... ,J�................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................... P . ... ........ . Appliration -for 43hipmat orkii Tomitrnrtion Vrxn i Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy ter at •--- ------• -- ........... l a.'l Loca' n-A dress or Lot No. '------------------------------------- •-•-----•-•--••-••••-•-•--...--•---•-•••-•••---.........-•-•-•••-•----.....-•••-----•....-----•--- W Owner Address ' Installer --•-----------------•-----------..._..-•--- Address UType of Building Size Lot____________________ _____Sq. feet -, Dwelling!VNo. of Bedrooms------------- ...........................Expansion Attic ( ) Garbage Grinder pa, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.' Otlter xtures --------------------- --- W Design Flow...........................................gallons per person per day. Total daily flow............i?L% ----------------------gallons. WSeptic Tank I Liquid capacitv#CW------gallons Length________________ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. ....................Width-__-___--_---..--.-_ Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No....I--------------- Diameter..IVM........ Depth below inlet_... _____�__._.__ Total leaching area____-..--.-..-__--sq. ft. Z Other Distribution box ( ) Dosing tank ( ) t!� �"� " ""7e aPercolation Test Results Performed by---------------_-- ..................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-..___-_-.-.---._----.-. f4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.__-.____--..-___--.-. a' ------- G ----------------------- ••-- Description 0 Soil - * - - `—= = ` 'Z ------ __ -r= = W �(..' - --f lL ! ................... .....................................--------------------------�--------- -- --------------------------------------•---------------------------------------------•---•----------------------------------------------•------------------------- .--------------------------------- V Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------.. -------------- ------- -----•------------------------------------------------------------------------------------------------------------------------------------------------------------•------------- Agreement: �' The unde signed agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ,f rthe provisions�bf Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be is ued by the b rd of lth. Si ed____.. 1:-. .. � Date ------Application Date Application Disapproved for the following re¢sons- --------------------------•---------------------------•----------------._.......---------- .................... --•••-•••-•-•••-••••--------•--•-•-••--•-••---- -------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH T . G ?..........OF...... ..... ... ✓1.�t�2� .......... ......................... Trrtifiratr of Touts Haurr �. T IS CE14IFY, at th r dividual Sewage Disposal System constructed ( ) or Repaired ( ) .....................................................irsta-iie.......!�------ ­­-------------------------------------------------------- at_____-------•----•---___-----••------------------------------------ has been installed in accordance with the provisions of Nfoe XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit N ._. _.____111_______________________ ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEP,AS A GUARANTEE THAT THE SYSTEM V+IIL UNCTI N ATISFACTORY. ��- ODATE.... : THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALT 7 // c.............O F.. ... ..... ........ .....��.......... "'....._.............. n o�� No.....s--�,/•••••••-•-•• FEE__�L�!-............. Displi I rk Cl,a ttr iott rrutit Permission i ereby granted--• -e-(� to Cons ct )L or epai ( ) an Individt al ew ge isp al Syst 1Yq J j at No. �` �-• �s z_a<__.3..3-� " dn.�tl -•-- tree as shown on the application for Disposal Works Construction Pe o.___ ..,: ___4� ill ted......��: _4' -............. L/ ----•- ----- -'� / 74 Boalth DATE.--•----•-------•---•--•------------------------••--•••--•---••----•--••••••• FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No......... �/--•-..... FRS .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA TH 1. /J l....... .. ..OF. . -................ -- ......... Appliratioo -for IiaVoiittl Works Tontitrurtion Vrrolit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, l U �y.� --------------- ----- - • . ............ ='----�''---�r---.............................. Locat' A ress or Lot No. ol�.o% (.. ''� ---------------------•------------------------------.......-----------------------..........-•---- ------------------------------- I1t�wL AI Address Installer Address UType of Buildit}g� Size Lot..........t-----------------Sq. feet �-, Dwelling—No. of Bedrooms.............v...........................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.i Other_fixtures ---------------------------- ---------------------------------- ------------•----- --------------------------------- W Design Flow._ _....... ..........................gallons per person per day. Total daily flow.......__..3©Q---_--___--.-..-.---gallons. W Septic Tank Liquid capacity- low-----gallons Length------------_-- Width.----.._--- _- Diameter........-------- Depth_............. x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area---__--..--_--__-.-sq. ft. Seepage Pit No....I--------------- Diameter...!04Q------- Depth below inlet_._. .________.____ Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) OO /'C� aPercolation Test Results Performed bY.......................................................................... Date---------------------------------.------ Test Pit No. 1................minutes per inch Depth of "Pest Pit...__-__-_______---- Depth to ground water-.._-___---.--.--.-.--.. r14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water...-.-.______--.-___---. O Description }Soil .. `/f ....... `�.' w"�J — � Z U ,� --------------------------------------------------------------------------------------------------- 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 Article \I of the State Sanitary Code— The undersigned'further agrees not to place the system in operation until a Certificate of Compliance has be is tied by the b rd of h lth. S' , ed..... -------- - ------`--------------- �/ Date A lication roved By-.---.%� .!... _ .._ 7 - = PP PP •---- — ✓ l l�' Date Application,Disapproved for the following reasons--------------------=-------------------r:.. ............................................................... t � ..........................................................................................................___ ._._________..____.............._....._.._.______..._.______.._._...__..___.____.......... ._.... Date PermitNo-------------------..................................... Issued........................................................ Date .� ` ►.,t TOWN OF BARNSTABLE Lc;CATION �X iv-Q-cj-A,_z \_e� SEWAGE # , ��c`ev� VILLAGE �� "`�—L..._ ASSESSORS MAP & LOT INSTALLER'S NAME & PHONE NO. C 0-9�f, O-v✓t'J� Z� SEPTIC TANK CAPACITY LEACHING FACILITY:(type)-ycu<) (size) i v NO. OF BEDROOMS PRIVATE WELL UBLIC WATER BUILDER OR OWNER (a,_Alziy c DATE PERMIT ISSUED: � -qb` DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r-- _ ;. � . ��' �. �� � �� � � �� ���� ��S_�C� � cU?TD �� Q` 1 yLC crW (d K(a ��`�' iv�a� :�� BY DATE SUBJECT SHEET NO. OF CHKD. BY DATE JOB NO. �s -r s V01 - 41L •�. 0 a f FLA tJ Am 174�o � cE•�T"i,�y rN�r rH� ,�G��v'tJ'-�a/J �-1,.�t.1 2evzEeeWC:r-- s�/c�v�v ,�✓� �v Go.4, 4P A117-,V 771e 15 I-1 '3 S � " z 4 4,OD S&IP e— n-ri of,4e2. i