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HomeMy WebLinkAbout0047 THOREAU DRIVE - Health c{ `� -f ,Q ce au D,r A/ SMEAR No.2-153LY UPC 12934 smaad.com . Made in USA SUSTAINABLE FORESTRY INITIATIVE camftd ftw 8owcbg �.�arooraie.aro � r No.... -- / F>�s..... ...... THE COMMONWEALTH OF MASSACHUSETTS , 2a BOAR® OF HEALTH APB® TOWN OF BARNSTABLE ��� Appliration for Diri wial Works Tott,s�r Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at* :J.....Q.r we........................................... ..... e VIB)o --------------------------------•------ ------ 1 Location-Address — or Lot No. �T� P-100-� ••••••---•-••-•-•••---• ••••-•-------•-•-•••-•.............................. a Owner Addre s a __�Qtr ._....KL�£S�L.�/ _.. 15� .-k�}L�DE'��-t . .......•.Ji.SI&,•X _. !ur!el�ltil� Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling Flo. of Bedrooms.-.-..------_-. .Expansion Attic Garbage Grinder aOther—Type of Building ----- -------------------- No. of persons.-..--.-..--..-.----.------- Showers ( ) — Cafeteria ( ) a' Other fixtures .-------•------------------- ---- ---•------------------------------------ -------------------------------------------------------- -- WDesign Flow................1../..Q...................gallons per person per day. Total daily flow..........33,n........................gallons. WSeptic Tank—Liquid capacitv../Avo.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_..................................... aTest Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit........•..-----.--- Depth to ground water........................ a .....••--•••........................................•••••-----•-•-•-••-••••-------•---•---•---•-••.......-----••--------------•--•-•--•---._...----....._.... 0 Description of Soil...................................................................................... -----•--......._......-------•-•-•--.........---.............................-•-- x U ---.........•••-•-••--••••--•••-----•......••-•...-••-•••--•--.........•-••---•••••---••---•••-••••-------•-•---•---•-••••••--••-•--•••-••••--•-••-••-•-••-------•-----•--•--•---------••••........---- W -••--••••••••---------------------------•--•----•••-----------....--•-•-----------------•••-••••••------••••...------------------...--•• ----.---- ------ U Nature of Repairs or Alterations—Answer when applicable-------t000......f .__ .__�1 �-P -j......__... �uf.. ..s1 �0�� 4•---------•-------------------------------------------------•------------------ 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 been issued by th board of health. Signed ------ --- -� .....S/-�i :5/..�'.. 1 Application Approved By .. .. ........ . .... .................... .. ...... Dace.................. Application Disapproved for the following reasons: ...................... .................... .............................. ............... ...................................... ................................................. ... . ......... .. -------- ---------------------- ......... —� ..to..... ...... PermitNo. .......... ---------------------- Issued ........... ....... .......................... aze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ce>r#ifi ate of Complianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by A- at .............................. ....._...... ........... ........... . ....7 �t.rsP ,ec/.... 'i✓ ...... ........ ....--. ........... ........... has been installed in accordance with the provisions of TITLE bnf The State n ironmental Code as described in the application for Disposal Works Construction Permit No. ....... - � .. dated _...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL 1FUNCTION SATISFACTOR . DATE...............`?"... ..~ ..../. .. -..... f:..-........ Inspector .....1 ..'`".. ...... ----------- V e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE irntt1 Workii Ton # ur#Uan Vrrntit � • Permission is hereby granted...................r?__'0�..4:!I-"--••---.-...43���_..I_r..........•..................••---........-•-•----••- --------••................ to Construct ( ) or Repair ( ✓) an Individual Sewage Disposal System at No.. ..... y' f" E.L� ✓ C�--- 1- a al .._L ----------- ---------------•--••--......•..... �?.. . s�tr��t (�� V / as shown on the ap lication for Disposal Works Construction Perini No.t((.__.____.___ (Dated__ --c..................../_........ �• -- -- v 'r' t �j Board of Health DATE i- /�---1-- ----- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS I ,,.+ -�•.�u.... ,..--v�..�v.. -.-..-J.,_ ,,.�._r.v �.J y s :�.. �`W� __ ._ _ ,J- •.r-�L.-•- ,,,.. �_ y -. .._ No......L..:3.... 1 Fxs....� .................... THE COMMONWEALTH OF MASSACHUSETTS k191 '23o BOARD OF HEALTH TOWN OF BARNSTABLE A ' liration for Dina ntittl i orkii ( ontitru.c inn/ rP nfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ts ------------------------------------------ .....0 .............................................................. •.••.��" Location-Address or Lot No. ................................................................ ................................•....................---....................._.................... Owner Add re s i,s /,',err:-------- ...... 9'? ' •"1 ?" s��l _ t.t �-ra,� , N�j ... ,-- Installer Address Q Type of Building Size Lot............................Sq. feet V Dwelling— No. of Bedrooms---------------2-------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QOther fixtures -------------------------------------------------------------------------.................................................... .......................................... WDesign Flow................. /n..................gallons per person per day. Total daily flow..........3.3.n........................gallons. WSeptic Tank—Liquid capacitv__/!2nP.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........................................ 1-4 ,Test Pit No. 1................minutes per inch Depth of Test Pit._-__------__._---_ Depth to ground water........................ L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 .................................•........................................................................................................................... ODescription of Soil....:-..........................................---.................__...------------------------------------------•-------------------•-----..........------.._....... W V -------------- ------ -------•--._...... --------- •----------- .------- .. ----------- ----------------------------------------------------•--- ------------- •-•-------- M .....................-...............................................................................................................................r................................................. U Nature oi'Repairs or Alterations—Answer when applicable......L oa^n------, .......•... .... `?! ... .............................................................. ......... ......... ......... ._.........._... ........... 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 been issued by the board of health. Signed -..._. .............>:.?..... .. 1: .. �:,. ............................... .....51.` d :, :...... A `lication A roved B ' /.1� .. ..._... .................- .....-...................... PP _ PP y Date Application Disapproved for the following reasons: ........................................................ . ................. ...................................................... ... .............. ........................... ....../......:.................................-------------------*..........---------......... .. Dare PermitNo. .........� ..............� . .......................... Issued ................. `.......,........... ............... Dare 1l� TOWN OF BARNSTABLE LOC TION Y-7 -ALex-E4a D/c►sat- SEWAGE # VILLAGE eEA=Ek vpL�E' ASSESSOR'S MAP & LOT "c;230 INSTALLER'S NAME & PHONE NO. A�„� SEPTIC TANK CAPACITY /oo® LEACHING FACILITY:(type) /oocs 64A AeZc,45 1(size) /o 0 o G9� NO. OF BEDROOMS 43 PRIVATE WELL OR PUBLIC.WATER 'Tovv,-J B OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 4e//t 7Y VARIANCE GRANTED: Yes No // l ca:� � G ARg Ge �. o T C• N A r� moo/ _ • Area✓.✓d a� s��rr iSot� . s. �le--� - F:cs .. No. ........ ..................... / THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEAL - ----- -- OF......�_..3... ......... .�j-� Appliration -fur Uhiputittl Mirkii Tatuitrurtiuu Vatuft Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at: p/�J/,1�/ //!�/ - ..... ........ .tom....... .... __ du- 4�/ __ _ 4 S�.......... ................................... Loc on•Address Lot No.----_-..... ............................. Owner Address ................. ................................................................................ a Installer Address QType of Building Size Lot____________________ _______Sq. feet U Dwelling Xo. of Bedrooms---------- --__.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.--______--.-_____-_--__-.-_ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------- - W Design Flow........................�,t..._ gallo s per person per day. T�tal daily flow.........��!v _....._....gallons. WSeptic Tank Liquid capacity-- _ --_< a ns Length________________ Wid l�-.-__........_.. Diameter_._._......_____ Depth-_______._._. x Disposal Trench—N . .................... �1/id li--_-_____-____ ___ al Length.................... Total leaching area-------------------- ft. Seepage Pit No.----_/...._.-_. Diameter- _��-Z�below inlet----------- ---•--- Total eachili ea.. -----------.sq. ft. t Z Other Distribution box ( ) Dosing tank ( ) e� aPercolation Test Results Performed by.......................................................................... Date............................... -------- a Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water...--_.__--__-._-.--_ fi Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 ------------------------------- ---- - ------ ------ Description of Soil-------------------•----__-_---__ `^ � .. x V --•--------•--- ------------•----•---------------------------------------------___-__-----•--•----------------------------------•--•---_--.-_--_--.-•••------•-----------------•------•----•--•--_-•--- U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------t............... .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage ' osal System in accordance with the provision§ of Article XI of the State Sanitary Code—The undersigned furthe agrees not to place the system in operation until a Certificate of Compliance has been issue y e board of alt . gned -- --- ------ ------------- ----......................... Date Application Approved By...........���- -•--• °� . .. ate ! Application Disapproved for the following reasons:............................................................................................................... ........---•-----•---•...---•----•---.....---•--------------------------------•------•---•...._.-•-•••-••-------•--•----•------__...........-----...-----_...._.......•--•----•-----•---_--___..--_-.-•- Date Permit No......................................................... Issued...... -/ Al 7 Date No..N?._�! ......... ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , rr yt-mot 4. ._..�c .lei 1..... . ----- ---OF...... j .......... ... Appliration -fur Ii.4pufial Works Tonstrurtiou Vrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemrat ` Location Address / i or Lot No.' � M � f .,� t -. , ,-, ............ W / Own Address er�j/ --'--•--•--•----•.............•............. --�-.------- -x -,-�".„.- .•��.�'•"t'--•-••--'��-''-'LLII�-lit.!S�!?,_�{`_.:-•---•---••-•--- •-•-•------•---••---•---------------•-•---- Installer Address U Type of Buildings ,_ �,+ Size Lot----------------------------Sq. feet a Dwelling-4-I'No. of Bedrooms_ ,,e--------------------------Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons--------._--_--.---____.-. Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------- ----------------------- d ,, f .-- -�--------------- W Design Flow.........:........... y_j_ ..._.gl�lro per person per day. Total daily flow________ 4 gallons. 9 Septic Tank v Liquid capacity__,t 'gallds Length---------------- Width............._.. Diameter_._.__...-----_ Deptli________._.... xDisposal Trench—No_ -------------------- Width---------------, ... Total Length.................... Total leaching area-------------- -----sq. ft. ._a.. Seepage Pit No....../---___-___ Diameter__f ? _ fD h below inlet___________ ______ Total •<r,leachingea._._____--_-_---sq. ft. Z Other Distribution box ( ) Dosing tank " W Percolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water---.------.._.____------ r3;4 Test Pit No. 2____---____--..minutes per inch Depth of Test Pit.................... Depth to ground water_._-_.._-_-.-_----._.. � ;�- X tr ., . . x Description of Soil. ,:� _....e------------------------------•------------------- 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 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.'' ,Signed. . -..." r 1 ~ Date Application Approved By--•••......� - ' ' ,_:_-!'--_I w ;✓/- r:=='f - ==... __- - Vr Date t Application Disapproved for the following reasons:--•--------------------------------- ---•---•--•----........._....------.._.... .....-------••••----•---•-••-•--- ••-•••-••--•----•-•-----•-•-----••--•----••-•----•--•---•---•-------•--•••--•----•---••-•---------•------..-----•-•-•---•••....-----••-••-•-••------•--------•-•------••--------------•-•••-•------------ Date Permit No......................................................... Issued.....A" f 17 E= Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OFiHEALTH,,�� OF........ r ...... Fly, 0 difirate of TlImptiaurr THE$,Sj7'© C.ERTI�Y,eThat the Individual Sewage Disposal System constructed ( for Repaired ( ) b j ?'�lax ..................................... '"' �. . � i. I Installer Al . . has been installed in accordance with the provisions of Article�XI of The State Sanitary Code as desc-ibed in the f-- / t application for Disposal Works Construction Permit No....:.................................... dated_..__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ED AS A G RANTEE THAT THE SYSTEM WILL N TIO/SAT FACTDATE--------•---- ••••. ------ 7.. ................. Inspector----- -----•... .................. ---•- ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF') HEALTH`�� to x_.. ....... y No............ .....•-• / FEE.---- �. .•. .......... �i n v o ii atfIV o/rkp; Tomitrurtion Vrrutit Permissio 1 is,hereby granted...-.- ----._!'----------------__._-- -: --.-:-- f ....... to to Corutwct, ( or Repair-( n' Individual Sewage-Disposal System J ✓ x- at No... (7 }/ - , �, pPermit-No Street - L� ..5 -- .2(4_ ... as shown on the application for Disposal Worts Construction Permit No._.____/_I__.�.•Dated_ .-;�� ._.__ . � ............... / . Board of Health DATE...... ...,. -------------------------- - --- v FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �" 3s 47