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HomeMy WebLinkAbout0105 WATERSIDE DRIVE - Health 105 Waterside Drive , 227-167 Centerville 0oumdo,, rd, NO. 1521/3 ORA ailli E m 0 100 K� s • For oftce use only - WN.OF BARNSTABLE. 14, Received' by 0 /wt OFFICE OF IIAMTM BOARD OF HEALTH Date039 `l• lt3 �/ 0�0 MAY , 367.MAIN STREET LT1InA0F!M_=_W D HYANNIS.MASS.02601. O V LS VARIANCE REQUEST FORM All. .variance, requests must. ,be submitted fifteen (15) days prior to the scheduled-::Board of Health Meeting, AP R 1' 8 19911 NAME OF. APPLICANT_E�S�2G'2VILZWG l>O . TEL.>� _1_1 I - 10 4-0 ADDRESS OF APPLICANT Q: f X. RS l ►TE2Vl�•�LL. dVl,4. NAME OF. OWNER OF PROPERTY QPr= -Cpzj-- 1G R u Ste(- Go SUBDIVISION NAME DATE OVA ASSESSORS..MAP & PARCEL NUMBER 2Z�] I6 LOT. SIZE S�, S l S `.F LOCATION OF .REQUEST VARIANCE FROM REGULATION (List Regulation) - EX RA*J 5 tort A2N; c 1 rAs" y12c3S (op REASON FOR VARIANCE (May attach letter if more space is needed) ?Ezmrr 1ssu ICJ IQ8S OLt> mmAwo LINe. 1g91 &V15a7b Gub-TZA.Np (-I NE .�CE!> u07' al..t., -O (Co.. �q' SSPA,RATrOiJ• fkIMAt2>4 . SYSTEEM lS 160 Pr FMOW �SW �NE PLC _ FOUR COPIES OF PLAN : MUST BE .SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED. REASON FOR b1SAPROVAI. &L d' Ann. Jane Eshbaugh, Chairman Susan• 'G. Ras . - ,Joseph C. Snow, M.D• BOARD OF HEALTH TOWN OF BARNSTABLE fP-'TOWN OF BARNSTABLE LOCATION /— / �'� j� I - SEWAGE # f_ ;�/� VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. / 11(1 C-2 7 _ SEPTIC TANK CAPACITY _ �' i LEACHING FACILITY:(type) l T �� (size) �� �NO. OF BEDROOMS PRIVATE WELL qR P LIC/WATER ,,K,— 4 BUILDER OR OWNER SAA'-/j l i4j� G� 1 DATE PERMIT ISSUED: i DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes _ No _^_ K L / gar ©k- E zlcs F SG`-c bq r �, No.----71=oa- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...----...... U(,U,e ........oF......... 3Il�t/ST / G ..... Appliration for Dispaaal Marks Cnnnitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ---L,®% �.3 Gt/�17�-�..._..... ......4?&........ ....... ........................................... LC ti n-A dress or Lot No. D M .l�C;/S� Jam. � �5 Co L Address ,Installer Address E-� Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............Ll..........................Expansion Attic (N(;) Garbage Grinder Other—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ---------------------------------- ...... - - - ------------------------------------- -------------- W Design Flow......................`_.•........_gallons per.g�ai3 per day. Total daily flow............. ......................gallons. 9 Septic Tank—Liquid capacity!..gallons Length.../d.`.._.. Widths Y/.... Diameter________________ De th_S-.10-`-_. Disposal Trench—No. ----q........... Width....Y........... Total Length------8.(........ Total leaching area----- S...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........................................ Test Pit No. 1_. minutes per inch Depth of Test Pit------ ..... Depth to ground water.......-............. (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------•-••-•..............•.---- -•-•--•--•--•--------------.-•--...................................................... 0 Description of Soil......Q-.a_?._" � z. .... � ----.... . C l.. x U -•-------••--•••-••--------•••••-----•-------•---------------••--•-••-•--•------••---------------••-•••-------------•-•----•--------•--...-•---••-•-••••-•--------•••-•.........--•---••--•-•-••-------- W --------------------------------------------------------------------------------------•••--•-••-••----••----••---------•-------•--••----•----------•--------••---------------------------•............. UNature 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 TT/'Ix - �y t: 5 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.---%.. ...= t� C....------•-•------------------------•-•--- < .3 Date Application Approved By............. ..... -------------------- ---------•.�D --- Application Date Application Disapproved for the f o lowing reasons:-----•--•-------------•-----•--•----•-------------------------------------------•---------......•----......----- ................................•--•-•--.............---................•-•------------•-- _ Date PermitNo....... .5 ------------------ Issued....................................................... Df.te No.._ :. Finc. ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ._...... ....OF............�f.. _... ...s a{ d . pphration for Disposal Works Tunstrnrtiun 11antit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: —To�/),? Locgtjo ddress or Lot No. !r f{G c�) n Address....... ........' ' Installer PQ Address d Type of Building Size Lot..= -'f_'___'"` .....Sq. feet Dwelling—No. of Bedrooms.............Y..........................Expansion Attic (1vj) Garbage Grinder Va. ) a Other—T e of Buildin ?'`�j()t= ✓' �'�� a —Type g`..:.........::..:c...'=.:. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ..................................... -------- ----•------------------------------------------•------------------------------------------- 00 W Design Flow................. ... ..gallons per+'�a ii per day. Total daily flow----.. t . ........._..........gallons. Ra Septic Tank—Liquid capacity.__'I..gallons Length-_-/tP_`.._.. Width..`.`..._._... Diameter................ Depth_.` xDisposal Trench—'_\?o. .._q............ Width... '':'.......... Total Length.._..: .f........ Total leaching -----sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1-" Percolation Test Results Performed by..........................................____........ ._..._ ....... Date.._.......................___ P P .... .p ground � ----.. 14 Test Pit No. 1....^.•..":'__._.minutes er inch Depth of Test Pit......��._....._.. Depth to water--------?___---......._.. LZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------- O Description of Soil...... .....:.- �i s�,t l - e �- ......1 ¢� _.._ :s-:c: a t A (� -------------------------------------------- •--------------------------------------------------------------------------------------------------------------.............................•.............. 14 ----••------------------------------------------------------------------•---•---------------------•------------------------....-------------•------••---•--------------•--•---•--------- 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 p 5 of the State Sanitary Code— The undersigned .urtl er agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. E Signed (10. f._.a;� r�-------------------•----..........•--•---------. =' - = --rl ` Date Application Approved By............. _.�.� y-- .........--•------- ----• �) 2/ Date Application Disapproved for the f o lowang reasons:.........................-------------•-----------•--------------------------------••-••-•---•-•-••---...----- .........................."-'---•-••---.......•---•---------•-••'--------•••-•-----••-'•-------••----••---------...••--------------------•-------•-----------•-•-•-----•----•-•-------••••------.....-- i ' .11 Date -- Permit No.------ - ---1A--- -------------------- Issued----------•--------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD �.OF HEALTH OF. f .zr; c. .......................... .............. err if irtt r of TompliFanrr S I-$ TO CERTIFY, That the Individual Sewage Disposal System constructed �z� ) or Repaired ( } y ............. , .. --------•-- •-•--•--------------------------'-- a M / ! yutgy Installer //' . %i— at ....•'n`�`'.......................................... '4 L Z L . .r41�t�*� •• -C L.� Nz,-�` y✓4f�>+ea ,,� -1--=------ ----- --- ----------- --------------------------------------------------------- has been installed in accordance with the provisions of"DTI Tye 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... ./; ....... dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUED AS A IG ANTEE THAT THE SYSTEM WILL FUNCT N TISFACTORY. n 9 s. DATE......................•• ._. �........---'-------•--•••-... Inspector..... � �� i --- . .......-------••---. -•-•-•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT/Hf, ` J i....................OF .-.-...........::................................'''..♦♦♦............................... NO.. ./... --�- FEE l O..C'-�.)•....... BiquisFal Works Tonstrnrtion rranit Permission is hereby granted........... .... �'r' G 4 .... ......... -- --- --- to Construct (,/,) or Repair ( ) an Individual Sewage Disposal System at No..117---7...... r'.>` .. _ " ," ._.1. .........:...... ... Street as shown on the application for Disposal Works Construction Permit Nc .?... Dated.......................................... •..............•--•-•----•-----------••-------------------------------•-----....------................... Board of Health DATE................................................................................ FORM 1255 HOBBS &'WARREN. INC.. 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