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HomeMy WebLinkAbout0012 WEQUAQUET LANE - Health CP-4v(r Ie.; 'ni"S o r® SMEAR No. 2-1 53LY UPC 12934 smead.eom • Made In USA ts• if� coo SUSTAINABLE FORESTRY INITIATIVE rer6fied Fber$ourcino rnwr.sfiproppmdnp TOWN OF BARNSTABLE LOCATION j�(/e( t/0 (l e� SEWAGE# ASSESSOR'S MAP & LOT S e/C5 INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY 00 A 0,4110 4�, ! 600 !'tom# oa/�A LEACHING FACILITY:(type) ! / .., /etc•Y (size) 6 6 if V NO. OF BEDROOMS .PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER /QR DATE PERMIT ISSUED: ' lam DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r 31 c y p R .515+;vn leiv-k4 � No.. ..� ... /FEB........ ........ ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripooal Works Tonitrurtion Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( 6,rlan Individual Sewage Disposal System at: ------------------- ---------44,kb�,lk -------••--------•-------•-----------•--•----------------•--- ....c�,..------- --�- �A-- -v��----.1�►vie-------- 14ocation-:\ddn'ss or Lot No. kOs 6 --••---------------••-----••----------•------------------ •-•---------------------•----•-------•-----------•---...----------.....----•------------•------•-- Owner Address 14 -- ..................... --- ---........................................ ---•-•----•--.-.....••-••--•••------------ ........................................... Installer Address VType of Building Size Lot............................Sq. feet ►. Dwelling— No. of Bedrooms..-.-.-...-3--------------------------_-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------------------•--..--•---•-•----••-------...-----..-....-----••-- 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 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lit Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..........-............. 9 ...-.•..•-----------------------•--...----..--...-----•--•-----•----------••--......-..---..-...---......................................................... 0 Description of Soil....................................................................................................-..-------------...------------------------•--•......-.....-..---•-- x U ....-•----•--••--•••----•-----••••-------------•-------•••-•--••------•---•---•---•------------------•-----------•-•-••••---••-•------•---•-----•----••- -.•......................-.-..•-•-•-•-•--... Uw .......................... ...................................................----------------------------------------------------------------------4�---•-••--•-••-•--•---•- Nature of Re irs Iterations—Answer when pplicable_--- -YI�� - - ......(.------� '-•.�� ..�:•....-�:e .G.6 ��% ...... sdnW �s ;h - ��` S ley ........................................... The undersigned agrees to install the aforedescrib d 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 ........................ -%,S� ... ............ ... ..-....-......... ........ .. Application Approved By .......... � .... .A.r.•�4 ; .... ......................_.... Da - 7 te Application Disapproved for the following reasons: .. . . ................................................................................................... ................ ....................................................... .... .. ............. .... ................. ...................... . -- .... . ................... ............................... Permit No. ........ ... '... D.. ............... Issued Date �——_—__—_--- J ti . Irv /FuB ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iratinn for Diriposul Morks Tonstrnr#inn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( 6o�<n Individual Sewage Disposal System at I ) Lor.,tion-:\ddress or Lot No. ....... _........?h..__.`_...........•-••-•--••--•--•-•......-•...............••• •--•••--•-----•••••----------•-•--••••......•••-••••--....---••-•..__..................-------•--- Orncr •••-•-•••.................................••Address Installer Address Type of Building ^� Size Lot............................Sq. feet ►� Dwelling— No. of Bedrooms.___--_-_--?-----------------------.-----Expansion Attic ( ) Garbage Grinder ( ) 0`44 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 91.4 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L=t Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•-----•---------------------•--•-----•---•--....._...--••-••-•-............••--...--•-•------•--......................................................... 0 Description of Soil......................................................................................................................................................................... ----------- •-------------------------- ----------------------------------------- •-------------------------------- •------------------------------------ .....----------- ................ ......--- --••---------------------------------------•-...---.........------...._.......--------•-•••.............................................•..........4/......................................... U Nature of Rep irs,�,r Alterations—Answer when applicable.-...Z t?5f _ ......t-------/�1- ?-...r�A-C,....... f cq.c..h 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 .......................... -- .................ll. . . ......s' �cy. are Application Approved BY .......... n `� . .. m ... ER Application Disapproved for the following reasons: ...................... ....................................................................... . .............................. .................................................................................................................... ..................._..............................----.-.......................... ........................................ Da" PermitNo. -------1 . ... - Issued ................................................................._ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE LLTTErtifi ate, of amplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( at �----�r�l-�l f��- ti�--------------1 � -............r.... . . .(.._-�h ---- . .. - -....................... ... .......... u.. has been installed ineaccorda�nce with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .._.... _a a.7.......... dated .......... _ gg THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE�THATm HW SYSTEM WILL FUNCTION SATISFACTORY. DATE......._ 7.. Inspector ..._....... - f'_....:... ... —————— ----,----.-----------------————————-----------•------,---- --------_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.. .' �...7 FEE: .4........-----• Disposal Works Tonstrurtion "permit Permissionis hereby granted........................./, ----------------------------------------------........------------------------.............._. I to Construct ( ) gr�Repair ( ��n Individh al Sewag_e Disposal;System at No.... ..........lti.?l- �'rl t-: o ......................................................L` •-•.........-- -street p,r as shown on the application for Disposal Works Construction Permit No. !,���/17_.. Dated....._.: ��.."..���.... i •----•--•---•-•••••-•--•----••-- ..................................................... Board of Health DATE.............. - - ------ FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS 0 � _� No........... F�$.....1 Vr................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE LTH �rtl �1..... ...........OF........ ... AppHratinn -for 43itipla ial Vorkfi Tonstrnrtinn Vernift Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... - xy.... ...�....... .... e� 0.�,.�.� .._ ------------- Location-Address or Lot No. j— ....... ItiO1Q .T..1le--------------------------------------------------- Owner Address QS---------------------•-----•--•--••---•----- ----------------•-------------..-..---- Installer Address UType of Building/ Size Lot--- �1 ------Sq. feet .-� Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ..... No. of persons........... ------------- Showers ( , ) — Cafeteria ( ) Q' Other fixtures --------------------------------- - w Design Flow. ...._...`r ........................gallons per person per day. Total daily flow____-____`?>�Q_____________--_.__._--gallons. WSeptic Tank—Liquid capacity-1Q04gallons Length......6...... Width------i-------- Diameter................ Depth._..______._.... x Disposal Trench—No..................... Width-------------------- Total Length.___-__-_____--__.- Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter-___-___-___.____.__ Depth below in t_............._._ Total leachin area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �� l�' °!� 77 aPercolation Test Results Performed by.......................................................................... Date---------------------------------- Test Pit No. 1----------------minutes per inch Depth of Test Pit____________________ Depth to ground water-..._-_.._.__._-_. ----- ri, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._._.-______-__-____---- O Descri+-ion of Sotl_ - . -----• = -- -- - --------------------------•--• - - � ... --- --•---•. ---------------2 � �=�-•---- ---- ----- --------•------•------�---- 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 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 i, s a __.JY y.I. Date Application Approved By..... �s//1 �' y� �----------- -------------------------------------- Application Disapproved for the following reasons_____________________......-•-•..............................................................Date ---_•-------. -------•-----------------------------------------------------------------------------•--_------------------_-•-•--•----••-•----•--•---------•---...__....---------------------------------------------- Date Permit No. -f----------------------- Issued. s Date -� - a No. ia_Y ". 1 Flz�. ��....... + THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HE LTH r . , F Applirattlan -for lhtip dal Works Tomitrurtion Vamit Application is hereby made for a Permit to Construct (. ) or Repair ( ) an Individual Sewage Disposal System:at - ------------------------- —location-Address or Lot No. �. Owner Address T e Of Installer Address { UY Buildin Size Lot_. } -----_.Sq. feet : 0, Dwellmg` 1Vo. of Bedrooms____ ______ ___________________________.Expansion Attic ( ) Garbage Grinder ( ) $ Other—.Type of Building 5AVT QX:-.-___ No. of persons.-...__._tP------------- Showers ( ) — Cafeteria Other xtures ----- - ------ -------------- - ,. • Desi n Flow_.- a gallons per person per day. Total 1rl. flow__._____ allonti W g �' *'0 ---- --_-- .g� P P p Y Y -- --------------- ...-.gallons. g Septic "1 ulc. }L>qui'tl`capacitvl�allons Length___= _..__.Alidta Diameter__._ Depth---------- Disposal Trench No Width___________________ Total I,en h --.. __.___._Total leaching area--------------------sq. ft. Seepage Pit'.No. _....... A:Diameter____________________ Depth bel?w in t_____. -------_ Total leachin area.....................sq. ft. z Other Distribution box ( �'Y„',L Dosing tank ( ) / "" t 'i✓" r-_ 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_-.._._.--_._--__-_-_. O �71r ... R .ey� / ---'------------- Soil Descrip ion Of "'.. + • ` ' '"�F �'� '°� "` 8 C-41-y` fa)7/ x ---------- 'rltet. � -_-_-_--_--_ ._..__._.. ___ ___ ______ _________ - ._____.____ .. ..________ ____.___. ...__. _ _...__......____... _._. _____._.. v. Vf Nature of Repairs or Alterations—Answer when applicable.-._---........ .. .... ..........:.__-_----_-------___---.--.-_.--------_....__--.-_..__ Agreement: n The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in,accordance with the provisions of Article \I d 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. Signe ;= t ► � Date Application Approved By..,', =. ---------------- ------ "";« ` "9 --- . . Date Application Disapproved for. tl e.f ollowit g'reasons ----------------------------------------------------- -------------------- ----------- T 4yy • ___________________________________________________________________ Date PermitNo. ..................'=.............. Issued---------------------- - ......................... Date . :THE COMMONWEALTH OF .MASSACHUSETTS BOARD 9F HEALTH ...... ....... OF:....: .. .. . .F...................... �prtifir tr ,of T111mVlia"nrr THIS S 0 CERTIF That the Indio Qual Sewa -'Di osal Y m constructed { or Repaired ( ) st ]er �f . . has been installed 4m accordan e with the provisions of.Ar ' XI of The State, anitary Code as drescrid in the hf, application for Disposal Works Construction'{_Permit No..._ � ____:_: dated._ ' "".7 _ ____________ THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A GIJARANI.,TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.; DATE... Inspector ................ THE COMMONWEALTH^OF MASSACHUSETTS BOARD O HEALTH 77 . ....... :.. .::..o ..:. F O ..... . ... ` ......... No. ---•-•-••-• FEE---....................... Permission i h by granted.._.. _; __ _ to Construe ( R air ( ) an jSndiv d al4ew Disposal Syste / (/ shown on the application for Disposal Works Construction Pe ..-___ __ . Dated_.. ............._ ". .ass Y� a may,. Warf Heal DATE.........=-................................................... -•----••--•---•-•---•• FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS LEO . LO,CATION SEWAGE PERMIT N0. VILLAGEr �, � �-- �. ► C,�"A. `&'Ia INSTALLER'S NAME & ADDRESS t,1FV /.e,o 0 4 ' 74 0 C.- B UI'LDE R OR OWNER4 DATE PERMIT ISSUED loom. � ,. 7 DATE COMPLIANCE ISSUED r � VI k}>Fiy,'y "." .r_ ;R .T.w r�.v..^gp.?'�.—+"^' w�•n..r'- ..r. y �' l'S'�'"'� -„ ..n �»- "i' ^. K w•,{• '""s � t x, +aw . ., x !r 3t..'!�r r'. >>A,� s- � � i J �,; *., x ,• +f' "d".-.3 " � «•� a• - �, �i' � .. .x ` ' ti'`.�-4'r ..t�. .''1'+;+r,..�t•ar-i,�` i '+M.,;� t_, «•,� ., .;, :�`* S� +.x. R. : .. ,r�- c,. Gr,' "h .r t !x t.�p.�'v' 1, .i" f' C'+}. •:`i....--:.+r� }�": lw. G- .` `r i•. :�� tip'. •�,�� .., } .y` .�•,�.� 'SL, ; ..P�`�.rk�:f, � 4+.�- .•.yt• ,�':�.•. Te. ry���.-, tY� ,.t,i' y., F:' �' �+<' .'�" f.. h,�., r.. sue* s x•. ,C.��'.:., { .w�a;�r e 4.-'r`�' } � •,'4+"w d.�"»� � . ° .R'.�*- ` 6 �'' ;Y+t `'� ! " . 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