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HomeMy WebLinkAbout1521 FALMOUTH ROAD/RTE 28 - Health -15-2-1-0LD POST—ROAD-,—CENTERVIL-- E A 209.082 S���I __fJ J�,RE�YGLFD��ti UPC 12543 No. 53LOR �100 cow°`� HASTINGS. MN_ No................. .. , , F:nt....:Sa...°��.... THE COMMONWEALTH OF MASSACHUSETTS �w BOAR® OF HEALTH To N ..._..._._.. �P 9 -o8'z Nwo&F� ........ ....OF......8.14r A/S ems............... aZ D 5��1 F&L4 I rdhv' ua ur iv 45- a urki' Tomatrurtiun Errant Application is hereby made for a Permit to Construct ( V) or Repair ( ) an Individual Sewage Disposal System at: OL7> POST 120AD Crzlli�LL ................_................................................................................ -••----•-------•--------....-•--•.....-••----- ....._.. Location.Address or Lot No. Ly LAW/z�C6 L7-b• �Jl�7n/ �Sm. ��_'-._t7+ N^i!- - ••--•------ ._..----•-•.... ---- ----•----•••••--------•-------••---•-•-•••......•... ----•------- Owner _ A dress W /�jL;tyf�L .5� -S SO�1 e�tU._Un// ,�OC.L lzT�. �. /N/S ----------------- -------••-- --............... ........... Installer Address 2oO®o d Type of Building Size Lot._J................---------Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building .6--7. ?Z ........ No. of persons---------------------------- Showers ( ) — Cafeteria ( . ) Pa Other fixtures ---------------------------------- W Design Flow.S-�IZ .2Q.0.459�-.gallons per person per day. Total daily flow........ig�_........................gallons. .� WSeptic Tank—Liquid capacity/.000gallons Length__ .6:'_._ Width__-+_rl() . Diameter__4r_(,____. Depth__._rrg-`-'... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit Distribution box Diameter...... D6ing t......... Depth)No th 6 below inlet...... .......... Total leaching area..� 0 7 ....sq. ft. z Other f Percolation Test Results Performed by —--i2___5 :r-----------------------•-_.-.-.- Date..... "_g ............. Test Pit No. I...�.L•_._minutes per inch Depth of Test Pit........!2-..... Depth to ground water-----^/0T....... Test Pit No. 2...... ._G'Z—..niinutes per inch Depth of Test Pit--------L'L..... Depth to ground water________________________ FD R� -----------------------------------•--•------------------------- -------------------------------------------------------------- ---- ------------------ � � �o Description of Soil________ ........ / ••-•----------- - s_. •- --------O. 2 Sqhlo U i r r _ r W ------------------------------------------------ ✓l2 �'� trx--M >:._ -S _ i? 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 LEE 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. Sigd•. ---------•----•----•---------•----•-•------•---------------------------• ................................ Application Approved By........._. . D ) Date Application Disapproved for the following reasons----------------- -----•-•----------------•-----•--------•---••-•--------------•-----•-•••-----•-•--........... --•.............•-•-----......•-•-------••--•-•------••-•---------•---•--------•-•----......-•---•----•--------•------•-•---•--•-----•----------... •-....-----------------•------............_..-- -- Date PermitNo......................................................... Issued-- � � --•••- Date ...No.- .... FEir.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a=. �...©.W e°✓.........._.....O F........4 .��IVS T 6C Appliratinn for Bispvii al Workii Tnnitrnrtinn famit Application is hereby made for a Permit to Construct (Y�) or Repair ( ) an Individual Sewage Disposal System at: --•=•--........._..--------•------•----. ..-••.......---•--•-----•----•---•--•---•------ ---------------------------•-•••-.....------- ............ Location-Address or Lot No. <. tfr / LW� .vGE /72:+• M3-rn� < '7"� -� •!!��?`' ...................... ... _....... ---------------------•--•------•-----•. ..---------- r .. Owner Add-ess LAE....5...4...7.A1:rc".'' i ,>10 A} �p h�;L�/1r 9 0C. tom. /1 ---......--•••----- ......... ..........................•--......---------•--. Installer Address DO�� Type of Building Size Lot......... ............ .......Sq. feet V Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ___ -.__ ....... No. of persons____________________________ Showers ( ) Cafeteria ( ) dOtl;.er::fixtu es .-------•-----------------------•-•-•---------------------•--•---•-------•---••--..........------•-----:......-•-----------------------•--.....-- ....Design Flow M ;gallons per person per day. Total daily flow............. ....................gallons, W �._ /.4 6 WSeptic Tank—Liquid pacttyl_bO0—gallons Length_?__ '__... Width.A__db:'. Diameter_-.-__ p x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No-_-_•..__.I--------- Diameter------4- ........... Depth below inlet...... Total leaching area..2=.._..sq. ft. Z Other Distribution box (V) Dosing tank ( ) r Percolation Test Results Performed by.......... . ............................. Date........ .......... aTest Pit No. 1...Z'_'--___minutes per inch Depth of Test Pit........t.'?....... Depth to ground water.....A'X�n:7!�........ rZA Test Pit No. 2---L."_Z_..minutes per inch Depth of Test Pit.......1:2....... Depth to ground ----------------------------------------------•----------•---.....-----•------•-----------•---------......------------•............................................................ O Description of Soil-•.74�-"....--- C 1w-_ _5 y?''. S--- G.=: - =" " W ---------------------------------------------- - " --1-v -------_C't_ ..r�1 x_ ' ._. ----------- .....1 ..................... UNature of Repairs or Alterations—Answer when applicable._----------------------------•--_--__-____-________--_-____-_-_--,---_------_--._.-_-----.._--: ---------------------------------•-`......-----•-•-•-•-----•---••--•--••••--••--•--•-----------------•---•-----•--•-•••-------•-••-------•--•--•-----•---•-----•------------•----•--••-••------.-....... Agreement: The undersigned agrees to install the aforeAescribed Individual Sewage Disposal System in accordance with f'1T�'1�--• the provisions of '.� 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. igd .--- . ••----- --•--•--------------------------------••----- ......R Application Approved By.......... ......... ...- .�::....... - '.11 Date Application Disapproved or the following reason . PP PP f f • 9 s• ................•---••-------••--•-•-------••--•------------------------=--------------------••.-------•------•----•---•---•-•-••----•---------------•-----•-----•--•-----•••---...---•-•-------------- '' Date PermitNo.......................---`-a--- --------------------- Issued....... -)--—---------------------------------- Date THE`COMMONWEALTH OF MASSACHUSETTS 'BOARD, OF. HEALTH . Al.............0F.......n:�ie,.: 'E�!�l,r 2 c;}y' L.Cn::....................... Trrtifirair laf TompliFanrr THIS r`ERTIF-P)n That th ; n9gvidual Sewage Disposal System constructed Cle Repair ) Installer ti r has been install in accordance with the provisions of TIT of date Sanitary Co a esc in the application for .,isposal.-Works Construction Permit No......... . .......................... dated__------- .. ....... . ..._........_........ TIME ISSUANCE OF, THIS' CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT TIME -SYSTEM WILL FUNCTION SATISFACTORY.. DATI................................................---------------.................. Insp.ector. ..._..---............ ...•...---....:: ............................... • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 M!N...........:....OF.. ` 4 ......... :....::�s L: ....................... � ... No......................... FEE........................ strmt Tbrrait Permission is hereby granted ,;.' ' -•--- --- a... -----•-•----------. to Construct %Repair an Indiv d al, ag�Disposal System atNo..---- --- • ------ ' ' = -- . ..--- --------------------------------..................... as,shown on application for Disposal Works'Constructio Street �/ w on Per o... ated.................................--.-•--- ` ___ _ ___ t/ "� � y Board of Health DATE.... /�f' P .FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS K TOWN OF BARNSTABLE - UNDERGKUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 2 ® I PARCEL NO. O X.7, TAG N0. A?-, 7 ADDRESS OF TANK: 14:1 f UL,O ;16 .ram ,?o 44 V I L L A G E: C'F_.� o Ee y/tl F fvumb�r •tr��! MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: V41vf,r ^A PHONE: 7 Fo - .2,7 o ,7 X-/1 I NSTALLAT ION DATE: V AJJ n! o w of BY: INSTALLER ADDRESS: -CERT .NO. *TANK LOCATION: ABOVE BELOW DC t0 P121iG TANK LOCATION W I TH 1lCOPGCT TO nU I LD I NO) CAPACITY c2,S-® TYPE OF TANK a/e AGE YRS. FUE ' CHEMICAL O /L TESTING CERTIFICATION [ ] PASS C ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [t/f NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ 132 2-- ] DATE # PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE — UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. PARCEL NO. c TAG NO. .� ADDRESS OF TANK: !S / Q 4 ; c3 ,r r 'Y4 VILLAGE: MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: /7)4 cyy,,. {H PHONE: 7 2 7 INSTALLATION DATE: UAl ham o w✓ .,) BY: INSTALLER ADDRESS: -CERT.NO. *TANK LOCATION: ABOVE BELOW (owsora z as TANK LOCATION W I TH 1►COPQCT TO nu 2 1_o I NO) CAPACITY 0 TYPE OF TANK (3/4 AGE YRS. ��UE(CHEMICAL TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [11-r NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ 13 2 2 ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD l"`+9'^•.'Fi�s�`^'*vw'^..w^r..,r'"^''-a-1.7t7. .; y:.„s..:r^{v3. M«+ "",;,.yi*4'nt'"'C .`'t�y+ir `t'; d`,ra!C'�wz3rxv t ',.^..+ '�,r+"' 'R`raa"w^,v-C:., - ry•, TOWN OF BARNSTABLE — UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION; / MAP NO. PARCEL NO. c' L. TAG NO. ✓"� ADDRESS OF TANK: ��. / '_?f t �cs v""' i`u lY4 V I LLAGE: Number Ytr��}! MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: J' PHONE: I NSTALLAT I ON DATE: •J BY: INSTALLER ADDRESS: -CERT.NO. *TANK LOCATION: ABOVE BELOW (0=0CM I as TANK {—OCAT I ON WITH RQ_OPKCT TO nU I LO I NO) CAPACITY - TYPE OF TANK /4 AGE � YRS. FUE.L-%CHEMICAL 014 TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ NO DATE TO BE REMOVED FIRE DEPT. 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