HomeMy WebLinkAbout2167 FALMOUTH ROAD/RTE 28 - Health (2) a Cp1 �1mv
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APPROM THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
��.. .. OWN OF BARNSTABLE
Applirati t for Diti-paiia1 Wor1w Tomitrurtiun permit
Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal
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...h ..t._.L'.l.Jt .�Nocatioi-ih1 �rt�---•----•------------------------- -tc`_-_ ....
-- .I_ � r. .!_:o.`_•_'`..----••-----____................_.._._
owner /�. Add¢ress
Installer Address
d Type of Building �9 Size Lot............................Sq. feet
U Dwelling—No. of Bedro0 is----_q,--__--_--------------------.-----Expansion Attic (A) Garbage Grinder (&Io)
Other—Type of BuildiiigV454 1� �i�_�._-_..__ No. of persons----t]--------------------- Showers (,Z) — Cafeteria (Nv)
Aa 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 ( ) I Dosing tank ( )
04 Percolation Test Results Performed by-------------------------------------------------------------------------- Date......................................04
.
Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
444 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
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ODescription of Soil........................................................................................................................................................................
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(� -•--___---••-------••---______--•----••--•-------•--••---•---------•-•---•--•-••-•-------•--••--------•-•------------••----•-----•---___---•-------_-_.-•--••---•------•------------•---•----------
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 TITLE 5 of the State Environ enta ode— he undersigned further agrees not to place the
system in operation until a Certificate of Compli c the board o, health.
` ' Signed ............. - - .............. - -Da.e.,.........: ...
Application Approved By ............. Ow.. /C Y
Application Disapproved for the following reasons- -------------------
----------------------------------------------------------------------------------------- ------------------------------------- ------------------------------------------------------------------ -------------------------------------
Dare
PermitNo. ...... .J.".. a .?...................... Issued ..... -.. ............................................_.....
Daze
V FEic-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
01-- X--53TOWN OF BARNSTABLE
Appliration for Dii,,Vnottl Works Tonotrnrtion permit
Application is hereby made for a Permit to Construct ( ) or Repair an Indi dual Sewage Disposal
System-,at: _
.....(•c..7.---}�F..w�-ate, J !
` \ ` Location-Ad less
�— f or Lod.-
-U 2.�...... ........ �n .......t_�.�-v r�W ...... In_....
Owner
W Address
._ ....._.... --------•-----•......................... ----•---------� �
Installer J Address
d Type of Building Size Lot...........................Sq. feet
F Dwelling—No. of Bedro�i ...... ...................................Expansion Attic (N.) Garbage Grinder ((Jo)
aP-1 Other—Type of Building ® l c--Q.------... ----------------
yp g -. No. of persons....-1 Showers (�) — Cafeteria (N�)
d 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 ( )
~' Percolation Test Results Performed b .................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit..-.--_-_------.-- Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..............--........
�4- --••---••••-----------------------------••--------•----•--------••••---------•••----............-•--.........................................................
0 Description of Soil........................................................................................................................................................................
x
W -
----•----------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- ................
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 TITLE 5 of the State Environ�ynen at 1,bode.—The undersigned further agrees not to place the
system in operation until a Certificate of Complianc�a�ee e21 b the board of health.
or_
�-- Signed ':....�. .:..... . --------------------
� Dare
Application Approved BY ......��r.Q. '"�_ ti . ................. ....... . . ............ -- ---- —fit..-...9 .j
Dace
Application Disapproved for the following reason r: ................ ............... ................... ................ .......--------
-------------- --------------------------------------------------------------------------------------------------- ----- ------------------------------------------------------------------------------ ........................................
G Dace
PermitNo. ------..1.....>_.6....... ... 2. ............... Issued ............---------_-..............................
.. ........ '--........D
Dace
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
(ILI-Er#ifira e of C iampliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired-------------------------------------------------------------------------------------
( �)
Installer
at ................. -.i....- -7cnsz-G ------- e�-------------
_...T ,,,�t? E ,a: ..
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. ---;-"..�_ �-2, ......--- dated ................ .. . ------------- --
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
G
DATE........ V----------- Inspector r.��-------------------------------------- ---------------_---
---------------------------------------------------- ---------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CCpp TOWN OF BARNSTABLE
FEE.... ........
�io�roottl Works Tonotrurtion Permit
Permission is hereby granted..........--_'etr:- � i���— ....... ............................
to Construct ( ) or Repair (l_. 'Individual Se ageDisposal System g.
atNo............. ---------•... r, ....... ............ =P e ------------------------------------------ �l ......
Street — 1
as shown on the application for Disposal Works Construction < pmlt .TO .��_337. Date)...........................................
-----------------
J Board of Health
DATE----------------r.... -•-----='�!'`, '
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
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No.. --I-------•-------- Fnic _
APPROVAL OF
THE COMMONWEALTH OF MASSACHUSETTS SUBJECT TOBARNSTABLE CONSERVATION
BOAR® OF HEALTH COMMISSION
------ rO.w N................
a
Appliration for Uiipnsal orks Tonstrnrtiun ramit
Application is hereb made for P r it to Construct (� or Repair ( ) an Individual Sewage Disposal
System at: FG I
..R.r.A....2.8__....... , n� ���. .�..,. ------------------------ ............/--c2-T---.......X7-.....................................................
James K. Smith
Location-Address Barnstable or Lot No.
Owner Address
W Vetortno Brothers Barnstable'
Installer " Address
Type of Building Size Lot.4,63.$3-------Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic (NJO) Garbage Grinder (NO)
p, Other—Type of Building ._N_/A--------------- No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ...............................:..
---------------------------------------------------------------
W Design Flow........ .......................gallons per per day. Total daily flow.........73.3.6....................gallons.
W Septic Tank—Liquid*capacity10.00.gallons Length._&eA..... Width__4../.b...._ Diameter________________ Depth_5.2'
......
x Disposal Trench—No..................... Width...................... Total Length.................... Total leaching
1 ia area.__.............____sq. ft.
Seepage Pit No...... iameter...:.J .�..._. Depth below ' et�_3C/�...r_.._. Total leaching area../90.......sq. ft.
Z Other Distribution box (e� Dosing tank ( )
aPercolation Test Results Performed by._R.4N/At,.i�...A......C1fA.0&D....T_Z,_S_..... Date.....h!LA7____�I,�_L_✓7�...
,.a Test Pit.No. 1...4_Xn....minutes per inch Depth of Test Pit..../ .1....._ Depth to ground water..J.3A_"....__.
Test Pit No. 2--- .__._..minutes per inch Depth of Test Pit... Z.......... Depth to ground water.�.50..`,/......
----------------------------------------------`------S----C•-/.�..-.-S---®--!--_-�------gi-------�------•-------�-�--------�---l-�------"-�---------�---.-,-T------!•-----------------------
O Description of � ---------
...... r...../ l AffTlA -"-------SAVAA........................................
5�1!9 .4-A A..........S.0/.4 _.. C_0.M_ZX/7lsl,N-I.......1-Al------739.r_ ...... GIST..__1Y,c�4.F.5......................
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 TITIZ 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.
^G Signed----- ------ -- ------•-------------- -------------------•---•------
/h(-/�, 1/J ,------•-------------
/� to
Application Approved By..... �—% ir/l!d =•--------------------------------- r 2��7-
Date
Application Disapproved for the following reasons--------------------------------•------------------------------------------------------........................
..................-...............
.........................................................................................................
---......------------------......------...----•--•-•----------
(0 Zj
7 Date
Permit No......................................................... Issued_-------------------------- •---••-------•------------
Date
No..___. �` .... FEs.. �....0..../...........
THE COMMONWEALTH OF MASSACHUSETTS. .: '
BOARD OF HEALTH
, ppliratiutt for llhipos al Murky (faustrurtiun nt
Application is hereby made for a Permit to Construct (14 or Repair ( } an Individual Sewage Disposal
System at:
.....- • - ._... .....--• - --- -----------•---•---•---•--••- ---.._......-------
James K. Smith Location-Address Barnstable or.Lot No.
......................-.........__............................................................... ..........--................................................................................_.....
W
Vetorino Brothers owner Barnstable Address
Installer Address
Type of Building Size Lot... 16.3.......Sq. feet
Dwelling—No. of Bedrooms...... .................... -___--__Expansion Attic (00) Garbage Grinder NQ)
aOther—Type of Building : ................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures .............................................
•. •-•-•-•-• ............... ••--••-••••-•-•---------------------
Design
Flow....../K d gallons per perday. Total daily flow_,_._.._ : _____________________gallons.
04 W Disposal Tank
—Liquid capacitytp�b Width ns LengthT Total Length
� 111. Dal leaching area___Depthl.,V ft.
Seepage Pit No.... ............ Diameter 0......._. Depth belo nle !! _'____. Total leaching area,, ?G'�+-____--sq. ft.
Z Other Distribution box ( Dosin tank ( ) � •'
Percolation Test Results Performed by_ �_NI�C __. .....4:������ �> ... Date...IM ly....eIj./17
Test Pit No. 1..5._. "---__minutes per inch Depth of Test Pit .._.,_ ' Depth to ground water.-__°�+� '.�
/r''
Test Pit No. 2._�L_�.....minutes per inch Depth of Test Pit..! _ .__.... Depth to ground water j !?t_ �..___
--------------------------------------------------------
O Description of oil.: . r� bJ+1' ' fdl ...... +F✓ °' +'" .` � �+' _..�� N .
U tg �� .t......� ......................................
.it !' $, .-- 1R'J�" "j1 � �Y!��+ i---
......./M--le f)R ....... o/A.......c.a/v.7 /.r'/o j s.-••-•-!�'-------aa-r*.......rel /5�'04
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 TIT!L- 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.
S• ned ---------------------•---------•----------------
Application Approved By_.-- 'A •_.. - ` l
Date
Application Disapproved for the following reasons:--•--------------------------------•----------------------------............................................
-••-••••---••••-•-••••-••-.........--•--••--••-••-••••-•--•---••-••-•.........-••---------------•--••••--. -------------•-----------------------•--------------------------------- --------------------
Date
Permit No......................................................... Issued................................::..::_:: =-------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town z Barnstable
..................................::.O F................::.:::..:::...........................................................
..(Intifirate of Tumptiatta
That the Individual Sewage Disposal System constructed (X ) or Repaired ( )
by - ._......: c-------------------------
Lot #27 Route 28, Centerville °1�1 Installer
has been installed in accordance with the provisions'of TQttE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No: __'?_..1 7d_Z'R............... da.ted_.. '. .. :�X....__.___.____..._.
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM Wl FUNCTION SATISFACTORY.
�f� G
DATE--•---•--.�.-.-- -7., _..._.: Inspector.... ._ --------------
THE COMMONWEALTH OF MASSACHUSETTS
h�
BOARD OF HEALTH
7I Town Barnstable
��• OF.................... ....-•----..._--•-'.................................. 2 e.a s�
N ................... .. FEE. ................
Disport l frks Tomitr iutt "permit
etor no Brothers
4 Permissio is hereby granted.
tc Cons ro>>tt �) ouet�ai�2 , �en e=�i�i Iea1 Sewage Disposal System
at No
Street
as shown on the application for Disposal Works Construction P mit Dated 1`'�) 9'
&...
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DATE................................................................................ Bo Healt
FORM 1255 HOBBS & WARREN, INC., PUBLISHERSr'
�< f MAY 1121978
ELEV, a.S. 7 MSS.
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