HomeMy WebLinkAbout0159 PARK AVENUE - Health (2) C` A90 9xK A►e.
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Uiopoottl WorkB Towitrnrtion thrmit
Application is hereby made for a Permit to Construct ( -1 Or Repair ( ) an Individual Sewage Disposal
System at:
.......................................................
Location-Address or Lot No.
......c�—N..`r- ...— LL.tt....................................................
••-•--'----'•--
owner Address
W
Installer Address
U Type of Building y
Size Lot............................Sq. feet
Dwelling— No. of Bedrooms._........ .............______._____.._Expansion Attic (�1'� Garbage Grinder QU6)
a Other—Type of Building _ Q01I_. A -No. of Expansion Attic
Showers (_5) — Cafeteria ( )
dOther fixtures -----------------•-----••---------..------------------ -•--------------.....---------- ---------.........._.....-••••........-•-.................'-•
W Design Flow.....................5�5. ...............gallons per person per day. Total daily flow....33.®............................gallons.
WSeptic Tank—Liquid capacity_106_0---gallons Length_6.(G Y— Width_Q_"_ro°(. Diameter................ Depth5'qf'__..
x Disposal Trench—No. .................... Width___.-_.__--._-._._.. Total Length.................... Total leaching area___.._...._..,.r_......sq. ft.
Seepage Pit No----0 0.__.-.-- Diameter..l�.j----------- Depth below inlet_5_67•(..... Total leaching area._!?!lX'!r!Pq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'~ Percolation Test Results Performed b .................... Date...........................
Test Pit No. l___.Z_.....minutes per inch Depth of Test Pit----J_2L//..... Depth to ground water........................
44 Test Pit No. 2.....✓.._._minutes per inch Depth of Test Pit----/_..!YSL9�--- Depth to ground water........................
-..+.•S �.Sh (�
D �escrptonoo . �. , ± ' 4 -...
v rta .........d..3g!!_.......
W --•'--7�`��.ry�fu---- IIA P._(u!u SAw-0_....._..
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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of ComF
has been issued by the board of health.
Signed ------- -------------------------------------------_........-------------------- --......-------------------------------
ApplicationDa�e
Approved B ' ' t
�
Date
Application Disapproved for the following reasons: .................... ---- ..-----------------------........................----------------------------
........................ ............................. .....
Q.
----------
Date 'e
Permit Issued..! ..---------------
W``.`'"
————————————————————————————————————————————— ———————————————————————————
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(IT rtiftca#e of Tompliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ---------------------------------------------------------------------------------_----------------...._---------------- ----- -_.......--------------------------- ------------------
at .... �4.._..........lt7_........._.... _ L..---- ----11_41:% _.._------------------------------------ --------------------------------------------
has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ----- dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT-WCONffRUEA AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ... ............_.............. ......._----------------------------------- Inspector ------------------------------------------------...... ......------------------------------
---------------------------------------------------------- ----------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
/ �
No................... --• FEE...............
�io�roottl or�� C�on�tr�rtuan �rrntit
Permissionishereby granted------nI--------------------------------------------_----------------- ------------------ -------------- ------------------•---------••-----
-stem Constr ct ( ,, //or-Repair anIndiv� l� Pi y
at No.•• L�-° � �!t - "g/�� � iat' ...................................
Street �.
as shown on the application for Disposal Works Construction Permit No��.��Dated____�_�'���"_..
---.....-•--•----•-•---•--------------------------------•----------•------•--------•--•••"-•-••-....••--
Board of Health
DATE--------------------------------------------------------------------------------
FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Dhi-putittl Workii Towitrnrtiun Prrntit
Application is hereby made for a Permit to Construct ( L)-or Repair ( ) an Individual Sewage Disposal
System at:
�v -------------------------------------- b-F -
Location-Address / l� Lot No. ..........
................... f...-L.—�J'rE�'•-----------
�.. �L -•----.......--•---..................................
Owner Address
W
Installer Address
Type of Building L' Size Lot............................Sq. feet
►� Dwelling-No. of Bedrooms----------__�________________________-----Expansion Attic 06) Garbage Grinder W6)
aa Other—T e of Buildiu
—Type g .JtJ_4'6.V----'--!^�No. of persons____________________________ Showers (5) — Cafeteria ( )
dOther fixtures ------------------------------------------------------ -------_----- ---------- ..............................................................
Design Flow....................S .-____-___--_._gallons per person per day. Total daily flow---_72.E gallons.
WSeptic Tank—Liquid capacity_110 0...gallons Length WidthLif.(o_"_(_ Diameter................ Depth"'71$--f....
x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft.
> Seepage Pit No----G'�-.�--.______ Diameter__/�_)_..-__..._. Depth below inlet_.>-6 T'.__.. Total leaching ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. I....2---------minutes per inch Depth of Test Pit----/lL-!1..... Depth to ground water........................
44 _ Test Pit No. 2.......—------minutes per inch Depth of Test Pit----/.LlSIl... Depth to ground water........................
D Description of Soil....6t5! -----------------------------------------------------------------
T� Z -.Z S�6.fv . S + a .. f ..
W i ------7Z--{—r�l�l'( ---.t'lAr Olun!----Iq —------------------------------------------------------------------------------------------------------------------------•--•-----
U Nature of Repairs or Alterations—Answer when applicable..............................................................._.............-..................
a -•------------------•----- --------------------------------•------------------------------------------•------------------------------------•----.....----------........................................
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 ComplianjCe has been issued by the board of health.
Signed .../.4. ..................................................;----- -------- ------ ----- ------r--------:------
/i .... woe
Application Approved By ---------�%� � `1 -------------------------------------------------------- �` Dne --- �
: � Dace f
Application Disapproved for the following reasons: .........................�... ----------------------------...............----.....------........-----------------..----------------
----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ ----------------------------------------
Date
Permit No. '�' ...... ".." ...._._
��.............. Issued ...-.-....... ....�.......��..........
- ....
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Gex#ifi ate of Compliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ---------------------------------------------------------------------------------......------------------------- ---------------------- ---------------------------------------------------------------------------
u --------------
Imo Ile, '
at .-4��...✓.... -------- -----. .>- .................................. ..............._..... .........
has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. _-... ..... �R __A
- dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E°CON S A GUARANTEE THAT fHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------------------------- .... Inspector ---------------------------------------------------------~--- ------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE f
-•
Rspml Work,5 Tomitrudion "rrntit
Permission,is hereby granted------------------------------------------------------- -----------------------------.---------------------------------------.------------
to Construct vo epair an Indivi2-��al• Sewage Disposal System
w_� ---•----
.� -� -----------------------••--••----•--
at No... Street ,
as shown on the application for Disposal Works Construction Permit No--- -`✓...
•--•--
Board of Health
DATE------------------------------------------------•--------------------------•----
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
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DESIGN DATA
SINGLE
NO GARBAGE GRINDER
DESIGN PLOW z q xllo qqd SEPTIC ' SYSTEM DESIGN
SEPTIC - TAkNF( 440 X 150�'0
LOT 8.",_7pARK___14VIN,V�
-usc- ISDO GALLON TANk GEIJTER\J.II....i,...l?..
LEACHING FACILITY (o�..h,cJh�c /a'. d�a p,i w/2' stohe
5`►:clt�.:ia1f 17.0 SFx:2,.5_lopi�.�ue'I-
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BAxTem N Y e INC
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OSTE•R1/ILLf= , MASS .
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DESIGN DATA
SINGLE FAm 1 L.`f.,_ f3EDRoon'1
NO GARBAGE GRINDER -SEPTIC SYSTEM DF-SIGN
JD SIGN FLOW z 4 x110 440
SEPT1c TRNk 44(7 X 1.50.076 = (o(o0 IN
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= GALLc i N I-ANK LOT
LEACHING FACILITY ..h,�r,IS co'Al p�# .w� 2 stone rt
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BAXTER �NYE , INC .
NU Tb-c'r L iod. 8 GPd REGIS'iIMP- 0 LAND SURVEYORS
C'1VIL EUINE@RS
OSTERVILLC , MASS .