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HomeMy WebLinkAbout0100 BREAKWATER SHORES DR - Health 100 Breakwater`Shores Drive Sewer Acct# 3267 Hyannis yi .... A = 306— 163 d 7 Ox� t �► No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp er: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for 3DispoBal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon i ❑Complete System ❑Individual Components Location Address or Lot No. /� � Owner's Name,Address, and nTel.�Io. �00 /3/a°, AWN Assessor's Map/Parcel ( h o'// 4,& Installer's Name,Address,and Tel.No. V. Designer's Name,Address,and Tel.No. 65ZI)778.V* / Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil "&Q6U Nature of Repairs or Alterations(Answer when applicable) ijr.4 G tKD` t —14 611 J ' Date last inspected: s Ub 0/, Agreement: G� The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in g � g P Y accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. P� PSied Date Application Approved by D Date ' Application Disapproved y Date for the following reasons Permit No. Date Issued TH'J COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance ertifit t THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at has been constructed in a c ce with the provisions of Title 5 and the for Disposal System Construction Permit No ated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector 1V5No. � - - -- ---- --- ------------- •- ------------------------ - --•- -- --- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal &pstem Construction Permit Permission is hereby granted to Construct( ) Repair air( ) Upgrade( Abandon( ) System located at #V and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: on ctio ust be completed within three years of the date of this permit. Date Approved by No: ,, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp r: Yes PUBLIC HEALTH DIVISION ='TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for Bisposaf *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon i ❑Complete System ❑Individual Components Location Address or Lot No. /Q J� Owner's Name,Address,and Tel.No. /p U Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. / 54X)77 X Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) G RR U 4 ,it Date last inspected: r S t ool) U, Agreement: 0,� �^^ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in-� accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. PJ IV Si I ed ,, Date / Application Approved by Date ! ,9. Application Disapproved y v V Date for the following reasons v Permit No, Date Issued TIC E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by -. at has been constructed in acc. dance with the provisions of Title 5 and the for Disposal System Construction Permit No. / ated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ---------------------------------------------------------------y--------------------------------------------------- - No. O •� Fee THE COMMONWEALTH COMMONWEALTH OF MASSACHUSETTS v PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS . , Nsposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade (O Abandon( ) f System located at I/ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con ctio ust be completed within three years of the date of this permiL�1 Date Approved by /1 a LOCATION SEWAGE PERMIT NO. Al ZA VILL GE li y IN TA LLER'S NAME & ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED � �e�,, DATE COMPLIANCE ISSUED--� �� x a. � - ` � � �'; �' No.. ...0�..6_. .. Fms.....Jr.� .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .....................OF..... /°-/1c5 7����� ........._-------------•--............. Appliratinn for Uiapniial Works Tnntrnrtion Vami# Application is hereby made for a Permit to Construct ( ) or Repair ( k-)"'an Individual Sewage Disposal System at: -...s.3r7__. Ar_jeat �r�'er._.. ar� ��.... �r��� --•--------------------------------------------------•---------------------.._............_. L cation-Address or Lot No. l_Leb------------------------------------------- ---------------___-__ .�_.�..... ............... -- Owner (� T- Add re s W a .l ��S.sS. Ua,f V Eryt_G :--•--•--•---.._ t _.__... . Installer ,Addres d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___s�...................................Expansion Attic ( ) Garbage Grinder. ( ) Other—Type of Building ............................ No. of persons _ 1 P� yp g p _____________________ Showers ( ) Cafeteria ( ) a' Other fixtures ............................ . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. x q No, _.Pacit__.__y__._ •gallons Length................ Width................ Diameter---------------- Depth..............W Disposal Trench W Se tic Tank—Li .. capacity ... 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........................................ aTest 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........................ f�+ -----------------------------------------................................ •........... •----- _... _--- --•--------•-••••-•---•---------------------------------- ODescription of Soil.....S4nd••--•-•---•••---...•••-•--------------•--•...•••••---•••••---•---••-•••••••........................--• x ---- - -------- -- --- - �----------------------------�--- ...... ....... ........................ lCl�d� � _�' e c✓ u Q-tit-�0------------------•--------------------------------------------•------•----------------------------------................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with, the provisions of i_T 1,E 5 of the State Sanitary Code—The undersigned further agrees not to place the,systen! in , operation until a Certificate of Compliance has been issued he boar Sig ed -__-�•• •------------ --•--• f} .. PP PP YD t �.� `. A lication Approved B _____ _ .�� '_.__._::_.____ Date,- • Application Disapproved for the following reasons----------------------------------------------------------------------------------==--------------- ----=-=----- ..............•----------.--------•---------•--------•-•-----------------------•--------------------------------------------------------------------------------- --- Date Permit No......................................................... Issued_.:e7:,-t— 2 Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HtALTH ppliration for Uiiipoiial .Works Tomitrurtiun Vamat Application. is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage'Disposal.y System at: ("f wwz lacatio -Address or Lot-No. }. . ...: ,.e!&�'l'J.......:.............. ............... .........................l :eel.P......................................................... Ow er Addr s Installer Addres d wj Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms__ ............. .....Ex ansio Attic Garbage Grinder Other—Type of Building ..........:................. No. of ................... Showers ( ) — Cafeteria ( ) a' Other fixtures .. W Design Flow.............................................gallons per person per day. Total i daily flow..................................... ...._gallons WSeptic Tank—Liquid capacity------------gallons Length................ Wldth 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. 71 Z Other Distribution box ( ) Dosing tank ( Percolation Test Results Performed by................................................................................. ,Date.. ....... ......:_........._ :. a Test Pit No. I................minutes per'ineh Depth of Test Pit----------.........: Depth.to,ground water...................... . # Test Pit No. 2................niinutes peer inch Depth of Test Pit .,::,.......... Depth to ground water........................ ':! ! ..--•-•--•--••--•--•---•--. •-----.---•- ODescription of Soil.....6.'end-.......................................................--- ----. -- ----- --------------- ------ V ......-----•-----•......----•-•...••---- ----- ........................................ -•------- , \ U . Nature of Repairs or Alterations Ans er w en applicable.______�/P"� th.,04,S4CI C9!?A............) 9�� , Agreement The undersigned agrees to install the afored'eseribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further`agrees not to.place the system in operation until a Certificae of Compliance has been issued he boar h th. a. Siged -- •--•-- --- --•-•--- _ . _•... _ - i .. D to t Application Approve By:.. N .Date' - Application Disapproved-for the following reasons-------------- .____.....-.-- __ ...........__..•_.... ! ... .......... ...................... t.......... J F Permit No._---- _-_--- Issued_: -------- " xJ Date i THE COMMONWEALTH OF MASSACHUSETTS j BOARD 'OF,-'HEALT l ' llr .. ` Trrtifiratr of Toutph anrr THI IS T C TIFY That ,e�e Individual Sewage Disposal System constructed ( ) or'.Repaired by. : � . ------ ---------- ,y I ller p C. r/ S j `. h s been installed in accordafrcewith the provisions of TI`� 5 o The State anitary' C de as described in the application fqr Disposal VVorks?Construction Permit No.' __.. -.....__ dated. ._ ' � `. 7 .......I---- _.- ..:..: THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A GUAkXNTEE THAT THE SYSTEM WI,LLL FUNCTION��SFACTORY vA DATE.. i}; ....................... � 3P � Ins erector" � '. �` A '`. .: s y y .•,;.-�r ,r✓ f1; m Fr, ats ,•tti ,.:r °�^s 7.3 i t' f7 , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT a-t-chi..........oF......-.. ..._:.-.: ........�.... °- No....... FEE.-_�-- ••••...... �1 . �to�oo�tl or � �un�trttrtton �ermtt ,>,; Permission is hereby granted:.`" j . _---:. _-:____________________________ �+ _..... to Cons ct ( ) o Re air' n Individual,Se ge D posal st J at No.__ 414. ..........e;!k............�1.Street n as shown on the application for Disposal Works Construction P it X__/J.,____ __ ___ Dated----- --------- `._....�....... _- ,....... .......................� Q $oard'of,IIeiyt (�7 e DATE.._ �------------� .: . FORM 1255 HoeBS & WARREN. INC..- PUBLISHERS LOCATION SEWAGE PERMIT NO. VILLAGE IN TALLER'S NAME ADDRESS t , B UILDE R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ' ( i 1 / �. i � }}ptJLf � i �� �� Make application to local Fire Department. Fire Department retains original application and issues duplicate as Permit. 1 �-b - J P APPLICATION and P MIT Fes: i, for storage tank removal and transportation to approved tank disposal y din d5;� rovisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereb e • iga Tank Owner Name(please print) �/C �i y L� X Signature(if apllying orpermit Address 1, !Sk'�9 i�� S HUZ � N`Jt9�J, .4A n Street City State Zip RemovalHOISTING LICENSE # J6:��YG�r-':4���Cf 4.r�/.''✓;IG�� J rj-�� `.�./rn Co. or Individual Print _ Print Address 69U RK)A Address Print Print Signatur plyin for rmi � ��' Signature (if applying for permit) ,�Z_IFCI Certified Other ❑ IFCI Certified ❑ LSP# Other Tank Location - J00 A1?E�r Steet Address City- Tank Capacity(gallons) ���SC�b _Substance-Last-Stored Tank Dimensions(diameter x length) `) X 6 Remarks: . . Ir Firm transporting waste QJ✓►1'0 S'9 FIE: State Lic. # J c1 9 Hazardous waste manifest# /] E.P.A. # Approved tank disposal yard Tank yard# D O a Type of inert gas 17770b2ZD Tank yard address cc�112 m(Z City or Town FDID# �J�� Permit# Date of issue /j 4?i Date of expiration Dig safe approval number 73 So i (v (, Dig Safe Toll Free Tel. Number-800-322-4844 Signature/Title of Officer granting permit After removal(s) send Form FP-29OR signed by Local Fire Dept. to UST Regulatory Compliance Unit, One Ashburton Place, Room 1310, Boston, MA 02108-1618. FP-292(revised 9/96)