HomeMy WebLinkAbout0055 CAPTAIN ELLIS LANE - Health 55 Cq4 Oks Rd., guj&m's
a50- Io3
TOWN OF BARNSTABLE
LOCATION �� � f��s�� SEWAGE # - 3
VILLAGE h&42_14.,H,Le ASSESSOR'S MAP & LOTS_ i63
INSTALLER'S NAME & PHONE NO. {qpE I -*(W10 �
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) pa-e-L&-i Ai- (size) 41v
NO. OF BEDROOMS PRIVATE WELL OR �e T R (�
BUILDER OR OWNERU
DATE PERMIT ISSUED: � �,.
DATE COMPLIANCE ISSUED;
VARIANCE GRANTED: Yes No ;�
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTHY b ��
TOWN OF BARNSTABLE �;��
Appliration for Ui ipasal Workii Tonstrnr
Application is hereby made for a Permit to Construct ( ) or Repair (to<an Individual Sewage Disposal
System at: r t
--................. ..... 1F .15----11�I.S----------------- ............. r2!4. ..........................................
Local n-Add ess or Lot No
Owner dress
Installer Address
d Type of Building Size Lot.................... .....Sq. feet
U
Dwelling—No. of Bedrooms....:3...............................:...Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP g -------------------••------- P ( ) — Cafeteria ( )
dOther.-fixtures ••••-••••--•-----------------•---•------------•------•••---------•--•---•----------... •-•••-•••-•••-•....---••--•------------•....--------...------
W Design Flow.........S..ZY .......................gallons per person per day. Total daily flow____ Z..........................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...___...it---------- Diameter..._. ..... Depth below inlet---6t ......... Total leaching area..................sq. ft.
Z Other Distribution box.( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0z4 Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................
M -•---•-• -------------------------------------
-•-----------------
•-----------
-------
----------------------------------------
•---.--
0 Description of Soil.......................................................................................................................................................................
W
-----------------------------------------------•--------------------------------------•------------------------------------------ -----------------•---------------------------•--------
U -(Nature of Repairs or Alterations—Answer when applicable. ���l_----------------------------------------------------------P-'.d
W..................................... .......................................
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 ' sued by the boa6A of heal .
Signed ...................... . _= /...........................
Date
Application Approved By -----------�`^-^�-------D ... . `.....,.:,7 ----------------------------------------------- ................ ..C. ?....... —
Dare
Application Disapproved for the following reasons- ............................................ ------
----------------------------- ..------------------------------ . -- . ------------------------------ -- --------. --..........--------- ---
e
Permit No. - 0--— . ......�-- ---- ----------_- Issued ....................................Dat..
L
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE��,,-
Applutt#uan for Disposal Works TonlihTduTn �[.erntt#
pptcation is hereby made for a Permit to Construct ( ) or Repair (,VI an Individual Sewage Disposal
Sy at
. ......_. __ _��.w_C...�A:............ t ...-........... ----------------
Location!Address or Lot No.
r
U S_--a t r ----------------S t1r�
_--- ---- T_._. ___ _ __- _- _------__-_-- ----------�
er
W '_ � _�' &n �.�_: (_((,Cderess
-------------- - - ; --- ---- -
Installer Address
Type of Building Size Lot---------------- ------Sq. feet
.-� Dwelling—No. of Bedrooms•-_-3-----------------------------------Expansion Attic ( ) Garbage Grinder ( )
aN e of Buildin ( )
Other—Type g ____________________________ No. of persons------------------------__-- Showers ( ) — Cafeteria
QOther fixtures --------------------------------------------------•--------------------------------------------- - ---------------------------------- -
W Design Flow---------�-- ------------------------gallons per person per day. Total daily flow....�_��> -------------------------gallons.
WSeptic Tank—1 Liquid-capacity------------gallons Length---------------- Width---------------- Diameter----------------Depth_--______-_--___
x Disposal Trench—No.-------------------- Width-----�------------- Total Length--------------------Total leaching area------------------sq. ft.
Seepage Pit No--------I.......... Diameter_._._4� ___••- Depth below inlet---4,f--------- Total leaching area--------------_sq. ft.
z Other Distribution box ( ) Dosing tank ( )
�-' Percolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
W
M Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground Water____--•_----------_----_
44 Test Pit No. 2----------------nunutes per inch Depth of Test Pit-------------------- Depth to ground water----_______________•____
a ---------------------------------------------------------------------------------------------------------------------------------------------
ODescription of Soil-----------------------------------------------------------------------------------------------------------------------
x
W
----------------------------------------------------------------------------------------------------------------------------------- ------------------ ---
V Nature of Repairs or Alterations—Answer when applicable_75- --_.___�-r? C pt_ -
---------------------------------------
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 i sued by the board of heal -
SignedDaw
--
Application Approved By ------------v------ ..... -- - '-,.`-" ---------------------------------------------------------------------------
Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------
PermitNo. --------7,�---------- -------------------- Issued -----------------------��-------------------------- �
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cner#ifirak of Q10"liance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by----------------------------------------------'-b _ F- t-A N---- ``� -��� -------------------------------------------------------------------------------------------------------------
�,� caller
at ---------------------------------------------------------�-- ------ ------- -----------------1
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. --------9 a---__S`f-_b----- dated ---------------:___-________-________-___-_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------------------r ' -- ------- Inspector -------- s ---------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No....... TOWN OF BARNSTABLE
Rapooat 19orks Tonornrtion Vrrnttt
Permission is hereby granted-------------------- n� 1 " -
---
to Construct ( ) or Repair G.}-atl-Individual Sewage Disposal System
atNo-------------------------------------- --- ------- j� _ _ C� C
----------------------------------------------------------------------
Street �a_Sy3
as shown on the application for Disposal Works Construction Permit No.IT ____ Dated------------------------------------------
----------------------- ------------------------------------------------------------------
DATE-----------`l--�-•-�--------�---------------------------------------
------ --- Board of Health
FORM 36508 HOBBS Q WARREN.INC.PUBUSHERS
• t
LO-C , ,?0N � f, Y SEWAGEAP�R�M� N0.
VILLAGE
INSTA LLER'S NAME & ADDRESS
2-
BUI'LDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
� �. �
O
r.
?( _�� � ,� .•odd
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEAL H
-...... . . .. .... -- .-.OF....... A4... .................
Appliratiun -fur 43iupuual Works Tomitrurtiou Prrutit
Application is her made for a Per,
er it to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst
7...... ................. ..................... ....
-... • •••---••--..... --- tAddress o
a-2.-------. - •--c .
w Address
rW-1 •---------------- ••-•----•-••-----•--------•• ••---•--..._...`:-----•---_._..-•-----------•-- ---------•----•--------._._._.. .. rlrGf {)_• -__-------
Installer Address
d Type of Building Size Lot............................Sq. eq
Dwelling—No. of Bedrooms_______________ ________________-___-_____Expansion,Attic ( ) Garbage Grinder
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures _______________________________ _ _ _
_ ---- -----------------------•----
W Design Flow_---------------t�.P.................gallons per person per day. Total daily flow___________ .__ _______I.5�-_ -__.gallons.
WSeptic Tank—Liquid capacity/'._O(:kallons Length---------------- Width-............... Diameter----------------- Depth_----_-___-_---.
x Disposal Trench—No...__.____f _..__ Width-------------------- Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No.16o0_{°'_4Diameter-------------------- Depth below inlet--- _____._ .__ Total leaching area-___--_-_-______._sq. ft.
z Other Distribution box ( ) Dosing tank ( )— d,,O. C _ :74-W l—a`/--a(
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-------_---------------
P4 -------- &--- --- ------
/ ` _ / -----
Descri tipn�of Soil-------------- .•�®----:4_�
Y ---- -
-C // fr'
W ; - -_-/ (s— �
x -------------------------------•------------------------------•-----------------------------------------•-••--•-------------------------------------•--------•••----•--•--•---•---------•--•----___-----
V 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 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 issu d by the boa .
Signe - --- _-- -•--..__.-•------••----••-----.pg.= U ��P m�
...-••-- ...`.
Date
Application Approved BY......... -------------- �� �� � .
Date
Application Disapproved for the following reasons_..............................._..............................._----------------__..............................
.....................•---••------•---....----.._._....--------•--------...--•••-•-•-.._..--------•----•-------___-•--------------------•------•----------------•---••------------•-••---•---------------
Date
Permit No......................................................... Issued_-- e--- f t
Date
No.0................ Fizu /6)
THE COMMONWEALTH OF MASSACHUSETTS
BOARD . HEAL H
... ._......_OF................Z>44. .. ................
Apphration -for Bigpoiial Workii Towitrurtiou Vrruift
Application is her made for a Per 7,to Construct or Repair an Individual Sewage Disposal
Syst it: r
�c
.. .I.... ...
..............
.................................. ....... ------------------------- ----------------- ...... --------
Address t No. I
..................... ...... ........ --- -- ......................... .........................
'_> 'e ----- ................
W �4' _ Add Tess
.... . .... __A
.................. .................. ....... ............... ........................... ........................ . ...............
Installer Address
U Type of Building Size Lot_ ......._•...............Sq et
—3
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
Other—Type of Building ---------------------------- No. of persons_.._._..__..._____._......_. Showers Cafeteria
Otherfixtures ---------------------------------------------------------------------------------- ------------------------------------------------------------------
Design Flow--------------_--2--C)-----------_----gallons per person per day. Total daily flow------------4---0----------------------gallons.
9 Septic Tank—Liquid cal)aCitV-AFR(.�allons Length________________ Width.__......._... Diameter__--__-------_ Depth--- ------------
Disposal Trench—No- ------- ------- Width____________________ Total Length-._.........____.__. Total leaching area--------------------sq. ft.
16 r_-�0 _� ........... Depth below inlet-.Seepage Pit No-------------------4iameter......... Total leaching area-------- ....._Sq. ft.
Other Distribution box ( ) Dosing tank .7-40 .9-2-/- n"
Percolation Test Results Performed by------------_------------------------------------------------------------ Date________------------------.----_-------.
,� Test Pit No. 1----------------minutes per inch Depth of Test Pit........__._.....___ Depth to -round water------------------------
f� Test Pit No. 2................minutes per inch Depth of Test Pit...______.._...._.._ Depth to ground water-_._..._.__-_-----_-___.
pi ------------ P
0 'ii�-!!.. . ... ... . ................. -------------------------------------
Descr* I'/-- 44�.X;_;
i tin Soil _/--- .... . ... ...... ...... -- --------- ------------------------------
Z----- lJ ----------------------------------
------ ------
4-
-------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------- ..........................
U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------- ------------------_-__-------------------
-------------------------------------I-----------------------------------------------------------------------------------------------------------------------------------------------------------
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 issu by the board_-,Qf-hr*h.
7 Sgne
l
i . ....... - ------------------------------------------------------- ........................
Date
Application Approved By......... -- - ------ - --- ... .. . .. .... ... ..
Date
Application Disapproved for the following reasons:.-_-----------------_----------------------------------------------------------------------------------------
...................... ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued-------------------------------------------.............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
....OF, ...................I.........................
Q.Trdifiratr of 0111mPhatta
THIS Il 70 CER)-IFY, That the Individual Sewage Disposal System constructed �orRepaired
by---=....... ......... ...... ------ ------------- ----
fa -
I all
i-
ez_ -
---- .. ........ . = - -----
has been 1i"ns`talled in accordance with the provisions of I of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No . ......... ------------- dated'..J.4..... -7-ic...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
7
BOARD OF HEALTH
?h
OF..........
........................................
N . ...... FEE..../... ...........
'Ton,5trurtion Vrrmit
PermissionZ's h eby granted_._...--- ........... ..................................... ..............................................
to Constrrtict or Repair stem an In SeNvageDinsa�1-7sS. r
.........
at No..%.V �0�-------ip (—.f .....f!7i--- ----- .. ...........................................
Street
117
n P I --- .......
as shown on the application for Disposal Works Construction it N0--
---- -- ---- ---14 ------------------------------------
oar oHe
I 7et
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
o ri l°LQ " h L-e dl ,r,,i i f� C� Ong. T R v C T
j Bed v00
AID C7Qt�h+aJ� �i5��a3Gl
JL T-/c
1,3 3'"(6 7a Ma s i. Er7 V A-oY7 7?7
�o � ,� / - / o0 col /c�ch
,Lot 9 /s oii t ,Sy. F¢. U
It
21,
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to
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ON a�
I CERTIFY THAT THIS PLAN SHOWS
\ ,� THE ACTUAL LOCATION OF THE
STRUCTURE ON THE LAND AND
THAT IT CONFOR?46 WITH THE
4° 4 BY-LAWS OF THE "'OWN
D�
7 ,r, 00 ,
PLAN OF LAND
A V a I N
OWNED BY
13
FRANK RANK
FRANK CONERY 3 TitEl'dTON ST.
_ < � � .
CONERY CONERY HYANNIS, MASK.. 02601
No. 6573 Q 4 J NO. 6232 t�kGIST�ilt$t)idNGiW&U!� 6t LAND SURVEYOR
��G/5Ts���wk, '¢�P/STSV�p
Fssi � 4*0 V�� SCALE 1 IN "i2o F`i•. ��C � /.9 7 U�tALEI� SUS
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