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HomeMy WebLinkAbout0028 CROOKED POND ROAD - Health 28 Crooked Pond Road Hyannis, NIA. 02601 A = 291-153 r TOWN OF BARNSTABLE LOCATION r'(jn k/-�,O ��- ;,,���SEWAGE # VILLAGE y /�(� (,'S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P(Z �� � Pr�(size) t (' NO. OF BEDROOMS PRIVATE WELL OR P LIC WA R ' BUILDER OR OWNER �,),_)c, n f2 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No , I iI ,4 RFA T CL v r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE , pplirathut for Dhipvii ai 10orkii Tnnitrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ,S_..... �oOIf ec 9..................... ....... .................. 1 ..0 -----------.-...-------------- ,fJ ` - Loca' n-Addresst �` or Lot No. ................1 v 1[, .OL.?.G►!�. Cam, ..........................•-----................... Owner Address ` a �� •!Q��� L\AL_4l_]�...�.C1 .�. (�.sc �� �� �..... ` �(p.........�!.`!'!�L_S Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms......3....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------------- --------------•----------------•-•--.------------------------------------------------------........---------.....------------------. w Design Flow.._......_.?_12�5 .................gallons per person per day. Total daily flow...... _iCD......................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.......LC? Depth below inlet....j(g�.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................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........................ a •---------------------------------------•--•--•------------........-----._........-----------_-•-•--......................................................... 0 Description of Soil........................................................................................................................................=.............................. x U ----------------------------------------••------------------.._._..._...-----------•---------------------------------------------•------------------•--------•----•-••--••--------------•--------------- w x --------------- U Nature of a �rs or Alterations—Answer when applicable.._____ .)Q__.._..Qlv_ _.__.__ �a__._( x.0............... ..------..C� 'a- -SOU Q+ c .(d S -S - ------------------------------------------.................... 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 Compliancehas bee issued bv the board Af health. Signed ----------:�............. . .:... ......... ...:..... ........ ....---- = �— . .�u� - Date Application Approved By ................. � �1....: � ---- Date Application Disapproved for the following reasons• ------------------- --- - --------------------------------------------- -------------------------- --------------------- ------------------------------------------------------------------------------------------------- ---------------- ---- -------------------------------------- -------------------------------------- ........... ...................... G�/ Dace PermitNo. .. 1.6- ....... .r ............................ Issued ------------------ -- ----------.......-- ------ Date R. No..,���...:. _� ©........... -•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Elhipati al Workri T11amtrurttnaa ramit Application_is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ......... ........... --•--- ------- ------------------ ............................................. _ Loca' ri-Address or Lot No. ............... v.�.. •..�i �._._.3'.�/...................... S)oE�_!CG!�-._:.................................................... Owner �s( ` rr r� - ------ ----- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......3.........._......................Expansion Attic ( ) Garbage Grinder ( ) W`k Other-T e of Building ....._..... No. of persons............................ Showers YP g.--------------= P - ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------••------------------------------------------- ---------------------------------- .------------ ---•.......... W Design Flow....•.......?._-..T ...................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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------- ---------------------•-•--------------••--------•----------....---------•................................................................ 0 Description of Soil.................................................................................................................. ..................................................... x V .•--•-•-••-•---•-----••-•••--------•-----••....•--•---••---•----------•-•--••---•••--•------•-••------•--•-••-•-----••••••-••-----------•......-•--••-•-------•..................................... W ---------------------------------------------------------------------------------------------------------------------------` = x Nature of Repairs or Alterations—Answer when applicable--------- ____ ` ................0 J---,,/...... f�1 S.l.%.•cam.......... S_7.TiN� 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 Complian_ ce has been issued by the board f health. Signed- - i`-- -- \r c% _-\.... �_7 - -- ---------------------- `- y T _ y— __. -� _.Date Application Approved BY ............:.:.. � t ...................... ..------------. :................ -------- Dare fir'pl Application Disapproved for the following reasons- ......................................................--------------------- ....................................................... ------------------------------......................................................---------------------------------------- --------------------------- ------------------ ---------------------- -------------------- ------------------ C�// - Date PermitNo. ..--J l -r--..�)---............................ Issued ......................-------._. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#tftca to of CfIImyitttlare THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by--------------------------- ......5... l (..................---------------------- -----------....----.... ....................... .--------- at -----------------------------------------� = '�- ..�(..Q.-.<.� -cc 0O.K - - ram .. C ............................................... 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. ------ 91...........3.a.7------- dated ....-- .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. i DATE------------------- ----....._...-- - ... Inspector ................... -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No TOWN OF BARNSTABLE .._. �:.. FEE.32............. ��7 Biquisatl Vorkn Tullnotrudivit rrmit Permission is hereby granted.............C�•A �a....L.A.!Yn...._S ._ r._C- to Construct ( ) or Repair ( �c) an Individual Sewage Disposal System at No... �� . ...... 4t..r _V"� v0(v ........................................................ Street as shown on the application for Disposal Works Construction Permit No.l_______._._./..__ Dated.......................................... 1 Board of Health DATE `..(� l_� '4 FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS 4/5/2018 AsBuilt TOWN OF BARNSTABLE LOCATION ,AZ C60 k,,Q -SEWAGE iV VILLAGE_� �(� ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. 0— A L--A tiL0 ( L SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 2� �{ ��,� -P4� (size) NO. OF BEDROOMS .3 PRIVATE WELL OR PlrLIC WA R BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 'FSSpoa_ http://issgl2/intranet/propdata/prebuilt.aspx?mappar=291153&seq=1 1/2