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HomeMy WebLinkAbout0050 HAMDEN CIRCLE - Health Sd 14amd.en Ci r., "Itir a91 - I8'3 i 2008 ANNUAL REPORT L 0 C,A T.LO N ,,. SS/EWAGE PER Vil L Ad E INS TA LLE.R'S NAME & ADDRESS ,BUILDER OR OWNER ' DATE' PERMIT ISSUED 0ATE COMPLIANCE ISSUED i rz 1 s: ' 1 r Y f 1 No..... ..............:.........`� THE COMMONWEALTH OF MASSACHUSETTS BOARD F• HEAL H ....OF....... .. .. .. . Appliration for Disposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systen at: ..................... - ..... Fe A .pApLo^ ti Address or Lot No. • $i�R�a (,.�'�� a�f -+ ner '!���`� --__-__--•-- Address '...�� Installer Address Type o Building Size Lot_/�, W___Sq. feet U Dwelling—No. of .Bedrooms______________.............................ExpansioV ttic ( ) Garbage Grinder ( ) Other—T e of But.in ��n�� No. of ersons_- - a —Type g _' _ p Showers ( ) — Cafeteria ( ) Otherfixtures ..........................................................................•••--- W Desi n Flow______________ _ ___ .._.___:_gallons per person per Aay. Total da•lypow._____._.__ _ _ _ gallons. g - WSeptic Tank—Liquid capacity.1 gallons Length____.®®_ Width___- .--- Diameter________________ Depth................ x Disposal Trench—No...................... Width-!........I........ Total Length....... _y__. _ Total leaching area____.__ __.___.___sq. ft. Seepage Pit No-------1_._.------- Diameter...6' ____ Depth below inlet...., ...... Total leaching area_ 3;�sq. ft. Z Other Distribution box (,��}- osing tank. - '� Percolation Test Results Performed by________ _ _______ __ _ . _. Date...... a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.....:-----------_------ Test Pit No. 2.................,m mutes per inch Depth of Test Pit____________________ Depth to ground water._ _ P4 0 Description-of Soil.------ _�✓ --. P!Tl .-----•-••--------------------•------------•--------------. -------------------------•-•---- t, •••----------- •------------•------------------ 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 iITILE 5 of the State Sanitary Code— The undersigned further rees not to place the system in operation until a Certificate of Compliance has bee ssued by the boar eftealth. P Date Application Approved By.......--- -•••- � -- Date Application Disapproved for the following reasons:............................------------------------------------------------------------------•................. ..------••-•--....-•••-----•••....--•---••-•_.----••••---------••--•••--•-••--•--.._..---•------------ ---------------------------•--• -•-•------•--• �. •�� � Date PermitNo................-`••-------------•---=--..._...--------_. Issued_....................................................... Date No.... .f r....... FEs........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H " ... e ............. OF.... tee?' Appliration for Dispas al Warks Tontrn.rtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �� Looation�-Address or Lot No. e. -•0�w •vs•'�;x:-• �, t- ,�.• j,�rner ••F � c=a'.. :-_ r c° =;.-.._S.S ,F...... a .......... ==� -ram —{ � -`-�`=44- ..... __-_-•------- ..........s�. _Adcf an... ............................•---- c6eInstaller Address Type o/B euilding Size Lot. t )....Sq. feet U Dwelling—No. of Bedrooms__________ ______________________________Expansionttic ( ) Garbage Grinder ( ) �4 Other—Type of Building1�# 'n,r �. 4AA No. of ersons_______ __________________ Showers Cafeteria d Other fixtures :--------- ---------•-•-••-•--••-----_------ W Desi Flow____.__ __.__' _ gallons per person er,da Total daily ow ................gallons. ]m �--•-------- ----g P P P Y• Y W• Septic Tank—Liquid capacity.1Mgallons Length_______.,_._ Width....fi........ Diameter ____ ___ Depth................ x Disposal TrenchLio .................... Width t ______ Total Length ___ Total leaching area........ ..sq. ft. - SeepagePit No_____ _____ _____ Diameter__ _, _._. Depth below inlet _, +._._._. Total leaching area.,,' s ft. � P g ro.. q z Other Distribution box ). Dosing tank ( ) . . '-' Percolation Test Results Performed by.. .Al do-Z _ _ ._ ; __ 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.. _ e .q ,. . D Description of Soil - k"t ..--•--------------------------------------------------------- x 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 TITIE 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/,�' } geed " ... t .... -r�-- - 2*- Date Application Approved BY - l' = -. .. .. `_--------- % Date Application Disapproved for the following reasons:................................................................................................................ -----------------------------•---•----••--•-••-------------•-...-------------••---••-•------•-----------•.._..•••-------•----•-------------------------------------------•---------=----•------••...................... Date Permit No......................................................... Issued_..................................................... - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (Irrtifirxtr of Tontpliana THIS)IS TO CERTIFY, That the Iddividual Seepage Disposal System constructed ('" ) or Repairedir ( ) Installer at............. f. ... J has been installed in accordance with the provisions of TI 5 of The State Santtar Code as d scrib d in the application for Disposal Works Construction Permit No.___ �____. ._ - dated..... ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............l Ins ector......_. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No .....�..:-,. .....: OF..... �`.af :, .: = :- FEE ... Mapollat for s wonstrwtion .rrntitf Permis 'on is hereb ranted - .E f�i-- -r 11 � - _ to Constr Repa ) an,In ' ual Se T e D)isp sal Syst at No._ ", ----- --- ..-�-- ------------ ______-__- - .. .....•- 2- Street -- Street / as shown on t application for Disposal Works Construction NtN __________________ Dated.._ _' lo �_7 -________ k__ _.___ ____.--------------.._••_______..._._.__...... aBoard of ealth DATE--- -----...7..f.....----•-------•--•----•------- a FORM 1255 .HOBBS & WARREN, INC.. PUBLISHERS - TOWN OF BARNST BLE LOCATION SEWAGE # 0� VILLAGE ASSESSOR'S MAP & LOTAI L'� $ INSTALLER'S NAME & PHONE N SEPTIC TANK CAPACITY U U LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER n BUILDER OR OWNER .,c3lry�o. S l _ C) O V7 DATE PERMIT ISSUED: - d1 ® 9� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No / a..� s �� i �s ri, �� �� 0� � ..� � '� C a _ � ... lr ��, �. ' r i Act � APPROVED THE COMMONWEALTH OF MASSACHUSETTS i rns ble tan BOARD OF HEALTH y OWN OF BARNSTABLE Tigned Date e ,Appliratinn for Divi-pm5al Wor1w Tnnitrnr#inn rumit Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal System at: ` ••-_-•Loc � i-:ddress [ ,�.r�L^ot No. ..................---`'• r•._._.....-•-;----- •----• --------•- Ow er ,� �r s - \�O_ `'�---.... --- Mom_.. --- ...fit.----- ... t..... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms------- _ _.-•---__-_.-___Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' 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 by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.--_-----_-_____.___.-. (i Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------- ---------- ------------•--••---•------•••---••••----•-------•-------------------•---•-------•----._..................................... 0 Description of Soil .............................................................................................................................. V ------. --- -- • -----•-•- ---------------------------------------------------------------------------------------------•••...---.................. . -------------------- ..............................----------•- --•---------------------....----------------------------------•••--•--•------------------------•-••--•••••••-••-••-•••. ----- o 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 Envi mental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co p •nnce h2 men issue))Z= . e� Signe - Dace —93 Application Approved By ............... . --...E' ..� ------------------ -----� .��.�.._....... / J Date Application Disapproved for the following reasonr- ------- ------------------------------------------ --------------------------------------------------------_---- -- - --------------------------------------- - ..------------.. - - ------------------------- ..... ---- ------------- .-.. ------------------------.. . . .----- ... ........I... qq Date Permit No. ........../-- ._" .......... ............ Issued ........_�- -P. ............. Date g3 _ THE COMMONWEALTH OF MASSACHUSETTS V / BOARD OF HEALTH j �/s-�TOWN OF BARNSTABLE �J Appliration for Divjipuittl Works Tomitrurfiun 1rrmit Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal System at ���` , Loc�tfiol ddr,ss ,,O 7 or Lot No. �C �� ......................_.......--- �---------------------------- ----- i _ ....... ........... ......------. Ow er ,fl � 1�rldr�s a .....0 -'...... `I✓ I ,. ......_ 1-(�Gti � ` ........ •.. --•-- .. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------3---------------------------.--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther 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 ( ) aPercolation Test Results Performed by-.--...................................................................... Date........................................ ,..a Test Pit No. 1................minutes per inch Depth of Test Pit.-._---...______---- Depth to ground water.......... f1 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 --••----•..............•----------•-------•-------••-----•---••-••••----•-•-••---•-••-------._...•--......................................................... O Description of Soil-------- ... __ --•---•-•-- ' - U --------------------------------------------•.... •---•...--•---------------••.... ---------•-------•---•--•----------•-•-•-••-•------•-•-••---•------•--••--• 11 W .ro (as x --------------------•------------------------------------------------ --------------------------------------- a 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 Envi i mental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co ply nce h s den issued by the boar of heallth. ) , n , 'L-- Signe ..- .. ._..............._.J..T-�.!`!.._.............. ------- ........................................ . Dare Application Approved BY •4,,....--, .---------------------------------------------------------------- -----1 a` ----3--^-1 Application Disapproved for the following reasons- ------------------------------------------------------------------------------------------------------------ �. ...... ................... ...... . .......... ..... ............-. G / � Date Permit No. l.. = /.. .�......... Issued ..........�.... ...".....3 -9-�------------ Date THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE ' (frdifictt#E of (foraplianre THIS43)TOYC\R IFY,That the I dividual Sewage Dis''p I System constructed ( ) or Repaired (L__< by -----..........� ..a----- -------------------------------......- --- - - --- ..._ C 1 3( sr Iler 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. -----73-,6---5-1---_------- dated ------------------------------------------_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------ -------t '.. ..1. ..^...[.._ ----------------------- Inspector ------------- --------------------------------------------- Q 5 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE.....-�.o...---.. 'Biup,g�oat or , Tunut u i.%Vr mjit Permission is hereby granted `� ' `---•..- -•--•• ........ -V0....... ` L..........................•-----------•.......----•--- to Construct ( ) or Repair Ir�dividual Sewage Disposal Sym ste atNo....••-----•--•••-- ..��---e..... � an--...--- ...........�'---......-•--••--•------ -- .....................................................................\ '---------•------------- Street / as shown on the application for Disposal Works Construction Permit No,�,3'�_ Dated----- _ `....f.3.--._..._ am ` a _1 ----- -----------------------------------------------•-- B�...� oard of Health DATE........ .. .. .............................................. FORM 36508 HOSES R WARREN.INC..PUBLISHERS �FELFI/• .l_ � FINISH CVAD.-• MYS FINISH GrA'VE FINiS'N 6ffgv441 - -- -- — __- - r F 0 v6R •'r.4 NK = I 1 14 OvER hiT Jl y Q \ To of FowNp. CcE✓.s i�x5. 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