HomeMy WebLinkAbout0040 STUDLEY ROAD - Health 4.0 Studley Road
Hyannis
A= 306'017
No. ! Fee
THE COMMONWEALTH OF MASSACHUSETTS y Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye
ftPlication for Disposal opstem cons Urtion Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon OVEI Complete System ❑Individual Components
Location Address or Lot No. Owner'seJ7 Name,Address,and Tel.No.`s/
Crowle-
Assessor's Map/Parcel � a, S
I/n�s�taller'j/s_N,aar�e,Address,and Tel.No.,,'Z,8-9121 935! Designer's Name,Address,and Tel.No.
�r[7�Ti7 K76W �6'�S�f2�'eCc1�Lr+G °
Type of Building: CMUL, 7 1E
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)
Date last inspected:
Agreement:
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 n place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. �;
Signed Date ;�/�
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued ��
No. /✓ •. & _ Fee
THE COMMONWEALTH OFSMASSACHUSETTS Entered in computer: e
- ; PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Application for Mispdsal 6pstem (Construction Permit x�
Application for`a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ) ❑Complete System ❑Individual Components
Location Address or Lot No. ` / Owner's Name,Address,and Tel.No.'J�/-
Assessor's Map/Parcel '. j(p O( + 5 L?//G-) �!'owle- 2'�3 A#'0e.)L 51-•
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building: C.�t� � �� �j' 6
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
1•
Nature of Repairs or Alterations(Answer when applicable)
1
Date:last inspected: f
Agreement: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 place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signe Date / -4/t
Application Approved by - I Date
Application Disapproved by Date
for the following reasons
Permit No. r�--v/`y / Date Issued L
- =-------- '------------------------------------------------------------------------- _
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS I 7TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned )by ; n 6 vffte. :T�a G
at of has been constructed in accordance
with the provisions o Title 5 and the for Disposal System Construction Permit NQ�?�,/ 5 dated S _
Installer I �)640 TT1 L Designer
T.
#bedrooms Approved design�flow f gpd
The issuance of this fp rmii shall not be construed as a guarantee that the system will f ni6tionfas designed. ,/
Date1 Inspector /�_ J,�/ 0 w�
l s .
---------------------------------------------------------------------------------------------------------------------------------------
No. /— ! S Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction permit
Permission is hereby", granted ttoo/Construct( ) Repair( ) Upgrade( ) Abandon
System located at '�f�) �. j�y�tvT, i so 2
y,,.�
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:Construction must be omplet within three years of the date of this p rmit.
Date /� Approved by '
ICI _
TOWN OF BARNSTABLE i
LOCATION ��� SI P16 �C1 BZI�s SEWAGE #
VILLAG ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER-
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by 5C04 Vg6 u 62G Fse
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s � �
No..--tq.`�,... ( FRs.....�`�..................._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
e�Z(c I (D�� ...OF............. . ..
Appliratiuu -for Bi,ipwiai Hlorkii Tiami rurtiou Punfil
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
i System t
Location-Addres or Lot No.
------------ -----
Owner Address
. ..... .------------ ........................................................•.........................................
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -__----------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P4Other 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 ( ) IDosing tank ( )
aPercolation Test Results Performed by--------- ---------------------------------------------------------------- Date------------------------------------
,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...-__...__-_.--__-.__..
Gi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water---------------.--___._-
W ----------------------------------------------------------------•----------.._......--•--•----------.........................................................
0 Description of Soil------------_- ---------------------------------------------------------------------------------------------------------------------------------------------------
V --------------------------------------- --------- ----------------------- - - ----------------------------------------------------------------------------------
W ez�'
-------- ----------------_- Q ---
V Nature of Repairs or Iterations— saver when applicab ._-___�.:............_ __ ._ .__ ____ _IC -- -.___._
Agreement: "
The unders gned 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 is ed by the board of healtly
7J
� Date
Application Approved By----"----- -- ---------=----- - t ' -----------------
Date
Application Disapproved for the following reasons--------------------------
-----------------------------------------------------------------------------=-------••---------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued.--I.?•----f u.... ...ft-.......-----••-----.
Date
00
_5EW4C;EPERMIT UP.
iMSTNLLER 5 W&& AE ADDRESS-__
- -IbUILDER 5 Q &MF-
M,TE PERKA T 155UED -- Z Z
D ATE ,COKAPLI &MCE ISSUED — — —
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No. 1 S .... Fes$.... .._._�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TD—e-fe
�'f.. OF............. 2 --t.--------------------------------------
Appliration -for M_qpoiittl Worku Tonotrurtion Urrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System t /4 � ( j
-- ! !� _.... "' R /�_!. T :.-_..--•••-•--•-----------------••••-------
/Location-Addres / or Lot No.
/� h- �--------- '
r f Owner Address
a ------------ 7,
-------------------------------------------
Installer Address
dType of Building Size Lot____________________________Sq. feet
U Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons.-________-_________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures _______________________________ __
W Design Flow----_.......................................gallons per person per day. Total daily flow............................................gallons.
WSeptic T.tnk—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---__________-_____-___-
LL, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__-__-______________--_
R+ ••--------------------------------------------------------------------------------------•---•••••---....................................••-•.................
0 Description of Soil----------------------------------------------------------------------------------------------------------------------------------------------------------------------
...........
.....................
W "
`_2
--- ------•--
VNature of Repairs or !Alter tions—Blnswer when applicab ._-___l/____________ ___ __ ________� � __._.___---____-
.. ... . ....(..........i.....0421e.)�'V'w------ ------- ... . A� ..
Agreement: /
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is ed by the board of healthy
Sign .` '--------•-•--•---•---- - --------------------------------
Date
Application Approved By...- .........f- ---------------/j ,�� ''�' Y=✓- i ....................
---._..__... Date--------------
/ Date
Application Disapproved for the following reasons:-------•------------------------------------------------------•-----------•----------._...----••---•----•--••••-
_.._....-•-••----•---•------.....-•-•----•-----------------•---•-••---•-••-•-----------------•--•-•------•-------•----•••-------•--•---• ...............................................................
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
(,�'l!'e ........0F.....-...�... ... !,!!.'Ii.-✓Z........................................✓
rrtif irnfr of Tontlrliatta
TH -SY TO CERTIFY, Th t e Individual Sewage Disposal System constructed ( ) or Repaired
�•••• �'.bY-•--•-•- ------ v� - -- �- -;------1---staff--r---- ------- - -------------------------------------------------------••------
i
le
. J
has been installed in acc r ance with the provisions of i�:e1XI of The S e Sanitary Code as desc ed in the
application for Disposal Works Construction Permit N ........ ��___._._. dated_-_-_%_.'__7....�-�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A4GARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------------------------------------------------------------------------------- Inspector-- - -- -••-•--- -----•• ----- ... __. ..._. .
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
.....
Gr......�.��.............OF_..... .... !z�?
�i� l ork� r,Tonsf float Prrnfit
Permission is hereby grante -A - --y1/1�!f't�--•�.... .. .:... .... -------.............................................................
to Construe ) oad epair ( In 'jai al age Disp-:a Syste
r .
Street
as shown on the application for Disposal Works Cons ruction Pe mit a7 _7_____ Dated__ __`_._ _
- -----------------
77 ..
y ( _. 1 z ��- - -----------------•--•----------•-
y ��.J Board of Healt�,
DATE ._.....•-•....................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS