HomeMy WebLinkAbout0205 OCEAN VIEW AVENUE - Health (2) 205 OceanViem,/Ave!fi � �G
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No. Z � �� Fee------- -------
BOARD OF HEALTH
TOWN OF BARNSTABLE
ApplicationArIetr CootructionAermit
Application is hereby made for a permit to Con�str}�ct Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
� � Owner Address
5 o
------- ----- ---------- V0----- --------------
Installer — Drille- Address
Type of Building
Dwelling -
Other - Type of Building ------ No. of Personss---- ---------____
Type of Well `'� Capacity ---
Purpose of
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until rY icat liance has been issued by the Board of Health.
Signe — jO,a ,`Z
late
Application Approved By date
Application Disapproved for the following reasons:
_ �.__ ----------- date `-
Permit No. — Issued --- -- - ---
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructedb� ), Altered ( ), or Repaired ( )
by — --- --- — --- - —
Installer
at G f1 V =0 Li -----_----
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.W�� �= Dated—A-r�LO2
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------ Inspector
NO. � Fee—
_ BOARD OF HEALTH
TOWN OF BARNSTABLE
0(pptication-forM,Oil Congtructionpermit
Application is hereby made for a permit to Constr ct Alter ( ), or Repair ( )an individual Well at:
Location` Address Assessors Map and Parcel
Owner Address
0 V1411
_ — — Installer.— Driller Address
Type of Building
Dwelling -
Other - Type of Building------------ No. of Persons—
Type of Well r95e' -- Capacity---/.5—�'L-'�--__
Purpose of Well
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until rt' icat oliance has been issued by the Board of Health.
Signe 7 — te
--
Application Approved By.
date
Application Disapproved for the following reasons: ------------ ------ -----
- -- ------- date --
Permit No. --_ Issued— ----------------_—_.__ ----____--
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate (Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ), Altered ( ), or Repaired ( )
by
Installer (�
at--_ D �� r�V S:has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.WRCS -=�e� Dated— l-I SVLUZ
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-- — Inspector _—_----
BOARD OF HEALTH
TOWN OF BARNSTABLE
i
Vern Con5truct ion Permit
No. ---- Fee— ---
Permission is hereby granted -- ----------------
to Construct'(4 Alter ( ), or Repair ( ) an Individual Well at:
No. 2 a c t", �6-2 C(:�)AA�I ---
-- -----------------------------
Street
as shown on the application for a Well Construction Permit }
No.- �"� Z y� - Datedu
Board of Health
DATE ��)C-) -
TOWN OF BARNSTABLE
LOCATION SEWAGE # F-T�<-�
VILLAGE ASSESSOR'S MAP SZ LOT
,
INSTALLER'S NAME 6: PHONE N0.10it---
SEPTIC TANK CAPACITY /Ga e e 6-9
.LEACHING FACILITY:(type) 1aZCH3-7- /�i T (size) /3
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER/Gd�/e-
BUILDER 'E•R .. ~.
DATE PERMIT ISSUED: 0 f� �•
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
P
p�O
fj
`a
1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 9F HEALTH
1. ...............................OF....... .. ....................... -------------------------------------
ApplirFation for Disposal Works Tnnstrurtiun Prrmit
Application-is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
qq
1.,�pation ,Address ` or Lot No.
......... .................................... .-C.............---•-----......------.................•.•...•....-•.....
Ads Owner Address
.......... ..........
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures -------------------------------- .
W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons.
Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter..........-..... Depth................
Disposal Trench—No..................... Width..............._..... Total Length.................... Total leaching area....................sq. ft.
3 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.....................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-----------------------------------------------------------------------------------------•••••_..............................................................
0 Description of Soil.................................................................................................................. .....................................................
x
U -------------------•------------------...•-•--•-----•------------------.......----•---_..._.•••---------...------------.....----------•------•------...................................................
...........................................•.---....._. .....------..._......_......................---.........J-------------------------------------i---------......................................
U Nature of epairs or Alterations—Answer when applicable._..I- '. !#?_/X_.T 7l /0�� T
----- ------- -
��
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i: .L
p S of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the_board of lth.
Signe _ ...._._ .
4� Date
Application Approved By------------i ..�------------------------------- ----------
Date
Application Disapproved for the following reasons:................................................................................................................
---------------------------------•--------•-----------------•-------------•------•-......-----------•---•-----------------------••-----------------------------------------•---------------------•--•---
Date
PermitNo-------- - - -------------- Issued-.......................................................
x ;jazz
FEs.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ram.............OF....... /�'
........./Zs�.
Appliratiutt for Uispoii al Works Toustrurtion umit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: r..r
..:.�:a_.�..
rC�� wr � � v� f �
........ ------ -" -•- -------- -----�t,.'..s....-`�t.....�.................................................................
l.o a`ion-Address or Lot No.
............................................... ....... ......................... ......-----......_.....•..----------.....----•---------...-----------------------------...------
I' A, Owner Address
Installer Address
d Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms................................ .....Expansion Attic (. ) Garbage Grinder ( )U
aOther—Type of Building ............................ No. of persons._.._______......_____.._ <awers ( ) — Cafeteria ( )
Otherfixtures ----------------•------------------•------------------------....-----------------------------------•......-•---•--•-•-----•-.
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
9 _ Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
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.....................
__-
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......................
a -------•--------------------------------------------------------------------------------------------.........................................----------------
ODescription of Soil.......................................................................................................................................................................
x
U ---•------•---------••--------------•.......-----------------------------------------------...----------------•---------....--•---------------•-•--•-- .................................................
UW ----------------------------------------------------------------------------------------------..................r.......................................................................................
Nature of Repairs or Alterations—Answer when applicable...............................................rc::_......._...... . s-------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions Df iI` .c=. 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. �-
Stgned. r .................. .............................�r
Date
Application Approved By------...... ................................ -------•--
Date
Application Disapproved for the following reasons:..............................................................................................................
-------------------------•-----------........._...-----------...----.....------------........--------------------...........---------------•----••-------------------•-•••----•---------••--•-----------
Date
Permit No-------- _�'__- -` .._ ---------------- Issued-------•-----------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ f
Z. ......OF. �1_�._�^:.:a--....... `:�'��ri-
C�rrtif iratr of TompliFattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
f-'7 �%'.
'> /`." G/t i i�C'" � %(.mod . " ..
has been installed in accordance with the provisions of TLITIZ 5 of The State Sanitary Code as described in the
application for.Disposal Works Construction Permit No.__..,..[5 ..-_�a.� ..... dated_--.____-__................. ..................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............,�...'. ... .?J..................................... Inspector.....--...........W_j:�..------..........------.................--.-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Sri - .1 ..........����:�'/•� 0 ......................................
f��;�-_�-,.•���.����................................ --
NO...t� !_,.:.fa a FEE-.e....>...............
r
Disposal Worko Ouonutrurtiurt prrmft
Permission is hereby granted�•) ----------------------------•17z--
to Construct ( ) or Repair (. w an Individual Sewage Disposal System
at No........R-4-'--- 1_ i
- •---......---•-----------------L--�----i---j---------------•-•-..............----------.........
Street
as shown on the application for Disposal Works Construction Permit No.&I Dated..........................................
----------------------------- -.s---- ............................................
B9ard of Health
DATE.................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS