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Home My WebLink About0092 OLD KINGS ROAD - Health _ _ - _ _ _ _ ( 9 --71 2 OLD KINGS RFOCOTUIT A= sM Fee---------=Y-------- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplication-*rVell Con5tructionPermit Applic tion is here y de for a permit to Con truct (:/), Alter ( ), or Repair ( )an ' dividual Well at: ----��_-O/ �w�� -------------�Z z -c�� - - ------------- ---------- ----------------------------- Location — Address Assessor,Map and Parcel ------- /C' •NO� ��_f /�fil/ - --- — QS'/P --------�----�------------- — -- ------------------ Owner a Address Installer Driller Address Type of Building Dwelling— —- - -- - —- - Other - Type of Building------------------------- No. of Persons------------------- --------_ Type of Well �� ---------------------------------- YP -- — -------- Capacity--------------------------- 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 a Certificate,.of Compliance has been issued by the Board of Health. Signed—�6l� Ge �°—— -- •�"r � date � C� Application Approved By 2--% --�- — -------—— date Application Disapproved for the following reasons: ------------- -- -- --- --------------------------------------------------- date Permit No. �o ---- Issued----- -— ------ ---- - - - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (/), Altered ( ), or Repaired ( ) Installer at- �d` D/ �it/9s All ------- 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 Dated = =O¢ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -- - -- Inspector-- ——-- - ------------ , J Fee------ ----- BOARD OF HEALTH TOWN OF BARNSTABLE p fuat onArVelf•C horuttion erntit Applic ti- Is here y made for,a'permit to Construct, (�); Alter ( ) or Repair ( )an ' dividual Well at:' Locehon Address , Assessors Map and Parcel >�r i Y Owner Address w �/ D, � �� - - -� -------------- -------- i� Installer — Driller Address Type of Building > Dwelling —--------------------------- ------------ Other - Type of Building--- - -=— - - = No. of Persons.--,. -. - --=------- • Type.of Well Capacity-- ---------------- ---------------- ---- - 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'a Certificate .of Compliance has been issued by the Board.of Health.. , Signed �6 : /e, date � . Application Approved By � � -------- �- ___� -� —� ( date Application'Disapproved for the.following reasons: -----= --------- --; — ----- = - --- ------ ----- — - - - -------- date Permit No. Issued------ - ------------- ---— - date �aete:.�trxbae+eaaa eew:salr.d.F:ai+a as:.w aasx�arx«:ro?::sre_a�asath.�s�:n:a,:�aratoe aRi:�aa�aQa�sss+aeranar�a essea aaes4aesi.x�u�tsla!wea�ae�svese:»coceae:ea:se.�ve a«eaeaea cs e.eaas BOARD OF HEALTH TOWN ' OF BARNSTABL E C ertf sate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (/); Altered ( ), or'Repaired'( .) f7leerl i� LUG`// 011 i 111A - by -=- -------- ------ ----------: 1 Installer — has be-en'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. -�-'•--- Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION-SATISFACTORY. DATE- ---- - 7 Inspector-- —-— ------------------ -------—---- ..'?;:eti.w.ryes*+ae�.�reasaeas.�nvca::saw�sae:w:o:easata,ersa:amours!s'aii+na+e�a5arece*asae:.seaeaea+s._ncam�eaan``era}¢r.raera.a�aet��a2a�w.. .,.d+i�a.7d!a+�oTs'k:q:v4+%a...C!ay.6�� ewa+•�.Re.?�.=_ BOARD OF HEALTH TOWN OF BARNSTABL E Yell Contructionpennit No. - L; - Fee Permission is hereby granted to Construct (r ), Alter ( ), or Repair ( ) an Individual Well at: ' Street as shown on the application for a Well Construction Permit . � ��No.- �— Dated •..� Board of Health DATE-- = �= c7r7 . No. 9 1 1 ............ ............... l THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 9 .... ... ......................OF...................................... 1 Appliratiun for UiipusFal Workii C o"mitrurtiun amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: tto-se -0 -7 aZ ............. .t� . - .1 . .._ f._. =-----------------------------_. ...........----••........_•..._....----•- Location-Ad�ress -- .� ., ,c p:a o�, 1� . _ ......__. Owner ddress c Installer Address S feet Type f Building Size Lot............................ q. Dwelling—No. of Bedrooms..- 3�................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------------------------------------------------------------------------••--------•--•--------------.. W Design Flow............................................gallons per person per-day. Total daily flow---..-.--.-.-.-_-------.--................gallons. WSeptic 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.-.-.-----.--------.--- 0-4 G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ --------------------------------------------------------------------------------------------•.---•••......................................................... ODescription of Soil........................................................................................................................................................................ x .---------------------------------------------------------------------.-------•••............................................. ........................................................................ w Z. 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 TITLi- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Cer 'ficate of Compliance has been issued_by the board of he J�J Signed ----- /`'`' ---................................ --------------------------- 117. ... ......... �J t Application Approved BY ........... .... ---- .............. Date Application Disapproved for the following reasons-------------------•---- -----•----••----- ---•------•---••-----• ••-----•-•---•-•-----....._....---- .......-•------------•••--•••--•-•------...---•---------•-•--------------•-----•......-------•---------•.--------------....•------------------•-••---•-----•-------•-----•----•--------.....-----...•--- Date PermitNo......................................................... Issued........................................................ Date f� No.----.,ilt� } FEx............._..... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF:�..................................... Ani iration for Disposal Works Tuttitrurtiutt Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -•- , /_.. : c :.....c .................................................................................... or Lot No r` Location-A ress Owners . / Addressss/��- .. . .. . __-..._.. A.......... .............................. ......... ....... ..._.........._..... Installer Address Type f Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms ................................Ex Expansion Attic P ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 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 ( ) WPercolation Test Results Performed by.......................................................................... Date........................................ l- 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 ................................=............................................................................................................................. Description of Soil x U -----------••-•......................................I............................................................................. 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 TITILj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the board of h Signedwiw.-•_-. ........... = Application Approved BY ✓.. / �. ---- ----------------- n ------------•- `ry� to Application Disapproved for the following reasons: -----x/ .............. .........-•-----------------------•---•---•--•-•--•----------...----.....-----•-----...----•------...----•------•-•-------•--------•--•---------••----•-•--••-•----------------•------•-----•----••-•--- Date PermitNo.......................................................-- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............j.............. .......1.OF..................................................................................... �rr#if irab of ftlantplittitrr THIS S TO C RTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .. �-�'"..... ----------------•------•------- ------------------•---------------------•---•------ ----------------------•-------------- y, / �.; at............. .I---._j...5ef�w? t Installer y — 4 -- . . has been installed in accordance with the provisions of fITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No .....�. _JJ__r�.............. dated--------........................................ OY THE ISSUANCE OF THIS CERTIFICATE SHAL N' # CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ _Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F............_...................... ............._................................. FEE... -........ • �i��, 1 irk �� inn rruti� ro Permission is hereby granted....., .......... '::----------•---------•----••-------------------•-•----.........---...............--•-•- to Construct ( ) or Repair ( ) a .......................................... I..............divi u 1 SeVrage Dispo S stem ..... ..............0 .............1.11 Street as shown on the application for Disposal Works Construction Permit No..................... Dated...................................... ------------- ---------------- -.---- �rs�! f ealth DATE......... FORM 1255 A. M. SULKIN, INC., BOSTON - .. LO CATION S f� S E W A G E PERMIT NO. je'& VILLAGE 9 �/ C�o-firlr 'A(ff5- I N S T A LLER'S NAME i ADDRESS tz R U I L D E R OR OWNER 19 S • DA T E P ERMIT ISSU E D �--l3— dhc � DAT E COMPLIANCE ISSUED g T �.� i 0 1,� e ,� � 'f,-•gel+ ,.r �' �atc {S itt Y� M• , • j. t , -N 0T TO _ �1. 0 f/N/S°y G�r'F,70E OVE,�' 3 E _ L, Q �3 OAST. D /70E OVE,E' ,,.. F/N/SN k'/70E OVER .� X, � d a �SE.o7/C T .tom 150`, . f / .o�PEC.9S T , MO.PTAiP 7-47 . Q •-=— a- r_ TE =COVE,Q ® CONC.PE ,. s / /2 _ .BELOh/ G••P,�7L�E c EV L x p OUTLET �/.oE L E ► .., a FOiP 2 M/N. v .P. ..ao :. ,� o .o• p o.c,. . . ' p d O TONE' a. 3 �.. 4 , P R 40 A x > r.� G ;♦ �. N. o• Y.:•o a . .Af , 'T g s e .. a c • a o a o ° .M R d n Y.C. i OUTG ET ' c _ o l CC ��L L O/�/ no L/ /4/i/ DX 6SMT. 1cXR. 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CSHANE' CONSTRUCTION CO. •"� � 'f� gg>x�•;,� 5��.{,+- - (fPRI ESERVE ,o/T ►9,<�E.F� ,. .*a LOT 100 OLD KING S ROAD G //_�Vi5iE7T Ed EV.gT/O/V , , �L O T 04/4rN BARNS TABLE -- CO TUI T — ' MASS . �i cH t�L CS I _�� ;cam ,t„,- •_ r� ,.• t I ,o pO.oE.PTY L/NE ;; t L:�TE• SEPT t 1 1984 , SCgL�'• .S° IVO r .. O .o O. a40lC 3•� rib , sv E OT' SE r'� s __ _