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HomeMy WebLinkAbout0678 PUTNAM AVENUE - Health 678 PUTNAM AVly-o - oil, - i THE COMMONWEALTH OF MASAtHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratinn for Bi-t-ipwial Ulurlui Tnn,itrnrtinn Vainit Application is hereby made for a Permit to Ynstruct ( ) or Repair 0*,4� an Individual Sewage Disposal System at: �................ ..Q.........l�. .a - &l. ............... ......T--....---•-------------------••---•-..---- Q 1 Location-Address b Q or Lot No. \vi1Cr ' \ ^ Ad �C \ . a yq Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms.__-_-- -----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.---_____--_-----_..._-_--._ Showers ( ) — Cafeteria ( ) Other fixtures _------------------ Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---_------------ Width---------------- Diameter......._._-_--- Depth................ x Disposal Trench—!Vo- -------------------- 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 ( ) .-4 Percolation Test Results Performed by.............................................................-............ Date........................................ ►.2 Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (X, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.-.-_-_--_-____----_--. a -•----- --- -----------------------------------------------------------------------------------------••---------•--•------••--•--•-•-••--........--- . 0 Description of Soil......... _ ------.e------------------------------------------------------------------------------------------------------------------------------ r......••------ U Nat e of Rep 'rs or Alteratio s—Answer wh n ppli 7-__^..____�o..______ _tJ.ri. 'fix • •vS:1 .. ...S�w w 2 ............ 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 Comp�ance has been issued by the boaI-yl^gf health. Signed . ..1LIJ.��. \;6- .. �'1°��- -' (I 7S ..... Date Application Approved By ...... ...�..'..a1-:,7`.s.... Date Application Disapproved for the following reasons= --- ----------------------------------------------......------._.-----------------------------------------------------.----- .................................................................._...............------------.._...---------....------ ---------...._------------------------------- --- ------ell .ra Date Permit No. -----7.5-..- I..r — 1 Issued ............... ...^... `I..^ s--------- ---------- Date . ,,, y THE COMMONWEALTH OF MASS�A, HUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allp iration for Ditipag al Work,6 To& ui Wti rrntit Application is hereby made for a Permit to Construct '`' , t+'PP y ( ) or Repair (" an Individual Sewage Disposal • System at ................ ....= tea- ,� ...... t= —� �t_ r. Location-Address ^ or-Lot (� j .p .. ..............--.. Y!��. ..........( L.GaT!Vol................................................... ` �•�4' r : W Owner Addre s ----- .�� �a � S r r � �nnG . as�y9 = lrna, t Installer Address UType of Building Size Lot....................... Sq. feet �., Dwelling—No. of Bedrooms........13---------------------_--------Expansion Attic,( ;) Garbage Grinder p., Other—Type of Building __________________--_-____- No. of ersons____-__-__--_________-----.- Showers P ( ) — Cafeteria 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 Pitt No________________--_. Diameter-__..-_-.__-.--._.-_ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) w Percolation Test Results Performed by.......-...............................................=` Date .................. === 1\ a - Test Pit No. I----------------minutes per inch Depth of Test Pit__-_____---._-____. Depth to ground water------ ______-__---_--4 r3� Test Pit No. 2................minutes per inch Depth of Test Pit-_---.-.._______---- Depth to ground water-------.............. `. D Description of Soil......._.._• _:_ ._ 1 r•:r ----------------------------------------------------------------------•-•......--- V .................•--- ------•--•---•----- •.. .. ----••------------------------------------------------------•-------------------------------...--•-----••--••--•- ------------- ----- --- --- i t U Natures of Repairs or.Alterations—Answer when applic ble __. t ��.__"�_. - "..... ....... .!fit _ie. VS• . 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 Corn t)ance has been issued by the board-of health. �. Signed GL10� c.X2A- -;L9 �. . Dme Application Approved By . --... L► -- fVl IJate Application Disapproved for the following rearons: ---------------------- ----------------------------------------------------------------------------------qq----------�..'_:... ..............................................__-------... -------------------- --------------------------------------------------------------------------------------------.-----------------------_--_. --------I,l.--- ---'.....(.�_ 4 Permit No. Issued ^- Daze ,..�,.. .• ,. �:�".,;.,. Dare --------- --- ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CertifiratE of ComplianrE THIS 1j TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ---------- ' ------------ ` nV -- ----------- f�® Installer at -------------- �"? ` - -tom �1C w1 4 "10— yn -- ---------------�- .. �- ----_..-'-'---------------------------------- 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. _�� ._^.- -_5?-4/- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISEAOT,ORY. 3 DATE--- -- -- -- Inspector ..... - v THE COMMONWEALTH OF MASSACHUSETTS ��. BOARD OF HEALTH TOWN OF BARNSTABLE Bispogal Workii Tountr ion frrmft Permission is hereby granted .. -- ---------=------------------------------------------------------------------------------ f' to Construct ( ) or Rep f ) an Individual Sewage Dis as Systems �� � , - Street as shown on the application for Disposal Works Construction Permit NoA�� Dated-_-- __^_��-1-_-?��...... ....................... x� -------------------------------------- r � DATE Board of Health s°� ---------- • FORM 365oa HOSSS 6 WARREN,INC.,PUBLISHERS .,f CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby y certify that the application for disposal works � construction permit signed by me dated cJ vie 9th I Q� concerning the property located at �o 0p P 00�k Inc, meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system e� The observed groundwater table is 14 feet or greater below the bottom of the leaching facility v There is no increase in flow and/or change in use proposed �• There are no variances requested or needed. q SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. r i I I [ i ! ► ! 1 d ; i ` i b f71t Cab� 1 t �` --�------•— -_.�-1 � � + � , �—'e {`--^--r--� -- r 'i -�+—?—+ n -�-- F it j� I ` p..�., � � .-.-r.—+ ./� p i" --�,- IAV"'_•.,�,.�—y --*^—x---F�--+- �—i— _.-it—�y�_ r---f �- --ie--• 1,, � -F 1— � i1 + ! --p {_.-•5-•--r— r. �r !;. i. �, M �t � r � � � � � � � t � { ~�' i — 4 i i i -, � '� f. e � �� f 1 r � i 7 i t � � I h —+---,--� F •-k �" -p { � � ' � ^' +�---^ ' F fi---r--•--T--`�. y---I. ,� —.i' i i � �«- � i i �5 1 };-1 I i. 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Fuic.......:l.. ..�...��� sB THE COMMONWEALTH OF MASSACHUSETTS 1J'X BOARD OF HE A TH ����'� o�� ��f� Apphration -for Ubi voat Workii Tonntrnrtion Virnift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , c Z..� oIri/r / AUK' �,� SI." S .. ......................................... Location•A dress o. caner - ddress -- -- - --- -- -- -- - -- - - - - -- Installer Address d Type of Building Size Lot__,,,20.al,_.-2.Sq. feet U Dwelling—No. of Bedrooms........ ----------------------------------Expansion Attic (r1/®) Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers (/) — Cafeteria ( ) Other fixtures ----------_------------------------------------------- W Design Flow____________________________________________gallons per person per day. Total daily flow__________._.___v�___�__G---------- ---gallons. WSeptic Tank—Liquid capacity�llff�__gallons Length______.... Width._L�._...._.. Diameter........._._.._ Depth________________ x Disposal Trench—No_ ____________________ Width-------------------- Total Length------------_------ Total leaching area--------------------sq. ft. Seepage Pit No...._--_____l----- Diameter____________________ Depth below inlet.................... Total leaching area.____-_.._..___._.sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by__________________________________________________________________________ Date---------------------_-----------------. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water..-._._--______.__.--. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... a -----------------------..........................................................................................................................----------- ODescription of Soil-------------------------------------------------------------------------------------------------------------------------- ----•----•------------------------------------ x /9-- -- - -1------- .0 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 Article \I 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. Signed_ -------- Date Application Approved By---- ��.... %/' A4--�- 7.l. ._ -------------------------------------•------•-•--•--- Date Application Disapproved for the following reasons:-----•--------------------------••-------------•---------------_____._-•-•------------------------•-•---•------- --._.•...-___..•-----•. --------_------------------•- ..................................------------•------•-------------------------------------------------------------------•••----•-------------- Permit No. Date J! . ------_•---------•------------------ Issued........................................................ THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) A�CLIM DATA THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.ire /. . Udv ........OF...................................... --.............. Appliration -fur 4%ipuuttl Works Tonitritrtiun Vrrutft Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Lr A C ---- o 5... Location.Ad ress �""- or Lot No. -�- ..................'--•'._._._............`...._-2V .................. ............... . ..!-...._......._......_. ,. Owner ddress ✓ Installer Address Type of Building Size Lot....o2D__V4_!9nSq. feet U Dwelling—No. of Bedrooms.-.__-__�------------------------------Expansion Attic (tea Garbage Grinder (� aOther—Type of Building ............................ No. of persons............................ Showers ( /) — Cafeteria ( ) Q' Other fixtures ------------------------------------------------------ w Design Flow............................................gallons per person per day. Total dailyf flow................. ..�._�'___._.._.__.gallons. WSeptic Tank—Liquid capacity-A�Aq.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-_----..-_--..-.-----. fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-.----__---_------. - R+ ------------------------------------------------------------------------------------------------------------------------------------------------------------- ODescription of Soil_---------------------------------------------•------------------------------------------_---------------------------------------------------------------------------- x - -- ? :.'. ................. ....••......•••.--.... ...�..�..-------•-•--••-----•-•-•---...--•----•----------.jW i' , XI ---------------- ---------- ------------ ------------------------------------- ----------------------------------`---------------------------- ---I--------------------------------------------- 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 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 issued by the board of health. Signed ----•-----•-- -•-.........-•---•----•--•---------•----------------- /{ Date ApplicationApproved By......r ------ --------------•--•-•----•-•••••-••--•----••••-•-•--••---•--•-----•....-•----•-- ------------ - h s( Date Application Disapproved for the following reasons:-----------------------------------------------•------•---•--------------------------------------•_------------ --•---•-•----•---------•---------•----------------------------------------------•-•----•-----------------•----•----•-----------•-.----••---•---•---•.---.•-•----•---------------------------•----------- � Date PermitNo. = /' ----------------------------------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... 4 w? ..........OF._.............../ 1.11...-.��c.(._..... /.................. IT.rrtifirate of Tomphanrr THIS IS . O CERTIFY,, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) J --Jf � � by �.. ---------------- ------- w Installer at----------------------- ........... _ v------y �Z"� ................................................ has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.--_--._�- _ -_••__________------- dated------- !._._'------_____ �_r'......_.._._.__. THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_..... y Inspector ---- --------- - l -c-�., ............................... r � 7 THE COMMONWEALTH OF MASSACH S TTS ,� BOARD OF ,HEALTH .....................�_.(a/i�.......OF............. No...... = f = FEE Diripasa lVarkii Ql nutrurtion f amit Permission is hereby granted----------- -- --------- "' 'C�'- �''''^ to Construct ( ) or Repair (i�� n dividual •ewage D�osal Sy t at No.----- l •-- ! •---••�-�`==. ,� cL <0� i ;_._...__. -------------------------------------------------------------------- Street _ as shown on the application for Disposal Works Construction Permit No----5_:��7____- Dated------ l-__c`__ / ............ ----------------•-•--------------------------•--------•----- .......................................... Board of Health DATE------------------------------------------------------------------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 x va ON 1 t- ao Wl'pF-) - ' - 9.<•$ `2 o 05S 5 F. a47 - _ .. P: - ., - - - a"3: •.. .j .. n. ,.� 1. 4 La-r - =� tu 'r ' L �0 00 ..ram..;,..... .,� ..��. f� ZH OF € CERTIFIED PLOT PLAN LOCATION 4 0.T tr" .SS. /STFR�• i► -tt Sa o SCALE . . : Q. . . . DATE 4v, to, vt S q- PLAN REFERENCE .5 Ko\A/.N .As. ,L cc?T 7rNOMAS E. ]KELLEY CO„ LAND SUIiV:EY©RS lac L014G PON15 ljilVE' C<J SOUTk YAI3iVIt,OTH;'MAM.-10244, " I CERTIFY THAT THE SHOWN SHOWN ON., THIS ,PLAN' IS• LOCATED ON THE GROUND W � � �;c� .` "taus AS SHOWN HEREON AND THAT IT CONFORMS TO T�i E ZONING LAWS OF THE,,TOWN OF Q ' 'l ►a tW' : E l DAuNS T� � HEN CONST UCTED, PETITIONER: V. 29ND SUR YOR