HomeMy WebLinkAbout0234 SANDALWOOD DRIVE - Health 234 SANDALWOOD DRAW COTUIT
A=025-044
I
TOWN OF BARNSTABLE
LOCATION 3 q S 4, \t VO®O SEWAGE # I -3o
VILLAGE ` '% ASSESSOR'S MAP& LOTAZ-6�'-�l
INSTALLER'S NAME&PHONE NO. q 7 7-;19&:�
SEPTIC TANK CAPACITY ' U ®Cc)
LEACHING FACILITY: (type) Im& Poo' �' (size) 6AP
NO. OF BEDROOMS
BUILDER OR OWNER �'� �� `D.V-3 5.
PERMTTDATE: T-1, 9 COMPLIANCE DATE:
Separation Distance Between the:
y'
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 fe"ofm1hi9xfli Feet
Furnished b
3Y �•i t
No. Fee �•��
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplication for Migooal *pgtem Consaruction Permit
Application is hereby made for a Permit to Construct( )or Repair X)an On-site Sewage Disposal System at:
Location Address or Lot No. 2 Owner's Name,Address and Tel.No.
Cam- 13 4 Sa�w k*e ,e L 'Dn— .,P_
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
A �
IIbS��:,,.. S� • �M�sh �t , Y�n�� b�.4
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil h�
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 not to place the system in operation until a Certifi-
cate of Compliance has been issy thpi Boazd of Health. e
Signed Date r`1 '
z Application Approved by ,
Application Disapproved for the f owing reasons
Permit No. �� �, Date Issued -7
———————————————————————————————————————
V r Y
No. FeeOr
Q V t
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
� I
0(pprication for Mi000l *raem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: ,
Location Address or Lot No. Owner's Name,Address and Tel.No.ne
woo
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
o
1M44 kLj . V\A4, D'ku
a
Type of Building:
Dwelling No. of Bedrooms Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
i Plan Date Number of sheets Revision Date j
Title
Description of Soil �—i 4%,
Nature of Repairs or Alterations(Answer when applicable) N@ +46.> 1 y° �► u�
'e ee z se f j -
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore describe�n-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system'?operation u ta,C, ti i-®�u
cate of Compliance has been issuep y this Board of Health. _..q
Signed le Dar7-kY� A
Application Approved by r —/
r Application Disapproved for the f owing r asons ��
Permit No. Date Issued 0 "" �R�',r•
THE COMMONWEALTH OF MASSACHUSETTS
s
PUBLIC HEALTH DIVISION BARNSTABLE.MASSACHUSETTS ,
4
Certificate of Compliance
, THIS IS TO C TIFY�that the On-site Sewage Disposal System installed( )or repaired/replaced(V)on
ewe �r"N for (Seoy!ja `.� Lo 01 ,
p
as w has been constructed in accgrdance"
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated�7— /4�'--- �'T
Use of this system is conditioned on compliance with the provisions se forth below:
rV V
--- —————————————————---====a----------may—/ --
No. Feed
-e D THE COMMONWEALTH OF MASSACHUSETTS
-= PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Miopoal *pgtem Cougtruction Permit
Permission is hereby granted to
to construct( )repair( PfllonoOn-site Sewage System located at isa k-e Vj 0.O
O INV
V1�
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions. !.
All construction must be completed within two years of the date below. j
Date: 1,5 11 A�0 Approved by
i
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I m
DATA
K Y L+
,
_w`��� - .. � €.�a:� �lrt,s?i• 5�+1+a`a9+dam.. •�..�. .$ ..,��.r 6.` _ _ya__W.•f r_.�J.41 �� '..;o-�4_.
*P>r*c
-" Y UJ Cam:. � .. ��� t l - .� t L � //�_ _ _ -.� •
YYY .
G �
ji u/t--Drive S 6TvQ ACK A2A Exp U i.��ME•�/T� --" _ ,
SHA 4-4- 7 MA SS = DES i G Al FL 0 N/ GAL�17A Y
E N►ir,e onrMEN r.4L. CODe- T/r4. Y L E A G At .: o2:4 T� Z MrN �/iVGN
r : _ %2�GL IZ-A T/ONS _
r�r P20,005 E a L E�4C�•✓ A,eE-4 _ ,.•
TOG OF'
L0.0 A ON S W A -, PERMIT NO.
V I L L A GE
INSTA, L� RIS NAME & ADDRESS
R
B UILDE OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED _ �� _ 77
r�
�c(CI<
Lod- 2.2 T-e- ►fe�-e_n
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7
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F��....... J'..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....--...0....... .
Appliratiutt -fur Uiupuual Works Tonstrurtiutt Vanift
Application is hereby'made for a Permit to Construct (Z,) or Repair ( ) an Individual Sewage Disposal
System t:
s cation•Address �---_ or or�ro„
,V5 ( ....d�duo�o ��oc ®� d �e.� Y�-------I��
L Owne`]� / Address
rW-1 d 1 �u r —1— l e
.................. = -------- ---- ------- •-•--•---... -�� � ��
Installer Address
Type of Building Size Lot----------------------------Sq. feet
UU Dwelling—No. of Bedrooms..--•____________ ___ Expansion ttc (d?c� Garbage Grinder
--------------
PA Other—Type of Building _��L1�`�r�___.. No. of persons.................:......... Showers ( ) — Cafeteria ( )
a' Other fixtures ________________________✓-__-__ .
W Design Flow.................S _.................gallons per person per day. Total daily flow....._3-G��-___-_--_--._- -.--.gallons.
WSeptic Tank—Liquid capacity-/6KC- gallons Length-----------_--- Width.........------- Diameter-----........... Depth...._ _.. ..._.
x Disposal Trench—No..................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No------- Diameter__-6/-5_6... Depth below inlet____________________ Total leaching area------------------sq. ft.
z Other Distribution box ( la— Dosing tank ( ) O 5 4—(a P YT "D L N
Percolation Test Results Performed by--------------------------------------------------------------------- Date---------------------------------------
aTest Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...................
L� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_._----___-._-.__--.--.
r---------I---------------------------------------------------------------------------------------------•------•---------------------------------------------
0 Description of
Soilx --__ ��`� DLOAM
p� ...........
.. ---------------------------------------------------------------------------------sussm— Way IA. .................................................•-----------------------------
V _ ....e
x - r � Pt�------------------------------------------------------------------------- --------------
U Nature of Repairs or terations—Answer when applim e..----------------------------------------------------------------------------------------------
------------------------------ ----•-----------------------.._..----------------••---•---•---•...... ---------------------------------------------------- ---------- ----------------------------------
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. /
Si ned ._ ..-------: �:. �------------je 1 l� >
\ ., _. _ _ - Date -
Application Approved By....... ------ -------- rr -----�=-----------
Application Disapproved for the following reasons-------------------=---------------------------------------------------------------------------------------------
..-•-•------•••••-••-•-•••-----------------=----------------••---•-•-•--•.....---•••--•------•••••••----• ------------------------------------------..................................................
Date
Permit No......................................................... Issued---�'-------� _7 7 -- (-•--•--
- � ------------------
Date
�----------- ----------------------------
N0.i . 4 Fly$..............................
THE COMMONWEALTH OF MASSACHUSETTS
'- BOARD OF HEALTH
Q. ... ... - OF...... ^ /t.ar�.5. �t-P.............
Appliratiun -fur Uhipvii of Workii.. Tote trurtiun PPranit
Application is hereby'made for a Permit to Construct ( . ) or Repair ( ) an Individual Sewage Disposal
System at:
�.....---•--•............:A��� d.------ ...---••-•--- �� ..�. .t--•--- -----•••-----------------•--•-•--...----
--------------------
r!ncation Address !� or o / !
� 1loSIle
--------------- ...... ...................................
OwneP / s Address/,
a ................ ht v ... C -'J �Ltf S.. .:!-••-------•-..............................
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms_________________-,--__-__-___-___..___._-.Expansion �ttic (etc) Garbage Grinder Ica)
Other—Type of Building '' � No. of persons _ Showers —
a g -----._..._!�:.-`-��.----- P __ ------------- ( ) Cafeteria ( )
QOther fixtures ------------_ --------------------------•- -------------------------------------------------------------------------------------------------
W Design Flow________________� ........-.........gallons per pet-son per day. Total daily flow....._3_0_G-__.______________..___.__.gallons.
P: Septic Tank—Liquid capacity_/g:C/_,gallons Length................ Width-----------..... Diameter-----.---------- Depth.-..______-_-.-.
x
Disposal Trench—No.,.................... Width-------------------- Total Length-------------_---- Total leaching area.__.__..____._.__-_.sq. ft.
Seepage Pit No _,f__........... Diameter _�`_''��..._ Depth below inlet...... ......... Total leaching area.____.____.__-._.sq. ft.
Z Other Distribution box ( - Dosing tank( ) 1� "'b"" Tun
aPercolation Test Results Performed by------- ----------------------------------------------------------------•. Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.._.________...._-.____-
(14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water__.__._________.___--._.
----- --- --
D Description of Soil----- ""'
W - '�ag' �"� ,WpiT Kk��l,,�.,,k: - - ------------------------------------------------ ----------------- -------
VY Nature of P.epairs or AZtera on tAnswe� hen applicable.
Are t:
eO ersigned agrees to. install the aforedescribed Individual Sewage Disposal System in accordance with
o.,, ions 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.
..
9.Date -
Application Approved BY - ------•- --- ........---- ��'
Application Disapproved for the following reasons:.---••--------------------------------•--------------•-=•---------•--------------•-------------t----------------
--•-••---------------------------•-------------------- 2-----•-----•-------------••--------••--------......._..------•---•-•-•---...---•--•••---••--------•------•-----------•-•-••-------------•---.-•---
Date
Permit No......................................................... Issued----�-- -- p. 7
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ :. :. '........0F. ?✓.ad 4 01
(11krrtifiratr of Tontofiaurr
THIS IS. 0 CERTIFY, That t ndividual Sewage Disposal System constructed (-_) or Repaired ( )
by ...... ,1-.................
. � � Installer
at
has been installed in accordance with.-the provisions of .fir I q ghe State Sanitary Code as described in the
application for Disposal Works Construction Permit No.- .:_ _. �............ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE -------•---------------------------•-------------------------............... Inspector....................................................................................
THE COM-MONWEALTH OF MASSACHUSETTS
BO. ARDI� OF, HEALTH
j,�r_ ...OF.... . /. :
No. t_ 7� FEE........................
0 ttl 3 nr Qlanstrur#iu., ,Vamit
Permission is hereby granted_........._____ _ .�.....___: 4.
----••---.-----
to Construct ( J.or Rfepair,( ) an Individual S,owage Disposal ysterfl-�
at No. ------------` c :� � �cr:€ Gr,
-------------' ----- ............................ ••------
`:`Street
as shown on the application for Disposal Works Construction Per -No....... ....... ited____ «b � ................
------------------ ---- Board of Health
DATE----------e ---�----�---�..............
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS `
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