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HomeMy WebLinkAbout0139 SHELL LANE - Health 139 Shell Lane cotuit A= 019 - 101 - 001 - --- _. No. L" v�.(j�g-C� Fee BOARD OF HEALTH TOWN OF BARNSTABLE 2pplication ,for Very Cougtructiou Permit Application is hereby made for a permit to Construct(0 Alter( ), or Repair( ) an individual well at: 13 U-(-�IT / — /a J —coo 7 Location-Address n / Assessors Map and Parcel JOaIL 6how.mS ��I Shc(� L— co l meu I7 Owner Address y L)fCpA)P <-G ��R pcC�JG SS rC� M �s�a /Lt6,O'D Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well Capacity Purpose of Well i Agreement: The undersigned agrees to install the afore described 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 Compl` ce been issued by the Board of Health. / Signed Date Application Approved By Date Application Disapproved for the following reasons: � l Date Permit No. d�^ I �' © ) _ Issued Date ------------------------------------------------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed , Altered or R ;alr;047 e (�7 j., �t by Qe10ni/s Installer at ��9• g4,4 4, CA�r f Srrs S�-8 Rf (k�S g 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.��CC 1;9---0 - Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ------- --------------- --_-,---- ---------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Cou!6tructiou Permit No. �, -�J Fee Permission is hereby granted to Of!� �...5 Sc�tiny' Installer to Construct('''j, Alter( ), or Repair( an individual well at: No. /39 T,, 1 1 Street / as shown on the application for a Well Construction Permit No. 1 C) 3 Dated 5 Date / /% Approved By , --- - TOWN OF BA RNST.ABLE CL Nt LOCATION �/���,C �AN� SEWAGE VILLAGE C_'ca��,t p� ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY__2jo®O LEACHING FACILITY:(type) ! j (size) 1 coo NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER � �h� �T ry) DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ib Fus.... ........ THE COMMONWEALTH OF MASSACHUSETTS ,BOAR® OF HEALTH TOWN OF BARNSTABLE Q Iq _/6j-60 s zs y i �ispusaal Works Tonstrnrtiun �Cerm' Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -------------------------------------------------------------------------------------------------- - L catio ddress P or Lot No. Owner Address a � P�----------------------- ............ , . ........-- ........ Installer Address � feet Type of Building Size Lot___________________________S q. U Dwelling—No. of Bed rooms...•.-------__.-- .__..Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .. No. of ersons----•___--__•-__-__-. a yP g ---------•------------- - P _-•_--• Showers ( ) — Cafeteria ( ) Pa Other fixtures --------------- - d W Design Flow............................................gallons per person per flay. Total daily flow__-_----.._...._._._....._........_..___...•gallons. 1:4, Septic Tank—Liquid capacityZMP..gallons Length__�t....... Widthv/...._�._.._ Diameter________________ Depth................. W 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........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---- ------------------- -------••-----------------------------•-•- ----- - Description of Soil M ��/U elfl �----------------------------------------------- x W ••••••••-•-•----------------••--•••---••---•----•---•-•••--•--------•-•-•---•- .....•-•--•-----•------ O U Nature of Repairs or Alterations—Answer when applicable.__ MPi 6__-_____�Y457:........1r,0..YpDZ'�,5.... 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 ' nce has b n is ued y �edf oar o health. Signed .. . ................ -J- __ .........Date ......r...... ApplicationApproved By ------------------------------------------------------- -------------------------------------............................................ --------------------------------------- Date Application Disapproved for the following reasons- -------- ---------- ------------------------------------------------------------------------------------------------------------- ....................................... 17 Date PermitNo- ----------- -- ...�------7-ter-------- Issued ........................... ----------. ----------------------- Date No..._.1.4.......276 f ' Fps..... r- t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE MY 6 1101 -(16 001 � �tr�t#taan�for Disposal Works Tnnstrnrtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............ ...................................._............................................................. ------ ----------------- -•- ----- ---.Location_,-,Address ... or Lot No. 1/.... �k iJ � '" 1Z2 %11/,E ���?�.t�?/-........................ST fj ----- -_--- Owner il�afl�rl Address 1 �.! -................................... /rJif/S•- ..a Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.._._._�...................... .Expansion Attic ( ) Garbage Grinder ( ) PL4Other—T e of Building ............... No. of persons..........._...._._......... Showers — Cafeteria Q' Other fixtures ...................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitva0 -_gallons Length..44?.__._•._ Widths."=h.1'. 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........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ _ .. ----------------------------------------•----•-----•-•---------------- D Description of Soil.C �!� /l7f4� -�i•�....... ; L../-�. j................................................................... x W ---•-•----•-....••-----------•••-•---•---•--•--•---••-•--•••---------------•----•-•---•-----••--•---••-••------•----•••••--•---•••-•----•-••----•-•-.............•-----•--•--•-•--•---••-•------•------- UNature of Repairs or Alterations—Answer when applicable_.Af........; ------------------ -- fir_... h••----`......./��...7V r----.................... 72 we--••...=-------�a c�'. __ -----------------------------------------•. 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 Compliance has been issued by the board of health. Signed - 7 e......� '=� �.. .�%.t- 7..._.-�-�.... 9 --" �/ Date ApplicationApproved BY '' ... ' --------- -----------------------------------------"-'--"--------------------- "--------- ------- ........................................ Date Application Disapproved for the following reasons: ---".................................................... ......................................................... 1 1 ........................'----------...---------------------------.............................................................................................................................................. ........................................ r Date Permit No. ............ v....... ' - a ,• �, . f r F Issued -- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (9elrtifira#e of (femplinure THIS IS. T.0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� by ...... .... - "......--.---'--------".............................'---------..............--------"---'-'--.................................................------------------.--------'---'--------- installer 1 � f at r.. ....... ��-L.cJc1­1 .......� ........... ... .._... At efJL=-----------------------------------------'..............................................---------- 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. ..... ���.-.-. .. ...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ���_ � �� DATE.... ✓........".' �? .`"' ......��. `.. G/ f .............L� `'"'� r Inspector-'• -................... ......' fy --....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y�l TOWN OF BARNSTABLE Disposaurk �untrni�n �ernti Permission is hereby granted ........... = `=. •-----..--------------------------------•---•---••-----......--•--.....-••-•-••..................... to Construct ( ) or Repair '(�)-an Individual Sewage Disposal System atNo. :---4' ;!? __ /� e,/ _. n -'- . ......................... r .` Stree �� as shown on the application for Disposal Works Construction Permit No.�....:....... ._ Dated..... ..._-_�..'�.._.�� V ----------•------------------------------ -----y----.----......------------------------......_......_ Board of Health DATE. C'-_----------�"._`?_._..:..._�. FORM 38308 HOBBS 6 WARREN.INC..PUBLISHERS r a vi nr6 �,✓ r x Ct s a I V