HomeMy WebLinkAbout0055 BARNARD ROAD - Health 55 Barnard Road
Osterville
A . 139-036
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No. '� C Fee f---
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_�
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftplitation for bisposal *pstrm Const uttion Permit
Application for a Permit to Construct( ) Repair Dd Upgrade( ) Abandon( ) ❑Complete System Xndividual Components
Location Address or Lot No.$5 &v- Owner's Name,Address,and Tel.No. -5
l d r,—AxLrreaa �
Assessor's Map/Parcel/ � ds tJ d 'Ape- 1,e_ 0A1A ®ate
Installer's Name Address,and Tel.Igo. 5v$-�/ �- ' n Designer's Name, ddress,and Tel.No.
2,ot�-oiot Cvr` vLl a ,Tr,�. It)IA-- 0�1C On
-�lS�-r�usFr t�nrs o��� t`�'
Type of Building:
Dwelling No.of Bedrooms Lot Size ` tl 4c-rICS sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) kf 1A gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title `
Size of Septic Tank Q?c�S��rK. f ooce e c� Type of S.A.S. ';P—k.I St�n
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) I (�0 ( i 5fr i 6 )C
�rrv►1Y .� e� .max.7 S 1-4�q e A (< l- bm_ Eu we
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 Co not to ace the system in operation until a Certificate of
Compliance has been issued by this Board of Health. yJ
Signed Date oTJ/ I'
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. �-�(� 30 Date Issued ��21/
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✓ ; �`
No. ` r� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4plitation for Disposal 6pstim Construction Permit
Application for a Permit to Construct( ) Repair 0( Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
s� Cx-ter
aj' G2r-ry,t
Assessor's Map/Parcel / o65ietill/c cG__ - l'P ,.it u o s _
Installer's Name,Address,and Tel.No. 5w-3�_l/� _'F-1 oi(o Designer's Name,Address,,and Tel.No. t i
L'C.N, r N/,4- cL/l 1C On t
Type of Building j __
Dwelling No.of Bedrooms 3 Lot Size b �a c_r eS sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ),Cafeteria( )`
Other Fixtures
x ,
Design Flow(min.required) gpd Design flow provided �- gpd
Plan Date Number of sheets Revision Date t
Title
Size of Septic Tank t?Xt'�,� ;, i i,�,r,, r Type of S.A.S.
Description of Soil I £
Nature of Repairs or Alterations(Answer when applicable) ljq 0,C)la r^0
•, �'1�fi�r �, c N l .,n S n 1 v err ! 1 f 6 4
Date last inspected: *r J
Agreement:
.R
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 d riot'" to @*ace the systemul operation until a Certificate of i
Compliance has been issued by this Board of Health.
Signed Date l
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. 'Date Issued
----------------- ---------------- --------------------------- ------------- ------------------ -----------------------------------
,, THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certifirate of Complianre
03 ' is IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Z �,Upgraded( )
Abandoned by r
at .S5 13C.rnC, - �S{,Pn ( /j has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.2 d dated ,F�� /,g
Installer 1?�a f ac t �w,� ( i M �1_v�C Designer n 21A`
#bedrooms A ,/} Approved design flow gpd
The issuance of this ermit hall not be construed as a guarantee that the system will ch d rse gned. p c
Date �..� i Inspector A
-------------------------------------------------------------------------------- ---------------------------------------------------
No. r `1 Fees-^
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
MispoBal .6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair O Upgrade( ) Abandon( )
A l
System located at j/Y)4�r n
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must
be completed within three years of the date of this permit.
Date J `�� ��/ Approved by "-VL 14—Ue i
Assessing As-Built Cards Page 1 of 2
TOWN OF BARNSTABLE
LOCATION&5_ /' ' SEWAGE #7�3-�pY
VILLAGE �S7YCUi�/P ASSESSOR'S MAP& LOT V- OJ(
INSTALLER'S NAME& PHONE NO n /d j 6M/
SEPTIC TANK CAPACITY
LEACHING FACILITY-.(type), "I f/ )/,rs (size) q' X 0_��t 7,�
NO.OF BEDROOMS PRIVATE WELL OR UBLIC WATER
BUILDER OWNER
DATE PERMIT ISSUED: jJ- f _g3
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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TOWN OF BARNSTABLE
1 G :AT10N }� % 67 r/ SEWAGE #
VILLAGE nx-rol ASSESSOR'S MAP & LOT/V- 63
INSTALLER'S NAME & PHONE N �
SEPTIC TANK CAPACITY Q/.
LEACHING FACILITY:(type),RZ j�,"/ } j (size) q ,V0Q76
NO. OF BEDROOMS _7:�3 PRIVATE WELL OR UBLIC WATE
BUILDER OWNERd
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: 7`✓
VARIANCE GRANTED: Yes No
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No..........
eemtSbleConsemadanDepen al THE COMMONWEALTH OF MASSACHUSETTS
11" 6- 57J BOARD OF HEALTH
rlgned Date TOWN OF BARNSTABLE
Appliration for Diti-poiial Wor1w Towitrnrtion rrrntit
Application is hereby made for a Permit to Construct ( ) or Repair Q<'an Individual Sewage Disposal
System at:
-- _ • - .-- ------- ------- - -----�••••...._.------ ------....a1--� ....
oc +
�sion--Address �-�A�j _ �/ or Lot No.
...........................................
.....................- .. , �/�6GtiJ/F6«J /�vJ lfC-
W 7 Own s J --7( Address
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 ( )
dOther fixtures ------------------------------------------------------------------------
W Design Flow.................._..._____ gallons per person per day. Total daily flow--------:� v____-----__-__---_---gallons.
WSeptic Tank—Liquid capacity/ ...gallons Length________________ Width_.............. Diameter................ Depth................
x 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. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................
�T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1:+4 •-•••---•--•...................•---•-----•-•----•-••-----•-•••-•-----•••••-•••-•-•-----.......-----...-•-•-•--------------•-•-----•.........................
0 Description of Soil...............................................................-........................................................................................................
x
U •--•--•-----------------------------------•------------------------•-•-----------------------------------------------•-•-------------...------------.. .-----------------------••....--•-•-......_......
W
UNature of Repairs or Alterations—Answer when applicable.--/ X_*e'Q..._..ll-�'�
:.. .----...�..��r/. i�-------Gv�..�.�T.......S��...!�------------•--••--••--•--------
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 o eration untl a ertl icate o m Lance; s en l u e board of health.
Y P p /� /
Signed -----l ............................... ............................... ----------------- -- / ..
Dace
Application Approved By ------... .s .,�-�.......... .....
Application Disapproved for the following reasons- -------------------------------------------------------- ---------------------------------------------------------------------------
---------------------------------------------------------------- -------- ------------------------------ -------------------------------------------------------------------------------------------- ----------------------------------------
Permit No. ...�...3...".....�r..... .��?. ........ Issued ......................................
Dace
L
93- � / ' ✓✓
THE COMMONWEALTH OF MASSACHUSETTS
77 I��G s3�.. BOARD OF HEALTH
TOWN OF BARNSTABLE
Alipfiration for Dim w3al Works C owitrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair C> 'an Individual Sewage Disposal
System at:
/ u/C�Locati�t� ddress ��_ �J.� or Lot No._
Owner � t (� Address
�(C`J
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms------------------•-__-._-_---.-__-_--.-----Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type T e of Building No. of ersons---------------------------- Showers
0.1 YP g -•-------------------------- p ( ) — Cafeteria ( )
04 Other fixtures .
d ----------------------------------------------------------
W Design Flow----------------__........._..gallons per person per day. Total daily flow.--_-- ��U.........._.___._....gallons.
W Septic Tank—Liquid capacityZ ...gallons Length----------...... Width---------------- Diameter................ Depth................
x Disposal Trench—No. --------/_....... Width.......-7........ Total Length. �_.?.�7Total 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...----•-----------------------•---
W -
,� Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water.....................
4A Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water....._..................
a --••---------•----------------------------•----•-----••--•------•-••••---••---------.•......-----•--.........................................................
0 Description of Soil........................................................................................................................................................................
W
V ---••"----------------------""-•---------....--•----•----------------------------------------•-----------------------------------------------------....------------------....----••-•-----•-•-•---•••...
W
U Nature of Repairs or Alterations=Answer when applicable..._ s " ____.. '�� _--S ( -....--47V!�
- - --- -- --
a
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 Ms een i sue d byte board of health.
gY SI ned ....../� _..... ... ------------ -........- /
Application Approved By ----- ----- �_ � ... .....�j 4- --------'.......................... .................... Dace
Application Disapproved for the following reasons: . .. ............................................................ . ............
................ .................................................... . .. ------------------...__------------ ----------------------......--------------------------- -----------------.......................
t Date
Permit No. ...��...j..........�� �1.9 ................_. Issued ........................
Date
___—. -—. _.—_—, --_—.—.----- ,.__——._._— —______—,._ —_._._.—_ —.——.——._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
e
TOWN OF BARNSTABLE
011ETtifirate of (ILI-araptiance
THIS IS TO CERTIFY, That-the-Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ..................... -
has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ._..3-.-_6.Y.F...... dated ..._..........................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIONS SATISFACTORY.
�j
DATE.......� -,,•..... . _--✓----f �.%--------------- Inspector ?��e'_r �'�.
f //
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 1
TOWN OF BARNSTABLE �a —
FEE........................
Eiiipniitt1 Varkii Tomitrurtinn "antit
Permission is hereby granted•................ t�!�-_--•-_-.-c-------1S��c.,ts�l--'�I
to Construct ( ) or Repair '`�_) an_Individual Sewage Disposal System
Street C� e�
as shown on the application for Disposal Works Construction Permit Nol '6.l e_- Dated...........................................
Q .........................
r
DATE_ I . �/ t ...................•-.---- Board of Health
FORM 36508 HOBBS A WARREN.INC..PUBLISHERS
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
IM A- F
DATA
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d r(4ry
n3p" 1 205 1227 0
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1/ 66.p� 0� -� �
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This MORTGAGE "INSPECTIO'N
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�+•RH+'lfr ..-•, T—r
THAT THE BUILDINGS ���P qc.
PATKO
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d� E " ..
-EC -AL-
", 1STE $I9 IdII,LS,T3d26t18,
a ���r�i� its-0�u����r:.r.r..n..�.-e�p:>�taa��•>,,:�� ' ..r tia . s r�+ T q (� F�
ASSESSORS MAP NO: L
No.-`-�- T� ' PARCEL NO= - Q Fee=M ---------- --
BOARD OF HEALTH
TOWN OF BARNSTABLE
App[icat ion fforlVe[Y C on5truct ion Permit
Application is hereby made for a permit to Construct ("'), Alter ( ), or Repair ( )an individual Well at:
/2 ����U� //P - - ------------------- -- - ---------------------------------------
Location — Address Assessors Map and Parcel
------------------------------------------- -
` Owner Q Address
�— —-—— — — = -dX-1__v� �� ---------'-----
Installer — Driller Address
Type of Building
Dwelling-----------------------------------------------------------------
Other - Type of Building ----------- No. of Persons------------------------------------------------------
Typeof 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 //s hA
- - --
date
Application Approved By ~
-- - — --- - -� o!Z -— -��-
date
Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------
____'__ _� .
date
Permit No. ---------- -- -- ---- Issued ---- - - - - - - ---------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif irate ®f Compliance
THIS IS TO That the Individual Well Constructed ( 'S, Altered { ) or Repaired ( )
bY-------- A_?RTIFY,
4Ati -----------------------------------------------------------------------------------------------------------------------
jInstaller/
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.k gO
n�-------1= Dated---�-!- ----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- ---- - - --- - -- Inspector-----------------------------------------------------------------
19
No. t== °v�-- �, Fee-- -------._,..-
BOARD ,OF HEALTH 1
4 TC W,N OF AR14 ABLE
pp iti t,ton,bor e C CongtrurPon Vermit
---_A lication is hereby made-for a permit to Construct ('�), Alter ( ), or Repair'( )an individual ell at:
-SS r-� %/e - - - -- -- ---------------------
Location — Address As sots Map and Parcel
O_w_net =— s t Address
�' -
i Installer — Driller j Address
Type of Building
Dwelling------------------------------------ - :--------------------
Other - Type of Building--------------= - No. of Pe rso s----------- --1 - -
Type of Well-��-�-= -- -- - ----- -- - Capacity----- - -- - t - ----—
Purpose of Well-!L- rs,- -l' -`-='--------------------------------- '
Agreement:
C
The undersigned agrees to install the'afore'described individual well in a cca ordance with tKf provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation The `undersigned Y her agrees not to
place the well in o;eration until a Certif>cate .of Compliance has been issued by the Board of Health.
Signed—U _ t ---------8
! date
Application
pp on Al ve By-- - -- �--------------------------�---------- -�----� �-'-"-�--
date
-
Applrcation
- -�- = -----------------------------
------------------------_------------------------------- date I
Permit No. - ---- -- --- -- — ssue ---- -_: ^' --- -- - ' ------ -------------------
- date
�'.. .. ... ..A,e,�.�__.�,.-�-.���ac. ._._.��.__..-. -� 3+.+�► }* iw219 �e.` .7""rg':`rr'w�,�r..•ea..rr'. - -- - '.w.�w+a:�
BOARD OF HEALTH `
TOWN OF BARNSTABLE av -
Certff rate ®f Comphanw.
THIS IS TO CERTIFY,: That the Individual Well Constructed ( 'S, Altered ( ), or Repaired ( )
by-------,?A-JCU N N t II— ----------—--------------—----------------------------------------------—-------—------------------------—------------ —--
t Installer
at /
—S � G —�—�— --- OS 7'c�t.�c ll
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
L i
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY. `
i,
DATE------------------- - —-- -- - --- - - Inspector-----------------------------------------------------------------------------
_..
..,
BOARD OF HEALTH
TOWN OF BARN STABLE
---
No. -- - -- Fee--
Permission is hereby granted-� - N�'JP /-----------------------------------------------
to Construct '] Alter ( ), or Repair ( ) an Individu4l Well at:
No. _ - 11'nJ c, ��—�-� -- _1`c/(J r --------------------------------------------
------------------------------------------------------
Street
as shown 011 the application fora ell Construction PermitNo. bpo�4 t �`
- ----------------- - Dated `--------------------------
-
DATE
Board of Health
---�---=' �-'`-'�'-- ----------
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