HomeMy WebLinkAbout0022 BAY STREET - Health 22'BAY-STET
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THE COMMONWEALTH OF MASSACHUSETTS Entered in corn ter:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppliLation for Disposal *pstrm Construrtion VPrmit
Application for a Permit to Construct( ) Repair(') Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.� �y V 1 \e, Owner's Nar�' .�,V\ W�,�n Address,and Tel.No. �JI
Assessor's Map/Parcel � (`��� Ale,
Installer's Name,pAddress,and
rTel.No.S2:q_1/77—V77 Designer's Name,A dress,and Tel.No.
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Type of Building: C C)o t-
Dwelling No.of Bedrooms Lot Size o fe l A sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) I i�A- Y-2 f M �' 461AS-Q- +b
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 Certificate of
Compliance has been issued by 's Board of Health.
e (b Date S' C? 4
Application Approved.by Date
Application Disapproved by Date
for the following reasons
Permit No. " "' Date Issued
No. p Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in ter: t
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for 30 sposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair Y� Upgrade( ") Abandon( ) ❑Complete System Nindividual Components
Location Address or Lot No.a Owner's Name,Address,and Tel.No. j a9-
Assessor's Map/Parcel L .Z ;22 -C
Installer's Name,Address,an Tel.No.5%_1/77-$877 Designer's Name,A dress,and Tel.No. 1
Cc� ' �6 t IE r-re-,r-f v-%9 e S
as ->
Type of Building:
Dwelling No.of Bedrooms Lot Size , r sq.ft. Garbage Grinder( `)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures t
F
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) )Ab,wssg- 4 b L "
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in` �a_=
accordance with the provisions of Title 5-of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Date t
Application Approved by Date
Application Disapproved by Date
i
for the following reasons
Permit No. Date Issued
----------------
THE COMMONWEALTH OF MASSACHUSETTS
` BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( )
' Abandoned( )by C W%As— k hfi �!' S QS L C
at .22 go, S� Cg-t-porvMe y -.,Has been cons cted in ac• r�lance
with the provisions of Title 5 and the for°Disposal System Construction Permit No.0 ated
Installer CAPle W l ek_ r 1,4+-&(',per 1$QS L Z Designer I
#bedrooms Approved design flow / gpd
The issuance of 's rmit shall not be construed as a guarantee that the s stem wi]Koih tion as d si ned O'
P g Y /�� g �! �}
Date ] Inspector /"l/1 a/Ni X lt'
61
-------------- ----------------------- "rt-' _ -- --.--"- _ _ - -
No. _ Ik Fee �1
--� �—
T '�—
HE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal *pstrm Construction 3permit
Permission is hereby granted to Construct( ) Repair i� Upgrade( ) Abandon( )
System located at �. gay �S I�xy�y�
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 ust ba compI ted within three years of the date of this permit
Date Approved by f / -
LOCATION �i SEWAGE PERMIT NO.
VILLAGE
A-�-e
INS TA L ER'S NAME i ADDRESS
,
BUILDER OR AXJLE.R.
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ./�
r -
� l
tits 5 ��
s,� a
®� /000
foot �A r
No..............1....... Fps.` . ..��......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
-
......oF..... ah C. ..............................
Appit'ration for Uispao al Works T11n trurtion rantit
Application is hereby made for a Permit to Construct ( ) or Repair (,() an Individual Sewage Disposal
System at: - ......._...
.....ed"
Locafo -Addres � ... Lot No.--. - •.-'-•-••......................•-
�1. .
a �. :.....D2Qco�' 1Jfr.. � �, ------------ f7...n&))5 ,---------------------------------------
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )
`4 Other—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 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........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----_-_______-_•.---__-.
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
. ............... -
ODescription of Soil-----------------��C q = ---------------------------------•--.--.._.....----------........-•---•---
W.
V --.•----------------------------------------------
..-----•----•-----•------------------------------
----.---------------------
----------
------------------------
-...........
.---------------------•-
W ••••---•----•----•----------••-••--••--••-------••-•------•....-••-•---•-•-••-••----•-•--•-----•-••---•-•-••••---- --....•-•--.--- ---•-••••---•••--•--••---•-•...................
U Nature of Repairs or Alterations-Answer when applicable........... '!�G' La__ 1-.�------------------------------------••-----.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIT I-;;;. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance haskbenssued by the board of h�lth.Signed �' QQ,' �(�QG�? '-..
�3.ft4 Date....... ....
ApplicationApproved By.................................................................................................. .............................-----------
Date
Application Disapproved for the following reasons----------------------------------------------------------------------------------------•----•••---•-•---•-...._.
-•...............................•------------------------.....---•--------------.....•..---------.......-•••-•--•-.._...•------•--------•-•---------•••-•••---••--------•••-------------•----•-........
Permit No. Issued. ....�.
—Date
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
I M A�C(, I
DATA
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Disposal Works Tuntru Lion Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (A) an Individual Sewage Disposal
System at: (?.� I
.....�=-.'..__.. --c �# 1 � !l-•............................................. .... .5'= -----•-----------••-- •---------...........------•.... ----
1 ` Location-Address or Lof No.
fiY
Owner ' Ad�iess�
`f T c ............ ... ---' -•...���-=.. `_•—.......................................
Installer Address
d Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fixtures -4 -----------------------------------•-------------------------------------------------------------------- .........-------------------
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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
GZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ............................................-.................................................................................................-----•---------
D Description of Soil--------------------- r j ' All el -J 1=I�:T,...":"- l
x ----------.•. ---------------------------•---------------------•............•---.....
W
------------ ---------------------------------------------------------------------------------------------------------------------••-----------•-......=:.------------...........------...-•--•-.....
U Nature of Repairs or Alterations—Answer when applicable............. ........... f.................................................
-••-------------------------•----------------------------------------------.....--------......................-----------------------------•----------...--------...--------------------------•---------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 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....... - = '- -' J' 1`= -------
; 1
Date
ApplicationApproved By..................................................................................................
Date
Application Disapproved for the following reasons----------------•----•-•-----•--•-------•-----------------------------------•-•-------------------------•_•_..._
.................................•-----------------------....-----:------•---.....---------•-••---------•.....----•--•-------•-----------------------•••----------------•-•----------•--•---------•--•---
' Date
PermitNo........................................................ Issued-----...._..__....-Dattee.................. ---------
t
_A THE COMMONWEALTH OF MASSACHUSETTS
t. Y_!!_ BOARD OF HEALTH 1
.................`.......�.f.......'...OF.... �r'r� f^�7 .._�.....L;%.)r......................
4.:
fi` Trr#ifiratr of Tomplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal Sy em constructed ( ) or Repaired ( )
Installer
at.... '__. %.....�!.....7- ---------- ¢--.-:------•- -----. ---•-•---------------------------- --�'� ...j
has been installed in accordance with the provisions of T T 5 of The State Sanitary Code as de'cr�ed in the
application for Disposal Vorks Construction Permit No. .___
A ,�z*� .. ..2_/.��'--------------- dated-_..elf�"=�- -- .................
THE ISSUANCE ,.6F THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. Inspector----------------------------------------- -------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1�....OF...... .......... .........................
No........................ FEE.s...::..:...........
Disposal Workil Tonstrudion ranfit
Permission is hereby granted.-----•1 ('l f 1............................................. J .............'...........................
toy Construct (� ) orrRepair ( ,) an Individual Sewage Disposal System
at No...-...... f' t / r' l l i /. i % I
Street
as shown on the application for Disposal Works Construction Pe= ,it Yq ........ . ...... Dated.... ..............
----------_------------------•—
Board of Healt
DATE... -"'/`.__ ------------------------•------•---------....... `
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS