The URL can be used to link to this page

Home My WebLink About0202 EAST BAY ROAD - Health 202.East Bay Road Osterville / A= 140— 169 - 002 W No.--------------- 0 3 Fee-------------------- BOARD OF HEALTH TOWN OF BARNSTABLE 0(ppiicat ion-for Veil Conoruct ion Permit App 'cation A her b made r a permit to truct ( ), Alter ( ), or Repair ( )an individual Well at: —� L ion — Address Assessors Map and Parcel .57 -- Address --- --- - - - Installer — Driller dress Type of Building Dwelling G __—•------------------------------------ Other - Type of Building-----_—___________ No. of Persons----- ---.------------ Type of Well CSe — -- -—_ Capacity--- Purpose of Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of th Private We tion Regulation — The undersigned further agrees not to place the well in operation ti cate . ce has been issued by the Board of Health. Signe date T`3 I(P Application Approved date Application Disapproved for the following reasons: --------•----------_.____—______ —_____._—_ I date Permit No. �' C3 3 ____._ Issued --_—.____—_-- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of Compliance THIS ;TO/CE I!YY, That tie Individual Well Constructed (4,1<tered ( ), or Repaired ( ) Install--------—--- - —--- —------ ------- --- q er 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. ----------___________Dated THE ISSUANCE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—_-- - —_ Inspector---- —--— ---------- - �t,J � ---4-1- 5 - � No.------------------- Fee -- - - ---- al BOARD OF HEALTH TOWN OF BARNSTABLE ` pld�at�onor' ell Congtructio`nermit App 'cation is hereby made fora permit to Construct( ), Alter ( ), or Repair ( )an individual Well at: Location'— Address — Assessors Map and Parcel -----------------—-------------------------------------- / Omer Address �--�'-+- n -------------- --- !-" !' h----��jg Installer — Driller dress Type of Building Dwelling- ---- '__ Other - Type of Building No. of Persons---------------------.-----------. - Type of Well ;—_ - ----- Ca acit Purpose of Well - f-€�- �—------- . Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private WOVPrcotection Regulation - The undersigned further agrees not to place the well in operation u•'it a C ','cate .off �p,i1 nce has been issued by the Board of Health. Signe Of �.. date / —Application Approved By b /3 date , Application.Disapproved for the following reasons:— -_----------_-_______________�__—_—_______�_ date Permit No. Issued----------- - ------------------------------- date ___________________________________ --- ----.__-.____---__.._____--______—__--______—_____._____ BOARD OF f�EALTH TOWN OF BARNSTABLE Certificate Of Compliance THISj5,TO CERTIFY, That the Individual Well Constructed (�tered ( ), or Repaired ( ) � � . // by - - - —�g-----------_____------------------------------------------------------------ - - ------------------------ / Installer 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. ------------.---------Dated-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—_------ — --- Inspector-- - ------------------ ---------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Vell (tongtruct ion Permit No. -- _0.3`f Fee- - Permission is hereby granted :• _ to Construct (4.-)•, Aster ), r Repair ( ) n Individual Well at: No. -- ��` — — ----- -- ----- -- ---- ---—-- - - - Street as shown on the application for a Well Construction Permit No. -� - -- -- - DATE 3/ �' Board of Health — -------- ----- LOCATION SEWAGE PERMIT , NO. VILLAGE &tsar vi filo mo l b d0� INSTA LLER'S NAME ADDRESS rC R UILD!��O R OWAIER` DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1/0 Ll �v N�� `^� ^ Finm-........._-____ THE COMMONWEALTH opMASSAoHussrrs K�� V�� 8��U� ~ ��""" ^�� ~" HEALTH ^�� " " " ' ...........................................OF �~�r � , , ° ° amit � ^�-` � � hereby� �6v made for u Permit to ��( oc Repair ( ) an Individual Sewage Disposal � Snmteno or Lot No. -------------------- � 7_ Address ---------------- ._---..-..-------..------' -----------------_---------------_-------------_ ' z�*lu= � Address � Type ofBuilding Size Lot............................Sq. feet � Dwelling—No. of Dcdroomo--- ------- .......... Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. c6 persons............................ Showers ( ) -- Cafeteria ( ) Other fixtures ----_--------__-_--_--_.-_---_----'-._--__'----_------____. Dry�� n� day. Total daily Design ------_-------------�ou000y�ry�rsooper ' ou ' --_----_.-_-------.gallons. 5co6c Iao�--��ukl� _--'�ukus ��oot6----_-' \��_.----. D��rr------. I}coth-----.-- � ' ' capacity - - ' � Disposal Trench--No..................... Total Total {t. Seepage Pit Nu-----.-' Dianzcter.................... Depth below inlet.................... Total area.................. ft Z Other Distribution box ( ) Dosing tank ) *o ~~ Percolation Test Results Performed by.-----'_--_-----------_----------- Date......................................... Test Pit No. l minute inch Depth of Test Pit Depth to ground Nature of Repairs or Alterations—Answer when applicable..... The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'JI TAU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be9p is�uAd 2e 4barld ^h ,.... Date Date Date +! �� FEB. THE COMMONWEALTH oFwAssAc*ussrTs ` - N�� U�� HEALTH ��" ^" "�� " .______________Or _____________________�________ ' � �.°° �l � � ��°�~�=~� �= �=��"� Works � Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -'-----'----------------------------------------- l�------------------------------------'--------'--- �=a�'��=s � � z� �� ------'---------------- - 7' Address nstaller Address KI4 Tse `�u�u-- ��. «u x�u/vu�/8 ..............��_---' No. of persons............................ Cafeteria ( ) -- �u��cc ( ) (Jt6erfixtures -.----'-��-'_____-__._____.................................................................................. � Design Flow............................................gallons per person per day. Total 6uUv flow............................................gallons. SenticTaok--Liquid ............guUnou Length................ Width................ Diameter--- ............ Depth................ Disposal Trench--IVo. .................... Width.................... Total Length.................... Total leaching area....................sq. {t. Seepage Pit No.----.--- Diaoeter.----.--' Depth bc>mniolct---------- Iotu leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) ~~ Percolation Test Results I`o6brzued by................................ Date........................................Test Pit No. ]................minutes per inch Depth of Test Pit.................... Depth tn ground water.----'---_- �14 Test Pit No 2................minutes per inch Depth of Test Pit.................... Depth to ground watcc---------.. 9 ........... ................................................................................................................................................ 0 Descriptionnf Soil....................................................................................................................................................................... / U _-------.__---__-'_-----------------------.-----------------------------------_____-_ -- � ......-_--_--._--'-'---.-_-_-.-_ ____-_---._-_---___-_---_. -'--_-� ' co - �-----'--'---- U Nature of Repairs or Alterations—Answer -.-----------_---.----------_------_--.-'----'-'------'^~�=_^~~-''^-^-=-_-------'.----.-_-'------- ~ ` . The un4ersigned agrees to install the afo/edesccibed Individual Sewage Disposal System in accordance with We provisions ofIIT U 5of the State Sanitary Code--The undersigned further agrees not to place the system in operation until u Certificate of Compliance has been issued 6y the board ofhealth. Signed...................................................................................... ________________ D�" ' 8yy�utou Approved 8y----------�z.-' M _ � ____ _�=� / /�uol�u1�u� D �r +X� .-_.--_..... ~--'-------------'------''---'-------- ' , ........................................................................................................................................................................................................ Date | Permit | ""t� ' r� THE ooMmomvvEuLTH or MAssAonussrrs - BOARD OF HEALTH � . � ............. .....................OF..................... ~°� ��«4uK�x �� u�c �� u� �� 'l � THIS IS, TO CERTIFY, That the,Individual�Sewage Disposal System constructed or Repaired Installer has�,been installed in accordance with the provisions of TiTl-F 5 of The State Sanitary Code as described in the THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH to Construct or�,Repair an Sewage Disposal System Stree � ofHealth`