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Home My WebLink About0120 EEL RIVER ROAD - Health TOWN OF BARNSTABLE — UNDERGROUNDFUEL AND CHEMICAL STORAGE REGISTRATION !! OWNER AND INSTALLER INFORMATION c A,7DRESS: r ^fJ QSa.liewl 1 \MAP NO. t f b PARCEL NO. Sr OWNER NAME: I'`r i� PI i� , if'r / t' +f W �-� S VILLAGE: St�rJ l/P INSTALLATION DATE: tln Y%d 1.1.,1% BY: �._A�DRESS_ CERT. NO. - - — 1.,,,,!7/ TANK INFORMATION' LOCATION } Y G-F_OF TANK: CAPAC I TY!000 TYPE S L AGE a kK4 FUEL/CHEMICAL Z- TESTING CERTIFICATION C ] PASS C ] FAIL DATE ' LEAK DETECTION CHECK IF N/A TYPE/BRAND ` + :ZONE ,OF',CONTR'IBUTION C--.71 YES,',.C„ ], NO ::_ .DATE TO _BE REMOVED FIRE DEPT. PERMIT ISSUED C ] YES Cf] NO DATE { UUNSERVAiION C 7 CHECK IF N/A DATE BOARD OF HEALTH TAG NO. J C ]C ]C -, ] DATE PLEASE PROVIDE- A_ SKETCH:!,'SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD � 4^?«'�;{ �+�` 4sP'�a°' ,,.. �"'..i�, CENTERVILLE *" z V K+- OSTERVILLE FIRE DEPARTMENT } Y r F PERMfT FOR STO PAGE OF FUEL OIL z +� In accordance with provisions of Chapter I48, G.L. and Re w made under authorityRe" thereof. Name d s..HOW3� '� � •* (owner or occupant) '. Nome AwA,ltr!=•4�• 6IQ Y 'Address 120 Ee1.. ,� ' ' (Installer) k _ dw Address QSI�PY ],g^• �4 ... . Burner _ . �+ Make .L' .............. rage ......... .... y Manufacturer ..� �a*�.A.. Type of Tan k wn, gw...... Capacity ...��QQ. gals. (or) Size..--' �.� ! Model No or Size .• 10 (• rY' y Location UUdeX9r-Q1Md p. G , r TYPe T�?7, royal " s ass APP No ~� Permit GG issued :L.. ........... .. ... JOhn M. Fa %>} .(Head r �?!.gt toa1:..:.h o f . t re ... �ep ent ..................... ........... By T (THIS PERMIT MUST SE CONSPIGUOU557 POSTED U ........... •••• •.• • N THE PREMISES) r LNo....96._.... Flcs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diti-puuttl Works Tunutrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair (04 an Individual Sewage Disposal System at: Location-Address rat No. ' 1 l-U/ f s -_... L �-��- ..�%�1-: .............................. }1 Installer Address UType of Building Size Lot............................Sq. feet N� Dwelling—No. of Bedrooms..................: ___._____..___Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons----------------------.----- Showers ( ) — Cafeteria ( )' P4 Other 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. .......Z.......... Width......fP..._.__.... Total Length._ l• Total leaching area....................sq. ft. 3 Seepage.Pit No--------------------- Diameter-------------------- Depth below inlet.......f�C--... 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........................ (%, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 0 ---------------••------------•----..........._..........-•-•------------•-•-----•--......-•---------......................................................... 0 Description of Soil........................................................................................................................................................................ x: w U Nature of Repairs r Alterations—Answer when applicable----IN,f} -__:✓---:--.-. U..Y ... ''`t k l T------ VDT-----f------ ------. �°J��-' 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 Complia e Vbeen e y the board of health. Signed ....... ..... ".....? ... ------------------------Application Approved By -- ...... . ...° ........ -- - - ----- ---------------------- ----'--...Date ------'-------- Application Disapproved for the following rear ....................._.---...--...................................---........ ...................................... - ......--............................ Date Permit No. 75- .-......1. ...-.... Issued ---- M-11) It l R.0 ZZ o....-----� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiutt for Biu.Vni3al Works Tuttutrnrtiutt Ilrrniit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 'fia Wit_ /C loErf� ......., :..:........ ... ......... I Location-Address !, - /V� V( l l U^'. J %c�- �� (/ f�t No. 6 _/�f�)l l4 ............................................................................. c�"A Installer AZ �1.� 'mess ....................................................... ----- • ----------- --...-_ 1 Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___________________------____-_-___-_-.-_.--Expansion Attic ( ) Garbage Grinder `L4 Other—Type of Building No. of ersons--------------_--__--.---- Showers a � yP g ---------------------------- P ( ) — Cafeteria ( ) 04 Other fixtures _ ______________________ _ _ W Design Flow................... ............. per person per day. Total daily flow..._._._.___....Vy�.....__._...__._.gallons. WSeptic Tank—Liquid capacity X ..gallons Length________________ Width---------------- Diameter--...._-_.-__.._ Depth................ x Disposal Trench—No. .......1.......... Width...... ...._._____ Total Length-.J/y=`� Total leaching area..................sq. ft. 3 Seepage Pit No.-_---._.-_---_---- Diameter.................... Depth below inlet....... r___ Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-1 Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit-------------_...... Depth to ground water........................ fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ....••-•-•-•------------•----•----••----•-------------------•---••••`•------•---••-•------------•---......................................................... 0 Description of Soil........................................................................................................................................................................ x U w - -----------------•--------------. ..------------------------------------------------------------------------------...--------•-------------------•--------•-••---- U Nature of Repairs or Alterations—Answer when applicable.-..1.-N-J.� 'C-----A /ZU 5,d S j7......... ------------•-•----------------------- U f / a:- _c..__!_ii /L�-----Ltd/ ....�,--------`S�...A!F= 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 Compliand e h s been iisss/iu deby the board of health. Signed :...Y. %« .......................... _ / 4 o J/,�/� �` P Date Application Approved By ✓f`= '--�--�---- ...�(_./(�' /i 1�'/�- -------------- �- Date Application Disapproved for the following rear .................................. Date Permit No. .......:.(.s. / Issued ......... -------------------- Darel � ----------- ------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gcrtifirate of C�ompliaare THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ................ „�G/e ;F(.a /'T/ C ol'i�i Insrallcr /�/ at ......... ..................... /C} 1 �- ..�. ��- F` � ................ `1�- V!1.t:. --.-------------- has been installed in accordance with the provisions of TITLE 5 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 YSATISFACTORY. ��%��,�r��,�� DATE..... - ----...--- 4........ -....... > .,.7 ...----------------- ---- Inspect - �../:.. �Jy�. ----- ------------------------------.._._---- Z �- 9'5Tt 4 -------------- �Q - -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ...A7 FEE......`.......... .. Utupnuul Works Tomitrudion rrrniit Permission is hereby granted......................... �.�...._._.-_�� 'J s i to Construct ( ) or Repair (\,4) an Individual Sewage Disposal System r Street - rl as shown on the application for Disposal Works Construction P�'er_rn�rt'.No.__ ._...____p__ - Date .:_.'.. ...........,...... L.- .. 5 ---------•_-------_•-• / Bbaid of Health DATE i FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS TOWN OF BARNSTABLE LOCATION /00 C e6✓&C SEWAGE # /�oL -DO/ VILLAGE ASSESSOR'S MAP & LOT 116 —G J INSTALLER'S NAME & PHONE NO. ge'I-+ Uc-a�� G�ttiJST" j�= Z l►, SEPTIC TANK CAPACITY LEACHING FACILITY:(type) size) NO. OF BEDROOMS Y PRIVATE WELL PUBLIC WATER BUILDER OR OWNS �"tJc ' lbw DATE PERMIT ISSUED: �7�y'� 9 DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes �No� �.�� `�, 5' ,. �°' ��. � ' 5� ; ��