HomeMy WebLinkAbout0018 FIR LANE - Health 18 Fir Lane, Osterville
A=120-063
1
ri
}
e
r � IZ�6 No. 0A1
� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
RpPlicatiou for loizpogal bpaem Cow6truction Permit
Application for a Permit to Construct(tefRepair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components
Location Address or Lot No. ��� �. t �� Owner's+Name,Addresss and Tel.No.
Assessor's Map/Parcel `
3G2 S? i,2
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
6D f)106-AIV
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
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) —7) 6"X C,--) I
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 Certifi-
cate of Compliance has been issued b his Blord of Health.
Signed Date /3 !T�
Application Approved by Date
Application Disapproved for-the following reaso s
Permit No. Date Issued
0A1 &:6
No. � Fee_` �./
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
3pprication for Mi000gar *rwm Co.nmruction Permit
Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. { �G v ��,,,� dS , Owner's Name,Address1 and Tel.No.
Assessor's Map/Parcel
,3
Installer's Name,Address,and Tel.No, Designer's Name,Address and Tel.No.
ED �O a A
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil i
Nature of Repairs or Alterations(Answer when applicable) {`c DA{.cr _71) �0.r x — Yl cL,.3 0, [ ,T
j
Date last inspected:
1
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 Certifi-
cate of Compliance has been issued by his Bg, d of Health.
/ Signed Date Q 11-3 A 6.
Application Approved by Date
Application Disapproved or the following reaso
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
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. '"- dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
a c;
Date � � - � Inspector
——— ————————————————————
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Migoal *pgtem Construction Permit
Permission is hereby grantecLto Construct(pair )Upgrade ) don( )
System located at ,!'7
and as described in the above Application for Disposal System Construction Permit. The applicant recogniz his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction mu t be completed :'thin years of the date of thi e it. +
Date: Approved by G'�/�
LOT NO. : a v ADDRESS: bs- C,,U LA,
014NERS NAME: I t L �w lnvts�� r 12-0 063
SEWAGE PERMIT NO. : a-7[, NEW: REPAIR:
DATE ISSUED:_ a�/� DATE INSTALLED: G a si
INSTALLERS NAME: 7 -7 a 7UU
INSTALLATION OF: Jrae ns
WATER TABLE: — FINAL INSPECTION BY•
DRAWING OF INSTALLATION ON REVERSE SIDE:
!'���
c� e\\ II
�,I �1 �n
6 ` � �
'�F �
J
; �
.I �-� ,�
.� _
- �
,I�� S-�,��,
� I
TOWN OF BARNSTABLE
`LOCATION SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY. (type) (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
, ppliration for Biopooal Works Tontitration Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (Lan Individual Sewage Disposal
System at: 1
btr..�Se..IJ� I`/...
--•• Location-Address -or Lot No.
. ------------------------------------------------- -------------------------------------- -------------•-•----................-••-••-••-••----
Owner Address
I staller Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................._ _Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
a Other fixtures ......................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity_1_d2_Qi .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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................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 Description of Soil------------------------••••-•----------------•-------------------•----------•••---••-•••-••-•---------•----•----••••••••••-•••-••-•------•--•-•---•--•..........:--••-
W
V .._..-•------•----•••-••----••••••-•-••-------••-•-----•------•-----------•......................•-•--•-------•----•••-•••-••----••••----•••--•-•----•---••---•-•••----------------------•-•-•-•-•-------
-•----------"------------------------------------------------------------------------------------------------------ -•----------------------------------------- -
V Nature of Repairs or Alterations—Answer when applicable._____C� _____Yc� ....IPV .__. y_ ___________________
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 ... ........................ ............. G /J�'/.........
Dare
Application Approved By ............. . Date
�'.R.a ems--pl
Application Disapproved for the following reasons- ---------------------------------------------- ----- ---------- -- ----- -- ------------ -- ------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------............................................................... ---------------------------------------
Dace
PermitNo- ----------?../--------ol 74t---------------------- Issued ..............................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH - -
TOWN OF BARNSTABLE
ApplirFa#ilan for Uhipoii a1!; ork;��Tonstrnrtiun permit
. ^t-.1
Application is hereby made for a Permit to Construct ( ) or Repair (!/fan Individual Sewage Disposal
System at:
------------------------------ ---------- ------------------...------ ------------.........---------.......----
�_ rr Location-Address or Lot No.
---------.:....................................•------.... .................................................................................................
Owner l � .
CS �C
• i-3( C Address
. -! ...............__.._.._...---•.... � ................. ...... 3 Ist a Address Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building No. of persons............................ Showers
YP g ------•--------------------- P ( ) — Cafeteria ( )
dOther fixtures --------------------------------------------•------------••-••-•-•-------------------•--•----------------••-••-------••-••....------........:...._...
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid*capacity.l.y�A_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. 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........................
a ---------------•-------•-••-------------------------------•........--•--•-•-••••....._..----•---•---.........................................................
0 Description of Soil........................................................................................................................................................................
x
U ..............................................----------------•--•-----------•--••••---------•------••--•--------•--•-•••••••-------...----•-•-•...---•-------••-•••--•-•-•......-•---•-----•......••••.
W ---------------------------------------------------------------------------------------------------------------- . . -----... ..........---------------------------- .....................
�y
U Nature of Repairs or Alterations—Answer when applicable_____a_(—K.___.oxe�._..�to L ...........................
------------------------------------------------------------------------••----•--•--•--.._..........---------------•------------••--•---------•-••-•••---------•-------••••-•-------••••----•-----•-----
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 ..- �� _ - - _GA5� 1.--....
V / Da[e_.....
Application Approved By 31
Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------- - --------------------------
--------------------------------- ----- -- --------------------------------------------------------- -- --------- -------------------------------------------------------------------------------- ------------------ ---------------
Permit No. ......... -------a.76--------------------- Issued ------------ ..-- ...................Da[e
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�ertifiratr of Toraylitt nre
THIS IS TO CERTIFY, That the Individual Sewage Disposal Systern constructed (� ) or Repaired (
by------------------ ,-r4..... ' �4---------- �^.....................................\
E'?C/ __n \
at ----1 e---- -k---------- ---- .......................................''......................----.- ----------------------. ------ ......------
has been installed in accordance with the provisions of TITLE 5 o 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--------- ----� - Inspector ................................................................ ......------------.. _ . . ........------_-----------
THE
COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH .
TOWN OF BARNSTABLE
No.__ .,..:.. ....2. FEE..........•.............
�.�yn�,,��rnnr�uan prmi#
Permission is hereby granted.......... °......!' ...........................•••••.._...------------.........--•--•........--•---......------
to Construct ( ) or Repair a Individual Sewage Dispo System
atNo.......... ----------••-- v..........C-3..........----...--
- -•--•--------------------•--•----- ,.
Street
as shown on the application for Disposal Works Construction Permit No..-_. .... Dated..........................................
................................. = .......................................................
r� Board of Health
DATE.•-----------[� 1 ,l....................................
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
No..- .............
u THE COMMONWEALTH FM ASCHUS;TTS00b BOARDFHAA
ff�-1i
Z ------ OF..... ... ...... •- --. .. - - ----- -----------------------
firation -for Biiivomt Morkii Towi#rurtion Prrutit
Application is hereby made for a Permit Xo Construct ( it ) an d ual Sewage Disposal
Syst at
• , --•• ....... --- - ----- - - -- ---• ...............................
c ion- ld s or L t N C
Owner L �/ Address
W v
Installer Address
Q Type of Buildiln� Size Lot____________________________Sq. feet
U Dwelling No. of Bedrooms.___.-_-.. _____Expansion Attic ( ) Garbage Grinder ( )
U p� —,. Other—Type of Building __ _________ ________________ No. of persons-.________ Showers_________________ ( ) Cafeteria ( )
a' Other fixtures
------ - - --
--•--•-----------------
W Design Flow.. ___ _____________ _ ons per person per day. Total daily flow-______ -.....gallons.
WSeptic Tank Liquid capacity__ _. allons Length------------_- Width......-......... Diameter_-_-____---_____ De pth..___L._..
x Disposal Tre ch—No_____________________ Width-------------------- Total Length.................... Total leaching area--��rrsq. ft.
Seepage Pit No--------------_________ Diameter____________________ Depth below inlet-----__,.......... Tota leaching area_-___-___-____..sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) %/ J
aPercolation Test Results Performed bY-----------_ ------------------------------------------------------------ Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water--_-___--____-_--_-____.
LT, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water__-____-__________-__.
I -----------•------••-• •-
0 Description of Soil..................................... =
x
w
x --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable.__.____________-----------------------------------------------------.--_-_-.._____-______-
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has issued the Loard of h lth.
Signed---- Q... -------------------
" Date
Application Approved B y
Dat
Application Disapproved for the following reasons:-__._
----------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------
Date
PermitNo............76--7-=••-.......................... Issued........................................................
Date
No.--TV..-- t1`�
--•
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEA H
Appliration -fur lhtip iial Works, Tonfitrurtion Permit
Application is hereby made for a Permit.,to-'Construct (� *^or. air ) a id' ual Sewage Disposal
Syst ,a
. _ :.
e t _
4ion d or C
............................ ..... ...
W, wner A dress
a4--------------------------------------------------------------------'........................... ......----....----- ....................... ......--_.---
Installer Address
UType of Building- Size Lot______________.___:__.._..___Sq. feet
Dwelling l No. of Bedrooms-_-______.��_�________________________----Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building _________________------------ No. of perso'ns--________________________ Showers ( )' — Cafeteria ( )
dOther fixture -------------------------------------------------------------------------------=--------------------
W
Design Flow__ _____________' Ions per person per day. Total daily'flow______ -----------------------
gallons.
°k Septic Tank Liquid capacity allons Length________________ Width...-..._-_..... Diameter :_ '� ___ Depth_W ,/ _
x Disposal Tre ch-No_ ____________________ width--------------------- Total Length-------------------- Total leaching -----. sq. ft.
Seepage Pit No....`"":'________ Diameter .................. Depth,.below inlet...... ...... Tot leaching area-.___.____-_____sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------- ---- ------ -------------------------=- ------------- Date---------------------------------------
a
Test Pit No. I___-------------mmutes per inch Depth of Test Pit..................... Depth to ground water...------____--_--____.
(Zq Test Pit No. 2............----minutes per inch Depth.of Test Pit-___`:.............. Depth to ground water-_--_-_____--_--_____---
!"1 ___ __ ___. ____ __________________..........................................................
O
Descriptionof Soil- „- ----------------------------------------------------------- -------------
x
U ----------------
W
UNature of Repairs or,Alterations "Answer,when applicable______________ __ _______________________________
.L "
--------------------------- ---- ------------------------------------------=-------------------------------------------------------------------------
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificated Compliance hasb=aissue the oar of h alth.
Signed --------------------
i .� Date
Application Approved B
PP PP Y , . -- � 4-
Dat
Application Disapproved for the following reasons:. 00
-• .......................•-- -=-------.........................................................
---•-----------------•---•--•-----------------------------•--------------------••-----_...-------•---•---..•-•--•----_._..:----------•-------------_----------•--------------------------------------•---
Date
PermitNo............ ---=------------ ................ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
`....OF...... .
Cgrrtifira o , fiaitrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (40000, Repaired ( )
by �.0 ...3�+ ......•--_:./(:G ..................... ••--•----
Ast r
at..' .. ------=. -- V. . -- _ --------
...........................................
i has been nstalled in acc rdance with the p ovisions of Article XI The State Sanitary C de a descrlb I e
` application for Disposal Works Construe on Permit No._-_____________ ______4_--7------- dated /Q-
THE. ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. )1
Inspector r....._ ..._.
r --------------------- ---- = -----------------------
THE COMMONWEALTH OF MASSACHUSETTS
"I
5 �
BOARD FfHEA H
*� . OF
�i��>��tti grk,� C��r��tr�trti�gr �rrutit a' `
FEE.L
Permission t h by granted.:_.._} �' !' -------------
------- ----------- ---------------------------------
to Constr " ( or Repair in 49dividual Sewa I�is_�34 System
� Y
at No. � :�r' i� -----
et
as shown on the application for Disposal Wo s onstruction er it No. ed_110
lth'
DATE. Z t ' -- Board of. ea9th`
FORM 1255 HOBBS & WARREN. `INC.. PUBLISHERS -
[.A NE
I
.. l
a 7b -)11 DATE R
L O 2,�
r
oq
10:00 �1. SEPTIC " a
C6 } €-
to
,
S c -
3
LOT