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HomeMy WebLinkAbout0084 HINCKLEY CIRCLE - Health 84 HINKLEY CIRCLE OSTERVILLE A = 142 053 0 _ TOWN OF BARNSTABLE F r p t. LOCATION LE I V SEWAGE # bOc7 - S S VILLAGE ASSESSOR'S MAP &LOT 09 0 INSTALLER'S NAME&PHONE NO. YOD ILt�j�t- srn�t ��M I- ovs"e SEPTIC TANK CAPACITY 61e.SS,26O1 J ✓-',t�l LEACHING FACILITY: (type) (size) 4. NO.OF BEDROOMS BUILDER OR OWNER 'z PERMITDATE: O_e O()—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 ,r 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 -) I f 13 c c 3Z No. Z?,401 Fee'Iff ae9v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for 30i5pool 6potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System Individual Components �. Location Address or LT. �^fl /ti/�L£`l C/it°, Owner's Name,Address and Tel.No. Assessor's Map/Parcel Pia , ©.S �" 1131 Install is Name,Address,and Tel.No. ,S'O F - 7f'��O a Designer's Name,Address and Tel.No. J��Q C�,�/t/C G 3 so 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) /ti Al C 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 by this Board of Health Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. i7�-r Date Issued 4pz� i , o No. � �E"�d✓ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for lnigooar 6potem Construction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) El Complete System (Individual Components Location Address or Lot No. 7 �/��L % P/�°. Owner's Name,Address and Tel.No. aST-" /71 e.4 Vi•u1 /� V vz F. Assessor's Map/Parcel 8` Instal er's Name,Address,and Tel.No. s !' -7 PO o Designer's Name,Address and Tel.No. ('4Nc o IV 1114, 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(An wer when applicable) ZA4Z Date last inspezted: 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 iss ed by this Board of Health Signed Date �¢ Application Approved by Date y Application Disapproved for the following reasons Permit No. Date Issued " --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that t e On-site Sewage Disposal System Constructed( )Repaired(x)Upgraded( ) Abandoned( )by X 1K � PWIV("o 55 a (r/-1/9'iP at AW A-,At L r t ('/e o.Sr has been constructed in"accordance with the pr isions of Title 5 and the f Disposal System Construction PermiAW49-' � dated,�-'i '" Installer Designer A. I J)d r ' The issu ce of this permtchall not b/e construed as a guarantee that the system will function as dr si�gnec��i , �� ;� � Date C A Inspector1 ! .0 �I.' /� - } . --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE, MASSACHUSETTS 'Wi0po0ar *pgtem Conotruction Permit Permission is hereby granted to Construct( )Repair(x)Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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 t 'is rmit. Date: 3;1- `' Approved ,4 TOWN OF BARNSTABLE • c ;^~ LOCATION 1Z o1 " SEWAGE # 2cou - S VILLAGE ASSESSOR'S MAP & LOT —06 INSTALLER'S NAME&PHONE N0. � it�'� 0 1—I S�- O O r oh-K . /,AX �aM cost= SEPTIC TANK CAPACITY 'eSS 126 o f < Nj s LEACHING FACILITY: (tlPe). (sire) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: - Z U U U COMPLIANCE DATE: j 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 Wedand and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet i. `Furnished 6 4' i ' I Zc o C� .. U H ASSESSOR'S MAP N0. PARCEL L0LAT1D ? SEY4AGE PER �6*1T RQ. V1LLAGE � HS7A LLER'S DAME & ADDRESS C. UILDE R DR OWNER jo DATE PERMIT I . SUED pr DATE CCthIPEIA ,ICE I5SUED �� pp I 3�. 3a No----V.L.227 Fizz...20..r� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ---------.OF... 1��v�l.lr b��......... -------------------------- Appliration for Disposal Works,Tonstrnr#ion Prrrif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:. ................__....__...................................................................... -----•-----•----------•-.....____-----------....--------------•--....-----...___...7...._____••--- Location-Address • or Lot No. Owner Address W ........................................ Installer Address Type of Building Size Lot.............................Sq. feet U Dwelling—No. of Bedrooms..............3-----------------------------Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Buildin ..._._. No. of persons............................ Showers — YP g --------•----•-•--•-- P ( ) Cafeteria ( ) Q . Other fixtures ----------............................................................................................................................................ WW Design Flow............................................gallons per person per day. Total daily flow:...........:...............................gallons. WSeptic Tank—Liquid*capacity........._..gallons Length.......:........ Width................ Diameter................ Depth................ xDisposal 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 ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch. -Depth.of Test Pit..................... Depth to ground water........................ L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------------------ ---------------------------------.......----------...I....................................................... 0 Description of Soil..................................................................................•--------------------------........_.._........_...---............----•-•--•-----•-•__ V :...................................................... W UNature of Repairs or Alterations—Answer when applicable......../Dip..p-----IF-j--JA-----4--CA-FLe-dui-•---••L►��$J ---------------------------------= 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 In Ith. Signed..... ►��----C---- . . ............... ---(� ���....t p Dat✓ Application Approved By..... ------- l 3 ...'.............._ Date Application Disapproved for the following reasons:----...-•..............•-•----••••----••-•-----•-----•--...----•-----•----•-....-•-------•-----••-......---•- ....................•-•.......---......-----•---•-'---•-•••-•---------•-••-•--••------••....--•--.......--•---------------------...........--•--•--------...........----------.... ...---.._ Date .... Permit No...... 7_� -------------•---_---., Issued----...---•---_-••- Date —...�.,.�,..-,`.,_..�:,�,-�.....v.r..�^t...-..�---...r".... --ti..,^�'..•'. �........'�..s-,'...ntr`•..s�`,•f•t a .......,:�b-+�5. ...r� .....-.eJb-vr,.-ti..... ....,.+z. - ._. .-' ... _ , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _(•e� ..,._ �..........O F.......1`��:A Q4 .3.C��; ��.F......................................... Applirativit for Dispnittl 10orks Ton'strurtiun "rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................___-__...................................................................... ................................................ •N•..................................... -••••....•-••........................•-- ................Location•Address or Lot - o ..............................•.. .....t ...... T---A .. _ Owner r Address aIrr ICt �S�� 1G. .� ..... ........................................ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............3............................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Oa Other fixtures .------•--•------------•-•-----. .... Q ------------------------•---- 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 ( ) 1.4 Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L"4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------------------ •----------------•... ....---------------------------------------......... ................. ..........••-•.......... 0 Description of Soil.....................................................................................-----------------------........--------•-----•--•------------------•--•-•---_..... --•-•-----------....-------------------------------------------------•---•-----------------------------------------------------------••-----•---------------•-----.....--------------------•-........ U Nature of Repairs or Alterations—Answer when applicable._....._ .n u_.v._...v.!..;n_....r.. . .. ��I. ter•. i !.._..... m ,_ _-------------•---------------------------------------------------------------------------------------------........._....----.................----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z- 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 Al- - --- ,-- \ � Dat� Application Approved B •--------�-•-•-----�-- ....................................................... ....._...................•---•---••---.......----• •---•- � t�. -_ ..tr.. PP PP Y J v Date Application Disapproved for the following reasons:-------•---:-•--••------•---•--•---•----•-•--•---•..............••-•----••-----•-------•---•----....-•-......._ •--•-•-•----.........................•---•---.........---•----------------•--------•--.........---------•.....-------------------•--------------------------------------•-----------•-------.....-••--••- c� Permit No......L2 ' �7_?...................... Issued-.._....___.____._______ Date ..�--•---- -•--• Date..................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALnT/H�/J CsGrit<s .......OF........... . ! + Lf................................. C9rrufirate of Tamptiaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.-.-...-..-.-----------------------•--------.--•-•-•----------------•-----..-------•-•---.----- ------•---•------•-•-•-----------•-•----•-•--•--•-------•---•---.---•-•-•-•---------.-----...- Installer at............................................................................................................................................................................................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �\ DATE..-..-...-..•-.�? S � Inspector. -- �l_ 6­71'�_-.M...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........7(_r...........OF............ ............................ No.....QQ FEE.... ........ Rapilsal Works _Tnnstration rrmit Permission is hereby granted..........lb- --- ---------------•---•----...----•---•---............•••......................... to Contract ) or Repair ( an Individual ea age Dis o al Syst at No..---•--......i-� ......1I.e. ---........_ , I�_a!7- P Street as shown on the application for Disposal Works Construction Permit No Dated D'ated.......................................... ..........................- ---- J l ....................................................... DATE.............. ............................. Board of Health t