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HomeMy WebLinkAbout0044 MANOR WAY - Health f2-, _ �t1 _J f No. ,� � r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplicatlon for Misposal *pstem Construction 3PPrmit Application for a Permit to Construct( ) Repair( }pgrade( ) Abandon( ) [:]Complete System ❑Individual Components Locatio��A��dggd`s((s or of No. . � v4 �w1' Owner's Name,Address,and Tel.No. 01 Assessh 141ap/Pa�e (Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank �(f Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) L'a 7—' 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 this Board of He 10 �® Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. `>-e X — 7 f Date Issued �l 1k �. eu !, No', �"�� r Fee `! '{ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i /f PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es ' application•for Mi8p08aY 6pstertt Construction 3permit Application for a-Permit to Construct( ) Repair(wp-Uprgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,! (� A� p,of �s. Owner's Name,Address,and Tel..No. - 1 Assessor's�Map/Parcel Jl J t�` ✓t f/ ,e �"c l,,r,1 1/N>'4 y y Installer's Name,Address,and Tel.No. 'x,, Designer's Name,Address,and Tel.No. � •- Type of Building: (( Dwelling No.of Bedrooms /V/ Lot Size sq.ft. Garbage Grinder(` ) Other Type of Building ! No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow providedy, gpd Plan Date Number of sheets Revision Date Title r 9 Size of Septic Tank U(,/' Type of S.A.S. / / Description of Soil A'S` Nature of Repairs or Alterations(Answer when applicable) 1000le f e j /50 pC 1 Date last inspected: r 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 this Board of Head, Signed / ��- Date e_- Application Approved by )� !4,/ Ae i Date Application Disapproved by Date for the following reasons Permit No. r)-s 3 — / Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS re� Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Y A Repaired( Upgraded O f y / Abandoned(yy��))by G"'y"''o Gam.�,"✓ 1,.��/CA. 1 at 4, �� 1iO4 h Q Y has been constructed in accordance with the provisions of Title 5 and Y211 r Dis osal System Construction Permit No.�oa J�2?/ dated Installer ��iiL. f� 41 Designer #bedrooms 1�/I< - Approved design flow /�,� gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date. ._. "" , -' Inspector _. �'L ij / 9 No, b Fee �J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal 6pstem Construction Vermit Permission is hereby"granted"to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at ��� 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 must be completed within three years of the date of this permit. Date /11 V 4!/ Approved by i w iO. No......L ._.. Fly c.. .. ...................... THE COMMONWEALTH OF MASSACHUSETTS (I BOARD F 1-9EALTH IIt Appliration -fur Uisp o iial Works Tomitrurtiott Vrrnift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S semat: ��l�J✓6 � l i_E�-G'!G4 Location Address or Lot No. ----•-- J -.....---._ &A,I. J�11---n ................. ----------------------------- Ow er Address aL am.= 4114-•-< ............. Installer Address Q Type of Building Size Lot...-__-l_ _------Sq. feet Dwelling—No. of Bedrooms____________ ___________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ----------------_.____--___ No. of persons---------.------------------ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------- - U .,gallons per person per day. Total daily flow_--3 3-q0----------------------------_gallons. W Design Flow -- g P P P Y Y 9 Septic Tank L Liquid capacity-/t_:PQgallons Length................ Width................ Diameter-----.---------- Depth_.------..._-. Disposal Trench—No_____________________ Width.XP kL`.. Total Length__----_-_.-___--__- Total leaching area...q_Ct?-------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area........-------_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) d i- !` C__111) aPercolation Test Results Performed bY--------- ------- ........................................................ Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground 'water-----------------.-.___- L14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--.-.--..-----.-_--.___. P4 --------------------------................................................................................................................................... 0 Description of Soil---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- x ------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable..-------------------------------------------------------------------------------------------- ----------------------------- . ------------- Agreement: The undersigned agrees to install the aforedescribed Indivi 1 Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Cg. The u e signed further agr not to place the system in operation until a Certificate of Compliance has b n iss ed t e bo d of health. Signed---- ------ --------- ••-•--= �0-- - `�------ -- ----------- .............................. Date Application Approved BY /G- ---'.f C-- '� �(L ..---•--•--•--•-_-_- Date Application Disapproved for the following reasons------------------- ----------------------------------------------------------------------------------------- -----••••------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- Date PermitNo......................................................... Issued........................................................ Date 0j3_ s- A No.•---z-��- •... Fsa...1k,................... THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH /f YL.. OF..... . - :............................ ...._ ......................... - Appliration -fur•3i,spmat Works Tonstrurtiou Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........ --.... —L,cation•Add ess or Lot No. -••----------•-----------•-- ••--•----------------------•------•-••••--••-•-•--•-••.....-•-•-•--------•--•--•-••---••-•--•--... Owner Address a L Gv Installer Address Type of Building Size Lot_. _�__ -------Sq. feet U Dwelling-,/No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PL4 Other fixtures ...------. -•-•--------------- W Design Flow-. -_-____ _O..........................gallons per person per day. Total flow___ J_'�:� l d U------------------------------gallons. R; Septic Tank L Liquid capacity_l_0?a6gallons Length________________ Width------ _....... Diameter__.--_-..--__ Depth................ Disposal Trench—No_____________________ Width..--`?.x.20__ Total Length____._._____....____ Total leaching arca_._�-_-_--?-------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet-- Total leaching area.--_---_-_._____Sq. ft. z Other Distribution box ( ) Dosing tank ( ) D�- C 4-P Percolation Test Results Performed bY.......................................................................... Date-.--•------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit-................... Depth to ground water..-._-__.-._--.--.-.___. fq Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water._.-..-.-__--_-.----.._. 9 ------------------------------------------------------------------------------------------------------------------------------------------------------------ 0 Description of Soil------------ •------------------------------------------------------------•--------------------------------------------.----------------------------------------------- X U w x ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ U Nature of Repairs or Alterations—Answer when applicable.--------------------------------------------------------------------...__.._._--_____---_-..... -----------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Indivi 1 Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code- — The ui} ersigned further ag - re not to place the system in operation until a Certificate of Compliance has b en ass ed the`boad of health. — / 7c — Signed - _,../.e'!'./c ��-c-_----------- -------------------------------- Date Application Approved B PP PP Y--------�---- L-- �3` Date Application Disapproved for the following reasons:...----•----------••------------•-------------------------------•------------------------•---------------------- •--------•--•------------------------------------•--••----------------------------------------------•-----------------------------------------•-•--•----------------------------------------------.----- Date PermitNo......................................................... Issued--------------------------------....................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Q HEALTH h - .i ........1 ...........OF........� .�r/j/lJl�� .................... �ertifirate of f�ompliaure THIS IS TO CER I Y, That the Individual Sewage Disposal System constructed (� Repaired ( ) by-•-• r- - -------------------------------------------------•------------------- % � Installer has been installed in aci�ordance with the prow• ons of Ar-i lc e XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--- -k._-...................... 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 1 BOARD .qF HEALTH d . ...... .........OF....... ...... . .....Y-'i....................--------------._............ No......................... FEE....................... RnVoiittl Norkii ( o strurtion ramit Permission is hereby granted--`---- ('�''� �� ... to Constr t or R p ( ) an Individu 1 Sewage Dis osal/Syste / at Noll/ -- ---- 6??�yrr %G - `----- --- G Street as shown on the application for Disposal Works onstruction PerLrai o.__.._... Dated-, 7 S �DATE................................................................................ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,9 5 O -- Lta-T _T WAM " ? I PLOT .. Ad is 4 ��1���.�{^1„ a1 ++ i�T�-'4Y"`.�1S✓�i! �� 1 �. �..V`�.�'^atr.� �^! 1 C EIR T`I T=Y Tl`4 A"t" "R'"t�t,== sU W OA Tt W r FLAX T Cta N E wc— ©NTE L.�'i" A.t?�'A. = Z. i � vt>c,� s�C`„ s'c��-� �'. I �rlv`(►.J R N•A�