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HomeMy WebLinkAbout0197 TOWER HILL ROAD - Health 197 Tower Hill Road osterville A= 142 -009 TOWN OF+BARNSTABLE t c� LOCATION �`� � \ \ q� SEWAGE# VILLAGE �.` ll 1� ASSESSOR'S MAP&PARCEL y — INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C 1 (� � GT t' LEACHING FACILITY: (type) (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: / Ora?! - C 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 y ti41 a, No. ` — / 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpl Cation for Bisposal 6pstrm Construction Vermit Application for a Permit to Construct( ) Repair(,/Upgrade( ) Abandon( ) ❑Complete System D46dividual Components Location Address or Lot No. k+*(`\ aj Owner's N Address,and Tel.,,No. Assessor's Map/Parcel , /Up dSv°�� �� 1e 1�c�fS Cam; 3-� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of BedroomsA-/4— 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Qeo`t~L-Q, O e� �n UV SR FLY x � nwf- r��i h� S c�- t-� P V L P% 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 Health. / Si d^ Date Application Approved by Date ' Application Disapproved by Date for the following reasons Permit No. O Date Issued ___________________________ / �/ �• ` • � '� Fee No. --� THE COMMONWEALTH OF MASSACHUSETTS Entered;n computer: �/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Misposaf 6pstemc Construction Permit Application for a Pern!t.to Construct( ) Repair 6,;<Upgrad'e( )' Abandon( ) ❑Complete System L�ofidividual Components Location Address or Lot No. 1 .{,0wcj, Owner's N Address,and Tel.,No. Assessor's Map/Parcel I � e�.IC0 0 S'�`W�\�G., � D + C�l e Qj It 1\c."J Lot .I 0 AS 3'—? Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. M V«V, l t'3 v\d Y�'chv e rnss M'\ 016fit .1s%4 0665 Type of Building: Dwelling --No.of Bedrooms 14— Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) e Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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) Q-Pn kt^G-Q-, ®w� UV`a�C �U k dJ s C,, r\yt y �i'E S c-\ u n P V C. i 6-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 Certificate of Compliance has been issued by this Board of Health. Sign, ! c Date / Id O 1)-7 Application Approved by > Date Application Disapproved by Date for the following reasons el— .- Permit No. C U Date Issued THE COMMONWEALTH OF MASSACHUSETTS } BARNSTABLE,MASSACHUSETTS c.. Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V Upgraded( ) Abandoned( )by :5ce0A NM at.1 S 1. khw ex MJ G S i`1 Z has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.vg0j "31S dated Installer S C t\ �'^ �r r c./\ Designer A #bedrooms I Approved design!flow, gpd The issuance of this.pe`rmit'shall not be construed as a guarantee that the system will�f�nction a>s designed. Date / AJ d !r Inspector _ i" - / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit � Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at t'q7 ! tO,_Z r "Ak qa 0_StC -U,-tk-f. 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. .Q P ti Date �`�C)"� T""'- Approved by o No...y,.3:_/g4_.. APPROVED Fim.............................. Barnstable Conservation 0EPj4r=T'MONWEALTH OF MASSACHUSETTS OAR® OF HEALTH �*U; OF BARNSTABLE Applirdlivtt for Di!ipmi€il Wnrltg Tomitrur#ion run fit Application is hereby made for a Permit to Construct ( ) or Repair (,'A) an Individual Sewage Disposal System at: -------------/ -- ---.---.--../ rnJ�/LrL� , � Clt :_...... ri inn-:�ddress _ or t No. 534 1..- --• ............................. Owner ^_ Address ?7-------------°�`�•.--•------•--moo ..-• -�- .................................................2 .I......-•-------.. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms-------------------.3--.----.-._--.__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Qa' Other fixtur ---------------------------••----------------•---......---- ---------•--••--------••-•.....-----•. •-•---•---•........ --------------- ----- --- - ---------•----. ions. W Design Flow.................. ,__._._... _.,5 ..gallons per person per day. Total daily flow------------------._3 . gal �` --------------- Diameter--- .---........Depth............•--- R� Septic Tank—Liquid capacity,l��._galluns Length_______________ Width Disposal Trench--No. ......../......... Width..........7........ 'Total Length...f!?� `_._Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a 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........................................................................................................................................................................ x ............................................. ------------------------------------••-----...... ................................................. •------------------------------------------------------------------------------------------------------------•--N-s•---••-•-------••--••••••-• ••...-- U Nature of Repairs or Alterations—Answer wheAn applicable._.., ___... -¢ ___. � 0.. 7!..'n1.�..e-- •• Qd ---------------•---------•---------••-----------.... Agreement: The undersigned agrees to install,t-he 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 h n issue by board of health. /S Signed . '....: ................... ...... ....................................... ..................... ........,��.............,/.. ... Dare Application Approved By ............... -.,...--�-`........................ -.�r�-Co..... 3 Application Disapproved for the following reafonf: ..... ...... ...................................................................................................................... ........................................................................ ...................................................................................................................... ........................................ c� q� Dare < ......./-!. ................................. Issued .............................................---.................. Permit No. ........ ...... . . d Date I� �- a'o"'..w�......:Jet'v�y,,,,y:.rrw*�..:;.�.q„r,r..,-�.:,L^k.-.".-�-3"�-►`-P:�-.h.�,Jt.�acr.�_w-r....,L^.�:..r:.. i�.�"L-r..L,.i.��,lM"..r�°®.}�i��'"l�'.4a�i��diw�'�:s��rrli.EJ.•A�.✓'•:a;-9�"-...ridnr,�,..r `.ram-:�—.�.jr No I' ms.............................. THE.-COMMONWEALTH OF .MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativit fur Diriputittl Wnrk,i Tomitrnrfiun 1rrmft y Application is hereby made for a Permit to Construct ( ) or Repair ('C) an Individual Sewage Disposal. System at: Location-Address- or Lot No. ..' ...4�� �if>J �s� �U . `5�2.�.��" �-7� .. 5 • - _- L-- --- - Own r Address ................ Installer Address Type of Building Size Lot............................Sq. feet t t Dwelling—No, of Bedrooms___________________2_-------_.--_.--.-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) p, Other fixtures ------------------------------------------------------ W Design Flow...................._._:_gallons per person per day. Total.daily flow.................... 3u..._.._.......gallons. e:4 Septic Tank—Liquid capacitv_,AntY)..gallons Length...............' Width---------------- Diameter................ Depth................ Disposal Trench—No. ..........;........ Width........:'-------- Total Length---!:�!:r—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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-•-•-•--•••----------------•-•-----••••--•-------•---••-•--••-•-•..................--------......._......................................................... 0 Description of Soil............................................................................ --•---•----•--------------------------•-------•---------------------- •................. W V ........•••••••--•-•...••-••-••--•---•-•...............•--•••-•----------•---••---............--••--•••-••---•••-••••••----••-••-----•••----••-••-••---••--••----••---------------................••---- W x •••-•••...-••--------------------------- •-•......-----••-•-------••----------------•--•-•-••--••------•-••------------------ ..............................•........................................ U Nature of Repairs or Alterations—Answer when applicable.--_� ..._.. ..% !�1!z..;:...D.,��6_ --- S ,. 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 ha /been issue by theboard of health. C 'f Signed ........... ��1S_-_- ---- ----------------- .........1� G/-?......................................... Date Application Approved By .............. . ...... .................................. ......._�— :_-.9.3(....D Application Disapproved for the following reasons: .................................... . ...................................................... ....-- -ate-----.... ........ .. .................. .. . ... . ...9......................... . . - ........... ............... ............................................ ............. ....................... Permit No. --------/.3,...fl().... ............ ..... Issued ............................. ......................... Dare __,-----------------.--.—•-----_.----__ __._.._----- _,_____.___._.__._..._.__._=--� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cger#ifictt#e jof Clompliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�) by ......................................................._................---------; ��C-�_G�r�.�......-------------c.r.,.ws .2�c�rro.fj by at _.. _.._..._................................_/�`,.7............ -- %'?v< ..f ..... .................................C4�57 _�KCC.. ..... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No ------... —� � Gated ....._.. PP P �;:.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. % Inspector _...... ,...�� DATE............... .......__._-------------------- ------------------------------ .�`— .0..� �.-...._..... ..._ ....._._.......- _... - ......._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �a No.. ,}............ FEE........................ �ir►�ttl nrkn Tun#rnr#inn "rrmi# Permission is hereby granted �l ---t .. ."ls..... to Construct ( ) or-.Repair C_1� an Individual Sewage Disposal System at No...............................= �ci ------•--•- ICJ ts- .--//-t----•-.-�=�-------- >S7_ t1��.. . r 1 Street q as shown on the application for Disposal Works Construction Permit N .13���.__ Dated........................................... IJ / ------------------ -.......... . ..o —--------------------------------------------------------•--. �7 '" ('J ---------------------------------- Board Board of Health DATE-------------------•---......---••---- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS �. TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE 0•• ZJli1`( ASSESSOR'S MAP & LOTi�% —06j� INSTALLER'S NAME & PHONE NO. SW7a 07l 6&,Ja SEPTIC TANK CAPACITY /f OO LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELLIC VATS BUILDER O OWN DATE PERMIT ISSUED: %%01, DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No J /9y eeir J o'