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HomeMy WebLinkAbout0151 ABLE WAY - Health i I i I LOCATION / SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME & ADDRESS r CA Ca le r 7 77-5-- 13 4 B U R D E R OR OWNER J-10, r -e DATE PERMIT ISSUED 3 _ ,S^- 77. © ATE COMPLIANCE ISSUED r �,- k, � � !� �� 5Y ��� No........... F�a......l..S.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..._.....OF.......... l-i---�--.......... ........_..........----.-----------. ApplirFation -fir Biapnii al Workii Tomitraarttoaa Vrra iit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an. Individual Sewage Disposal System a : .... .. -- ------------------------------------------- -------- o_ ----�•-•-----•------•-••--••---••-••--••-•-••-•••...........__ r ation-Address or No. y . ---- ....................... Own a Address t ----- Installer Address / Type of Building Size --------Sq. feet U Dwelling—No. of Bedrooms _ ...................Expansion Attic ( ) Garbage Grinder (4 0 Other—Type of Building _'. No. of pel-solls............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------- - Dest n Flow__ -.........................# . ............ ..gallons per person per day. Total daily flow._....s�®® _.._._...___.__ Mons. W g g P P P y y ------ g Septic Tank L Liquid capacity_ APP—gallons Length---------------- Width-------- ------- Diameter___:_...__ ....____ Depth....______... xDisposal Trench—No_____________________ Width..._..._._.. .___. Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No------i------------ Diameter___/�m_d�.E `LTe�fi below inlety�._._._ -_- 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 round t �{ ....---- ---- -- - .. -- -- ODescription of Soil--------------- ------�--- .--- .---- - s�------------ � + � -V ------------------- -- - W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature 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 \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued b the board of health. Sie I _ --.---------•-•---•--------•-- ...... � = ,........ Date Application Approved By------If-14 - ------ _--- ------ --� — Date Application Disapproved for the following reasons:.....-----•---- ------------------------------------------------•--------••••-••-•----------------------------- .....................•...--------------------_--•••-••---••-•-•••--------------------••-•---------------•...•---•-----------•-------.--_._....-•••-•----•••••-•--•------------------.................... Date PermitNo.......................................................... Issued-----------------------------.......................... Date ii11Yd THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 ,F HEALTH Application is berebv~ouu]e for a Permit to Construct ( ) or Rcnuc ( ) an Individual Sew4ge Disposal Syste4ma Own ddr --_-.'--_''-- -___'_-~--�^ "",="°°=_-.-_-_'- Installer. « Address Type of Building Size Lot40,0./,.r..) So feet Dwelling—No. of Bedrooms,------ ---------------------Expansion Atfic Garbage Grinder Z Other Distribution box ( ) Dosing tank '- Percolation Test Results Performed 6y........................................................................... Date.---_---------'' 04 Test Pb No. l................minutes per inch Depth of Test Pit-------------------- Depth to ground water-------- � Test Pit N � i ^ �h D ^ ' _ -� - � DescriptionmSoil . |�U Nature of Repairs or Altcntidna--Auywec when applicable-'--_-----'_------------------------------ ------------------- ----------------------------------- —'-'_-.,---`-'-_-'—'--__---�---_--_--_._---------------._-- /�g/ocozcot: - The undersigned agrees to install the aforedescribed ' Systeminaccordan ��h the provisions of Article XIof the State Sanitary ode— The undersigned further agrees not to place the system in operation until a Certificafe of Compliance has be issued by4�e�oard of health. Application | '' ~ ' ..~- �������-��-_-'- ___..------'--.-� � ,/*" Application Disapproved for the following' ��_''_'�r_----.--_-�.---_--.---------------------------------------- --'-----'—'-'-'---------'-,�'_---------'-----------'--:`-------------'-------'- Date PermitIssued......................................................... Date THE oOMwomvvsxLrH OF wAssAo*ussrrs ^ BOARD `~ ' �� ' \ w���tufir*o4�� xm� ��1«M4 jfiaurr ` THL,9-.JS T� CERTIFY, That the Individual'Sewage Disposal System constructed .( ) or Repaired by...ly"A. ............... -- ----- -------------------- .......----------------- ------- .1...........­ ....... - -------- ............4 at.... . ... X�69 -4 has 4eren installed in accordanc'e with the provisions of Ar of The State Sanitary Code as described in the THE- 15SUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEKWILL FUNCTION SATISFACTORY.:. r*s omwwOwvvsALrH or mAssAc*usErrs ' BOARD OF HEALTH ----�]F-��- ._�_____' | BJ ` ~`- ' - " �� � . - ante 1 7 S/>o 10 r, O T) Gr1 , 1P w�f A •o Hof a�-�°� n, :� C' d. �o p k e 73 Ao 4-0' 40 t ry t ..148ka WAY Ii -1 , CERTIFY THAT THIS PLAN SHO b. I THE ACTUAL LOCATION OF THE WS PLAN ° STRUCTURE ON THE LAND AND �N THAT IT CONFORMS WITH Tl�4� _ � /��PsTn�y BY-LAWS OF THE TOWN ► i ,jT? cta By 1 _ a FRANK \ a FRM �• � f cQwE.A'r t y CO�'ERO u O Wfa CUMMVoH �'a ��►��Jt�Q`�t``� PQi+¢T¢�' eCAq.G Q lCQ •,3D V4'. �opA f�/ q� SU t 'I No.----------?___ ---- Fee---- ---- -------- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion-*r Melt Congtruct ion Permit Application is hereby made for a permit to C nstruct ( ), Alter ( ), or Repair (k")an individual Well at: -----------=--------------------------- L cation — Address Assessors Map and Parcel — _ _ (416 LGN ve Owner —----------------------— Q AK--- -- ----------------- ---------— Installer — Driller Address Type of Building Dwelling-- -------------------------------------------------- Other - Type of Building--------------------------------- No. of Type of Well—�� -`'tG------------------ -- - Capacity---- - - --—---- --— Purpose of Well--— v®ctL-- — ----- ------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificat .of ompliance has been issued by the Board of Health. C? date Application Approved By date Application Disapproved for the following rea :-------------------------____ ---------- ---------------- qq 44�� date Permit No. -— -- Issued----- -- --- -- ---— ----------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CfRTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired Y--- - ---- - --- - - -- - ------ -- Installer at-_/ Ct b/P L co®y /`t c,r S �v k s _Mhas been installed in accordance with the provisions of the Town of Barnstable Board of e It PP''vate Well Protection Regulation as described in the application for Well Construction Permit No. ✓Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- - - Inspector-- ----- ---- --- — �,1 r ------ 1 -- Fee---- ---= -- BOARD OF. HEALTH TOWN ' OF BARNSTABLE :y Rppliration Ar Well Con truction errttit Application is hereby made for a permit toConstruct ( ), Alter ( ), or'Repair'(�an individual Well.at: a&of S—M 1 -— - -- --— - - - --- --— L cation Address Assessors Map and Parcel' / is 0 f Owner -�u �drresss --- 0.---- -- SC U N"e - 0-_- /�-O / 0 6�, — - —---- - --------— -- - - - •------- - - P - - X - — Installer - Driller Address Type of Building - Dwelling Other - Type of Building --- - ---------- No. of Persons' -. - -------------- Type of Well--��`� L---- ,------- -- Capacity---- -------------- -- Purpose:of Well � ''`-`_cC�►C'----- -_------ Agreement: The undersigned agrees to install the afore'described individual well in accordance,with,the provisions.,of The Town of Barnstable Board.of Health Private Well Protection Regulation - The undersigned further agrees not. to place the well in operation until xCertificatf of ompliance has been issued by the Board of Health. Signed �'` — --- - /-- ------g f/ v date I Application Approved By date ' a: i Application Disapproved for the following rea ;— --------- _7qq date ` �.. Permit No. — -- Issued-------------- date I�'.dies•Ta:t3ieofe<±evsb.4:re'w'las�t9frYi:r.Gea-�aes�i2o9c�`.ieat c-,.:sec.:�'aeaa�ceex:oSv:4S£u..a.®=S n:aceaeoteereeSea!gala}.deaeoagazAH+�+41e!wsll2StatCiseaZzfr9ii.+lta+eu,sa9i}zestuN,lb�lst$�!ara!e.�pwaasn; Ilkµf BOARD OF HEALTH r TOWN OF. BARNSTABLE - • ;-- - Certificate Of compliance THIS IS TO C RTIFY, .That the Individual Well Constructed ( ), Altered ( ), or Repaired( ,. � ��N �L by--- ------ ---- -- ----- _— r, Installer / at has been installed in accordance with the provisions of the Town of Barnstable Board of eal 'Private Well Protection ' :Regulation as described in the application for.Well Construction Permit No: ✓Dated'------ --- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION,SATISFACTORY: DATE----_-- — -_ Inspector--------- ---- --- -- asEli�s�YT6Rii�ffliViei9GSiebo�eGliiSi.li'1i95ltpAfe�li9SEie'se(:Ti!a'ei4YlG�iRi!b1�i9GL i`�f4f83•!iRi.!lC9alYKeiiT�Nlieilaf�9alw^..►�i9,s1!W+ �i�A�iN1!V!li.Y!�fa.�a,k�iT6:.W.b�i�i�e'f r>i�us BOARD OF HEALTH TOWN OF BARNSTABLE , i lVell Con5tructionVemit No. -------- -- Fee--_ ----- Permission is hereby grantedto Construct ( ), Alter.( ), or Rep zir an Individual Well No. if f I street _ as shown on t e ap licatiio P fora Well Construction Permit ` =�- No.- -------- Dated --------------; --_-- - ------ r , � Board of e -th 1 DATE I1 i 1