HomeMy WebLinkAbout0154 ABLE WAY - Health Ab)e
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LOCL.TION ' y� SEW&C;E PERMIT UO.
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VILLAGE
IWSTNLLER°S 1JWAE ADDRESS
BUILDER S�Q W AE ADDRESS
DATE PERWT 15SUED
D ATE COMPLI &MCE ISSUED : - - _
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BCD r v� / THE COMMONWEALTH OF MASSACHUSETTS
-: 7S BOAR, D OF HEALTH
_..- ..444k e'O ......-- ..OF.........
Appliratiun -fur DiiiVoimt Worko Cnunstrurtiun Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst at
ion-Address r Lot N
............. •-•--- ...... ................................... .................... •----
er � d s
Installer Address
Q Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-____ :_ '_ ____________________________Expansion Attic ( ) Garbage Grinder ( )
p`L-, Other—Type of Building _. _ No. of persons____________________________ Showers ( ) — Cafeteria ( )
0.i Other fixtures ------------ ------------- ........................... •
d ----------•--•-••---•------------------•--------•---_-•---•-----------------•----
W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
1:4 Septic Tank—Liquid capacity,00-9-gallons Length---------------- Width........-------- Diameter................ Depth................
xDisposal Trench—No. ______ ___________ Width-------------------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._.d..Q!9 Diameter____________________ Depth below in t---- Total leac ing<tre ------- ----------sq. tt.
z Other Distribution box ( ) Dosing tank ( ) 04 r
aPercolation Test Results Performed by.......................................................................... Date-------------______--------------------.
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground writer---_____-__-__-__-.____-
�14 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------
---------------------- ---------
-
•
4G �Descriptiop of Sol-- - --- •C7._`'•G---- -- ......
P
U -- ear_._.. 6
---------------------------------------------------------------------------------------/----_------------------------------------------------------------------------_-----------------------------------
V 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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued b the board of ea Q
-
Date
Application Approved BY -- ------------- r :� - Tt�
Date
Application Disapproved for the following reasons____________________________
--•-•--••---•-•-••-•--••••-•••-•••-•--------------------------•--•-•-•-•--------•----•-----
Date
PermitNo......................................................... Issued...................... .................................
Date
4
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
Y. .U'�.............OF.......... �r... .. .. .........................
� �
ApVfirtt#iun -fur 4%iVoottf Workii Tonotrur#iun Vrrnti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:/
on-Address �n y/) Lot No.
_ wn&
Installer Address
Q Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms-------....................................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building __ ------
No of persons____________________________ Showers ( ) — Cafeteria ( )
aI Other fixtures _____________ _
W Design Flow__________________________________f__________gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity_/-P_�gallons Length................ Width................ Diameter------- Depth......-.........
x Disposal Trench—No- ___________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.__119010.9 14 Diameter____________________ Depth below inl t-----___�______._ Total leacl-ing area-._---_--.---____sq. ft.
z Other Distribution box ( ) Dosing tank ( ) d; /' �+—� G
a .Percolation Test Results Performed by___________________________________________________________ .___ Date_.________---___-_-__-.---.--___--_-----
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water..---.--._-_--.--.--..-.
(14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Ix .................... ---- f ....................... ............--.......
r ✓ -r
G1-7� c T —
x Descript�iop �foil---- --�-----------�--------�--r�------- - ��---�-�--;;---- ---�---- --- --�- - :------
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 NI of the State Sanitary Code— T e undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued b the board of health.—,f
.,
g 1 .. '___...>. �'AEr
I ned.... ^s,, .`�....
f Date
Application Approved BY - d �*` .. ._ 1�. 7I.......
Date
Application Disapproved for the following reasons------------------------------ ------------------------------. --....__......_-----------------------------•-
---------•--------------------------------------------------- -------------------------------•----------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
OF......... ... -::' , ..................................
C�:� rr#ifira#r of Tomphaurr �.
TH -' S TOVERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by �•- ------ :.�•-- -------•-----•---/I/- Installer {;
----------------`----
has been installed in accordance with the provisio of < r I of T/�e State Sanitary C e a (descri d in the
application for Disposal Works Construction Permit N - ^3 datedl ( 1::.�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- � ----- ��---- Inspector. ..........................
THE �-
THE COMMONWEALTH OF MASSACHUSETTS
7 BOARD` V' HEALTH
..OF.......... .. ...1� & .................................
No...........l..__._ FEE__ ---
�i��u�ttf urk� un�#rttr#ivat �rrmi#
Permission is reby granted----.------- < ? �.....-. ' :.........................
to Constru ( �) or Repair &) n ndiuidual)Sewage Disposal stem,�/
at No. .2- V--g.. = = � t ...
Street
as shown on the application for Disposal Works Con traction Per o_______________/____ at /__________ (m...
___
�� . --_-__-_•-----------------------------• Board of Health J
DATE...... . .... ........ ...�- /
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
a�.
No.-- - -- --- Fee-]—Z
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rVell Con5truction3permit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( fan individual Well at:
—G
Location — Address Assessors Map and Parcel
—— _ �ls✓_------ -- ——-- —— — -- ----- ----—------------------------------------------------------------------------
Owner Address
------—-------------------------- ---------------------------------— --- - -— -- --- - ---------------
Installer — Driller Address
Type of Building
Dwelling -------------------------------------------
Other - Type of Building----------________ No. of Persons------------___-_-------------------------------
Type
i.
ofWell-_ - - - --- -
------------------------------------------------ Capacity------------------------------------
Purpose of - --
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 Certificate o Hance has been issued by the Board of Health.
Signed-- - - ="--- -"` ---------------- -----------------------------
to
Application Approved By— =----' --`----------------
date
Application Disapproved for'the following reasons:-------------------------------------------------------
date
Permit No.----------—__—_ -- -- -— -- - Issued------ --
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
r ►11+^1
by---- -------------- ----- -------------------
installe
at--- -`�_- --- '� ---------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.--_iAR/ '2-5--Dated �-----
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-- ---------------------------------------------------------------- Inspector---------------------------------------------------------------------------------
. , NO. -Vr_--- !_—Z r Fee ---
` BOARD OF HEALTH
TOWN OF BARNSTABLE
ZIporicationArVerr Condtructionpermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( an individual Well at:
j Location — Address Assessors Map and Parcel
00^
---------------- --------------
-------------------------- --------------------—-----------------------------------------------------
Owner Address
--------------------------------------
Installer — Driller 0 Address
Type of Building
Dwelling--- ------ --- -------
Other - Type of Building----------------------------- No. of Persons-------------------------------------
ram,.
Type of Well-- --------—-- -- Capacity------------------------------------------ ---
`
Purpose of Well
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 Certificate of-Compliance has been issued by the Board of Health.
r
Signed --------
date
�
/ f
Application Approved By ; �,-- �' 1i/ --- — - `- '/�& 9 J-
date
Application Disapproved for the following reasons:--------------''-------------------
date ---_---
PermitNo.----------------------------------------------— --- _- Issued-----------------------------— -
t '• w. — date
BOARD OF HEALTH
TOWN OF- BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by----- ------------------------------------------------------------------------------- ---- --------------- --15 y - W `in s>�� .-/1 � �s ----------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health 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------- -___—___ ----- --- ---
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Con5truct ion Permit
No. --------------------- Fee---=----- ---------
�""/11✓tn,
Permission is hereby granted----------------------------------------------------------------------------------------------__—____---------------
to Construct ( ), Alter ( ), or Repair (1.--an. Individual Well at:
No. --�-�r� u-'-- - -AA-M t -----------------
--------------------------------------------------------------------
_ Street
as shown on the application for a Well Construction Permit
No. ----- Dated--------------------- --
------------------ -- - ------------- -------------
DATE--/-�i�
�y Board of Health'3 ���'-'-/----------'-----------------------___---
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✓4 s/ .3"h vio c r7 Plan / �l�c/ io to e. C. l . J. eo .Z 73 �4y c •Z .2
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�. i CERTIFY THAT THIS PLAN SHOWS
THE ACTUAL LOCATION OF THE
STRUCTURE ON THE LAND AND
THAT -IT CONFORMS WITH THE
W BY-LAWS OF THE TO
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90 ° PLA OF LAND
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AR.5roN lil j- Is .
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4- / owNED BY
OF,y.4r
FRANK caivERv 3 TRENTGI�1 sr,
FRANK � �� FRANK HYANNIS, MASS. 02601
o COtrERY y (� CONERY cm
INGINEER a "ND gt)pVlY(!Q
u No. 6232 1 No. 6573 O /
GISTEP4' �`�' SCALE t iN 'ZQ ,FT, ✓i�SCALE7,974
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