HomeMy WebLinkAbout0054 CALVIN HAMBLIN ROAD - Health (2) l'
54 CALVIN HAMBLIN ROAD
MARSTONS MILLS
A= 101 - 032
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No. Fee UU
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
9pplitatlon for Misposaf 6pstem Construction permit
Application for a Permit to Construct Repair(V/UPgrade iAbandon Complete System vidual Components
Locatio/n r e7'kd�d�ress or L(�ot p. sq&.(UeN) t"��rv►��iv� t Owner's Name,Address,and Tel.No.
Assessor r's1GT p ) al 3 Z V-i
Installer's Name,Address,and Tel.No. Designer's NJme,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) 30 gpd Design flow provided 1 gpd
Plan Date j I Number of sheets Revision Date
Title !
Size of Septic Tank 6/5-j'fNi Type of S.A.S. Cc'ac��
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) r14SJJJA) `V" 0, 0—10
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 Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
i
Permit No. 21"a Date Issued
No. �Zt " �U1( Fee
`¢` THE COMMONWEALTH OF MASSACHUSETTS THE in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zippfication for M sposa 6pste u Construction Verrnit t
Application for a Permit to Construct( ) Repair(V} Upgrade( ) Abandon( ) ❑Complete System ❑,Individual Components i
1 � � Fl �.
Location Address or Lot No. ,q(r,(U►r0 ticmb 14) k4) Owner's Name,Address,and Tel.No.
Assessor's Iv1ap�/Par�cel ,
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling, No.of Bedrooms ,3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building �� �` No.of Persons Showers( ) Cafeteria( )
Other Fixtures t
Design Flow(min.required) Q gpd Design flow provided gpd
Plan Date S/ $��j �. Number of sheets / Revision Date
r �
Title J'
Size of Septic Tank 'CX/5h N yi js Type of S.A.S. O G!(f`
Description of Soil
Nature of Repairs or Alterations(Answer when applicable.) rJS&1 4, / r.) 1)bM �. ` 10 '�-oo 00/ }
v
Date last inspected: t
Agreement:
p 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. t
Sign edt ,...:-�' .!it' �` Date
Application Approved by =r��.i 1 Date
Application Disapproved by - r Date
for the following reasons
a
Permit No. 3 j / Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY',that the On-site Sewage Disposal sy`siem Constructed( ) Repaired( Upgraded( )
Abandoned( )by
e ro,TAX.-
at S 4 e',,1U r ekr
t f t!,% C) 4 A& has been constructed in accordance /
with the provisions of Title 5 a-nd'the for Disposal System Construction Permit No. �;)021.-2 1/, dated
Installer BMW T-NC. Designer
#bedrooms Approved design flow . gpd
The issuance of this permit shall not be conns4rued asja guarantee that the system will func id as(e is,gnledd
Date / �J / Inspector
44
No. 2-D 7 Fee / U-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstpm Construction 3permit
Permission is hereby granted to Construct( Repair( In .Upgrade( ). Abandon( )
System located at �� �'t}r111: G11Q 1t ;" (Ilaf'EiC�IY''1
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with d -
Title 5 and the following local provisions or special conditions.
r
Provided:Construction must be completed within three years of the date of this permit.. i
Date la fr / Approved by t t�:V j
._ < .
r
Town of Barnstable
o� t Regulatory Services
°++ Thomas F.Geiler, Director
` RAMS LE. ' Public Health Division
Thomas Mclean, Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: Sewage Permit# aoD/-2 1/ Assessor's Map/Parcel /Q_ /-32
Installer &Designer Certification Form
Designer: 6 (� Installer: `2
Address: f
�l C�'1����`"/ Address: t�•j� �6 X /,_y.�
On ✓-� _was issued a permit to install a
(date) (installer)
septic system at Cl/ f%;,.� j l..,,,, I J,;
(address) ,� J based on a design drawn by
b_ dated
(designer)
I certify that the septic system referenced above was installed substantial) according
'the design, which may d t
g , y include minor approved changes such as lateral relocation
of of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were -ound satisfactory.
I certify that' the. septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system).but in. accordance with State & Local F ',tions. Plan revision or
certified as-built by.designer to follow. Stripout (if r- acted and the soils
were found satisfactory. ��1N OF�,jqs
DAVID
(Installer's Signature) M +�s
At 4 C
- a
No.. Fx$..............................
` THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
fin.........................OF..::. Lam.
---------------------------•----...••----•••-
Appliration for UWpooal Porky Tnnitrnr#ion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at: I �i,,
--... '. ...� .... !.0 w...k!.C.✓✓r ......••-•9-s..Q ........ � -1 >�k�... ✓mil b.
Locatio -Ad Tess or Lot No.
��cAbskS....(&),=...1. .................................... ---16 a.........................
r - Owner Address
a ........... 4.c.2 4.... G. .................................................. •-•••••.........••••---•--••••.......••--••••...............•---.......................-•-•-••....
Installer Address
U Type of Building Size Lot..20f./.A.Qy...Sq. feg
,., Dwelling—No. of Bedrooms......... .................................Expansion Attic (ts)' Garbage Grinder v�
per, Other—Type of Building _.._..k ........ No. of persons....�................ Showers ( ) — Cafeteria ( )
P� Other fixtures -----------------------------------•••• -
W Design Flow............................................gallons per person per day. Total daily flow......5.,5.0......................._gallons.
WSeptic Tank—Liquid capacit/k9`�?-gallons Length................ Width................ Diameter__-_____.___.--. Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area. .....sq. ft.
Seepage Pit No............/..... Diameter----/A_...... Depth below inlet...6............ Total leaching area..A/o..,�...sq. ft.
Z Other Distribution box ( Dosing k_A(p) _
� �. 1�!g��i�'�,'? ...... Date_._:. 11fl--7f�
Percolation Test Results Performed by._ _. ... .... �. . .. .. ... ............
aTest Pit No. l._o :Q.....minutes per inch Depth of Test Pit.................... Depth to ground water........................
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
04 ................................. .... ...•---.. a0------�---------�-i- - ..---
� �Akt � � �� Z _O Description of Soil----- La
Wd :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 i?TLL 5 of the State Sanitary Code—T e un rsigne further agrees not to place the system in
operation until a Certificate of Compliance has bee s e y th o d heal'Efi.
Si e .....
.......................................... ••
to
ApplicationApproved By...... •--••... ............................ ............................. .-.....
Date
Application Disapproved for the following reasons--------------------------------•-----------------------------•--------------•--•-----------•••-•_............•--
..........................-.........................................................................................................................-----•.......................... ...••••-•.....
Date
PermitNo......................................................... Issued........................................................
Date
�. :s '.c,
� s
NO................_....... Fizz............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........:................OF....d4e.r.7.!"rl.. tLte ......_......................................
A- ##ftrtt#ion for Dispstii' nrks Tour dr iun. amit
Application is,hereb made for a Permit to Construct`( )` or Repair ( ) an Individual Sewage Disposal
System at
..... ..... ..... `1CatM �vl ' E3f� A 133t cy d 6. .a... " dA
t Locatio Ad ress or LO
................... ---••-•-••-• .�� ' .11rz. ............. ..`_' .! r... ....
....................
Owner Address
W s/
... _. S 'LJi t.:....i-=-�S..3t�S. ................................................... -_ -_ y_- ----______-__-__-___-_•________-__-_...______.............._....______'
" Installer Address
Type of Building Size Lot; _ _ .....Sq. f t
Dwelling—No.,,of Bedrooms__.. _____________ ____________Expansion Attic ( Garbage Grinder )
a 'Other—Type'of Building ..... ......... No. of persons ' .........._ .Showers.'{ ) - Cafeteria
Other fixtures .....:........ a
W Design Flow..:..:......................................gallons per person'per day. Total daily flow____. ' _:_.._gallons,
W` '` Septic Tank—Liquid capacitj(Q _gallons Length................ Width................ Diameter--'.......... Depth_................
x Disposal"Trench—No. .............. Width.............;...... Total Length-----------1........ Total leaching area n_4......sq. ft.
Seepage Pit No............ ...... Diameter.._ ..f)___._._ Depth below inlet._/.............. Total leaching area...;.I%_/a_...sq. ft.
z Other Distribution box ( I Dosing a k
w .
Percolation Test Results Performed b "� JA _+ .._t °aDate....
W Y - .;, - ' --.....---
a Test Pit No. 1. .,__,.minutes per inch Depth of Test Pit.......... ........ Depth to ground water.........................
(i Test Pit No. 2_._..__�_
......minutes per inch Depth of Test Pit..................... Depth to ground water:...:....................
.
R.
O Descrip�on of Soil--- _ + r�.0.4t✓�'7_ ��z a ----=� r�.-- - -�.VQ, .
0 r '••
Ui ds srm ..........--------------- --------------
U Nature of Repairs or Alterations—Answer when applicable_:".....
d
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— he un rsign further agrees not to place the system in
operation until a Certificate of Compliance has bee s e y thyb oa it f health.
Si ,ned_._. ._ •-••=••-----••--•---•-----••--......_._ .. �_ .�' ._..._
-.-•• ate -• ,
r �, . _ , ��
Application Approved BY �I.. • ✓1..G�. ........................... "' .......
V Date
Application Disapproved for the following reasons---------------------------------•-----------•-----------------...------=--•=--------------•---•----------•--•--
•--------••---------------••---------...----------------................................................---•-•---•-----•----------••-----••--•-•--------------------------------...------•-----...._...
Date
PermitNo...............:......................................... Issued.......................................................
Date "
THE COMMONWEALTH OF MASSACHUSETTS
BOARD -;OF EALTH
Y 7 OF................./�" '-' �:...... ;
f...:e....................... ..............................
(Irr#if iratr ot Toutplianre
TH,S IS TO CERTIFY That the Individual Sewage Disposal System constructed ( 4—or Repaired ( ) {
bY..... 1 (�-�''j= .= ••--•--------_ _• -_ •-------••-_-•--• ----------
/ J�// /q V j I staller r
at._. !=. ° •••1 .•••• ! P_9e ?!e�Z-- �- E f!fz`- / 'G .. - �! 1..
has been installed in accordance with the provisions of TIT"L1 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. �__ .._......... dated_.... -.<?:. _-_7.y1..............
THE ISSUANCE OF THIS-CERTIFICATE SHALL HOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY;.,"" "'
DATE....................... Inspector. :'..............._.................................
THE COMMONWEALTH OF MASSACHUSETTS
- , BOARD OF HEALTH
JJ
�i rt
? % OF...... •/fil:....,1...............................................
.... FEE...... .............
Disposal Works Tonstrnr$ion Vprrmit
Permission is re by granted.....; 1tf wt7 ........................•----------.........-- .........�.J__.. �-
to Co�truct ( or Repair �) an Individual Sewage Dis�osal/ ystemi
at No !Jr, �2 �... '� '...........»• � 2' 1-- f�� � _� _, __t fI'f %`!i(Ij'
-.
Street r
as shown on the application for Disposal Works Construction Permit)No........ !.....__ Dated..-.� ..:. '_. _.'.'� ..........
'J
--
' r Board of Health
�DATE....__ �1_ �'----�. .......................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS T
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