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HomeMy WebLinkAbout0145 LOVELL'S LANE - Health Marstons-Mills, A 07.8' 070'. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Zigogar 6petem Conotruction 3permit Application for a Permit to Construct( . )Repair(/)Upgrade( )Abandon( ) ❑Complete System LvJ Individual Components Location Address or Lot No. �� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Toot 1�e!V1".N,Y 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 gallons per day. Calculated daily flow gallons. 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) �Cl 74 r 6r v , D c Y 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 Certifi- cate of Compliance has been issued b s and Sign d Date / Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- No. aC)G -� —✓ / Fee 50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ys PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpplication for Miopool *p$tem Conztruction Permit Application for a Permit to Construct( . )Repair(V)Upgrade( )Abandon( ) EJ Complete System VIndividual Components Location Address or Lot No. � Owner's Name,Address and Tel.No. eeryAssessor's Map/Pazcel ©��- o '7 v Af 5)-vV3 r /s 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil, 1 " Nature of Repairs or Alterations(Answer when applicable) /v111,o 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 Certifi- cate of Compliance has been issued^y this Board o Health. j Sign d it Date �f G Application Approved by Date Application Disapproved for the following reasons " rF Permit No. Date Issued 12��� 1 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site,Sewa�_ Disposal System Constructed( )Repaired(P/)Upgraded( ) Abandoned( )by zfep �G2� / C� /JS r at �y.7 l5 N /�//l`y lG'H5 J//5 has been constructed in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 200 3- 395dated2 o U Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will f ct ersi tie, Date Inspector .� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ligotal bps�tem Con!5tructton Permit Permission is hereby granted to_ConsSruct( )/ epair(/✓ Upgrade,(, )Abandon System located at S G��'/ S /07 a l.�c�P C3. rack "o, 7 KQ_ c��rv�n ��k t v^CaU 5 Ca l.J r�i�S�� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 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 p rim . Date: /U Approved by��� r TOWN OF BARNSTABLE LOCATION /G/ l,aucll5 L�NC SEWAGE # 969 tl-339 VILLAGE yy/, ASSESSOR'S MAP LOT —� INSTALLER'S NAME & PHONE NO. A/& B CANCO 775-6264 SEPTIC TANK CAPACITY /0 6 @ �°- �` LEACHING FACILITY:(type) 16,o o !,e 1 (size) t� NO. OF BEDROOMS__PRIVATE WELL OR PUBLIC WATER �- BUILDER OR OWNER DATE PERMIT ISSUED: --� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No l r p; Cap THE COMMONWEALTH OF MASSACHUSETTS BOARDQ OF HEALTH TFi W Yl....................OF...-�?G� . Alipliration for Disposal Works Tonstrurtion rantu Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at ...1 ys...nq4 nrx�n> T #41--�0n...1?(.►.1-6...-•-•---------- -----------------------•--•-----............----------........................_..__......._.. L atidn-Address or t�No. 1 ..:-•. •--•---•----•........................•-•-- �at�ztey... tf ► /l {� . ---•- --... .__................ n Owner Address a .....!r .. Ce! 4 _.....:.... ................... -• ...........- -350 Dial" {1. s�. CdlllQ�cc1 ........_.... Installer t Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................. ,. -___:__Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building No. of persons............................ Showers Cafeteria Q, Other fixtures ..........................--------------------- WWDesign Flow..........:.................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length......:........ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation 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 ground water........................ •-----•--------••-•------------•-••----•-•--------------•-----------.................................- ....... .- -...._. O Description of Soil.......................................... U ---------------• ------------------•---. ---•--•----------•- -.-------------•.----.------•------•-•---...._.... -- -----.......... -----.------- 1"l •... ....:............. .... U Nature R airs or Alterati ns-An wer when applicable_: !04W.•�UaQ-1j 4t1.. lQ.o�?j . �/ Qtl. ac .f?L '..G�+ _.7..-.Sm ..# �ar�A.. s 1'. !!"P .: . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code The undersigned further agrees not to place the system in _ operation until a Certificate of Compliance has been issued by the board of h lth. Signed...... - •8� -----per'- --- ---------------------------------- --��.__a1..........-_-.. Date ApplicationApproved By................................................................................................. ........................................ Date Application Disapproved for the following reasons:..................................................................................................... -------------------------------------•----•------------------------..........................------...._.---------.....------......--------•=------........--•--......................--..........•... Date II11 Permit No. u� 3 ._�.... Issued.............................•--•-•.._..... Date t~ 7 Nw2fL:...1 3 _ Fss......�c, ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.................�...........------..OF.... CPRnuv+4b�Q. , Iirtt#Uau fur 14spnstti 39urks Tiius#rur#Wn rye and 4 Application is hereby made for a Permit to Construct ( ) or Repair (-Y-) an 'Individual Sewage Disposal System at: Iarl I) � 1 •.»•. O U Location--Address........�. -�- -+- ------'or Lot No.»...................»..�.«..««._.. , ...................................«........... .............. » �!5=..cwe i s•_���:?:�:../}IMP 5................1 s_...»»....»...»... /► T.«« Owner 1, �( Address I 1 rr a Installer Address Type of Building Size Lot........................L..Sq. feet U Dwelling—No. of Bedrooms...............................-&......Expansion Attic ( ) Garbage Grinder ( ) ow a Other—Type of Building No. of persons............................ Showers — Cafeteria QOther fixtures .-----•----.......-•............................... WW Design Flow............................................gallons per person per day. Total daily flow----........................................gallons. A4 Septic Tank—Liquid-capacity.--....__...gallons Length................ Width................ Diameter............•._. Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area..=-_'-......--.--sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 4 aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water................:..,... L=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ v 0 --------- ------------------------------------------------------ ---------------.................... -.------------------------------ _...... ..•••--------------- 0 Description of Soil...........•-•--•-•--••-----------------•--•-••.........•-•---•-•...----......--------•---------•----•-------------•-•-•-----•-----•-----•------............-••-•-..--- W ----••------••••---------•--•--•--••----------------•--•-•••---••••--••----•--.........------•---••-----....--•---•-------------.....-----•---------....-----••--•-•-•------....._....._...-•----. .... U Nature of Repairs or Alterations—Answer when applicable. _.lad' ./%�p�Gno��!c -•••�,c•- rr 1 4 .Sane �s �? UrdLC7 `/ v.__... _ /._.....»� �� o lr�o Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL' 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig ned........ - ut4 -----------------•-- ------ ........ _.._: Date ApplicationApproved By................................................................................................... ........................................ Date Application Disapproved for the following reasons:..........................................................................................................--- ...................... .._.... -•----......-----...-----..........----.....--------........----•-----......----....--------•---...------------•--•••--••••--•--• --•-•-........« PermitNo....._......z........z� ---------------------» issued............................................D�..... ate ------------------------------------------------------------------------ F THE COMMONWEALTH OF MASSACHUSETTS or r BOARD OF HEALTH I ' --� I. c!??'YI...............OF.......<<...Ctr>�`>�- ��':................................................ f1rr#if rate of Tuutphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ' by.....:...... ................ - ............................................................................................. has been installed in accordance with the provisions of TITLE 5 of, he State Sanitary Code as described in the application for Disposal Works Construction Permit No....... �_.�.✓...�..._. dated._...r.Z'..��v_.X��.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION N SATISFACTORY. DATE............................................. ------------ Inspector.. �� 1 t` THE COMMONWEALTH OF MASSACHUSETTS �^ BOARD OF HEALTH Y' f c�w41CF 315�V�n�[E. Disposal arks Tuns#rudi�an f ruAft Permission is hereby granted...1...A�nn;, `------•---------------------------•-•--------.----.------•----•--'................................»».. to Construct ( ) or Repair (o ) an Individual, Sewage Disposal System ---------••...... ....:...... ... ........................................................ StreetZ, -' J as shown on the application for Disposal Works Construction. Permit No..................... Dated....._... ............................... .................... ^......... - -------------------------•---............ ✓ Board of Health DATE ........................................ I