HomeMy WebLinkAbout1429 OLD POST ROAD (CT & MM) - Health 1429 Old Post Road ,
Marstons Mills f
A= 057— 023
TOWN OF BARNSTABLE )2�`�"� "-
LOCATION o y`> SEWAGE # 2-e o o -+0 z_
VILLAGE 14 g-snu J- p ASSESSOR'S MAP & LOT 3
INSTALLER'S NAME&PHONE N0 j�/ � �� i✓o.. ��, 3.9° -547
J
SEPTIC TANK CAPACITY /Oo o G✓1c c a�J
A
LEACHING FACILITY: (type) 3 (size)
NO. OF BEDROOMS -,>-
BUILDER OR OWNER . (jn-t-3 rasa
G. �v r
PERMITDATE: _y COMPLIANCE DATE: 42/
w
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
f
r,,
No. Fee —S
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pplitation for Migpoml *pgtem Congtruction Permit
Application for a Permit to Construct )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
/,47_9 O LSD Po s r /J 111�1,c.C-s 4 2-6 - 0490)
Assessor's Map/Parcel OS'"? ®21 3
Installer's Name,Address,and T No. 3 99—9 '7 44- Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size �3 6 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 /o° y G Type of S.A.S.
Description of Soil
Nature of Rwirs or Alterations(Answer when applicable) JZ&f
J "-!3;—
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 Ce
cate of Compliance has been issued b this Board of Health:
Signed Date � Ov
Application Approved by Date
Application Disapproved for the following reasons
Permit No. 2,6 Date Issued
)Z-`p 4
_ TOWN OF BARNSTABLE
LOCATION j�1'�t 0(- ��'' SEWAGE #
VILLAGE /�i9�.STV) �'`� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. Uwe n,9sa.. w� �j✓°..n�v-titi 3 50 -y4;7
SEPTIC TANK CAPACITY
LEACHING FACILITY (type) 3 �J«``' 33u ' (size) �°'= ' �*
NO. OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: -7 6 COMPLIANCE DATE:
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.
_.- ----------
' c7
0 0 �-
No.ro �U'' e Fee v/ e
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: '
Yes
' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipprication for Miopaar *p.5tem Construction Permit
Application for a Permit to Construct A)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
.4.Z9 04D )-'O s7- 07 / �f �jiL4.i W/LG., 41-7 /-49,�. 7 4 Zv . SOco,0
Assessor's Map/Parcel 0 3 ¢�g Q(•,'0 Rd S r A?
Installer's Name,Address,and Tel- No. 3 9,0, " `�4 7 4- Designer's Name,Address and Tel.No.
Roy e4n5 #_.21-ve/Z ki
Type of Building: /hy
�7V-�/ /,i t✓,--/
Dwelling No.of Bedrooms Lot Size �j sq.ft. ,y, 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 Revisibi�Date
' Title
Size of Septic Tank °° o G i Type of S.A.S.
Description of Soil
Nature of Re�airs or Alterations(Answer when applicable) L�E� �'� �= L� -2
/ '� v.� r» 3 (�✓c.T Lc C S 3 3 U r3 3 ' O s -a r t`
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 Ce ifr-
cate of Compliance has been issued b this Board of Health.
Signed Date ,2
Application Approved by s Date
Application Disapproved for the following reasons
Permit No. Q-Z Date Issued
---------------------------------------
THE COMMONWEALTH OF,MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
QCertificate of QCompriance
THIS IS TO CERTEFY. that the On ite Sewage D' osal System Constructed( )Repaired ( )Upgraded( )
Abandoned(, by ( / 1 C?
at J1 )l ( L i _ has,been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 00-W&-dated
Installer Designer / I/ A - �
The issuance of this pbe t sha I not be construed as a guarantee that the syys�te�m_will,function as/des ig�ed�i
Date , Inspector 1{ / � } i �(1 'f "V
t
J \/
----------------------------- ------
r No. ZO'TlCJ " Z Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mopozar *p!6tem Conztruc ' n Permit
Permission is hereby granted to Cons ct )Rep Upgrade( Ab ndon
System located at
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:Constructi n ust be completed within three years of the date of this ;rQ�rit. t.
Date: Z ` �� Approved by
7/ L. c
R
V
I d
s' � ✓
,✓T
No..0.1..4�.y. F��.. .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
CL /�. e
. ......... .. .OF.............................�.....--------------------------------------
Appliration -fur Di,spuuttl Workii Towitrurtiuu Vrrutit
Application is hereby made for a Permit to Construct (k ) or Repair ( ) an Individual Sewage Disposal
AS t t
f,
(� 1�
Loclo.._Addr
. e gI' Cs5'e / Lot Pp----..... -------------------------------------•------ ..................................�o �y-S-----.
Owner Address
Installer Address
Q Type of Building Size Lot...
.7/ 3 _..Sq. feet
U Dwelling—No. of Bedrooms-----------2____________________________Expansion Attic ( ) Garbage Grinder 1\0)
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures -------------------------------
Design Flow........................ma.........:-gallons per fe}so er day. Total daily flow-__•-______-___-----__�3__®__._..gallons.
W Septic Tank—Liquid capacity/�-G-gallons Length----Pt `� Width-�-_--C-- Diameter_------------- Depth.5__!�_P...
x Disposal Trench—No..................... Width...............----- Total Length-------------------- Total leaching area.........._....__...sq. ft.
� o -
Seepage Pit No.......I.......... Diameter......`d__.---- Depth below inlet.................... Total leaching area.-- _.sq. tt.
Z Other Distribution box ( !/j Dosin tan ( ) `
a Percolation Test Resultssss Performed b 1_--.-.._- ---fi r---_--- .................. Date---.----------------------.------------.
Test Pit No. L-)V_A�-----minutes per inch Depth of Test Pit--------- _�. Depth to ground water........................
4, Test Pit No. 2___;-i-0------minutes per inch Depth of Test Pit---------/j'_--- Depth to ground water--------------------
------------------------
----- ------------ ---- - -- -------------------- ---------
D Description of Soil-----------------0_ --Z-------- G a �. �i ,2 �— /.2 c a 1^ 3 r S9� w
x
U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
W
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 XI of the State Sanitary Co. —The d gned further agrees not to place the system in
operation until a Certificate of Compliance has . e sue e rd of health.
Si ............. --- •--------- ---------------- ---- - --------- -----------• ........--•-•--•---------------
-
Date
Application Approved By. d � /�
---------- 3/..-�
Date
Application Disapproved for the following reasons------------------•----••-- ..............................---------------------------------•....................
........................................................................................................
Date
PermitNo........................................................ Issued.........................................................
^ Date
.................................•............•..••.•..•.•.••......•...•.•••...•..•....•,........,.....•.•..•.....•..
HE COMMONWEALTH OF MASSACHUSETTS
HEAL�,�//
BOARD JAL
.................................OF.....................................................................................
�rrtifiratr of 'T"uutlinrr
THIS IS T ERTIFYyThat t�idual Sewage'Disposal System constructed ( or Repaired ( ) r
by i'c' '
� staffer
at-------------- --------� ------- - A.,-
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
$J _application for Disposal Works Construction Permit No. _-_1_2_Y-------------___ dated----------..---._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector............................. ••-•------------•-•-------------------•---•---------•-
_.----------------------
z. � ti •�
j
NoWTILAY.. 300
THE COMMONWEALTH OF MASSACHUSETTS
BOARD �,,QQF HEALT
H
O`A- .............. .OF........ l?,IA �`h f/�2 ..... .-..... ..-.-..... ......... ..............
Applirtt#ion -for Bi,ipuiittl Worko Totuitrurfinu Vamit'
Application is hereby made for a Permit to Construct (;"*)*'or Repair ( ) an Individual Sewage Disposal
u�S st�I t
--......1.5 .. 1..---...----............r . .................... --•- ------
Locap�on-Address/ or Lot
6siJ( �l t !'� e� { ram✓ 1 .�`C
A--'-V -------------------------------------------------------------- C
Owner Address...
Installer Address
UType of Building Size Lot_- .7.,. _ ____Sq. feet
Dwelling-No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder (Ive)
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ----_------------------------
Design Flow________________________/Z0.__.._.__--gallons per q)@woRi per day. Total daily flow________________________? 3__0---_--gallons.
W G ��/ Width_ .a _ Diameter.___.--_---___- De>tli_ ' F�/
Septic Tank—Liquid capacitvf_________gallons Length_.__ _.__� __ 1 .`-
xDisposal Trench—No- ____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No-------I----------- Diameter------/-C/_�____ Depth below inlet-------r_1..... Total leaching area-_ X --sq. ft.
Z Other Distribution box (Pj' Dosing_tank
Percolation Test Results Performed by. __fit�-` Fr/="�. ��:' h '�_/ i_ __ Date._ °'-----------------------------
Test Pit No. 1. s____minutes per inch Depth of Test Pit---------/4 . Depth to ground water-__----___-__-_-_----
1:14 Test Pit No. 2---;_.Ce------minutes per inch Depth of Test Pit--------- Depth to ground water________________________
------.....- t------------------__--• -r--- : --
------------•--•----------
o�ODx � � r'c 1 5 ` hc �'
escription of Soil----------------6--- .. ---- -•-- -••- -5- -------- __ ------ --------------------------- _--------
V ----------••-•-------------•-••--------------------•--•-----------------------•---•------------------•••-••-•••-•-•---------•------------------------------------------------
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 XI of the State Sanitary Co e—The d gned further agrees not to place the system in
operation until a Certificate of Compliance has sue 'b e and of health.
Sig -•••- •••••.. ----••••--••• -•••-•-• ••••----•-----•-�--------•---•••------- ------------Date--------------
Application Approved By---------- - ------- ----------------- ....... 3.0 Z-----------
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------------------•-•-• •---••-••-••------.
............................................................... ----------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued........................................................
Date
HE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTiH
...........OF..........................:..........................................................
0111rrtif iratr of 0111mVliaurr
THIS IS T ERTI-FY, That tl4 IncVvidu4l Sewage Disposal System constructed ( or Repaired ( )
--- llsta - •---••--------•at ...�3•-•---- - ---- -- -- t �rff�
.....................................................
has been installed in accordance with the provisions of Article X`I of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No f -_✓_- ________________ dated................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.-
DATE................................................................................. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEA T
f/4�- ..-
>j ...... ........OF. ,..-.-.
FEE D.............
%ripaiittl Pnrka Cltt rur ion Errant
Permission is by granted----------��---' L!t'"yN_- M- ----- -- --------- ------------------------------------------------ /-------------
to Construct ( or ep 'r ) I ivi Se ;�Di sal�tem ''''f //�
Street
as shown on the application for Disposal Works Construction Permit No--------------------- zted--------------------.--------------------
-- --------•----=----------------------------•-
DATE------ � ---------------------------------------------
of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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