HomeMy WebLinkAbout0175 OLDE HOMESTEAD DRIVE - Health 175 OLDE HOMESTEAD'D M. MILLS
A= 043-001 .017
PTO O ASTABLE
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LOCATION SEWAGE # q�—
VILLAGE S ASSESSOR'S MAPS&Lef!2T�II- 6//
INSTALLER'S NAME&PHONE NO. W S�1lf"r- r!—�i��0
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)l 416 X 4/ X ' ��`� esize) YQ f
NO.OF BEDROOMS
BUILDER OR OWNER + ` L P.4 -Y
PERMITDATE: i<, �,— COMPLIANCE DATE: / — -— .
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
2 0 .S
F �o to �.
L z LL
2 2- 4 �r
I
�i,, G
ASSESSORS MAP NO• 4-3
PARCEL N0: 1 - 1-7
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliratiuii for Di-tipuial Workii Cnunitrnr#iun ramit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
..J-7l1`3 OLDS j-�tin S??E�'r '�• :_M.!_L4S ,-M.A---------••---�.....-�- 3G0
-....- ----••-...- —
Location-Address or Lot No.
- .�...!- ' ''' �-r ��c . 1 •5E,A r'��af�R-� ��1 _....�7b't�-+tie�s I�iA • CA-6.
.._ .. y--•-------------•--• -•--------.-. ------. -•••+---•-........................
Owner Address
ova
Installer Address
22 451
� Type of Building Size ........Sq. feet
Dwelling—No. of Bedrooms._......i?fiR-....;E=....__........ ----Expansion Attic (H,,) Garbage Grinder (Nc,)
Other—Type of Building ---- -- No. of persons---.�lP.............. Showers (NA) — Cafeteria (►,A)
Otherfixtures .------ k+dtn'E--------------------------------------------------------------- ..............................................................
W Design Flow....._.....!A.�------------------------gallons per person per day. Total daily flow-.----.----—b......._...............gallons.
fy Septic Tank—Liquid capacity_TP?..galIons Length--_ Diameter.'-•.LA....... Depth..-`-?'Z"._...
Disposal Trench—No. .................. Width......:`F.......... Total Length---4o`........ Total leaching area...!;!7!n.......sq. ft.
Seepage Pit No....k�.IA..------- Diameter._..F- J.A------ Depth below inlet....e-t.LA....... Total leaching area..) /- A..._...sq. ft.
Z Other Distribution box (✓f - Dosing tank (NA)
'" Percolation Test Results Performed by....1--m.. !+.! `!�!.`.� .'�__A`. �'.G____-_-___- Date--___`2.._'_!to._8�o
-------_....
aTest Pit No. I.....:'L'-----minutes per inch Depth of Test Pit.----I'...._..... Depth to ground water...l`+5 E-__-._.
LL, Test Pit No. 2..�/IA.....minutes per inch Depth of Test Pit---t~/A________. Depth to ground water.._ JA____.....__.
W --------------------------------•-••-•-•--••--------•--------•••-•••------------------•----•._...•••.........................................................
0 Description of Soil... l : a -V �'p4 '7-' - tti' ; [A6-Divan SA�®- - ------•--- ..._ _. _. ---------...--------- -----------...-----------------------------------------------••-•-••+
W
-------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
VNature of Repairs or Alterations—Answer when applicable.-._H JA.................................................................................
-----------------------------------•....._........--••--••---------••••-••.....-•--•----------------------------------------•--------•-----•-•_...-•---------------------•--•••._......................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance ha een iss 2--
board of health.
.
Signed ---........ ............�-- ...... ...... .............................
Dace
Application.Approved B ------ ..------------'------------. ................. . ------.................---........... .."....Dace
Application Disapproved for the following reasons- ---------------------------------------------------------- ..---------------------------------------------------------
------....._---------------------------------------------------------------------- ------------------------..........-----------------------------------------------------_----------- ........................................
Permit No. ._ '-<..��...�- Issued ---------------------------
Daz
I
No ....
r THE COMMONWEALTH,OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Divi-puial Works Tonutrurtitun rami#,..
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
Y
--I-I9 oLD �M�S 1 9`�fl NCI . M 1 LLB M A----•---------LoT -4 3�p
.......... __.. .__ ..._•----------•••-- -i ---.--•-- ,... ------••-------- •..............................................•-
Location-Address or Lot No.
......................F-1-! j. 1= ,•-Lt _A Q.•�( E-T vtic . �1 5E-" �csf�Q f� U Q1y tk--•--f 1_�]t`ti�N 1 S 1�A �(oo
Owner Address
G� .......... ........................ i...............0 .__Q..., M M_11.t. �° . O'Lb4�
Installer Address
UType of Building Size Lot__'L'1 +45 t_______•Sq. feet
Dwelling— No. of Bedrooms--------D---------------------------------Expansion Attic (Nb) Garbage Grinder (No)
Other—Type of Building ..... !+ ......... No. of persons.....—_1A-------------- Showers (NA) — Cafeteria (�,A)
Otherfixtures ..------ti,a+.l ------------------------------------------------------------ -------------------------------------------•---••-•--••-----.
g I 1 .?________________________gallons per person per day. Total daily --------------------------------gallons.
W Design Flow...................
WSeptic Tank—Liquid capa y_!S----- gallons Length--- a'. Width_.5'�"... Diameter.."./A.. .... Depth._`5'7:'_--..
x Disposal Trench—No_ ------__ .......... Width......`1.---------- Total Length.._!c? ........ Total leaching area--- .....sq. ft.
Seepage Pit No-.__�n!A._.__- Diameter___.- ----- Depth below inlet-_-.1�!A____._ Total leaching area...t�J_1a_______sq. ft.
Z Other Distribution box (✓f Dosing tank (H A)
Percolation Test Results Performed by BHA �+v iek -� �4 ssoG Date___.S................................
a
,� Test Pit No. I------ .._..minutes per inch Depth of Test Pit.-.--!'L-..____-__ Depth to ground water---r"c� G.......
ri Test Pit No. 2...� e-N.....minutes per inch Depth of Test Pit---� _________ Depth to ground water.... ...........
P4 .._.._..--••--------------------------•---••----.._..-------...__...----•---•------..--..--••-------.........................................................
0"►� > -1- bP S ,L • 2 ' - 12' -. LUED,vvt SA-+-40Description of Soil----TR ------------------------- -------------------------------------------;-____.
K-,=:> wrt ri=-2.._�_..__12
U -----------------------••-----•---••••-•------
W � -
----------•--- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------••••••---_---•--
U Nature of Repairs or Alterations—Answer when applicable.-__-�-:'. A............................................................................:....
•-------------------------------•---._...---------------------------------------------------------•----•------•---------------------------------....--------------•---------------------............-•--
Agreement:..,-
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by thboard of health.
Signed ---------- -- ------- ---- - --- - .........................................
Dare
Application,Approved B - ------- ---- --- ------------- ............... ......................._ ..g~.
Dace
Application Disapproved for the following reasons: ...................... ------------------------------------------------------------ -----------------------------------------------
------------------- ------------------------------------------------------- -----------------------------------------------------------------------..._.... ........_........_........... ....I---------------------------------
Permit No. 9�_ �2---------- Issued e
- _.... - ................................ .._..................
Dne
_---e--- -- -----------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
`LPitiftrate of 01-11ampli2 are
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
1'4—eELit-.tom CaNSTrz�f�1or-+ 35 o�D f-^r-eAovi�t 2oftfl Its , AA1L-4S AAA .
by _---------------------------------------._....--------- +._....... - ---....--------- - -_...... ..-...---- ------ ----------+ --------------------------
1nsnaler
at ----1-15 .v_0a f lc�rt E-si�fi�...�.(1t�,E a M.r4Qsi7>�S...M 1.t_t_� r...AA ft\ .'._... -- ..._..... - -
has been installed in accordance with the provisions of TI"fLE of e Stat Environmental Code as described in
the application for Disposal Works Construction Permit No. ---- dated .G0 ��j�.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
.i
DATE..--/l�°'�^- '' �lv� ----------------- --------- Inspect �'L�� � ..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
J1 TOWN OF BARNSTABLE
NoZ.-V............... FEE. .
�iu�ruuttl Turku �unu�ra�rtiun �rrmi�
Sr(z�eC L l -,� /�.S-rvv nc5t� 3f�---- - �D P rtizrv,oc� P-►�
t Permission is hereby granted---- ....
to Construct (__�or Repair ( ) an Individual Sewage Disposal System A" AA L L-'s
1 1 S c�L t�� i{�M S i�rt s un t t_Ls K.�A 0 2 to4-8
at No..... ------0----•---- --------- _t ---...........................................-------------...---- -----------• ------- , ..............................
Street �*
as shown on the application for Disposal Works Construction rmit �A - 1 ted.... .`-..��''
--:------- I I ---------=----------------
� Board of Health
DATE.. -
FORM 36508 HOBBS♦!WARREN,INC..PUBLISHERS
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SULLIVAN . A. `
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