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HomeMy WebLinkAbout1411 OST.-W.BARN. RD - Health s ! �� /a 6 O `f .a .- No....73--3...... F>�s...v�. .......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1A [, 3� off/ TOWN OF BARNSTABLE .11lip H i tt or Dirii.Iasal Work C outitrnr#inn rami# Application is hereby made for a Permit to Construct (' ) or Repair �an Individual Sewage Disposal System at: ............... lJ=:./a.:..................... -•---------------- .w -----•------------------------------------------- "cation :\Id e rrss or Lot No: .. �cncr Address Ins alter Address UType of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms.____. __ ______-______--_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ___________ _______________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04- Septic Tank—Liquid capacity............gallons Length________________ Width................ Diameter---............. Depth................ W Disposal Trench—No. .................... Width.................... .Total Length.................... Total leaching area....................sq. ft. x 3 Seepage Pit No................ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ---------•---------•----•---•••------•--•---•-••......--••--..... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ 9 --------•--------=-------••--•--•••-•--••-•-----•--•-----...•-•••-------............._...._.._------......................................................... 0 Description of Soil........................................................................................................................................................................ V W ......................................... -----•-••------•-----...-•--•--•..._...----•-••-----••--••-----•---- --_----- .._.. UNature of Repairs or Alterations-Answer when applicable... ------------------z __ �i�tll _T ..� 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 e board of health. Signed.,-- ... .. ................... .................... ...... . ../.......19,3...... Dare Application Approved By ----------------- ........ .. ....................... - �e.��...... Application Disapproved for the fo lowing reasons: .................... ............... ....--- ........................ ................................................ ........................................................... . . ......... ..... . .................................... Dace Permit No. ....... .......................... Issued ............................................................... ..... Dace �+{k::.y�•'wu.v+`••V�•..�. ti nrw�� ..s.,..�.1 r'-.- .•t.w�--- . �v-- ,fir. 1.:_ •.iTiFrFa.l...:.,wr.,.. wr..-...:w rr.pev..,.s..—.y,_„^i.i^r&�--f`.�3...��n�ti.l...ya....,r"`.-^,.�.�..' •+l.++r�.Y�:,�• No...-p 3."� ....._ Fas .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratintt for Diripaiial Works Tomitrnr#inn Prrmit Application is hereby made for a Permit to Construct (' ) or Repair an Individual Sewage Disposal System at: — .... �:._��l yV�.1?1_... Location A4 iA_.-------------------------------------------•----------------• Lot Lp.`S.1_/j4...----•.............................. .•----........... ...............••... ...-••-•-............-----^---.........� Are a ner .............. Ga?o�.. �V A4•S..........•--•-•-•------•----••-••-•-•- ••----•---------------••-•---•••-•••••----•-•-•---•••-•-••••--•-•--•••••......--••------•---....-- Inslaller Address Type of Size Lot............................Sq. feet Building ,.., Dwellings/of Bedrooms._....-2________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers,.( ) — Cafeteria ( ) a' Other fixtures ............................... . . W Design 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 ( ) '"' Percolation Test Results Performed b .... ...................... .. Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r Test Pit No. 2................minutes per inch Depth of Test Pit_----------------- Depth to ground water........................ P+ ..............:------------•--•••-••-•-••----••--•---•••••-•--•-•---•....................................................................................... O Description of Soil......................................................................................... --------------....------..._..: .............................................. W /--------------------------•----------------- x U Nature of Repairs or Alterations—Answer when applicable._._ !;l�j_. r r__�/1�__-- n a.T 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 V he board of health. Signed �t�.../.!�s =��� .. . ........................ ----- Dare Application Approved By ............ a. ... .., .,,,: ----------------------------------------------------- 4.-"-Q .ram.. ------ Dare --•''j Application Disapproved for the fo lowing reasons: ..................... ............................ ........................................................................ ..................................................... . .............. . .................. .... ................. ......................... ................ ........ .............................. q, Dare Permit No. .......... ..-....�.3 .................. Issued . . ........................... . ...-- . ......... Dace -------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE u Qrtifir tt of Q-1amplian e THIS IS TO CERTIFY, That the Individual.Sewage Disposal System constructed ( ) or Repaired ( L,- ) by ...... ...................... ----_---------------- _..._.._.... ----------------- - ........................... at ......... ...... / ............o .--.. ... : 1/ ..� ........... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._.... '�_-�� ......_..._ dated ._................................_...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_..........{ . ...1 .. �r ........_......._.. Inspector ..�.. �, 0 ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9 _ TOWN OF BARNSTABLE No.. = ..... FEE.. ............... 13inpnnttl Worse Tnnitrurtinn rrmit Permissionis hereby granted------... _----------------------- ---------------------------------------------•-•-------------- to Construct ( ) or Repair (b,4�an Individual Sciv .. _,7---------------------------------- --------------------•--...:. Street a.s shown on the application for Disposal Works Construction Permit No._�� ; _. _.._ Dated........................................... ................................:.v..................._.............................................. �y l/ Board of Health FCRM 36508 HOBBS&WARREN.INC.,PUBLISHERS l � AT 10� 9 litSl PERMIT NO. VILLAGE Lv INSTA LER'S NAME ADDRESS kwe" OR OWNER DATE PERMIT ISSUED 5---2 �.-, �� DATE COMPLIANCE ISSUED r-2<� _ �� i e t _ i o, �1• �r j THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH ...........................................O F.........---...........................-----..............----------............._....... Appliration for Biipnsal Vorkii Tonstrurtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atd441�.... .....4d .................I...... - car ddress. /f�J _ .. .................•-^--...Lot No. -----_e t .... ............. .......f.._...: i_._ ..........._...... ownerddress.. .. .............. �............................................ �. .. ..:....... a Installer Address ��p Pal , UType of Building Size Lot_.6?........................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther-L-"'Type of Building ....................... . N . of(persons......................... Showers ( ) — Cafeteria ( ) Other fixtures .-.-----•------------------------ W Design 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 ( ) Percolation Test Results Performed by.......................................................................... Date------.....-------------------••-.---- W 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------------------------ x ------------------ .. ......... . ................... ................... 0 Description of Soil------ x V ..............•-------------•----------........_....••••--•-----------•-••--........------•--------•-....••------------------------------•---------------------------............------•-------•--------- W -------------------•------------•--•---•--•-•-•--------•---•-----------------------•--------•---------------- -------- -------------- U Nature of Repairs Alterations Ads when applicable___. _. ------ -------- .... .a.. .. ....., ----------------------------------------------•-----• ---•----------------------•------------------------........._------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI.L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d by e board health. / i ned.. .. 6 - Date Application Approved B =------------�-•---..._------...---- _',----� q -f Date Application Disappro for jhe oBowing reasons:-------•---••----•--------------•---•-••-••---------------------------------•-------------------......----•---•- -•----.....-•--------•-----------------•-------------------.....-----------------•---......-------------•---...-----------•...----------------•-------•--------------------------------•----------_..... Date Permit No. /6/E- ------- Issued-------------------- ............. Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..._.......---.............................OF.....................-------"--...._... ....................................... Appliraation for Mipatiaal Workii Tondrnr#ion thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at f n .Address j`} J or Lot No. ................................................ .......................................... ../1/. a f Installer =•w � Address Type of Building Size Lot___ -_� .�......Sq. feet aDwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) AL4 Other—Type of Building A_ _ k. No. of persons____________________________ Showers ( ) — Cafeteria ( ) Other fixtures _l-' !`ad`(q-•----•"------>�-'l'�------------- - - W Design 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. Seepage Pit No--------------------- Diameter.................... Depth below inlet._._._.._........._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ aTest 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---------------- ________ f._._..----••-•-------------------------•--------•-.._.................................................................. O Description of Soil---•-•. ----=`-�-=---A'•a'-N==�'•�........................................-------•--•--•------------"••--•-----------------------•---•---.......--------- x _ U Nature of Repairs Alt rations A when applicable_.. �'t .... _ ....................nr..?_: .............__... __._______.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sugd by t•e board of4health. / _ ............................ Signed c ..__._:_:... -•-•--• == Dat , Application Approved jjollowing Date Application Disappr d f or reasons:............. -... ................................................................................ ............. .... •---------•------------------•-------------------•---------------------------------------------------•------- Date PermitNo..---------•-��-�--•------------------------------ Issued_----------•-------------......----•---•---•--•-•--.._.. Date THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HE ..............`...........................OF.....: P....,:""..... ........................................................ (In ifiraatTe jalf u t �iaanrr T TIF at t ndiv ua ge Disposal System constructed ( ) or Repairedby (✓f J,... .................••------------•---.....--•--•--..........---....--••------....... �.a-"y` (,•,l�L�,,,. i," �/ - Installer at...................................... 1. �`•-L�-t has been installed in accordance with the provisions of T IrE 9fhe State Sanitaryd�as d �ied in the application for Disposal Works Construction Permit ivo.__.___/_.__�._____.(o____________________ da.ted--- ......._.:__... .... ___..__...__._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... -.a q- ........................................... Inspector........ ene y THE COMMONWEALTH OF MASSACHUSETTS BOA t4OF HEA 1 .........................................OF................._..._....--........................................................ No......................... FEE........................ Disposal Vorkv 0,41nitr inn amit Permission is hereby grante p. r-..._.. .: to Co> is (� ) r epairr4 n Int 'U e �. posal Syst V �y�' .../ � Street �/ 2 as shown on the application for Disposal Works Construction Permit No f____-�/____ Dateds_:.___.._____ ................ ----------•-•--•-•.............•--••-------------------------------....------••---•-•-•----..._------ Board of Health DATE................................................................................ FORM 12-55 HOBBS & WARREN. INC., PUBLISHERS 4. r No.........1-7.1...._ ` r, FIz$..... JG..._............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . v.tu�` .....OF............ !# 1Th,1_ ----------------------------------------------------------------- ApplirFa#ion for Disposal Works Tonstrnrtinn Frrutit Application is h&eby �made for a Permit to Construct ( -)vlor /Repair ( ) an Individual Sewage Disposal Systm ................. •---•------------------------------------- Location-Address or Lot No. `..L......c /..IJL ccGt................................................. . ........................................... 7 Addre�L caner Y _ ........................................................( ✓J.t L✓ �. S.................................. Installer Address d Type of Building Size Lot...................:........Sq. feet _ U Dwellingk No. of Bedrooms....._3...................... .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons....--------------------- Showers a Other—Type g ---------------------------• P ( )--- Cafeteria ( ) Otherfixtures ----------•------------------------•-----------------•------------------•----------........----------------------- ------ W Design 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. Seepage Pit No..................... Diameter.................... Depth below inlet/ ........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' -- ..... - • --- -•-••-•---------. -- --•---------------------------------------------------------- 0 il of Soil . .._.�:...: . - -----------•-•----------------------------------------------- V -----------------•-------------------------•---....----------------•-•-------------------•----------•--------•-••--------------------•-------•-••--•---------------------.......-•-•------------------- UW --------------------------------------------------------------------------------- ------•----•-------------- ---------- ---- ...................................> Nature of Zi or Alterations, nswer en applicable.: EY�(.__.1 .._.�_ 1. �........................ �= _ .......................................................................... ...................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'I . 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 b the board of 1 ealth. Signed.___ 1-� Date Application Approved By.---.----- /.---------••-----------•---•-•---------•-...•-------------------------------- el-p l- 7 P Date Application Disapproved for the following reasons:..................................................................... .......................................... .....-•---------••--•-•----•-----•------•-•-•--.........-•-----•----------------------•----y Date �z�---I �� _ ---------- ---... --•----------- Permit No........1 l..._.................................... Issued_-- -- ..-- 7 ----•-------. Date - �4 No....... Fins............._............ THE COMMONWEALTH OF MASSACHUSETTS i' BOARD OF HEALTH c,t...6e.................OF..:........P�9+rat tT.G/CEc ApplirFa#inn for Bispvii al Works T.oni#rnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System 4t., .. ' . ....................•----•---- •------ ..........- Locahod5 Adl3ress y .t :c or Lot No. .... ....... •. ... ................._ caner r Addre ._----•----... . ............................................................. Installer Address Type of Building Size Lot____________________________Sq. feet _ Dwelling/4 No. of Bedrooms______ .........________________________Expansio Attic ( ) Garbage Grinder ( ) Other—T e of BuildingNo. of ersons... ___________________ Showers — Cafeteria 04 x Other fixtures ---------------------------------------------•-•--•s J Design"Flow __.. �'" `°'_______________gallons per person.per day. Total jaily flow% ... W gallons. Cad Septic Tank Liquid capacity........_..gallons Length ___;Width �� Diameter _-___._..._- Depth................ Disposal Trench l To; ' -. _.--______ Width__.::_;_.....___ Total Length ....._r...... Total leaching area....................sq. ft, _-- _:______ Depth' below.inlet/Q_.._..__.__ Total leaching area..................s ft. � Seepage Pit No .�: .. Diameter p , g q. z Other Distribution box ( ) Dosing tank (; ) Percolation Test Results Performed by.............. .........................._........._....................... Date........................................ aTest 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 �'•- --• -.:__- �".....! P------ V ....-••••-•-•----•--•--••••---------•••.....•---••-•....----••••--•••••••-•••-•-•-•••--•••.....--•--••-••-•------.•--••---•----•-•••-•••--- W = s-- ---------------- - - VNature of Re s or Alteration+; nswer a plicable .._._ _ (................................ --._...• -•--•-•• ---------------••••• --••.._----.............................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT12 ' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued b the bo rd o iealth. w� .Signed ............. ......•••---••••----••----•--- ••--•• •-•---- Application Approved'By.....-- . --•-•-•. --•---•• ••-•..... .....:..•---•-••-•-•-••••-••-••-•-••- ........................................ Date Application Disapproved for the following reasons:------. '-'=----•---------•---•--•------------------.................................=----••••-._._........••-- .....................•-------•-----------------------------------====----•--------------•-•---------=------••-•-•---••••••-------------------•---•-------------•�--------�--•------`........... ....... ....... Date Permit No........&_t........................................ Issued_......... f �•--ADate TH`E'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ �`� fix OF.... � �c.!/�Yl..4.. ................................................. Tntif iratr of Tom' pliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) byi. 'fi.� f�Gt.c�` ...................................................................•••-•-•••-•--•- } Installer has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code s d�escri�b d in the f for Disposal Works Construction Perm t No.:__. � f/._._.__`________________ da.ted_. .._._. .........!�----------------­------- application THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E® AS A GUARANTEE THAT THE SYSTEM WIL FUNCTION SATISFACTORY. DATE...... :- _" —.`-7, -! Inspector_.. •--- -•--- .... - l'= .. -- --•- -- THE COMMONWEALTH HOF MASSACHUSETTS a 14 t BOARD OF HEALTH �Q64f,. .... .......0F...............................'f .t h'�tc No..........Il:1....... - , FEE........................ �i �rrr atl irk Tuomit'rur#ilan pautit Permission is hereby granted......... .«.R�_w�___ ........l✓G[.. = --• -------•--------------------••------------•------------•------------........_..___•-•••-•••- to Construct ( ) or Repair O an Individual Sewage Disposal System atNo............. ±.L�AA.h........... ...... --•----------•---------------------•------------•--------------------•--------- Street as shown on the application for Disposal Works Construction Pe rrht,;No �__l� `L_.,Dated.._:_ ._y 'kt " --Y__._`_-_-___ tz t ........................ ....... ..... ••• .......................•--•....................................... y /� w Board of Health DATE....... ...............��--�=-'..-- ----••-•- Y FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - - 3' .fig f1 ..,,, .. w.:v:+�.�_.kr;.!:s,.,. ""+.�. �., �•�,_..""^...:5'aa:'iicyr.e�+�c.:?r. ,a. r� R . APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS ,OCATIQN.i ©s%.-V/t/ �3.9 P�✓Sio�3 try '�5 N0. :o.� ✓�i�i s ,DATE "'✓�''! 1I LLA E __. /�•3-4'� 5 ' FEE �PPLZCANT, �� (Non-refundable, � ' TELEPHONE NO. 1DDREP,S :NGINEEIf �L�. C.¢,p� ��G 2 6�,��.` _TELEPHONE N0.77FJ=OU S� ' )ATE S.CHE:DULED (Applicant' s signature • ASSBSZ.*OR'S*biIP 6i OT NO:• �7s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SOIL LOG I 3UB-DIVISION NAME DATE f '� jam -. - TIME :XPANSION AREA: .YES NO _ .J/ i1,�J ENGINEER . COWN' WATER ✓ PRIVATE WELL BOARD OF HEAL'TF ' • � �,�{77 EXCAVATOR 3KETCH':"' name,etc. ,dimensions of lot, exact location of test holes and . . percolation tests, locate wetlands in proximity to test.holes) NOTES: , r• /44o.7/ � , • Lvss .. :• r� ?ERC01 W .RATE: :EST 140. ELEVATION: TEST HOLE NO: ELEVATION: 2 3 5 fU6,� i✓�,/1 5 8 9 9 10 10 11 11 . 12 12 13 13 14 : �O 14 15 16 16 �UITAB�,E"FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES INSUITAB.LE'FOR SUB-SURFACE SEWAGE. REASONS: TOTE: `,,ENGINEL!RING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION AN RETURNED TO BOARD OF HEALTH 1RIGIN•FL:' COI4PLETED N ENT RET Y P' •nov• RETAINED BY APPLICANT _ __ . _....... i E)(N ;�Tj- I �a b Exis IN6 - - -- 'NMOL, f - - l li _0 ►� _ - T 0 t