HomeMy WebLinkAbout0242 RACE LANE - Health 242 Race Lane
Marston Mills
A= 150 - 040
No. gaq Fee
THE COMMONWEALTH OF MASSACHUSETTS ntered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppfieation for Misposal *pstem Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.r 1501 .040 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel �'T� R-4{ S�CvE Aa� D
Installer's Name,Address,and Tel.No. I j 3 c �z`v►'� Designer's N e,Address,and Tel.No.
TL
Type of Building: k
Dwelling No.of Bedrooms Lot Size _I sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date p �� Number of sheets Revision Date
Title
Size of Septic Tank Oet,v !A-'W 15'Oa 9-h Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) � t 1�9'UV�
USN Pv\. �A-- to l j oa gtAw
Date last inspected: , 20 1g
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.
Signet Date 9 7-
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. _�-_o 1 — �j 4- Date Issued f
1 .
No. �• Fee
THE COMMONWEALTH OF MASSACHUSETTS 7'-)xitered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS' Yes
application for ]Disposal 6pstettt Con$truttion 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade(„�) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. S b f i^ Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel 242 (L4-CQ STcvE (..)A77o
Installer's Name,Address,and Tel.No. 1 4�- �r 6 .� Designer's Name,Address,and Tel.No.
Type of Building:
ZZ- .
DwellingNo.of Bedrooms Lot Size.•�.-� � --• s .ft. Garbage Grinder
� ,� g ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.re uired) /V gpd Design flow provided gpd
Plan Date 2 Number of sheets Revision Date
Title r 1
Size of Septic Tank ,11)Ol,l — 6DQ iAl Type of S.A.S.
Description of Soil
Nature of Repairs or r Alterations(Answer when applicable)
Date last inspected: As o I$
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.
- t SigneB ; Date Z�
Application Approved by q. Date - q
Application Disapproved by Date
for the following reasons
Permit No. 10 ( cl -� 12 2�_ Date Issued r y
..:
------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
A eertifitate of Compliance E
THIS IS TO CERTIFY,that the*On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by `�p�*d I- D_ Od& L C3 C�•a,�..c
at Z t-� L (LA ce- )r,3"_ has been constructed in accordance q
with the provisions of Title 5 and the for Disposal System Construction Permit No. p `V b dated 2 _
Installer rtit �i , �,,A Lo . , Designer 6 14
#bedrooms !v Approved design flow Al gpd
The issuance of this permit shall not be construed as a guarantee that the system will function as digned.
ti Date ! Inspector
-----------------------------------------------------------------------------------------------------------------------------------------
No. A01 / —' J Fee (00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *p$tem ConstrUttion 3permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade b47 Abandon( )
System located at "o f-ki WL, yrp,!�
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 this permit.
Date r Approved by
I
C,
TOWN OF BARNSTABLE
LOCATION_.( . 12 i Lf � SEWAGE # j I
VILLAGE ASSESSOR'S MAP & LOT 92)
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY 2itC`di�-►� ( (jj�� C-,y�. ,y
LEACHING FACILITY:(type) C-06�- FF (size) I(
NO. OF BEDROOMS —a PRIVATE WELL OR P IC WA RSA
BUILDER OR OWNER
DATE PERMIT ISSUED: 1Q, '�2-7
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
J
t.
V 4� GUaz Pr-
No.... .........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH Ar"POO ED
TOWN OF BARNSTABLE ter;.anon De
Aartment
Appliration for Disp.aial Works Tonstrions urt
Date
Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal
System at:
............. •`4 .... :- .................... ............ ...------. ------------------------.....----------•-
Location•Address
or Lot No.
.. - � ... J- 1 "-- ---- -----------------
..............
-- -------
r A d ss
ac. cane--------- ---------------------------- ...................
Installer Address
Type of Building Size Lot............................Sq. feet
U
�-, Dwelling—No. of Bedrooms......s. ...................................Expansion Attic ( ) Garbage Grinder ( )
` 1 Other—Type of Building No. of persons............................ Showers — Cafeteria
04
04 Other fixtures ------••--••••••--•--•---••---•----•-••...............•--•-•...........................................-•-•----------•--...._..--••------•••---_....
W Design Flow.:...'5&6 ........................gallons per person per day. Total daily flow-.----Z3D........................gallons.
WSeptic Tank—Liquid'capacity............gallons Length................ Width.......------... Diameter-----.-------.-- Depth................
x Disposal Trench—No..................... Width.................... Total Length......�.".f..._._._.. Total leaching area....................sq. ft.
Seepage Pit No...../............. Diameter....LO. --.... Depth below inlet.164.............. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by..............................•---•-••--••--•-................---......... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit...........--....... Depth to ground water........-----.--........
fX4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................
04 ........_-•----------------------------------•-•---••••.........-----.._.....___.___.........................................................................
0 Description of Soil.........................
x
U
W
•••••-----------------------------------•--•--•••--••--•-••--------•••-•-••••----------••••••-•••••------------------•----...... .-•--•--------•--••-•----••-------•----•--...-__.......------•----••---
U Nature of Repairs or Alterations—Answer when applicable.-. -0AW.... ...................
< _ -&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 Complia ee iss oard f h alth.
Signed ------------- --- .......... .................. .. Dare................
Application Approved By ..............
-...---- U .................................................................... ........
Application Disapproved for the following reasons: ...................................................................... . --................----- ....------...---..........
------ ----------------------------------------------------------------------------------------------- -- ---- ---- --------------------- --------------------------------------------------- ----- ----------- -------------------
Dace
PermitNo. ------- ` ------------------------- Issued ....................................................
Dare
yo
NO.._.l..r 1. FES...... .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal nrks -Cnnnwnrtion CrM1 - d -�a-g 7-
Application is hereby made for a Permit to Construct ( ) or Repair (lam an Individual Sewage Disposal
System at:
04
......
Location-Address ` or Lot No.
—c.�n�.....; '....
.. ....... ....!�:�. ..........-•-•- ----••---•--------.... tNt'_.....------••...............................................
- --
owner Address
af L� S ,Q f�� --•........................... ••••........- '......................................... S
Installer Address
d S Type of Building Size Lot........................... q. feet
U Dwelling—No. of Bedrooms__...Z...................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP g -------------•-------------- -------(---->--- Cafeteria-( )
Otherfixtures -------------------------------•----------------•-•-------------•-------------------.._.._..-------- ------
W Design Flow.....`�.`� ....._..................gallons per person per day. Total daily flow.... s D........................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.....I------------- Diameter....1.Q......... Depth below inlet.k.............. 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..............-.........
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
G4+ ------------------------------------------------------------------------------------••......•--•--•••--•----...-•••-...........---•-•. .......
0 Description of Soil...............................................................................----------------------------------...---------------------------•-.....-.........---
x
V .-----------------------•-----------•--......------------------------------•-------------.......---------•-------------....------------------------------------...._...----•---------•------•------------
W
---------------------------------------------------------------------------------------•------------------------------------------------------------------ ------•-----------•---....-----------------
U Nature of Repairs or Alterations—Answer when applicable._-._'±'` S_T+�...�_ .p!._1_.__ ? ! ...................
--•-----�X�-fit w�----S�r�Y-r''°`-!�=---------------------------
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_hasabeen7 issued-by-the board of health.
Signed . . ........... ................... /.��_ � - �
Date
Application Approved By .............( ..0,,t.,-•- ........ . ..-..�.a-
----------'------------...-----.................'--'---'-- Dare
Application Disapproved for the following reasons- ---- -- ------------------------------------------- ---------------------------------------------..........................
- -....................................... ---------------------------------- --
---------` ' S� Issued --- ---------------
Permit No. ........ ........... .....................----..Date------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertifirate of Canytianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ��
by----------------------------------------!...AP� i_.ANC).-- ./'q C-
.................
er
-- ------------------------------------------------------------------------------------------------------------------
r � Instal S
at .................. ...... ............. ` - Ir? t ...!t-w e
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. ......c�pZ..,........5_1... .......... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-------- -- -------------J- --
�1— -1 -�---------- ---- Inspector --------------- --- ........
:............------......---------------------------
THE COMMONWEALTH OF MASSACHUSETTS
! BOARD OFHEALTH
TOWN OF BARNSTABLE
No.- .. ..a.. . �y FEE_ .�........
Disposal Works Tnnotrudivit Prrmit
Permission is hereby granted........./--A.t` �le-L �`e 1
to Construct ( ) or Repair ( a) an individual Sewage Disposal System t 4
at No..................................!R \ �114(< J cf _.-------------- c i�lli! l
-----------
Street 9� r/�
as shown on the application for Disposal Works Construction Permit No....... ..-.......... Dated..........................................
................................
.........................................................
/ n v
DATE................ •�-1..::.c�:s�...------�----
................................ Board of Health
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS
�01 3
No
... ..... Fz s.. .................
THE COMMONWEALTH OF MASSACHUSETTS
OARD HEALTH
`l
q
lo4o .......... ..( i...........OF.......... .. ..... .......
.NpPliration -fur Did uiitt1 Works Towitrurtiuu Vamil
- Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
/�. .......��% cam° �.✓��� .�o. �' �e ._
Location_Addre�s Lot No.
/J Vwner 1 Address
........1?`.;/1� 2G1.f Y............ ....................
Installer Address
Q Type of Building Size Lot... feet
V Dwelling—No. of Bedrooms________________�_------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------................... Showers ( ) — Cafeteria ( )
dOther fixtures ------ ----------------------------------------------------------------------------------------------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons.
WSeptic Tank—Liquid capacit�C_�_-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]e�acltitt area----_._..__._.....sq. ft.
z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed by-------------------------------------------------------------------------- Date. ..... ------------------------
a
a Test Pit No. 1-------_--------minutes per inch Depth of Test Pit..................... Depth to ground wa er.--.-__-_-._-..-_---
rx, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground wa er---------------.........
' a' . , a t
- _ /- ------ ---•---= ---
..
x Description ofJSoil .;"
x - ---------------------------------------------------------------------- -------------- ----------------------
V 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 lI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss ed by the boar of h lth
igned_.. r.�- - --'-- -
.•. --•. ... ----- �_
Date
Application Approved BY •. . .....2--.. ----••••--- ....Z�-""-1 ------
Date
Application Disapproved for the following reasons ------ -.__., ______ _______ __
---•----•--------------------•--••---------•--------•- -- --- ------- -----------------------------------------------------------
Date��
PermitNo........................................................ Issued........................................................
Date
ANJFEE.. ..1.0..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Of HEALTH
.....OF.........
. L.-..................................
Appliratiun for 43hipmal 30orkii Tunitrurtiun Vaulit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.................................................................................................. ...........---•--•------•-••-....•---•----•---•------••-_....•-•--•............---.......----•-.
%ems Loca-t,inon�.Addre ' N
� ..yp... -o.�
Owner_ / n Addr"
Installer " Address
U Type of Building Size Lot... feet
Dwelling—No. of Bedrooms................5�--_-___-___-_-_-__-Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type T e of Building Showers — Cafeteria
a YP g ---------------------------- No. of persons---------------------------- ( ) ( )
Ca 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.
Seepage Pit No--------------------- Diameter....... Depth below inlet_.__.____ Total}eachin <ire:l..----------------sq. ft.
d" V z Other Distribution box ( ) Dosing tank ( ) �� /'`' r , '- / " zj
Percolation Test Results Performed by------------------------------------------------------------------------- Date----------------------------------------
a 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-..--._--__-_-_.-_-__-_.
t f lj
Description of Soil ln1 r� ".Z
--dam'
VNature 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 Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i ed
f bythe bo�x�of h ltl
GSign( . ' /-
...............
�
-_.... = /ate
Application Approved BY ^G ---- -- Date Application Disapproved for the following reasons:----------•---------••------------------------------------------•------._...----------....-•----.....------••-•
----------------------------------------------------------------------------------------------------•------------------------------------•--•-•-••--•-••----•---•-----------•---............-----••••---
Date
PermitNo......................................................... Issued.......-------........................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
...............OF....
...�0 .............................................
ulrrtif iratr of Toutpliaurr
IS S TO JE Y, That the dividual Sewa e Disposal System constructed ) or Repaired ( )
by - ---------
i
I, staller
at ---- --------Y------ ------------�.-- •---- h� - /.._ ,.r-e+a71d
--��
has been installed in accordance with the provisions of .1c.e X f The State Sanitary Code as descri� n fhe
application for Disposal Works Construction Permit No!c;./.__ �/__ .___.___- dated. (___'�.,, ...-._7•S`""._.__..___.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----- y `` w. ........................... Inspector---• -••- -•--------- - ••• ---------•-••-•......-••--<:
f
PTHE COMMONWEALTH OF MASSACHUSETTS
O
BOARD FHEEALTH
.............. - /FE�I
jV
u r fiat �r tit
,.� '`�
Permtssto ereby granted ---------------•--•---------------- ....
to Con Repair ( ) an Indi� al S ag , i9posal , y to000
f a,
at ......- - --•-
f , !,
"V ----
Street
as shown on the application for Disposal Works Constructio mi C4 ..
�. 7J
. _. ------- ---------------•-•---------------
DATE................................................................................
Board of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
y `s C dv
ice. AC'nk" - S � - .:,._ � r•+. �'}`y� Ya:
� "fit y_•L' .i _ 1 � � T` � F000
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PST W�/'STovF
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Q t�B• sF:53'f Fo t-roi.v 77�ivK 0 r
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f�TENJENT
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t YCERT . FIE ® PLOT _ PLAN
L:b C AT I O N n�9.es T0/c/S /t�7%L LS F
5 C-A L E i '�d� D A T E
Ae
/ C D A`T £
J HEREBY CERTIFY THAT THE BUILDING
REG. 1 AND. 5URvE('�OR
SHOWN O N THIS PLAN 15 LOCATED ON
Tt 'E GROUND AS SHOWN HEREON A -N D
TH tH
AT it � a�-� C0 N FORM TO THE � OF
Z (tNtN G BY - LAWS OF THE TOWN- O>F Mqs��
, A,E�ivS7"�BG� W H E N CONSTRVCTE D. - GEORGt
i LOW,JR.,
40
,. BARNSTABLE SURVEY CONSULTANTS, INC . Fc187tY`' oQ' }
} -} :N �.,
WE MASS - JSURv _,
TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
NAME 1cv' 2 C ern C CT e c�e,t� ,Jc v,'\�t
ADDRESS VILLAGE
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE:
p OR CHEMICAL \C1`1 o
(Give same information for any additional tanks on reverse side of card)
G.
DATE OF PURCHASE OF EACH: 1. kcA ' f)610 2. 3. 4.
DATE OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED:
PASSED DID NOT PASS
i