HomeMy WebLinkAbout0749 SANTUIT-NEWTOWN ROAD - Health rl y9 S r-r To N `P�17 _P
1 � -
TOWN OF B/ARNSTABLES All If c
LOCATION 7�� ,�:t/ �l�/!7 roe• SEWAGE 1#
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.h/-,1'440g�l
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) l— (size) 4 �X /�2
NO.OF BEDROOMS _
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE: '
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S` Feet
Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by'
ii4, a,
3
3)s3 3)sa
t
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No. Fee
�P THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS
Application for loin ooar *r6tem Congtruction permit
Application is hereby made for a Permit to Construct( )or Repair(�an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address d Tel.No.
Assessor'sMap/Parcel
/�/',��a�5✓r9I/�� �.� 7�����fa�dl r� �lQ/�ror�,s ter,'/l
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Apf-loLoei 4olo;`•
/-
Type of Building:
Dwelling No.of Bedrooms�-3- Garbage Grinder(+r
Other Type of Building K 5/G 6,-e No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow Ila gallons per day. Calculated daily flow 33P gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alteratipns(A nswer hen applicable)
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 by f H /
Signed Date /Pli
AV_
Application Approved Date 1 1l— r-
Application Disapproved for the following reasons
Permit No. ` ��-L / Date Issued 4�� X/*4pler,
———————————————————————————————————•— --—
No. Fee
THE COMMONWEALTH OF MASSACHUSETT
} PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0(ppfication for Miopogal *Potent Construction Permit
Application is hereby made for a Permit to Construct(. )or Repair(/an On-site Sewage Disposal System at:
Location Address or Lot No. �p /i`o -O�y r�I Owner's,Name,Address apd Tel.No.
Assessor's Map/Parcel 7 y?.IeWA0A W r
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
BD,,)wol)
9
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder(i(J
{ Other Type of Building e_ No.of Persons -Showers( ) Cafeteria( )
k Other Fixtures
Design Flow ll� gallons per day. Calculated daily flow 3�� gallons.
Plan Date Number of sheets Revision Date
Title } `
Description of Soil
f
r Nature of R Repairs or Alterati ns(Answer when applicable)
iE /-eOGr✓lf t.117-4 1 a
h
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 by ,ar of X /
Signed Date /Ol/h
Application Approved �-/- Date e A51-
Application Disapproved for the following reasons \a/
Permit No. 'T 5 ��i �. rn Date Issued
——————
THE COMMONWEALTH OF MA�SACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposaj System)'nstalled( )or repaired/replaced(-' )on
by M00 Installer r'.�e4e f/ 4045,r/'
at /)eGV*O1,elh re;(_ has been constructed in accordance
h with the provisions of Title 5 and the for Disposal System Constructio P rmit No. •- /" dated,��
Date 1/ / 1�� Inspector
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS-
TEM WILL FUNCTION SATISFACTORY.
G ---------------------------------------
NO. / -" ... � D Z '"®�� Fee"—"�
'r
THE COMMONWEALTH OF MASSACHUSETTS
i
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
loi!gpozar *Pgtem Construction Permit
Permission is hereby granted to &4c Z ��
to construct( )repair( Van On-site Sewage System located at No.# 7!9 Gv h r
1-015ow oh 5 10 S
Street
i
and as described in the above Application for Disposal System Construction Permit. No. Date
'r
The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within three years of the date below. -
Date: Z e-- e! Approved by _ r./ i A
Board of Hedlth
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rr
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1"44 p VJ S /L x t Lyj o
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THE COMMONWEAL-1-1-1 OF MASS CHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratioll for M!,ji11!ial I'liiirlt,�.i 01llliitr1ll`tilill FPrillit
Application is hereby made fur a Permit to Construct ( ) or Repair ( ) an Individual Sewage.Disposal
S stem at: j
// Location-.\ddress or Lot No.
........!i`ciQ---/'` .�.l-------------------------------------------------------
" egym /�]r('^) O�,,,,rl/ �^A .................Address
..
.............4[:d.1.111�L/,✓----------.Y-�.� --..._........_.
Installer Address
VType of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms..:3.......................................Expansion Attic ( ) Garbage Grinder ( )
a.-I e of Building ............................ No. of persons._.._...--------
Other—Type persons: .----.-._-- Showers ( ) -- Cafeteria ( )
Q Other fixtures ........... ........ .. ................... ...... ..... ......
W Design Flow............................................gallons per person per day. "Total daily flow..................................-------...gallons.
WSeptic Tank--- l.iduid capacity,,�`e1---gallons Length---------- %%lidth---------------- 1)i;uneter._.------ _.... .............
xDisposal Trench - - No. .................... Width--------------- 'hotal Lcngih.................... .1,111al latching area_.................sy. f1.
Seepage Pit No........ ............ Di,uneter............._...... Depth below inlct_.......•........... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
aPercolation. Test Results Performed by----- ------------- ----_-- ------------ ------. ------. ----- ..__ Date__...................... .......
.a "rest Pit No. I................minutes per inch Depth of Test Pit.------------------- Depth to ground water.......................
(i, Test Pit No. 2................minutes per inch Depth of Test .1'It............. Depttl to ground water.........................
Is; .............................................................................................................................................................
0 Description of Soil................................................................................... -- -------- ----- ..... ----------...----------- -----------•----•-........_..._....
x
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 TITLE; 5 of the State Environmental Cole — The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued/by the board of health. l
• Signed �,� _ .<R".('�-'�:.... ... ....0.__...._................ ....`/`./Sy'_5'__.
_ ti liar
Application Approved 13y . . .... L ..__._,, �.... .. �✓�:. :.(..'... . :::........_ ._.....
Application Disapproved for the followilig tee. »t.r: ........................._... _............. ........................................_._.....................................
.......................................................... ___.................._...__...._......................
Permit No. ....... �............: Issued "._""_._ ... ... L.
THE COMMONWEALTH OF MASSACHUSE17S
BOARD OF HEALTH
TOWN OF BARNSTABLE
CGertificate of 01unip(ir>ure
THIS IS TO CERTIFY; That the Individual Sewage Disposal System constructed ( ) or Repaired)P
( )
by ...........1��. . ..................7
c
has been installed In accordance with the provisions of I I I LI'. 5 of The S�j a eel vironmeWdl Code as described in
the application for Disposal Works (o1)Sn-UCtI011 Pcrnm No. �' dared
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B��ONSTRUED AS A GUARANTEE THAT THE
,SYSTEM WILL FUNCTION SATISFACTORY.
DATE ..........................................................: . _........... ... . . Inspector ...... ........_. ............ ....
.....__.. ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE Y '
No......:............... FEE
�li��u��tl �lurk� ���ti.�t�lcr�i�ul �, rr�ltit
Permission is hereby grant—............ ��..':.�.�..:.......�1: I ( t../..lc... A:..:..........................................•--•••......
to Constrt c or Re air ( ) an -Individual ScHa (• llis xJ,sa'S y�til F
t
at No........ _..-./.....
._. $)t �.. (.4 q ........... .....
Street , I q ,.� � / ,.
as shown on the application for Disposal Works Construction ]Fern;Lt No,-..-.:......... :�Datcd...,.:i... ..........................::.
lluard of
DATE..................'•�-- }- -- -`-- ......................
... .___... -- 'llcalth
FORM 3A-5nS 110FIFIS 6 WARREN,INC..Pont ISn F_RS
=I
1
�- ASSESSORS MAP NO; D
No. Jk?
- PARCEL fto0:_s_-_ y Fri$..... ..D..........-
THE COMMONWEALTH OF MASS CHUSE
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Bi-nVitiatl lVor1w Tongtrnrtiun jJrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
�J LSystem at:
7.
Location-Address or Lot No.
............%..c��.._ s ------•------------------------------------------•--- -----------------------------------------------------•------------_-___---__-_--------------------
yyco Owner� �A Address
Installer Address
UType of Building Size Lot............................Sq. feet
14 Dwelling— No. of Bedrooms._3
�4 Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons...........-................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
W Design Flow___________________________________________gallons per person per day. Total daily flow--------------------------------------------gallons.
W Septic Tank—Liquid pacity`f ._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 to ( )
04 Percolation Result Perform d by----- - ------------------------------------------------------------•_._ Date........................................
� Test Pit o. 1_______ _______minutes p r in h epth of Test Pit.................... Depth to ground water........................
(1 Test Pit _ _______________minutes pe i h Depth of Test Pit-------------------- Depth to ground water------------------------
P4 ......... •---- ------ •--------------•--•-----...--•-----••-•-•--••-•-•-•----•-------.._.....---..__...-•---•---.......--- •-•••-••--•-•--•----•--•-•--
Description of S '1._._................ ._.
- ---------------•------•--•---------------•----------------------------------------------------------------------••-----•-•--•----••_•••_..
x
W -•--•••-••--- --------------•-- - •--•- ..._ .------------------------------------------------------------------------------------------------•-----------------------------------------------...__.._.
UNature of Repairs lte ations—Answer when applicable_______________________________________________________________________________________________
Agreement:
The undersigne 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 the board of health.
Signed .. ......-..
--- ......�/ Dace--�-----
G
Application,Approved By �---
-------------------------- -------.-.-...Dace------'---....-----
Application Disapproved for the following re n.r- --------------------------------------------------------------------------
...................................................... ... ............... . ........... - ............................. ..........-.. -------------------
---- �' Dace
Permit No. ...... - - Issued -----------
(e ... .... . ................
I -
- -------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of C�umplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
Y _... - .............. _.-.-.
-----
/��,l]�
at .. . .....�......_._. �A L V l.. / l 1f V lam/ )- / e l / ...... --- - ......
has been installed in accordance with the provisions of TITLE 5 of The S a e�E vironmental Code as described in
the application for Disposal Works Construction Permit No. -.---. ----- dated ----------------------- _--.---.. .......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bt ZONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------- ------------------------------------------ -----...-------- ---- Inspector ------------------ ---------------------------------.--------------------------------
a •rat -.
THE COMMONWEALTH OF MASSACHUSETTS
i BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Di-wipw3al Work,i Towitrnrfinn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
�y S stem at:
Location- Address or Lot No.
L.ticri� �r,P�
owner* Address
w �c�_nl1 ••••••-••-------------•----•--•-••--•••--- -•-•••••••--•----•--••••-•-•--••--•--••-••-
Installer Address
Type of Building . Size Lot............................Sq. feet
Dwelling—No. of Bedrooms"_3.......................................Expansion Attic ( ) Garbage Grinder ( )
as Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
04 Other fixtures .-"--------------------------------------------------------------------------------------------------------------------------------------------------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity ''�___gallons Length-----1---------- Width---------------- Diameter"--------------- Depth................
x Disposal Trench—No. .i................... Width........ ........... Total Length.----_-_--_--._.__-- Total leaching area....................sq. ft.
Seepage Pit No...............t..... Diameter----.-----..---- --. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank( )
`" Percolation T�e Results Perform nutes d by ---"-e th of Test Pit.................... Depth to Daound water........................
1.4 Test Pit`No. l......._ P P P
44 Test Pit `o. ....... .......minutes pe ingh Depth of Test Pit-------------------- Depth to ground water........................
R+ ---- t - /--------------------------------....................................---•----------------------------•--....._........-••-•---
O
Description of S it ` 1
V ..........••.......................\----•••----•. -----------------------------------------------------------------•-------------......----•------------------•-••-•-----••
U Nature of Repair or �Iteations—Answer when applicable................................................................................................
-------------------••-------•--•-••..-- -•-•-•-•--•--- -•--••--•••--•-•-••---•----•-•--•-••--•-•---•--••-----------------••--•--•-•----------•••--•--•---••••••--•••--•---•••--•-•---•--•••--•--•
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 the board of health.
\ Signed ..... .:�Z� ` n —/�/f' .......
v.. ..�
Date
Application.Approved By . y.._. -f/ i�%t� �..../...s�..._ . . - , • J� '-------------_-------------- Date
Application Disapproved for the following re Ens: ...................................................................
.........-------------------------------- --------------............-------------............------------------------------ ............. -----------------
TI / Date
Permit No. Issued .. .-({/%/
......................... ............ Uate .r :.. --------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Q. ez#ifirate of C�nmyliance
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ---t .........
-------- -- ------------ --------- - -
at ................ ...L :/....... ? U.L..1......=, . �� . .. ........(K �1. t
.. �....
has been installed in accordance with the provisions of TITLE 5 of The SgjgA, vironmental Code as described in
the application for Disposal Works Construction Permit No. JC_�"cX(�t. t ----- dated _..................................------_.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bt bONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------------------------------------------- ------------------ ------------ Inspector --------------------------------------------------. ...---------....-----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE a
No........ ...........`,, FEE....
�t��1I�II�t1 yIIrM�t��f II3i �rl�rfiII�1� ..fir tf
Permission is hereby rante •-•------... ..1 /.1. �Y;.- �. -----7---�. --------"-----------------•----•---..............--
e Yg � `zr . .
' o
to Constr or fair an dividual Sewa_e is osallS
at No.-----./ =.....-- , ( ;.. j "i `�t v 0-r 'StFrc--y
as shown on the application for Disposal Works Construction )3r et
it NOY ________ __ ted---_ ._-.1S...........
...._.._._�_ e
.�
Board of alth l
DATE...........................2•g-•P•............................
FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS
TOWN OF B/ARNSTABLE G
LOCATION 7y1p.4.1n4yle- wl1 /or. SEWAGE #
VILLAGE /l/�l�1��5 f��5 /�//i S ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) l� I' 1— (size) ��y
NO.OF BEDROOMS_ 3
BUILDER OR OWNER
PERMTTDATE: /D—I�' COMPLIANCE DATE: L s 11 - 2 2
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 Iv Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist J-Z) Feet
within 300 feet of leaching facility)
Furnished by
3)5 3 3)5';?
3