HomeMy WebLinkAbout0177 SCHOOL STREET - Health 177 SCHOOL STREET
MARSTONS MILLS
A= 046 - 012
77
1
TOWN OF BARNSTABLE 1--'
LOCATION I �� o� C SEWAGE#9�
VILLAGE E� .�`� t 1 FS ASSESSO$'S MAP & LOT 92y6 -6 2-
INSTALLER'S NAME&PHONE NO. M6k,#A)
SEPTIC TANK CAPACITY a e> Seq /
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER LV.4 y1q N6I (I lI 3u YV i
PERMTTDATE: -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
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0 Y6 - O
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Bi-ripuittl Workii C omstrurtiun rrrmit
Application is hereby made for a Permit to Construct ( ) or Repair (04 an Individual Sewage Disposal
System at:
7 1 u. ........./--; ------------ --------------------------------------`._........... .------
Location-Address or Lot No.
Address
mLj
.._
a -------------
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms_________________t'Y________________-__._.Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fixtures
Design Flow................-`—._... --------------gallons per person per day. Total daily flow.............. �.�o..................gal
W -• -----.....gallons.
W Septic Tank—Liquid capacity/569__gallons Length
ength________________ Width---------------- Diameter_---...._-__-._- Depth................
x Disposal Trench—No. --------/........... Width...._..__-------- Total Length_-___' Total leaching area....................sq. ft.
Seepage Pit No_____________________ Diameter-------------------- Depth below inlet___...../%:r-. 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........................
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •----•-•---•----------------------------•--•--•-••-----•-•••---•---•-----------•----••...._.................••--••-•-.....-•-•••-•••-••-•------.........----
0 Description of Soil.......................................................................................................................................................................
W
U ---••-••-•-------•--•---...------•-•-----•....-••-•••-•-••--•--•-------•------•--•-------------------•----------•-•-•---------------- .......................................••--•-•-------••-•--•-----
W --••--------------------------------------------------------------------•---•----------------------•-----------------•------------------------.....-------•--------•-•--------•-- •. ----- -........
UNature of Repairs or Alterations—Answer when applicable._____/_!�F __.. '...... S� �c-
' ----.49f/a4 . fi............./0..._....//V'e i_1,. tti ���1'43'-.....1�-!•lfit.......�...i...1•-��.
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
....... health.
system in opera7ove"y
' nc� C r 'ficate of Compliance has en i ued by th boa o
/✓ i ned .............. . l
DateApplication Ap ---------------- ---- ...sc �-�� ... fo...:M, ...�..IP. /
Application Disapproved for the following reasons: ............ . ...... .... .. ................................. ........................................
.......... ...... ... ... .............. ....................... . ... .............. ........................ . ........................................
Date
PermitNo. ............ F -- —&y---------------------- Issued ..................... ------------------------------- ...
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
&rtifira e of Cnomplianre
THIS IS TO a ' That the Individual Sewage Disposal System constructed ( ) or Repaired ( Oe)
,3'� ark--..
l' ,',f�..... 1
_..... - ---------------------------_...-..--------------...... --..... .......
Installer
at ...- - _/.2. 5 Ut_ 5'3-i -- - ----- --------- ......� �.�'` ------------------------
has been installed in accordance with the provisions of TITLE 5 f The State(Environmental Code as described in
the application for Disposal Works Construction Permit No. .----- e L .....-.._. dated .--------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU .D AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �� ��O✓
,�� . t� '
DATE ... � ..._.............. ............ .. -............ Inspector ....-....... . .•-.. -�
d✓ h
6 Y6 - C)
6
No.._._��-.__ _y FIms. 7..................
THE COMMONWEALTH OF MASSACHUSETTS
' BOARD OF HEALTH
TOWN OF BARNSTABLE
Aliptiration for Uiopooal Workii Tomitrnr#inn Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair (W) an Individual Sewage Disposal
System at:
/ 7 7 �,q ti - s;cr Zvi s
ITV Location \ddress' ....... ..........-•--- .... No............................_.............
or
rOl,ni {1 J J Address
IustatIer Address
Type of Building Size Lot............................Sq. feet
�., Dwelling—No. of Bedrooms------------------r/_ ---------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons____________________________ Showers — Cafeteria
p' Other fixtures .._.._...__
w Design Flow.........--------?` ..................._..._gallons per person per day. Total daily flow-----_-_____-_//�'0..................gallons.
Q; Septic Tank—Liquid capacity/ �v_gallons Length---------------- Width---------------- Diameter................ Depth..............
Disposal Trench—No. -------/........... Width...... ......_.__. Total Length--___� �� otal leaching area....................sq. ft.
-Seepage Pit No..-.__-_.-_-------_ Diameter-------------------- Depth below inlet......./%7'r•_. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
�Z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._--__--__-___-._--_--.
9 - --•••-----------------------••-••-••---•••----••----•-••-•-•••-•...••••••-••••••-•----------•-•••------•--•--•----••-•-•----•-••---•-•--.............-•......
0 Description of Soil........................................................................................................................................................................
x
w
UNature of Repairs or Alterations—Answer when applicable.__.._l.. '44____.................................. <- _...�.��.T7�
�rj-e ;1.......-•-•-•- aZ,
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 operat/icn,,until-a C�t'ficate of Compliance has been is ued by the board"of health.
l�lgitted ......-------------4,14 ..... ---------
Dace
Application Ap• oved By --------------_ ,..,., Z s <s.r-1% ------.. /-...........- ..--./. ...-.�f. '
V'" "y-----..._....._ I ........ Dare
Application Disapproved for the following reasons: .................. ... .............. . . .. ................................................
Permit No. ............. V---=-1 Issued- �' Id
........ ........................ ............................[e......
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(�QIL�iftrate IIf omplianre
THIS IS TO C,,ERVLY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ',,4)
.....sue.*--LW�-�r��
Insrdler
, �?it i t LJ
at ---------------- 1...7 7------------------------------------------------------------------------------------- ...........-..� .................... ..........--------------
has been installed in accordance with the provisions of TITLE 5 y�..f The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..._..I -...lb q-'/.------
_... dated ....._........_......................._.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....e'r... �-
�� .. 7 -------------_---------- Inspect r . ---- --!^'+---%---y --.-..---..........__--- ----------------------- ------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No.... .. �./n C? L� FEE...::��... .......
Riipnoal Workii Tonotrndion "rrntit
Permissionis hereby granted---------------------------------••-••--•-•-• ... ............................................ ...........................................
to Construct ( ) or Repair. ( 4} an Individual Sewage Disposal System
at No. --------- 7 ............................. j..`�•�"-r�--•-- ------!/t�. .`.......�� t t C-5...........
Street J L
as shown on the application for Disposal Works Construction Permit
�jNol� _( __ Dated...... ._'�. .........
Q , --------------------------- Board of Health
DATE.................. "---•-=--`-----••�•---•
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
No.............w....... Fxs....f r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
< TOWN OF BARNSTABLE
C �i_r_ tyui fur DiuVuuttl Works Tunutrnr#iun remit
Application is hereby'ma e for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...1?...7._Sc .®a .--.`'� � --------- --------------------------------------------------------------------------------------------------
ocation-Address r or Lot No.
®2r4 Rry�o- 09
Y---------------- --- -----�. . �' -----...---------------------------................------..........
wner Add ess
a2 __.... ....�`�_... Ostaller ................................... ...•-----•--------...........•.............. ....i.••-`............•....�.........
I Address
Z e)� '
Type of Building Size Lot..........t S feet
...........-... q.
_t Dwelling—No. of Bedrooms.............3...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.---_3---............... Showers (Z) — Cafeteria ( )
Q' Other fixtures ------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity/f 00-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 b Date........................................
a Test Pit No. 1----------------minutes per inch Depth of Test Pit.-.----.-.---_----_ Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.-..----__.-_------. Depth to ground water........................
04 •-------•------•---------------------------•------•------•--------•------••--------------------_----........................................................
0 Description of Soil.....................................................................--•---------------.------------------•------••--•-••-•-•----...---•----•--------------------------
x
U ---------------•-•-•------.....----•-----------------------------•-------------------------•-••.....------•-----------•-------•-------------•--•------------•-------------------------------------...-
xw _
------------------------------------------------------------------------------------ ----------------------------------------------------
U Nature of Repairs or Alterations-Answer when applicable.-.--- .- ... ..... G2------- JQ. --- -
Agreemenio l
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE S of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has iss by the board of health.
Signed .... ....................... .... .....
ce
Application Approved By ....:. ..-... - - .... .. .............. -----------------------------------------------
Application Disapproved for the following reasons: ................................. . .......................................... .. ...............--------------------
............ . ..... . . ............. ................................ ..... . ...................... .............. ------.--------- -------------------
/. Dace
Permit No. ....�7 ...® ..7 go------------------- Issued ..... . �..�� { ..... ....... .. ...
Date
---------------------------- -------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BAR��TNSTABLE
Q-Tertifi ate of (111omplianve
THIS IS TO CERTIFY Tha�thhee,ndividual Sewage Disposal System constructed ( ) or Repaired ( )
by ............ .. � � ....... -- '- ' - - -
•� .......-
at .......... °d .....'�..�.....�...... ..ar�' .... . l --------------------------------------------..._------------------------------------------------
has been installed in accordance with the provisions of TI"I LE`5 of The State vironmental Code as described in
the application for Disposal Works Construction Permit No. ..... __..."':%i,ff,�.... dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE 20NSTRUEA AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......-------------------------------------------------------- ------------------ -------- Inspector ---.......------------------------------------------------------------------------
A
;4t �6y 0/z SC
No.._�..j-.f� Fr:$.... 1- ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
` TOWN OF BARNSTABLE
Xrotitt1yiwt for Di-tipwial Works Tunitrur#tun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..-=..-��---Sc�i vd�-........ ......../Yl .............•-
� V 5 ..................
.Ltia h Address f��e� Y/`?rv/4 //4 �/q✓yl$�
V f or Lot No.
Owner Address
Installer Address Z ��
Type of Building Size Lot..__---.--�_ ___Sq. feet
Dwelling— No. of Bedrooms------------3---------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons--.__w3------------------ Showers (Z) — Cafeteria ( )
a' Other fixtures ....................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity/,__94G-gal Ions 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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
0_1 Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
fZ Test Pit No. 2................minutes per inch Depth of Test Pit__._-_-_-.______-_-- Depth to ground- water........................
1:+ ••---••---•..............•••-----...----•-•-••----•-•--•••--•-•-••••----•-•-•------•--•......................................................................
0 Description of Soil........................................................................................................................................................................
x
U
w
U Nature G Repairs or Alterations—Answer n applicable. .f - ` '�1 ...V
yam` 7' 0
Agreemen6:
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.
�. / ,r
Signedfare- ....(.....: ;/ ..,.-, � .� :......................._. .. ...
Application Approved By .. �y ��.. ..., ... - - ---------------------------------------------
Dare
Application Disapproved for the following reasons: ................................. .......
....... ........................ ............... .. .............. ... .............. . ................................. ---------------`--------
Dace
Permit No. �K! /Icrl a.................... Issued ----....:_ ..' ..................................
Dare
THE COMMONWEALTH.OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�ex#ifirate of Cvmp ianu
THIS IS TO CERTIFY That the ndividual Sewage Disposal System constructed ( ) or Repaired ( )
by ..................... .V...aw PCs- '� .....
---..
I
at ._........1.47 . ....... ' 'j. � ..-��� _..... .... �� .................................._.............-----......------------------------------ --------
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. .....J` ��- `..� .��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 OF HEALTH
TOWN OF BARNSTABLE FEE,.-/ �?
No.. -
Disposal urkti Towitrnrfion Vantit
Permission is hereby granted----- ._ C! �' 1 ----- —00, {W,�j.--------•-----------••----------------
to Construct ( ) or Repair (4_' an Individual Sewage Disposal ystem
atNo..... ....-� '-/l c� = `- r =........y.... . --------------------------------------------
Street ll
as shown on the application for Disposal Works Construction Pe J-`��� Dated._?__'r._. ...J.Zee•-
•---••-•---........ .. --
�,...•l Board of lth
DATE......... C
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS