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HomeMy WebLinkAbout0420 WAKEBY ROAD - Health T20 Wakeby Road Marstons.Mills p A = 028 014001 J TOWN OF BARNSTABLE rL LOCATION &, SEWAGE VILLAGE M� � S ASSESSOR'S MAP & LOTV OG/%Y:/ INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 0-i�:, G � LEACHING FACILITY:(type)1!-Le �4 11 (size) X..;f- 4/17 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERNC✓,fj/., Z- BUILDER OR OWNERS p.^✓ �/�,� ���v ®�,�r��� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No © a IYia J3 , No. Fee lQ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYicatfon for ]B gpogal OpAem Congtruction Permit l Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components; Location Address or Lot No. 4 Owner's Name,Address d Tel.N Assessor'sMap/Parce .� d �`� Installer's Narne,,Address,and Tel. Desi er's Name,Address and Te`o� S 6�9_ � NS e NIV& Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil A. Nature of Repairs or Alterations(Answer when 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 issu d by this Boaz Health. Signe Date Application Approved by D Date Application Disapproved for the following reaso Permit No. Date Issued y Nq- .. T COMMONWEALTH OF•MASSACHUSETTS Ente�d rn computer: Yes kq .> - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASS CHUSE{TTS A-.1.,plication for Dioonl *pmern Conpod£jJuction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) :D Complete System ❑Individual Components Location Address or Lot No. �/'� J Owner's Name,Address pnd Tel. No Q LA Assessor's Map/Parce ,�, Installer's Name Address and Tel. Desi ner's Name,Address and Tel No. Pam W p���� j ev-e j'` J V S � iA Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) ` Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil n Nature of Repairs or Alterations(Answer when applicable) V VV EC 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 this Boar Health. 6 Signe Dale .. Application Approved by d Date Application Disapproved for the following reaso Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) epaired(✓) Upgraded( ) Abandoned( )by ''C;p at 4-0 1 , ,�'' n constructed in accordance . . with the provisions of Title 5 and the for Disposal System Construction Permit No lowated Installer Designer The issuance of this permit shall not be construed as a guarantee that the sys em ill f nction as de _ne Date � ^ t)-2 2- _ Inspector - n, —— ——— ---------------------------- No. i "� � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Dizpoaf 6potem Conotructton Permit Permission is hereby granted to Construct( )Repair( )upgrade( )Abandon( ) System located at tl_20 Lc/16 Ar e �/ �/ ��.�iz t�-1G0�/ )fw/lfs and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 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 t ' t. Date: �✓ i Approve V i ♦ f TOWN OF BARNSTABLE C LOCATION dk 6(Z 5/-, , SEWAGE #e!9/--- � VILLAGE rM nni lL S ASSESSORS MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 9xGP-f Pi y /d Oa LEACHING FACILITY:(type)l-,l0' ;44 1 (size) NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER VYj1, G BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No /L ® 0 ,4� Z�-� H - OC) No.a— , Fim S_ ............... THE COMMONWEALTH OF MASSAgCHUSETTS BOAR® OF HEALTH 1.0-W-0...-.. oF.-.-.. . -t -------- 3, b liration for Uiipnsal Worko Tonotrnrtinn runfit 01Application is hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal Sys � .... . `1 A."M. .---.. a. l(/1 Loc ;ion•Addresses r� or Lot No. . - L AJI Address W "P .. "`�l��jrYt�L�G'i J`S ....._ ..... ......... ......••-•---•-•--•......................•. ...•-•---............................... � Installer Address Type of Building Size Lot--- j��Ac--Sq,,eet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers`( ; ) Cafeteria ( ) Otherfixtures - -------------------------- ........................................... W Design Flow------------------ `�1T-------•-••••-•gallons per. Oi; on 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.......... iameter.......12.... Depth below inlet.._.�3o 4...... Total leaching area..24-S�...sq. ft. Z Other Distribution box ( o� Dosing tank ( ) . Percolation Test Results Performed by-__-AA)f a' __...___,__g_ ____________________________ ��_.. `..__ ...... ^i�' --- Date------. �J'� Test Pit No. 1-----7......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........................ 0 a .----------•------••••-------•--•----- .................................................................................................................... Description of Soil........................---•---------------...------..........---•-------••-----------------------------------------------------------------------••-•-------....----- x -------------------------- •------------------------------------ > ........................................................ U 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 provisio of'TT`.-E 5 of the State Sanitary C e— The undersign urt:era rees not to place the system in { ration til a rtificate of Compliance has bee ed the h 1 " 1 n =--.-----• . Application Approved B _...._.. ................. ��.`--V`' ate/ PP PP y - -----------•••--------- ' ..�' ... Date-----------— Application Disapproved for the following reasons_______________________________________________________________________________________ - .....•-••-----...•--•---------•--.....••-------•-.....--•--••-----••-----------------•-•-----•--------•--........---------••----------------•••-•...----•-•--------------•-------•-----------•--•...----- Date PermitNo......................................................... Issued...................................................... Date No.... -- i! Fps... ....�......... ' # THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J ApplirFatinn for %qpwial Vorkii Tnntruxtinn ramit Application is hereby made for a Permit to Construct ( k-)""or Repair ( ) an Individual Sewage Disposal - System at: AA Location-Address or Lot No. ...................... =1 I III C~:L1 ..... 1 ...................... .........._..................................................................................... . Address-.... . .( . Installer Address Type of Building Size Lot___./..LU._.......:..Sc}--€eet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( Other—Type of Building ____________________________ No. of persons----___-____--_-____--__-_ Showers ( ) — Cafeteria ( ) _ QOther fixtures -----------------------------------------------------•-----•--- _...----------------- -----------------•--•-------•-......---------........-•------ Design Flow..................: _. ...............gallons per person per day. Total daily flow_.-_-___---._•_.---_--a -d......._gallons. 9 Septic Tank—Liquid capacityf�-D.gallons Length................'Width................ Diameter................ Depth................ Disposal Trench—No.................... Width_--._____----_------ Total Length.................... Total leaching area.........._---------sq. ft. Seepage Pit No----------f.______. Diameter' ..._. ... Depth below inlet___.1 J_...._. Total leaching area..Z',.�__...sq. ft. Z Other Distribution box (� r' Dosing Percolation Test Results Performed by..._..VIY�� ��__-......�_b.................... /y`j 7-� a Date. =...... ,.a Test Pit No. I_:_. ______minutes per inch Depth of Test Pit-----A_....... Depth to ground water---------""_--:_:;, f� Test Pit No. 2...::...........minutes per inch Depth of Test Pit.................... Depth to ground water........................ ' a ' =-------•---------------------------------------------------------------------•--•-••--•-------------•----.........-------•-•----------...._....•-----------. ,O Description of Soil............................................................................................Z..---------------------------------------------------------..._...-------- W UNature of Repairs or Alterations—Answer when applicable._...........:........................ ------------ ------------------------------------------•--•---------------------------------------------------------------------------------------------...----------------------------.._...---•------ Agreement: The under'signed agrees to install the aforedescribed Individual Sewa e Disposal System in accordance with the provisio of TITI:% 5 of the State Sanitary CAle—The undersign furt:era rees not to place the system in ration til a rtificate of Compliance has b ed the h 1 ate- ........................................... ----------- --•-.. ------ ivc Application Approved By............................... .............................................................. ............... -�' Dat Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- -•----.....•.................•------•-------------••---------------------....-•------------....•-•-•-------....__...._••------•----•--...-------•.:..-----•---•--•------------------------•------------- Date PermitNo......................................................... Issued-----------•--------- Date . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF............„.......:.................. .......................................... .4( . �ler��f�rtt r oaf hum l��anr�e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------------------------------------------------------------------------------------------------------------------------------------ Installer at . has been installed in accordance with the provisionsr of 'PIT1 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_________________________________________ dated-__..__._-.___.____..._._.._____._;........... .,... f,`,,THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE- ....... -•-•-•• Inspector.:........ ----•- --- ................................ ' THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH 12 -� IP� OF.... ......i7fl���L3t..4- .i.............................. Noy......................... ; } Permission is hereby granted__. _.____.T__. _ ...... to- Construct ) or R?p it .( ) an Individua Sev�age Disposal System ., r ` ......................................... J Street - F: "as shown on the application for Disposal Works Construction P,erm>t N.o� � __ Dated'.._. 6 ................. .0 APO DATE 1 . FORM 1255 HO .,&r ARREN,jINC• ,PUB.LISHERS (KC A'7t MON .-, o 4'-2" 41-2" 61-2" h''ICJ" G1 I ANC>� N A 1w 2446 -2 A ANPW5EN O a ca iW 2446 ? co ;. 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