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HomeMy WebLinkAbout0665 WAKEBY ROAD - Health �2� O�'-.�--� vraci-rs,.�.-�ns M r LL.S �- C UUU v LOCATION -SEWAGE PERMITjg_ � VILLAGE 122as77M,,, 61,- \'/1J ONST ALLE.R'S , /fgJAIDE 0 ADDRESS S �22&_�g /xila 11UIEDEIt OR OWNER d�e e ire DkT E PERMIT ISSUED DAT E COMPLI- ANCE ISSUED I �b ,6 C) o aG No................._ . 2 i Fizs. ........_ THE OKMf{TCPtA ®�S.ti ®` � �--- BOARD OF, HEA TH 7;®��/..�............oF....Z � ' ,sT�r.� - '------------------------- Appliratiou for Diopooal Morks Tnuotrur#ion Vamit Application is hereby made for a Permit to Construct (4_-)eor Repair ( ) an Individual Sewage Disposal system t: /!:- �� I Location-Address o t No.L Owner Address a ,e .1�. c ---------------------------- ...... �` -----...-----•. ------.---------.. Installer Address �� UType of Building Size Lot.__ f...............S q. feet Dwelling—No. of Bedrooms..........3--------------------•_--._.--Expansion Attic (�(� Garbage Grinder (Ad) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .............................................................................. Design Flow.............$ ..........'........gallons per person per day. Total daily flow........3. �_..................gallons. W. WSeptic Tank—Liquid capacity�O;Pgallons 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 tat ) '-' Percolation Test Results Performed by.__._., '/�!'-,— _�_.... '.�1 / ?.C6n/� Date..... Test Pit No. 1_�t 5.5.....minutes per inch Depth of '. Pit....--_ r_.__ Dept o ground water________ LL, Test Pit No. 211: �..�minutes per inch Depth of Test Pit...l ._....... Depth to ground water........................ RS ,,�........... ... . Description of Soil.....__'..._ ....---.. . ,� ®e_�_------.-- v ---------------------------------r. j ,�oP"e_ ..5 r,Q`� �--------••-----------------------•---•--.---•--------. 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 iITL%, 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 by the of,health Signed--- - - --- - --- --- ----------------------------- -----�p�-........Q.... Application Approved By................................................. �I a g_6 Application Disapproved for the following reasons: .----- -----•--------------••-----------..................-------------•............----._._........---------------------------•---------------•----------------------------------------------------....--••--. Date PermitNo......................................................... Issued....................................................... Date No....................... Fitz......................... THE COMMONWEALTH OF MASSACHUSETTS ,,,�-- BOARD!gF HEALTH la 6e-)e,-,7 OF.................. ----------- -- ** *......*............Appliration for Di-opasal Workii Tonstrurtion 1hrmit Application is hereby made for a Permit to Construct 4oror Repair an Individual Sewage Disposal System t ................................................................... .....jLocation-Address t No.eVI f ............................. ................................ ..................... .................................................. ............ Address .................................... . ................................................................................................. Installer Address #5 C,C/q Type of Building Size Lot - :.................Sq. feet U Dwelling—No. of Bedrooms.._.......3............................Expansion Attic (Alp Garbage Grinder (Aq Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ........................................................................................_1.............X.T.5 Design Flow....._._......5—Ir...................gallons per person per day. Total daily flow........ ..................gallons. Septic Tank—Liquid capacity.l <X30!).......kallons Length................ Width.........._..... Diameter................. Depth................ Disposal Trench—No. .................... Width_..............._... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No..................... Diameter..........._.__..... Depth below inlet..................._ Total leaching area.... sq f t. Z Other Distribution box Dosing to Percolation Test Results Performed by...._. ...... Date........ ....... 14 Test Pit No. Lk.�5-----minutes per inch Depth of TZ--Pit ... Depth o ground water PLI Test Pit No. 2.< ..... ................ Depth to ground water....`... minutes per inch Depth of Test Pit*.... .........54 6----------------(--------------------------------------------------...................... -So ' 0 Description of Soil....... l ------------------ --------------------------------------------------------------- U ......................................................................... . ............ ... . ........................................................... .......�cn,d..R ............................................................................................................7........................................................................................... 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 T I TI! 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been *,ssued by the 4&t'rfi of bealth Signed.... V. .44.............................. ..... cf Dat Application Approved By................................................. .......... .......... --------- -------­----7- Da e Application Disapproved for the following reasons:..... ----------------------------------------- .1......................................................... ............................................................................................................................................................................................"------------ . Date PermitNo......................................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAUH, ......Z ...........OF......e ............................ Tutifiratr of TI-Intphaurr TUJS IS TO C.MTIFX, Th4the Individual Sewage Disposal System constructed or Repaired by..�J ... ...................................................................... ----------------- .......*..........*­(•--- --- InstallO &......... at................................("") e P/61 ................................................................... has been installed in accordalice with' he provisions of T;"�- j Q'If The State Sanitary Code as,described in the application for Disposal Works Construction Permit No.."-S-•Cp 5 2y L17-A ............ dated.._ .................... ........ .... ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT-BE"CONSTRUED AS A GU EE THAT THE SYSTEM WILL FUNCT SATISFACTORY. ........... DATE. /.. ............ Inspector.................L!!��......................................................... FUN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H:tLTI+ ..............OF.... . ........../7 .. ...... ........................... `Z No......................... FEE....................... 1411,V11 W Permission is hereby granted.... J��.A b. A.........4*1_1_137.7.111:�n__._."W.W1_.1......................................... to Corist ct 4, Rppai an I vidual ewage Dispo 1 � I0 ,S & .,eS- ystem yuA .2 at No.... ... Street as shown on the application for Disposal Works Construction Permit NO.. ated. .... ......------- .................................... ............................ Board of Health DATE ............ ..................... FORM 1255 A. M. SULKIN, INC.. 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No. ------------------- ASSESSORS MAP N0: F e— -- ��-�- BOARD OF HEALTH T O W N O F BPS E '� AppluationArMelt Cwtructionperntit Application is hereby made for a permit to Construct ( ); Alter ( ), or Repair (man individual Well at: c c s_—c'u It R'i • n16-S M, tt .cation — Address Assessors Ma and Parcel -pa i.t----4 N N-e/$V sv rs �-) c r — Owner Address Po ,30 -&s °--' 'L A S t ._-�- - ---------- - -- = ---�`------------------- - ----- Installer — Driller Address Type of Building Dwelling___��"`i e _ --- Other - Type of Building —------- No. of Persons---------------------------- PO L Type of Well —--�—--_ - ------- Capacity--- - - --——--- —-- Purpose of Well-dOiu`s --- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Cert' icate .of Compliance has been issued by the Board of Health. / Signed - — -- --- — — �1te date Application Approved B date Application Disapproved for the following reasons:-------=----------------------------------_ �/�A ! date Permit No...�1''—�`� � — Issued ---- date BOARD OF HEALTH TOWN OF BARNSTA§j6KPNO: Certif sate ®f C,omPtia EL NO:C3 ;;?5-0G L THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ('7 b Installer athas been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit 4k'� ,/_� Dated ' f—��� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE - - -- Inspector------------------- _ —___ Q r No. - ----1 Fee_ BOARD OF HEALTH /� r ,04// TOWN OF BARNS4ALE Application.*rVell ConetructionAermit Application is hereby made or a permit to Construct ( ), Alter ( ), or Repair (man individual Well at: CGS_-4�u I</3 ----- Location '^Adder Assessors Map and Parcel / j`—��Sa� ,ut,/(�"___ — t Owner J\ { 'Address Installer nt eP-' Address Type of Building welling , ----- e they -, ype of Building=-------------------------- No. of Persons-------------------------------_ Type of Well _�.� — Capacity---— - ---——------— Purpose oA Well-0, ft�--- Agreement: The undersigned agrees to install the aforedescribed ibcgxidu$l�w��ll ' `accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulllatio Tie undersigned further agrees not to place the well in operation until a Certi icaiT-7 om rance-h�een-6.��P� the Board oLHealth.; +� Signed - vim' date Application Approved B — ----—' `�� date Application Disapproved for the following reasons: ------------------__________—__—_—___—_ } —date Permit No. — ----- Issued--- -------- -- ______ date EKI) BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Com0liance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ►� S Cu..�..a// �~ by--- _----------------=--------=- Installerat— has been installed in accordance with the.provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit 40 --�Mted --- THE ISSUANCE OF THIS-CERTIFICATE SHALL NOT BE C0 STRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. j DATE---- - Inspector------------- --- SisPs�9 jP'iR�liNPPPiPG�iKPiOP6P1�PlP�iOi�ilitYRilisi�ilMYlYOfI9iTP9PP`i1li'!iiYQi9CMi�YAi.�A4Gli V iMiN9ili�01!44iK4�4i�i4�iii8i!TPTi!MiY?!Y!!ei!i}!.P'!i!'i"�.i!i!iKlP4G'!�!i lPti�ia!G BOARD OF HEALTH TOWN OF BARNSTABLE Yell Construct ion Permit / ASSESSORS MAP'NO: No. �! -- z,J�`, dD Fee PARCEL N9 T— Permission is hereby granted U i Lu''"t'` — — --------- to Construct ( ), Alter ( ), or Repair'( Ian Individual Well at: No. - _ G G f. w ICIS V t4d M AA - ----- ------- ----------------- - - -— street --as sho on the ap ication for a Well Construction Permit No.-� � " ---- Dated -/ ____ -- Board of Health' ` DATE— � A CEI3TERVILLE-OSTERVWLE-MARSTCCS MILLS - FIRE DISTRICT 1875 ROUTE 28 CEOTERVILLE, MA 02632 (508) 790-2380/FAXIO(508) 790-2385 OILMAZARDOUS MATERIAL RELEASE FORM F.A.# > 7 A !l C 7 LOCATION: ADDRESS OF RELEASE: DATE OF RELEASE: PRODUCT RELEASED:- .r2a, ESTIMATED QUANTITY: /t-20 f CORRECTIVE ACTION TAKEN BY RESPONSIBLE IPARTY: NOTIFICATIONS: 1 FIRE DEPARTMENT: YES(X) NO( ) DATE: / '/5 7 TIME: NATIONAL RESPONSE CENTER YES( -) NO( } 6ATE f DEPT.OF ENVIRONMENTAL PROTECTION YES( NO( . OIL SPILL COORDINATOR: YES( ) NO(A DATE: TIME: I TOWN BOARD OF HEALTH: YES(;) NO( ) DATE: Sf> TOWN HARBORMASTER: YES( ) N* DATE: TIME: I OTHER AGENCIES: I I 1 COflMmT . ('r�.,r ;. ( �r.' />f� . (alp ,1 ( In- P I I I REPORTED BY:—( t r: 1` f F�, l DATE: .P- WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH C-O-MM FORM #58 f I . f i �