HomeMy WebLinkAbout0059 GEMINI DRIVE - Health ��59-Gemi rive
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W:Barnstable
No. Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
2pplicatiou _for Yell ou5tructiou Permit
Application is hereby made for a permit to Construct( Alter( ), or Repair( an individual well at:
q (seIm n / 131 — dSj
Location-Address Assessors Map and Parcel
�w-� S� C-� Q •n,.v, t �� s� 1 �r�s�c
Owner Address
S �0 n 9-V
v
Installer-Driller A ress � ��
Type of Building
31
Dwelling
Other-Type of Building \ c No. of Persons
Type of Well r �(� ���'��o\-Q� Capacity , c�
Purpose of Well:3?, 1 r IS
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Pro ection Regulation-The undersigned further agrees not to place the
well in operation until a Certificate of C m 1' c s been issued by the Board of Health.
Signed
Date
G�
Application Approved By — (
Date
Application Disapproved for the following reasons:
- 9 Date
Permit No. vv1 �O Issued —�
Date
--------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of "omc Yiance
THIS IS TO CERTIFY,that the individual well Constructed( Altered( ), or Repaired( )
by �, � QC, \V ) 0II
Installer
at `� �1 .2_\no yl
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 No. W.70)3 -b13 Dated :JL-11—/'_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
woNo. Fee S
BOARD OF HEALTH
TOWN OF BARNSTABLE
2pplicatiou _for Yell ougtructiou permtt
Application is hereby made for a permit to Construct , Alter( ), or Repair( ) an individual well at:
r �q -7
gcm / n i -, i -, d S
L&ation-Address Assessors ap and Parcel
a
Owned Address
CJU
9-V,V�CJO n
Installer-Driller !• Address � Z,6 3
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of We1T P\� 6-1 �p�G3i�o Capacity
Purpose of Well
1, A V 1 Yti� t Vl �`t
�� C'� � � c�
Agreement: J
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Pro ection Regulation-The undersigned further agrees not to place the
well in operation until a Certificate of m '�c /h been issued by the Board of Health. �J
Signed
Date j
Application Approved By
Date
Application Disapproved for the following reasons:
Permit No. "" do( 3 — )( 3 Issued Date
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of bout Ytouce
THIS IS TO CERTIFY,that the individual well Constructed( , Altered( ), or Repaired( )
by �A 1 C.C, p--e__ P] 1
_ Installer
at e( 2YY1 t Y1 1
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 No. Wo?013 `013 Dated �"19
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
I
BOARD OF HEALTH
TOWN OF BARNSTABLE
I^ )v ")� _ Yell Cou0tructiou Perron
vA
No. v � � � Fee 1
.6�
(ot
Permission is hereby granted to O
Installer
to Construct( Alter( ), or Repair an individual well at:
No.
Street
as shown on the application for a Well Construction Permit No. 3 Dated
r 3
2
Date (� Approved By �e
C./
AsBuilt Page 1 of 1
Y 7 ;3
LOCATION SEWAGE PERMIT NO.
VILIXGE
PARCFl--NOS
- . INSTA LLER'S NAME i ADDRESS
0 U FL OR OWNER
DATE PERMIT ISS,NED - 7—J/— 7/-
DAT E COMPLIANCE ISSUED
67'�ro /
http://issgl2/intranet/propdata/prebuilt.aspx?mappar=131037&seq=1 7/19/2013
45
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LOCATION SEWAGE PERMIT NO.
�L��it�i .D/'• 4®7'4/T
VILL GE ` `K
' �/'�S/ •�r9/rvS °�L,� PARCEL Na
I N S T A LLER'S NAME & ADDRESS
B UIL OR OWNER
r I
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED-
. r
I r
G 7'�" /�
No........ 73....... .......
THE COMMONWEALTH OF MASSACHUSETTS
SOAR® OF HEALTH
Town.........oF......Barnstable....--..............................................
Applira#ion for Dhipos al Vorkti Tonotrurtion Errant
Application is hereby made for a Permit to Construct ( ) or Repair ( g) an Individual Sewage Disposal
System at:
59 Gemini Drive
..... _ . .._....................... ........ .............................. ..........................------...........------------------------------••--•-................•-
Locatiori-Address or Lot No.
- Charles HUssty................................................... ----•---West Bay?alable.-------•---............------......._.......
W Joseph P. Macon%'dY & Sonlnc Centerville Address
Installer Address
Q - Type of Building Size Lot............................Sq. feet
U
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
4
Other—Type of Building ............................ No. of ersons.....................---.--. Showers — Cafeteria
W YP g P
Pa Other fixtures --•----------
Q
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 leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by................ ......................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit..............--.... Depth to ground water.................... ...
Test Pit No. 2................minutes per inch Depth of Test Pit..............----.. Depth to ground water........................
-----------=-------------------------------------------------------------------------------------------------------------------------------------------------
0 Description of Soil.....Sand--A...GraXeI.........................................................................................................................-...
x
U .......................-•----•••••••-•-.....•--•....-•--••--•-•----•-----•--•--•---•-•-••-••---•-•••-•------•••-••••---•--•-•-•-•----•••--•--•-•-••-•---•-..................................---•--••--
W
UNature of Repairs or Alterations—Answer when applicable......1-?1_0Q0---gaJ-lon...o exflow_-------------•---------.
---------------------------•------------------------------•---•--..........................------•-----•---------------------------------------------------------------------------•-.............----
Agreement:
The undersigned_agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITiE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ee issued by the board
f health. `
Signed.... ..._... ...........................................� �-
Date
ApplicationApproved BY•••--••....' ------------------------------------•-------•--------------------------------- ---------- -.......-..----
" Date
Application Disapproved for the following reasons------------------------------------------------------------------------------------------------------------•----
---••---------••--•••---•--...••-•-----•-------•---•-•--•••---•-•--•---•••---••••---.........••-----•••--.........--•-••--•--••••--•----•--•-----••-•----...----•-------•-•--•-••--•-••••--••---.........
Date
Permit No.------ --------------------------------------- Issued_......-� JQ-- ------- ----------------
Date
b. -
No. ..................... r. FEB:;. :A ......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,
Towmn.--......OF.....??ar.a. -tP.b•j:�"-.----...............:......•--"--......._.......
s ;� rltr�t#i �t Mr z t a �a1 Works C # ' �r#taarn Brut # "
Application is hereby made fora Permit to Construct ( ) or. Repair (' ) an Individual Sewage Disposal
w'C p. „;
P�'System 8t• Y .
% 33..
Location Address or Lot No.
�-------•1: 3 k . .._.� _ --------------------------------
Owner
Installer! + :e'''r y#x73Xg tvi1 .8Address
n Cente
, ..
Address
4:T e of`Buildin �� '� `
d YP g ` ! f Size Lot._-- _-- ----------Sq feet
t° Dw.elhng-No. of Bedrooms Expansion Attic ,,(p 1 Garbage: Grinder-' ( )
4-Other—Type Of Building' _ _., __._.. No. of persons. ' ,z Showers ( ) Cafeteria (�, )
fn#{ y r E 9 # �taT a"ti3
Other fixtures .•-•-- ..
ions.
Desi . Flow ............................ #°` gallons per person per day. Total da>*ly flow. '
WSeptic Tank t_Liquid capacity ,� gallons Length................ Width n ... Diameter...___ Depth .,..._..
Of tit �D.isposal`tTreuch—No..__._...... 'Width____ _____________ Total Length`--',.....: F _:.:Total leaching area............::_.. sq.,ft.
-. :s t ft.
Seepage.Pxt'No...................... D>ameter ................. Depth below inlet.'_ Total leaching areas__ _.,.:...... q.
z Other Distribution box ( ) r ,," Dosing tank ( )
Percolation Test Results Performed'-by. ................................ ........ Date.........................................
t Test Pit-No. 1-______._-•-__-_minutes per inch . Depth of Test Pit Depth to ground water ....
f= , Test Pita No. 2................minutes per inch Depth of Test Pit -•__ Depth to ground water `....
# t , ° '
�O description;of-„Soil----- {� i'r --- :"`` C -- -------------•-••-•------••----- 4 ---- '--- ---------•••--••-•-• ..................` --
W Ar�o+3 d - -....... w . ... .._E . E .
V _ ._............................ - ____________________________._...._..._..._._. 4 _..____..... _
W � •- E
_______________________________________________ _.._._.____._._..___..._._.____.__._..._- .. .
U -Nature of Repairs or Alterations Answer when applicable � '�:
•. -----•........... ----•............. -- ............................... - ••--
'Agreement �f a
The undersigned agrees to install the aforedescribed Individual SewageM1bisposal System in,accordance'Fwith
the provisions of iL 1E 5 of the'State Sanitary Code—The undersigned further agrees not to place the system m
Operation until a Certificate of Compliance has iss ed by t bo rd f health.
,� t ;Signed- `'/r F___ ��'`�,,, ✓f f
>t .. --- •-• -••--•......•••-
s,s 1: ' •� ` ' r � „ ; Date s
Application:•Approved By...... .._
e�4..
Application Disapproved for the following reasons:...............................................................: •'
........................................................:................................................._..__...._.._.._..._...._..___._...__._....._____-_-_-___•____-_--_---_-.-•_•--•_-_-_•-_:i_.._.
a : . Date '#
Permit No.........._.. 'z ! ------.. Issued: ................---------- - µ
e� ,,43 �.� Date AA
rx.r 7 a r# 1 A'
j THE COMMONWEALTH OF MASSACHUSETTS
tiS
'BOARD OF HEALTH '
Yw ,
i
` a�: ..OF......ti.� ?'�7,�a•�`•abl G.......... .... ...................
E
r � a pr#gfirtt#r of' TvM 1ianrei A .
THIS IS TO CER�gT�IF] Tyhyat:,the In Sewage Disposal System'.constructed ( ) or, Repaired ( :
WS ...-♦ 0�� -c7t •e__••'s'L'F+ria v4!i� 'd• -,i � jyA............................................................................... .._•__ -..._
Y _ r -
Installer - -
at qn ( III... r' '3 £ 3 �- s7C ..........'
lids been installed;m,accordanceu �i`tl Cher provisions of TITI 5 of The State Sanitary Code`as described m the
app)ieation for biS)osal':Works Construction Permit No................ -____. ..:t ' dated
'THE-IS:SUA'NCE OF THIS OERTIfICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT-THE
SYSTEM WILL,FUNCTION SATISFACTORY. a �" �: b `0
ATE; z` - :; ----...... Inspector k ------•--
..
z .tz'w�' 'tlbt#+St- t .t ,k ., •ASak "tN3,7M+. ,n+ ,� 4�d .k..
. � . . r�• i •� � � . s is'
/f y ftHE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH _
,
s` FEE........ .
_Pet ssi `i 4s hereby 1granted "X _4t� 1__ .:.._ p• _��►1 x' 1`: _�1�--- 1�{�...............: ;
to ConSt uc �.€r� or Repair ( 5 ,an Individual Sewage Disposal System
at,No �' . ^ ,.< .__x3� _ ,r yyp �jj,iY? ,�,.nh'
..+y ` G .+.C��.. Aa.•+•J t7...srti' t:3+•.... na�'°r i�.:...e - � .r............................11-• Fl _
. .. t - -• --- -
c t ,._'., •'' ' Street ` , °
as shown n the a'plication for Disposal.NN orks Construct ion Permit. No.. .....Z/.3__ Dated.........f''�, f �� :....
�.
r` ' r ....................~.
. /d .R �r r Board of Health
9
DATE • - --- ` ¢
1 ... ._..... .
LK .
i,FORM 55 +i6BBS 8e WARREN, INC •PUSLISHERSP