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HomeMy WebLinkAbout0114 KETTLEHOLE ROAD - Health 1 .4 KETTLE HOLE RD, W. BARNSTABLE A: I NO. L)�\­�w Fee-----��------ BOARD OF HEALTH TOWN OF BARNSTABLE Application,forlVerr Con5tructionPermit Application is ereby made fc a permit t Construct ( ), Alter ( ), or Repair ( )an individual Well at: .� , Location — Address — — Assessors Map and Parcel - -: -__i111V , -AA"_- _ /1 . tea ;20& --- Owner , Address Installer — Driller —� _ Address Type of �Dwelling -------_—___—_______ Other - Type of Building-- ______ No. of Persons--------------- ---- Type of Well �0 �6/ ---- Capacity------------------- Purpose of Well — -- - --- 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 Certificate.of Compliance has been issued by the Board of Health. Signed ,atr e Application Approved By -- —�\` � ---- U date �— Application Disapproved for the following reasons: - -------------- __;__—_— —_ . - -- ----------- — date --- Permit No. -7� `5 _- Issued J BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of Compliance 4,11 THIS IS TO CERTIFY, That the Individual Well Constructed ( ), tered ( ), or Repaired ( ) by - Astaller at---.J/ 1--d.11_ _ 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. DatedL' - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--_— — - — Inspector---- —-- -- - —--___—------- F r y.. E:�..r';y�,R'r+.� .ar .,�- ec i4'�+';'<.:i.. ,.. ,� a• °j�' 'jb^,.,. ..,--a ,'.++swa.yr„_ ,. �y?;iY".;.•_• No. �?��-- �_�� 6Fee-----'----------- BOARD OF HEALTH t, TOWN OF BARNSTABLE Application-for Veil C60trurtionPermit E Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owner Address ---------- Installer — Driller _—� Address Type of Building Other - Type of Building - No. of Persons------------------------------- Type of Well AO^ 'LM!�- —-- Capacity------------ -- Purpose of Well--- 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 1 place the well in operation until a Certificate of Compliance has been issued by the Board of Health. - Signed ate to Application Approved By `-\ - . loll U - date • t Application Disapproved for the following reasons: --------------- ----------------- ` r date Permit No. —E��-` -�- `--� — Issued �k date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well.Constructe I (. ); Altered ( ) or,Rep aired. nstaller zz AL 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.LL- Z-C�Lk=Sk Dated-- Zia THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- - -- Inspector--_—_ - - -_---_-------- 1 + BOARD OF HEALTH` W TOWN OF BARNSTABLE Veil Con!5tructionPermit No. �_--- �-- ` b . . Fee- — Permission is hereby granted ��, �l'`�� 1/ -s��► �/� - — - ----- ---- to Construct ( ), Alters ), or Repair ( ) an Individual Well-at: ., Street + as shown on the application. fora Well Construction Permit: I Dated _ I z --------------- -_ ! Board of Health _ ;R •M5 DATE r LOCATION SEWAG E PERMI T NO * i 14- e7, <�U � D. - 1 VILLAGE VAAP 34- I N S T A LLER'S NAME i ADDRESS �.� L 4 44 B U It D E R OR OWNER T o H4( DATE PERMIT ISSUED /p y _ DATE COMPLIANCE ISSUED 6 q i i r e, f LOCATION ®� ` / SEWAGE PERMIT NO. VILLAGE 4. INSTALLER'S NAME & ADDRESS V y i LJ r BUILDER OR OWNER J c f lff /LIc- /4 DATE PERMIT ISSUED �` 9z DATE COMPLIANCE ISSUED zd', 4�/._71— o ,n r ,, yo. �,r, �. '��. . If �y ® �, �, A No....... Gy Fx$....:.«� rJ ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF` HEALTH �! ............ ..........................OF................................_......-----•-----....._.......------....._..._........._. Appliraa#ion for Disposal Works Towitnutiun Frmit topplication is hereby made for a Permit to Construct (K ) or Repair ( ) an Individual Sewage Disposal System at: .__... 9.. ......e ........................... Lt1_ a7-----: feNS'_ 4,6:.C..--... Location-Address �r Lot N /S � �/t1 i D S ° ..-•---11C?.sylZl_--•�-•----�.t�1_.....�--6:;Zz � --•-�-----� -.>�.�P.---Q.�!_..1.�.----------...�............��t11_T�I.�U%�� Owner Address M 4 .. ,�...... �,X/yp .ram Y7-�----......o f 04�r ' Installer Address d Type of Buildin Size Lot............................Sq. feet U Dwelling- To. of Bedrooms_______________________________Expansion Attic ( ) Garbage Grinder (�f U pa., Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fix rer___._.._.. . W Design Flow__ _:____.___ 1..__.... llgns per person per day. Total daily flow....... ___._ -........gallons. WSeptic Tank Liquid capacit ___. allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width_.. _...__._._.___ Total Length____.____._ _ Total leaching a rea_______...____.__._.sq. ft. Seepage Pit No......./-___-_____ Diameter........ Depth below inlet_._..._.___._. Total leaching area_._, .d_f...sq. ft. Z Other Distribution box ( ) Dosing tankY ) �4/ — _Y—/Y- 7�- ~' Percolation Test Result Performed by. ��l ..__(/l/.` -----------.Date---,T_--�. 7 = aTest Pit No. 1__ � '._minutes per inch Depth oL Test t____________________ Depth to ground water_..__....__._____.___... PLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•••-------------------•-••-•---•-•-•--•-----••-------•-----•-•......_•--•---------------------•----......................................................... 0 Description of Soil--------------.4 ........ ----•----••-•---------------------------•-------------...-•---•--••-•-----•-----------------••----.....--- x w UNature of Repairs or Alterations—Answer when applicable--------Nl4_............................................................................ . ---•-•-• ••---•-.... .•••-------...--•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLI'LLE 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 .y t5h�p board of health. Signed---z"-- ----------- Date Application Approved By-- ---•-------------------• Date Application Disapproved for the following reasons_________________________________________________________________________________________________________________ .................•--------.........--•--...--•----•-----------•--•--...._..-------•------------......-•--•-•--------•-•--••--••_..... n Date •--•-•-----•-------•----•------•-__.. Issued_---• _ � . Permit No �.`� �` � Date No......A ..... Fxs..... .. C' .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' -- --..............OF....................................... -------•------............................. ppliraffou for i ustt1 nrk Cola rii n amit App&lion is hereby made for'-a Permit to Construct or Repair ( ) an Individual Sewage Disposal System afl Locate r Lot.. - T -, l.:.I T o No. Owner Address ...7e.._T__iyF .. /__1404172k ... Installer Address d Type of Buildigg, Size Lot............................Sq. feet aDwellingAK Bedrooms------ ...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of.Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fimuirg.9 Desi Flow..___.____ _... .. _ allons per person per day. Total daily flow_______ ✓ W 1 r P P P Y Y ................melons. WSeptic Tank—Liquid capacity/ ________gallons Length................ Width................ Diameter-_-_____________ Depth................ x Disposal Trench—N _ ____________________ 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 V40/ ) G� Zvi 3 /�- 7s= Percolation Test Resu s Performed by `...-� ?' -----------------• Date 3=1 ,.- - Test Pit No 1 minutes per inch Depth of Test Pit____________________ Depth to ground wa4rl ------------------_- (i,, Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ .••••-•---•-•-•--•••••••--•••--•--••-•--••••...............•------.......-•---•-•------•------------........................................................ 0 Description of Soil.........As---A rr4e✓vv 4.-------••-•---------•••--••••-----••----••------•._____-•----••-•••... U W -•-•••---------------•- •• ------.____••--•••-----•--------------------------•-•-•---•......••-----•-----•-•--.__..._ ` U Nature of Repairs or Alterations—Answer when applicable.......... V/t ..............................._______.___.______ ...:----•-----•-•-••----•--•••-•-------•-----•-•------•..:............•-•------------•--............•-•-•-------•--••---•-----__._......---••••- Agreement: The undersigned agrees to install.,.the aforedescribed Individual Sewage Disposal System in accordance with the provisions'of TITTIE 5 of.the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue y t board of health ,9 .� Si ned -- e� . mac... . ___-- .. `-- -._. _. Date ApplicationApproved: BY..........................t..... _______ f •----------••--•---•----•----•--•--•••-•--•- Date \Application Disapprov/d4f olWhe following reasons:............................... -- ....................------------•------•-----••--•----•.....-•---- t f x a Date Permit No. - --------•---....•--•.. Issued 4' Date P4c+d°—THE COMMONW i M q,F NLASSACHUSETTS BOARD OF HEALTH OF..... ... ......... .. .._. ....-. THIS IS TO CERT.-�{Ff' IT�hat`�the11-Adividua Se*a isp'©s6lISy oo�r�st�veted ( ) or Repaired ( ) b ...................................... ,*, 1}�r- .f... .......................... at....................................... 1..'. .:. a«► • f'"' it+� � "' ' has been installed in:accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the -------- --------- d at ' application for Disposal Works Construction Permit No............ ed� .____._._._.__.__.._..--..________.________. M1.THE ,4SUAN,CE:OF Tt�JS mCERT6F;I:CATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE S1(STEHeI 1dNILL F�IJNCTION SATISFACTORY:,., P' '7, .:, DATFrL ` ♦. .a.. -: '" Inspector . THE CMMONE,ALT4MASSA.CHUSETTS BOARD OF HEALTH No...... :. /T x Yt v d,+G "�.._— 1✓ .W..,r+s, FEE!..................... Z rh f�gnotrt�tt Permission is,hereby granted---•- ••-•- . •••-----...---•---•-•--••-----•-_•••• •• __...__ ..____ ................... to Construct ( ) or Repair``( ) an Individual S.wage:•D- posal Sy9teli as shown o e a tii��'pj_f/]�/ Disposal,�t�orks Constructi Permit No. ----------•..___ Dat* fie . { Boar of Health DATE-- � f "' FORM 1255 HOBBS & WARREN, INC., PUBLIS OF StL GL� �.- t►L�l - 3 151—=D1 r00A& �y UO G, [z.oGE C�IzI�� Uat L� s �w _ 1 ib � 3 = 330 �•RD• � 1-tctiL = �30.� ISo % = 4•-95 E6.Pn. i l OC>L7 SQL. �pc+• k. PIT uSE l oco GAS. /ALL AV-F- = l 70 )4 2.S - S7S ^� iO)rA AOeA z 9�;O S1=. CT'AL 'r->ESl6Q = 425 G+•P.D. Tta't'dL tad L�f F'Lvw = 330 &FD. Pta2G0LQTl0l.1 tOk�TE Cl" 2miw 02 ,f TO? I-.Ic =,00.o *� o- r r Gt�A/1') - d�� l o00 lug 9G g •�' S tc. 4 Ave-- I71,T. ._ GIW 6AL. '. -Z•� r 'Box 1�� Sepnc INV. qq TAWV- S'QIUO� GFvic'L PIT e � W c rt.1 •� _8 1'fa����/Z • III 1 WASkILD I � STONtc � C..EV-TtF1ED pLC>r Ptzo�'iL LoC.ATIOV l W, -l3 PSr k10 S�A,L�- S�AQ-- ; 1Ja SGA ATt--- 4 .s IAA GGiZ't•+p-( TWAT Ti4F-- i 5UO\AJ1J Pt-Avlj REPEZia ca i-1�_l?t;�aJ GC:vV�[�L.�(S �/iT1-i Tt-•a� S1U'ir_l..l►-•1E: L::�"T" l� AWL:> SETt3ACV WEQUIQeAA&"Ty -To w Q of Z�4 3 RGGISC'cIZED 't,.A4•.!G iUeV�:Yo�'� WOT AW osTEszvtL.Lc o /+rCAS�. Il�sr�� �+.,, �,vc:.�c=Y �►{� c;s=�S C'�. Sl t�t.,w A4�t t_t GA��1'T' J C>�4 Q 1,6 4LR7 JLZ- (?>t:_ uSe0 rc.) Lo t-,wCE _ _ V � N �� !moo(,.,qlS,rAyvK 1 GoTVTLOW /8 f [ CEQTIF IED P LCbT PL.li�l LoCATio"_ cAL ' 1 ! U' pAT� 3 Z Z. t CM4ZTIFY T&4AT TM'E HOR WJ6,Uk)&-S0,40w�7 , `t-lEQ E aa,s Gav�PLtifS . W t TN T► G 5 t v'r=-.LI WC-- Aun Sr IitusT�. Z-74 ?AG6 33 To w Li53 ! t REGtS'fUZEb 1.A�-tC� SI�C'.vG`�o�S t7�•.1 Ati.J os-reizv%L�.E o 11rtppASS� TNlS P+t_A1..1 tS Ll4T �ASE'V NJ,qrQtlAMENT SU2VC`( T�a� oFG"S T-S St lcww APP�.i GA."T b bT 6E usao To D�T�eM�NC LO t_t►-tC:S No.A ``' ��" ,� � � � Fee--��`�-�------ BOARD OF HEALTH TOWN OF BARNSTABLE ApplicationArlVell Con0ructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (le )an individual Well at: 62 Location — A dress T Assessors Map and Parcel Ax!----��n ---- --- --- - - -- --- - --------------- ____ -- ---- - Owner Address --- ------------------------------------------------------------------------------------------ Installer — Drillef � Address Type of Building DwellingII_1�l--R------------------------------------------------ Other - Type of Building —-------------------- No. of Persons----------------------------__—___________ f/ Type of Well— - - -——--------------------— - Capacity—'ry-------------------— --------- Purpose of Well--- 7--------------------------- -- 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 ertifica of Compliance has been issued by the Board of Health. 4 Signe ------------- --------------------- �j date Application Approved By —sY%s! - — /— date Application Disapproved for the following reasons:-----------------------—------------------------------------__—___—______—_ — —------- --- - — -- ----------------------------------— - - -- ---- —____-- { / date Permit No. g 'i — -- -- Issued--- —v-v(---- ------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, Tha the Indb dual Well Co structed ( ), Altered ( ), or Repaired (14 ----------------------------------------------------- ------------ nstaller at-� � �_ ----------------------------------------------------------------------_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 Ih�gY4��DatedA`-'A��j THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------— —-- ---- Inspector— - - - —---------------------—--- ------------ .• ,yea.,ay 4 r#^ _ _ t#ssy,f ; _ �� ..r „ '`�•"t —_ 11r+C,%,Vf .-:...irc�r4jt'" i ; --------- --- -------- No.-_- .� Fee------------- BOARD OF HEALTH TOWN -OF BARNSTABLE __ Application fbr10ell Cootructiotfpermit - " Application is,hereby made or a permit to Construct ( ), Alter ( ), or Repair (V )an individual Well at: t Location'-.' A, dress Assessors Map and Parcel —----------- -= G' --------------- ------------------ `-Owner i a Address - .. Installer D ilf" _ Address Type of Building a Dwelling ----------------------------------------------- Other - Type of Building,,-----------—------------------- s ~No. of Persons-------------'---------------—---- i/ ------ Ca acit Type of Well ------------- -`-------;-=�------- ---- ---------= P Y-6�------------------------------------------------------- Pu�rpose of Well ------- � � —--------------- 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 ertificat .of ompliance has been issued by the Board of Health. Signe - —, ------ - _ -— -- date to -- Application Approved By — - — ..+ „ / date / Application Disapproved for the following reasons:-- ------------=---=---------------------------------=_—______—_ --------— -- ___—— --- —=- — --------------------------------------------------------------------__— -- - date Permit No. - °'—�! `� _—__- Issued--- — /~----T-- — ---- - date BOARD OF HEALTH TOWN OF BARNSTABLE - Certificate Of Compliance THIS IS TO CERTIFY, Tha the Individual Well Co structed ( ), Altered ( ), or Repaired (Vl by _ c _ ------ installer atA ----------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable in of Health Private Well Protection s� $ � ��D ' Regulation as described the application for Well Construction Permit 11tI� ,-- ated-U__'---l__-•-- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. - - DATE- - - ------ --- =-- Inspector----- — --------------—--- - --— BOARD OF HEALTH TOWN OF BARNSTABLE 1Ve1l Congtruct ion permit No. ----- Fee-- - - Permission is hereby granted - �'C�� � 0 - - J/ ----------------------------- to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at: No. --------------------------------------- Street 3 as sho on the application for a Well Construction Permit No. - - - Dated---- - - — --=- ------------- R4 ------------ — -- --- -- -- --- Board of Health DATE