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Home My WebLink About0170 THE PLAINS ROAD - Health 170 MINS RD. WEST BARNSTABLE Fee---- ------- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion r V ell 5t uct,�o ion r ion Permit A licatio� s here made for a permit to Construct Alter r individual Well at: pp y p ( ), ( ), o Repair ( )an m a Location — Address Assessors Map and P ceI Owner Address ------------- --------------------- Installer — Driller 7 —— Address Type of Bu' ' Dwelling Other - Type of Building--- ------ No. of Persons----------------- Type of Well— ---_ 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 Df Compliance has been issued by the Board of Health. Signed_�r� ' � /S�D�---- date Application Approved By ———— 3, 0( - -_- date Application Disapproved for the following reasons: ---------- - -- - -- ------------ date Permit No. -- Issued---------------------- ----------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individu 1 Well Constructed ( ), Altered ( ), or Repaired ( ) by— Installer — — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prot ction Regulation as described in the application for Well Construction Permit No.4 f---?ZDated _ .I / �--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector------------------ ----------- Fee---- - BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion for IDeYr CContruct ion Permit, I .�E.�We Application► s hereby made for a permit to Construct`( . ), Alter ( ), or Repair ( ' )an individual Well at: Locat'on — Address Assessors Map and P cel Owner Address Installer — Driller -- Address Type of Bu'din. Dwelling --- -- ----------- r tier - Type-of B,ifl.Ong- -- No,.of"P..ersons _ — Type of Well -------- 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 date 3 O Application Approved By ------ ----- date ;r ; Application Disapproved for the following reasons: --=------------ ------ — — -- date K 1 1 D Permit No. — Issued----_ -= -- -- -- - ` . date " 01 BOARD OF HEALTH ` TOWN OF BARNSTAB'LE ` i Certificate ®f CompUnce THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) y-- ---- - ---- - -- - - _ I/nstaller-• � has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prot ction Regulation as described in the application for Well Construction Permit No. �_?Z Dated � ��---- 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 BARNSTABUE- Seri �Con�truet ion hermit No. to 2(jy 0 ZZ Fee_ a - t Permission is.hereby granted___�%,�---_�__--� to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at: , - Street . w as shown on the application for a Well Construction Permit No.-tki 0 2 Z ------ Dated / 0 A Q� B and of.;Health DATE a �. ...., v TOWN OF BARNSTABLE LOCATION o -T�AC Pl-vrNk" SEWAGE # 5V -WSJ VILLAGE iJ T 6 JS7?PX4C ASSESSOR'S MAP & LOTf '� 'r ri INSTALLER'S NAME & PHONE NO. COA)SU SEPTIC TANK CAPACITY j , ,�= ( - (�vvv LEACHING FACILITY:(type) ?('T— (size),L-k at3t) NO. OF BEDROOMS RIVATE W_L R PUBLIC WATER BUILDER OR WNE . �/dyl�Lli4�1 DATE PERMIT ISSUED: +" DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t o off` Q b A ,- No ..I... ... FRs v APPA'OVED THE COMMONWEALTH OF MASSACHUSETTS Barnstable (;onservati(o poo gQA R D OF HEALTH w� -a.Y-9 OWN OF BARNSTABLE igned Date Apphratioll for Diupnuttl Wurk.6 Toustrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: lol ,& -...� d...............•Lj±JS.. RQ �t' f.�.S - �`�S ,C�" - Location-Address or Lot No. �`.�N W �� - ....- 6 «5 / ...... 4.ne naa Installer Address UType of Building Size Lot............................Sq. feet t t Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv--..--.--.-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........................................ ,.-I Test Pit No. I................minutes per inch Depth of Test Pit...----------.------ Depth to ground water...................--... fZq Test Pit No. 2................minutes per inch Depth of Test Pit.....--............. Depth to ground water........................ 1:4 -------•---------------------------------------------•- -------•--•-----------------....-•---. ............................................... 0 Description of Soil----•••=� S'� `3 S x --------------------- ..........---•-•----•---------••••......•••--- V .....•-•-•-••••.....----•--••••-•-------•--•••--••-•••••--------------••-•••-----•-••-----•----••••••-•----------------------------------••--....--------•----•••••-••-----•----•••••-••••-•-•-•--••••••. W Z. ••••-------------------------------•-•--........---•-----------------------------------••••---....-•----•--....•------------------•••-•-------------•......-•-••--••••--•••••......-•--••--•----•••••••- Creb U Na re of Repairs '4 r Alterations—Answer when applicable.----- ------ ...-.............�- �!�.L Z S�bti1,� - ---------1�----------�-{-•-----------•------------------ ---•------�1'a----------��..�------------��------------------•------- 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 operation until a Certificate of Compliance has been issued by the board of health. Signed ......... g p.. Da e Application Approved By ----- - .. .. .. .. ......... ........... .........e... ..... ....... ....... ... ... .................. .........-...... .........-------- Date the foApplication Disapproved for llowing reafo r _...._...._...................................... ----------------- ---- ----- ------------------------------------------------------------------ -------------- --------------....................... Permit No. ............... ... - _ Issued .....-� .....at .......................note...... ace d L - ........ Fps..... _1.. .....� THE COMMONWEALTH OF MASSACHU'SETTS r p0 , BOARD OF HEALTH i—fl t S,,-<TOWN OF BARNSTABLE Appliration for Diripa!3Ml Wor1w C outitrnrtion ramit Application is hereby made fora Permit to Construct ( ) or Repair (/,I an Individual Sewage Disposal System at: ----------------------------- -•-•-•---•--••-••••••--- --•••--•-•--•-•-••••... Locatimi-Address or Lot No. CA4"—IL Ca ` Addres. Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures _______________________________ _ _ , W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. Wt Septic 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fro Test Pit No. 2................minutes per inch Depth of Test Pit-_-_-_-----___-____ Depth to ground water.-_-___--.-.____---.__-. --•--- -•--•-----------------••............---•-•------••--•--••-•-• ............-----•---------•...... ............................................... O Description of Soil----------Q �'"------------ S-'-/.kZ........................... -----------------------�----------.-__5 -, '......---------------------------............._.. V ................. ----------------------------------------------------•-----------------------------•--------------------------------------•-----------------------------------------------•--•----•---- ---------------------------------------------- ---------•--------------------------------------------------------------------------------------------------•-----••-•-•-----•--•-•-••...I...._......--- Nat re of Repairs ' r Alterations—Answer when applicable... ._ L �, C�a'D �-�............... �} ---------- ---- -----U ............ P PP 5�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 system in operation until a Certificate of Compliance has been issued by the board of health. Signed ..... M .................. ........�`2�(�9 Y . ....�/, te n 77 � — .... /— Application Approved BY 17 ....%. �* ;------------ ---- s .... :.�4..%X.: ... .......................... .. / Ihte Application Disapproved for the followinglrearon�/ ...................................................... ......................... .. ...... ....... .................................................... ��.... ......`/ ....-.._._............._.-....1-........................................._-----.._...---.._.�._ � ...............Date.................. �1 -- � Permit No. ./..... - Issued . Ft f V .....................................` � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ertifira e of (111omplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired 4-\. L �.L-```Z c`o PS ------ _..------------------------------- by ..... ---....._.----------------------------------------__ ;....._....-.........._..... ..... Installer at .......1`? ................_. .`.�\,t1,S.-----------�--. -------...-----W.........� ,- --------------.._------------------------------------------------ has been installed in accordance with the provisions of TITLE of The State �iivironmental Code as described in the application for Disposal Works Construction Permit No. -�. --------------- -0.... dated ......................._------..._...._---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE_ 1--*" Iect ^r- . - ... - - nsp -- -p -------- ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No ..... FEE, �i �rnsttl nrk Tuni#rnrtuan Urrmit Permission is hereby granted ?•-\C\L ....-C�--+�1�1�S3;P-----------------------------------------•--------•---------............--- to Construct ( ) o Repair an Individual Sewage Dispos�s at No.......�7 Vt-f`c O �_ at�d a ----•---•- • ------------------------- -------------- Street �fi�. v as shown on the application for Disposal Works Construction Pi' No.____=1 -_. ____�__� � �`� PP P -� - i i Y-, _.�-� ---- ; , �. Board of Health DATE................�../ha� ._�.........f•••-•................................ 36508 HOODS WARREN.INC..PUBLISHERS