HomeMy WebLinkAbout0153 HOLLIDGE HILL LANE - Health 153 HOLLIDGE HILL-LANE
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIPPYication for Migogar Op aem Congtruction V ermtt
Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) El Complete System let dividual Components
Location Address or Lot No./5 311-011* t Owner's Name, ddress d Tel.No.
Assessor's Map/Parcel
Installer's Name,Amass,and Tel.No. Designer's Name,Address and Tel.No.
7 7/
Type of Building:
Dwelling No.of Bedrooms of Size sq.ft. Garbage Grinder(It
Other Type of Building :J No.of Persons
Showers( ) Cafeteria( )
Other Fixtures
Design Flow !le gallons per day. Calculated daily flow ' 7 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. X/Z 3,.1' �—VF'Nrg)
Description of Soil /BOAT V'rl 4eAYi
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 issued this Bo f Hralth.
Signed
Date
Application Approved by ` Date
Application Disapproved for the following reasons
Permit No. � ¢ Date Issued �`�f�y✓�- G `�:
THE COMMONWEALTH OF MASSACHUSETTS 'I.
S�l--DZ
BARNSTABLE, MASSACHUSETTS
ctCertif Cate of comps,,
tante
THIS IS TO CER ,that�e O -site Se ge Disp sal System Constructed( )Repaired( )Upgraded(4_�
Abandoned )by fG4O/J5
at / .�3 Ile has been constructed in accordance
with theprovisio fide 5 and the for Disposal System Construction Permit N � ®° dated 4'
Installer Designer
The issuance of this e t shall not be construed as a guarantee that th syst will func 'on as desi ned.
Date �1
` Inspector �� �•� .
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
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fgogaYi gtent.�ottgtructiort
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Permission is hereby granted to Construct epair'(, `)U grade((/�Aban on
System located at / 3 �� /a'YC'' %�� �1�/1'P �i �
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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:Co truction must be completed within three years of theAate of this t.
Date: Approved b
' TOWN F BARNSTABLE L"
-CATION / L d
w SEWAGE #
v i.LAGE Z- /1Ii ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO. A.,,S,�e .
SEPTIC TANK CAPACITY .�C.4 C
LEACHING FACILITY:
(type) (size)
NO. OF BEDROOMS
BUILDER ORC!q
PERMITDATE:_ 9-_-0/ COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �� Feet
Private Water Supply Well and LeachingFacility ry (If any wells exist
on site or within 200 feet of leaching facility) /.r0
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within 300 feet of leaching facility)
Furnished by Cso Feet
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH B �
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Appltratiun for Disposal Works Tonstrudiun,prrn #®f
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Dispdail
Sys f
U
n. .. ........................ ...--•--...........-----•----
• . N Location_ dress. ........ ...........•-- .. ._. or Lot No. ... ...............-•-••-•`
................... ..x..,.. ...... -------------------------------- 3--- ...........— ....?:'�j:..al ....................../.c,
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling K No. of Bedrooms.--.�...............................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type T e of Building .._. No. of persons............................ Showers
W YP g --•----------------••--- P ( ) — Cafeteria ( )
�a ------•-- .....
.....- - -- allonst=-e�---erson y..-•----•------•-----••----------------------------------------------••---••--•-----•-------•----
W Design Flow..pp Other fixtures -. g P P per day. Total daily flow.......3 __d........................gallons.
WSeptic Tank f Liquid'capacity_ e.gallons Len�h................ Width................ Diameter................ Depth----_-----.--.
x Disposal Trench—N ..................... Width.................... Total Length....._._._......... Total leaching area...................sq. ft.
Seepage Pit No......._.......... Diameter............... Depth below nlet....�t............ Total leaching area.la.4.sq. ft.
Z Other Distribution box ( ) Dosing tank ) Q
w
Percolation Test Results Performed by...—.. 6.)'A. .................... Date.- -?... . .
/y' 7..............
Test Pit No. 1.-/.,y..minutes per inch Depth of Test it.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........:...............
a ---------------- : t
O Descri tion o Soil...._....._Q._�.2-.. . .YG�..a........2.-..�.7 ..... ...... ..............
P_..... ' :_ ..__.::: :::._:::
W
..... ._... .._.. .._..
UNature 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 TITLE 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 board of health.
Signe ... ...... ......................................•-•-----•---•-••-•------.-----• ---------------..........•a� -
n
Application Approved By....... .---- ---- � ... .7. _`-- .
Date
Application Disapproved for the following reasons:........................................................................................................._.._
..............•-•--------...-•---...............---------------......--•---•---------------•-------.......................................J-..-..;7i .................Date....................
PermitNo.................•--------------.........---•-------.... Issued.... O..Z! .................------...
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD :OF '.HEALTH
.,.,
OF..... ..... .^ ................................
rrfifirab of Tuntpliana
THI .I T E I T ' he Individual Sewage Disposal System construct ( or Repaired ( )
------ --•--- ----- ........... ...
• 11
i,/ w' n cs
at.. " '` '- , '•----•-------------•---------------
has been, installed in accordance the provisions of T 5 of The.State Sanitary Code as described in the
application for Disposal Works" 17
Cokstruction,Permit No �__.___.., �..._......... dated...... ` '"". '-
'THE ISSUANCE OF THIS-CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..., ..................... :... ...................................... Inspector ,..-----------.....---------_... ---------------.._.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA T
4��V No ..
tnusttl r it tunrrnttf
Pe is iereby granted...... ..... ............. : .
to Cons �r r ( an vi u Sev►r posal Sys
at '. .-
�.. _ _ . ,�
Street OF
as shown om a application for Disposal Works Construction Pe No. Dated.__. ' .... .:.........
� of Heal jj Bo4ard
DATE::. '�. (.d✓ rr `� -------------------
FORM 12ks HOBBS & WARREN: INC..,.PRPLiSHERS
AMR 6•E PER IT NO.
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