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HomeMy WebLinkAbout0111 MOUNTAIN ASH ROAD - Health (2) f'9'i IViountain Ash Road . Marstons Mills ' .030 i 0H No.- -------------- Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Well Conotruction Permit Application is hereby made for a pegn� to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — dress Assessors Map and Parcel -- - M - -------------------- fI!M w_l -- --_-------- Ow er Address Installer — Driller Address Type of Building Dwelling -A ----------------- Other - Type of Building--------------------------------- No. of Persons------------------------------- - -------- Type of Well—-- �1 - ----— ---- Capacity------------------------------------------------— --- ----------- Purpose of Well--------— �'-v -----—- 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 L� ------ — ------------ date r) Application Approved B / _ 3r 'L1 _O 8 --- -- date --------- Application Disapproved for the following reasons:----------------------—------------ —_______________________—___—_________ -------------------------------------- -------- - - ---------------------------------------------- - -- ----------------------- date PermitNo. -----=------_---------- --------------- Issued------------------------------------------------------------------ date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CE TIFY That the Individual Well C nstructed ( ), Altered ( ), or Repaired ( ) bY- -------- r� -- - - ------ Installer --- - /- - -------- at---- —1 --—--— - - - - ------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health-Private Well Protevipn v_ Regulation as described in the application for Well Construction Permit No. � ----------Dated---3-- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------—- —---------—-------------- — -- Inspector-------------------------------------------------------------------------- 00 No.-y---------------- Fee BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell CongtructionPermit P Jam. n Ew}-- Application is hereby made for a pe k to Construct ( ), Alter ( ), or Repair ( )an individual Well at: JII ---- Ay� L— -- — --- - — ---------—- --- ---- Location A dress Assessors Map and Parcel G IqmLd - -- -- Owner Address ----------------- Installer — Driller Address Type of Building 'I Dwelling..... -�` -t"!-------------------------------------------- ` 1 Other - Type of Building-------------------------------- No. of Persons--------------------------- r ------ Type of Well- -- - —�-- - ----- --- Capacity------------------------ - - - --— Purpose of Well---------------DC--^'-�----------- ---—- i 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. I ` Signed - --------------------- ----------2-------------- Application -- - — date f� A roved B / ---------------------=------ ---- 3 - '�1 -O " date Application Disapproved for the following reasons:-------------------------------------------___--------_—--------- ------------ —__________ W'a oo 60 4 Permit No. --— --- - --- Issued------------- --------------- date - - ------------------------------------ date ------ ------------------------------------------------------------------------------------------------< BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY That the Individual Well qqnstructed ( ), Altered ( ), or Repaired ( ) /- -- by- ?l` -- ----__--�ry u- i -------- 1 1: ----------------------------- — Installer -- �u� — — _ — — — — -- — — — at �Y �' � f j has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prote ti•n � �g,0 i Regulation as described in the application for Well Construction Permit No. ----� ---------Dated----- - -------- i i THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------------------------------------- f ----- -- Inspector-------------------------------------------------------------------------- jl I I ----------------------------------------- ------------------------------------- ---------------------t BOARD OF HEALTH I TOWN OF BARNSTABLE Ve[Y Con!9truct ion Permit ' k j - ------ 064 �� ------ No. =-" �v� Fee----- Permission is hereby granted- ----- - —-------------------------------------------------------------------- to Construct ( Alter ( ), r R air ( ) an Individual Well a /C'Q/f No. - - - —-------- ------- - - ` ------------------------------------------------------------ I Street i as shown on the application for a Well Construction Permit No. -------------------------— - - ---- -- - -------- - Dated--- — - - -------------------------------------- -------------- --------------------- �_ Board o ealth DATE-----3 i I i LOCATION SEWAGE PERMIT NO. 77 VILLAGE I N S T A LLER'S NAME i ADDRESS a U I L D E R OR OWNER DA T E P ERMIT ISSU E D �s /en DAT E COMPLIANCE ISSUED d_Aa r _ � '�� �H� �J � r" '% t . i� �� L;< :� �� a -_- - � ., k - y No........ r.. T F�s... U.......... - THE COMMONWEALTH OF MASSACHUSETTS 'P BOAR® F HEALTH IJARCEE, f e30 ...-----.... ............OF..... ... , . ....... LOT ,.... _. Appliration for Elispoottl Works Tootitrurtion runfit Appl oi d s hereby made for a Permit to Construct (k* ) or Repair ( ) an Individual Sewage Disposal System at l{ e •. Location-Ad ss, .- or Lot No. e — Owner ' Address :1 ..t��r._._. aA� t........ .... .......V----------- ----------------------------------------- ----------------------......---------...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms._........_._:.......................Expansion Attic ( Garbage Grinder aOther—Type of Building .,66.vme ......... No. of persons............ Showers (L) — Cafeteria ( ) dOther fixtures -_------------ -----•------••-•-•-------------•--••-•--•-••--•--•-------•----------•-•-----------•------•-----------•------•--------•------------- Design Flow............a.h.....................gallons per person per day. Total daily flow..........3 .I lions. WSeptic Tank t Liquid capacitylQ._ . allons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.... _._...._...... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No.._.__�._..._____.. Diameter.__..1�....._ Depth below inlet...... ......... Total leaching area...-.11-sq. ft. Z Other Distribution box ( ) Dosing nkk ) Percolation Test Results Performed by.., .........................:.......... Date...�.—.2z-" Q.:.......... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r3;4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t ...... //...II..-•T. ..... f........ O Description oft Soil- �� l9�. .GI'� :._.eZy �. G -e :�. .... w -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 TITI LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n ' ed by the bo rd o ealth. Sig Application Approved By--•- ; . ......... .... -- .------••------ - V .............. Date Application Disapproved for the following reasons:.............................................-••--•-•--•••--••------------•----••.........--•---------------- Date Permit No......................................................... Issued-.1k--- :a Date No.. _-_-•............. - - Fins............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ,OF HEALTH .............0 F....1,5� i { . .. ,gyp iration for Dispwi ai Works Tonstrnrtiun ramit , Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: /� 1 V:......6:!5/1 -lOcQ.. , `LyT�fl�l��� .. 4 Location•Ad rgss, or Lot No. Owner Address in Address. UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms�______________............................Expansion Attic (QUO Garbage Grinder (00 Other—T e of Building 1n1 l2,SC.__._.___.. No. of ersons_._:_,_____�............. Showers — a yP g �! PO Cafeteria ( ) dOther fixtures --------------- ----------------------------•--------.•-------•--•------------._.._._.. ._.....--------______.---.._._...------•----___--•.....---- Design Flow............ ..............gallons per person per day. Total daily flow--------- Ions. WSeptic Tank)—Liquid'capacity f gallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench—No_ ____________________ Width____._._.._.___.___ Total Length.................... Total leaching area__..................sq. ft. ____. Depth below inlet___.._�2____.___. Total leaching area__. -fit ��_sq. ft. Seepage Pit No------l------------ Diameter____/� 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........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ xDescription of, Soil-_�- -� (ihrgiL�!- f �fdji J u �19�_ U 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 TITILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bin 's ed by the board of health. Sig d f 'r `f .• �.na e Application Approved By•-...... ..... .-- ..... . Ll ,� ---...................... ..7. ...a`:�-t----•--...--•--- Date Application Disapproved for the following reasons-----------------------------•-----•---------•--------- ') ...................................................................................................:......___._.._...___..___.___.______._____________________.___________.________.._ Date Permit No......................................................... Issued.._� _3'`D"' Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. .... I........OF.......... ...... .................. (9rrtifirFatle of Tont pliFanrr T� IS TO C ;RfIIFY�That the Ind System constructed Sewage Disposal Syste constructed (�r Repaired ( ) Y , by....._-. vl!�,:.. LC_...--.................... -------------- -------•- ------------ ✓ � Install ---- ----- -- at. --�--- L1.2w1 �`!..-- 7 F�11/ 'K-r•�� _.ri:! l:1__!:��. has been installed in accordance with the provisions of r of The State Sanitary Code as des ri ed in the application for Disposal Works Construction Permit 1 0-___ .____ 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 O HEALTH s 'j-r/1'?..........OF......... ...................................................... No......................... FEED.-- _--••-•---- - t �tla "Norks, n otrnrtuan amit Permission is reby granted......I...................... ......... ----=•---------••-------•••----------------------------------------•---.._....___...... to Con truct ( )1,9r Repair ( Pan ividu 1 Sewa osal ��ytem / ,f� �q �/J at No l)?YJ 1-SLI H-_._._... � ��: !! _ ._.._.. � ^.. . l�__1�� �I..!_:-!••`--•-- Street as shown on the application for Disposal Works Construction t N� Dated...... __ - --------------- __----- - ---Board .. ^^ S-pC'p DATE------------------------••--------••-------••---•--•---_........-----__....._... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f-Y:• �. _ L0 �' 1/ "`:, .:w ! �u :'� ' t,K',. W � � ....I t � .. 1� °�< ,t- - 'l r�•^ it k r' � .E<,; ' Irv, j- r r ! -4 Vgo PA »ray �� ..4 b 1:`, ' \ 3 /ems ` q.:. Y- F •v�b a X A k r �# ,4 � . `D zo 36 . N ISO EXIST/N. Ffi 4. 4 r f{dvL.•r. 7 .'' �.c f h / 7 •x x i +• ROBERTj P. M� r ii Q v _ BUNIKIS' N a No:.22162..0 IST DNA! q � - .31 EX/ST/A/6 LEGEND EXISTING o t PLAN SPOT ELEVATION 0 Q Q � A CERTIFIED PL 8+.• d ' EXISTING CONTOUR — _ O L0 7- 7 M0VA17-AIA -4S1.1 Rv , f, _.F.1141SHED SPOT ELEVATION 0.0� � .:,FINISHED ` CONTOUR - :. .p - !'').4tR,5TOS _ APPROVED - BOARD .OF HEALTH .9411 1 S'IAS 1169j.ialASS. x :DATE '` AGENT - SCALE .� ,<; D DATE #< t CDR EDGE ENGINEERING CO. INd _ CLIENT �l?IGHA�i� I CERTIFY" THAT THE PROP03ED' '' (��EGISTERE REGISTERED JOB NO. 80003 BUILDING SHOWN ON , THIS PLAN J .• f CIVIL �' LAND CONFORMS TO THE -.A M._ ZONING LAft DR. BY � ENGINEER4 I,SURVEYORS� OF BARNST B M S3. `_ 33 NC MAIN ST 712 MAIN ST CH BY .� .j':� r Q- ,SO. YARMOUTH, MASS. HYANNIS, MASS Z x r SHEET_L_ O F .___."___ D A E REG. LAND tiF�i; 1.�,�,�•<. ... ._. f • _. _ _ , ,� .ate, '� �' - '• +o-, r •.."•a:. -...'nii. ,**,;,..y'i �a..x . -.9 �;V.'t y. li:..,�.xz :p. '. �. hp.-. 4. � v i>�� ��y� ,. .k� x .2 •,:tc .,. .K,' `�,+y.F ;tti .wa° `;9"b`c+.'ajd%xf i .�,�`. 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C SEE 7f1BU1-A7-ION�) OUTLET SEPTIC TANK V INLET Ul5TRlf3UT/ON QOX SECT/O/V OF GROUNU WA-r--R TABLE y OUTLETD/ST�4/B✓T/ON BUX�.�. -FT. /,NLc r LEA CHI/NG T _C 45-F .SELVAGE O/S°POSA L SYSTEM DAI LEACH//VC. P/T TABULAT/ p DES/G/V CK/TER/A .SCALE U/MENS!ON AFT. NUMBER OF BEL>ROOMS 3 D/MENS/ON C FT. M/A/' GA RCA GEO/SPOSAL UN/r_ SD/L LOG SOIL TEST TOTAL EST/MATED f LOl t/_3.3 0_GAL.�0.4Y .SOIL TEST A/ SOIL 7EST#2 NUMBER OF EAGN(NCn ,v/Tyr`-EL�Y._9 � : DATE OF SOIL TEST . .� r Ic .:S/OE LE.4CH/NG PEK P/T .6vTTOM LEACHIAIG PIE I? P/T_ZY,SQ. FT. RATE #/ LESS ly/N. /NCH r.•` TOTAL LEACH//VG AREA . 6 SQ. FT. .StJt��SL'/L �'U/j SdrL AERCOLf�7'/ON RATE 12 T �^" MJ1V./lNCH RESERYELEACNI/V6AREA_2---� SQ. FT. . 2�_ I� '_ Z�_ $ Z• O e�z S R g T 7 MO aAl TA /4/�,4SIol D. ,_ �F� ROBERT, � P. c,l `-' • /0 '-1�--.-, 8' - ,�' '.�" `" /�'1�41�sToi1/S RAJ/ BLS BUN}KIS 3*x y'• P No.22162 4 Q _ `' F' S�F/✓'' �, SA IfD. FG/S `., `,+ EL DREDGE ENG//VEER/NG Co,INC. r - a , cv � FSS! 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