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HomeMy WebLinkAbout0169 MAIN ST./RTE 6A(W.BARN.) - Health 1(��1 W►cuh �fi7r' t� i TOWN OF BA"STABLE I I ® 2J .C+CATION Cl SEWAGE # VILL G r'-;R y-(Z- \ -lc,;'66 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. e-- PL L JANC Q SEPTIC TANK CAPACITY P � LEACHING FACILITY:(type) y�,2 --�,►c�5'j q r�(size) tiC�I X NO. OF BEDROOMS P TE WELL ) PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No / �f --FAO D _ �ou5c C'�ST1cv o THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Apphration for Bispoiial Narks Tnni#rurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair Qc-) an Individual Sewage Disposal System at: .Pry .. a�a .. Location Address or Lot No. .... .�. ..... O�.Q. ........... ....... ..................... .......... Owner Address ..; ................� �$�................ ................P...�..........,1� .... ........... ......................... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.......�................. .._..Ex Expansion Attic a g— --------- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ...--•--•------------------------------------------•------------•-------------------.............--------•-•-------..........--------•............... W Design Flow......�.Cs........................gallons per person per day. Total daily flow__-_--_--q{ ?-....................gallons. WSeptic Tank—Liquid capacity ___.....gallonsength................ Width................ Diameter................ Depth................ x Disposal Trench—No... ,q.1� idth..................... Total Length...al . ........ 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........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ 9 •----------------------------------------------------•-•------------......----------•..................................•...................................... 0 Description of Soil....................-.......................................................... ----------------------------•----------------------------------------------------------- W V .................•-•-•--•...-••------------...._...-----------------------------.....----------------------•......................... --------.........------.....•••-•---•-•------••---•-........------ -- -------------- •. U Nature of Repair or Alterations—Answer when applicable .a .......---��s , : -------. :. ��......----.TI. C.-�-------------------------------------------------------------•---- 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 Com lia\n ehas been issued b the b and of health. Signedc\ . . . ......... . -- ------ ...................... - ---- 7 Date Application Approved By .. Date Application Disapproved for the fo owing reasons- ----- --=-------------------- ----- -----..--..............--------------......---------------------------... --------------------------------- -- ------------ ---------------------------------------........................... ----- ------------------------------------------------------------------------- ---------- ------------------------ Permit No. ..................... Issued ...................... Date . �� Dare r I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iration for Disposal Murks Tonstrnrtiatt Frrntit Application is hereby made for a Permit to Construct ( ) or Repair ( sl_an Individual Sewage Disposal System at:� c nt f% �--� l� ----------------�-------p--..».-------�----------.»..._._..... G Location-.EA_ddress or Lot No.-- W e_- 04-I " L y�C ddre ss l r ------- Installe Aress - ---------.-.7 Type of Building Size Lot--------------------------Sq. feet U Dwelling—No. of Bedrooms-------- ______________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building Pao —Type g ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ----------- ». Design Flow------------------------- ;----......-____--gallons per person per day. Total daily flow---------4_r��-�v------------------gallons. Septic Tank—Liquid ca..Pacit __�-------gallons ,,4ength---------------- Width---------------- Diameter____________:___ Depth________________ Disposal Trench—No.__!_ t�`.�Width____y___________ Total Length___ .T_`_----- 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---------------------------------------- 1.4 Test Pit No. 1________________minutes per inch Depth of Test Pit_____________'_____ Depth to ground water____________________.__. tz, Test Pit No. 2----------------minutes per inch Depth of.Test Pit____________________ Depth to ground water________________________ ----------------------------------------------------------------------•-------------------------------------------------------------- ----— ODescription of Soil-------------------------------------------------------------------------------x U Nature of ------------------------------------------------ R i "s apr Alterations O! t.�Answer when�aPPlica �__j__(l ►�1�y-!- ----------"�--t•,- r y--=Z � ---------- AVr._.. ---------•------------------------------------ Agreement: The undersigned agrees to-install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the4State-Environmenial�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 3 -! -a�` '-r --C P Lr �,/�.__-_-.-------._--__--_--- Dare Application Approved BY J V------------ -_-------------- ---�� ---..'...........................---------------_._...__..__._.._.__ Dare Application Disapproved for the following reasons: -------------------- ------------------------------------ ------------------------------------------------------- ----------------------- ------------------------------------------------ --------------------------------------- Date Permit No. Issued Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gex#tftrak of Toxnylian>cP THIS IS TO CERTIFY aattithe Individual Sewage Disposal System constructed ( ) or Repaired (4 ) by---------------------------------_--------------------------A------ --------- --14."0---- 1 -t�_ --------------------------------------------------------------------------------I- ------- } /!T Installer at ------------------------------------------------------------------- ----- -`( -------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. �Z.-_.lz--_.�.__--____. dated __________________________-_-____-_-___...- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE � ) � - 7� Inspector '--- --------------------- --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE N ................... FE3E ._........ Disposal Works Tonstrnrtion ]Jrrm t Permission is hereby granted-----------G_0-_N_l2.__(=_�t`_/__V)....... "_ _��- ----------------------- to Construct ( ) �r Deepai ) ' I`dividual sew g Disposal System atNo------------------------------------- - �._.�._... ------------------------------- - .. Street pp as shown on the application for Disposal Works Construction Permit NdZ.7{��/__ Dated__________________________________________ - (y ------------------------- -rd --H --------------___----------------------- DATE------------ oard of Health FORM 3850E HOBBS Q WARREN,INC.,PUBLISHERS LOCATION SEWAGE PERMIT NO• f VILLAGE INS-TA LLER'S NAME i ADDRESS ���'J CASs�o ! �C�u►C� BUILDER OR OWNER DATE PERMIT ISSUED C9 DATE COMPLIANCE ISSUED II. f ice/ 'J '4 fad 6(4' .,'LOCATION ' 5EW/J,64E PERMIT. UO. . VILLAGE - - - - - - LER�S -W&ME-� r D.AT-E-COMP_LI.W.ACE Imo=--- - - - - -- - --- - ----- - - ------- - -- - -- - � � � ..• .� ����' �� �f�va�i . � 1 ��` ~� 1 a� � � �� � _ �" . f No..---.l..l-:. Firms .32s.22....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispasal Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or RepairX�CX) an Individual Sewage Disposal System at: 314 Route 149 Marstons Mills --...-• -- ---.......... •-• ....... ............................. ----•-••---•--------•--•••---------•------•---••••-------•-------------•--.............--•-•..•--- Location-Address or Lot No. Carlson W J.P.Macomber Jr. Owner Address Installer Address d Type of Building Size Lot............................Sq. feet U DwellingX—No. of Bedrooms..............3...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g --------•------------------- P ( ) — Cafeteria ( ) dOther fixtures ..........................................................-----------------•-----•--••-•-•--•-----------•--------- •---•- 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........................................ ...l Test Pit No. I................minutes per inch Depth of Test Pit............_....... Depth to ground water---------------:........ f%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil........................................................................................................................................... ........................... W ...........................................5_a115,_&..GXaVea --------------------------•-------------------------------------------...---------------•-------------•----------------• W UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------ ................................................................................--------------------------------•--------------------------•-----•--•-----------1-1QQ -gallon leaching fit* ------------------------------------•---- 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 issued by thejDoard f health. Signed ---- --- -------- ..-. . -------------------------- -.6L24.L91------------ ` �''`'� ^-� Dace / Application Approved BY --- V V ----------- -- ----- Dace Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------- --- -------------------------------- -- ------------------------------------------------------------------------------------------------ Dace Permit No. ......�/.......01 .- --------_-_---------------- Issued ................................... :.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Disposal Works Tonstrnr#inn jhrmit Application is hereby made for a Permit to Construct ( ) or RepairX(KX) an Individual Sewage Disposal System at: 314 Route 149 Marstons Mills ...• __....._............... ..... ...... ............................. ...-•-----••-------------•..........-----------------.............._........_...._...._-------•-• Carlson Location-Address or Lot No. W J.P.Macomber Jr. Owner Address Instailer Address dType of Building Size Lot............................Sq. feet Dwellings No. of Bedrooms..............3...........................Expansion Attic ( ) Garbage Grinder ( ) PLIOther—T e of Building No. of persons...........:................ Showers — Cafeteria 04 Other fixtures ---------------------------- - 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.................••----------••-------- I 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..----...............--. -------------------------------------------•--......----....---------------------...------•---------......................................................... ODescription of Soil........................................................................................................................................................................ U --•--------------------•-;�,--------...S :C1r..-`4c Ctr 3La1 -------------------------------------------------------------------- W UNature of Repairs or Alterations—Answer when applicable................................................•...................................`.✓....... ----. Eg 3,nn_... Q!%r'.h J.n.P�'--Pit-_------------------------------------------ Agreement: �1_ • '+ 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 b e issued by the ,oard/of health. Sign '0V .�l...c-------------------------- ......................................../91 Dare Application Approved By . / ... .: t.. .-- .. == I -..-.�----- / ._... ��..�.......�.'.'""r�. .. Dare / Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------............--------------------------------------- �� Dare Permit No. ------7-/-._�_. .a-�� Issued -------------------------------------------------------------------- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cger#t£trate of C11antyli ure t TTHIS IS TO CER77Fy That the Individual Sewage Disposal System constructed ( ) or Repaired (XX )� by J.Y.Macomber Jig. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- InMller at ....314....Route....140...M9_r.t rcn c----MI..l.l.c------------------ ..............................----------------------------- -------....._..-- .---------------- ---.-------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. __......... ....... ... ... ..... dated ... .................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL/FUNCTION/SATISFACTORY. ��� DATE.......-.Gi......:.. ...�" 7.� ---------------------------- Inspector - - ... --- .......---------.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH b TOWN OF BARNSTABLE No...// 11&/,. FEE.. E ,•aa. )o Disposal Works Tnn#ru #inn Vprrmit Permission is hereby granted....... r__:Jr............................................................................................ to Construct ( ) or Repair (XX) an Individual Sewage Disposal System atNo... Tk Mi 1_l,c---......................................................................................................•.. Street �� �� as shown on the application for Disposal Works Construction Permit No..�__.:l\._._Q. .. Dated.......................................... _ /� Board of Health DATE.................. .-. ..,... .................................. FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS 82 00 No--------------------. 37Y ° Fa$�...5...... ......._ THE COMMONWEALTH OF MASSACHUSETTS d ' BOAR® OF HEALTH ..................town..............OF..............Bs?.=Stable................................................. Appliratitfu for Disposal Works Tongtrnrtiun Vernat Application is hereby made'for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: , 169 Route 6At_West Barnstable.--1 :___Q2668 -•---- ................•-•------........--------------•-•---•-•-----•---............--------.........--- Location-Address or Lot No. .. ...Neil Terleson ............................ .................... 169..k�4u e ..Barxistable,— Q?.6iE$ Owner Address a •--.... ---...... .. .. Cesspool..Service...................................... .....D2bA1....... Installer • Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..............3................_..........Expansion Attic ( ) Garbage Grinder ( ) — p,, Other—Type of Building ____________________________ No. of persons.............3............ Showers ( ) Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank-Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. i ° i Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( )0 Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 -----------------------------------•--------------------------------•------.---.---------..:------•---•--•-••--------------------------------------••-------- ODescription of Soil------sand--------------------------------------------------....................................................................................................... W ---••-•---------------------•----•••-•••-•---•••-••---••••--------•-••-••-•••....-••••-••-••-------•----•--••-•-----------------••---•••••--••-•-------------•-•••--••-•-••............--------•------•- UNature of Repairs or Alterations—Answer when applicable_axLstsl-lati.*sl...Qf..a_-1T0Q0_..ga_1lzn,-..pm-r..ast, -------st_one..packe...leach.. -•-•---•------------------ --------------------------------------------------------------------------------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TA!'�T Z 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 ofhilth. D Signed...Application Approved B ........................................ Date Application Disapproved for the following reasons:................................................... ............................................................ --------------------------------------------------------------------------------------------------------- Date Permit No......82-...37Y ...... Issued-.-•--•-...711 AO?..------••................... Date No...............'...... J7Y Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. .Town.............0 F.............. r..natahle-----------..................................... Appliration for Elisposal Works Tomilrnrtion ramit Application is'hereby made for a Permit to Coristruct ( ) or Repair ( g) an Individual Sewage Disposal System at: • 169 Route 6A=__West Barnstable. 14A 02668 Location-Address or Lot No. Neil Terleson .... 54.. Qt Q..F)A,-JiP_lat...F..a=stab1e,--T'A 0256E... a B CesspoolOwner Address A & _..ervi.ae...................................... .12Rishos..Tee.,...Ii�R aax? .. A....Q26Q Installer 1-•-_-- Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..............3...........................Expansion Attic ( ) Garbage Grinder ( ) '4 a Other—Type Type of Building ............................ No. of persons...._._....__.3. ............ Showers ( ) — Cafeteria ( ) Q' Other fixtures ---•-•--•------••-•-•-------------•---- . 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water___________-_----_------ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f ---•-•................•---•--•-•--•-------•-••••-......................_.. --------•----------------------------- -...... ...... ..----------------------- •-- ODescription of Soil.-•---Bar•••---••.................................................................•---------------------•-•--........••--••••-•-------------------........._.----- x e U ----------------------------y.--------....------------------------------------------------------------------------------------------------------------------------------------------------------------ U Nature of Repairs or Alterations—Answer when applicable-Ptallation... f_•.. st onepacked leach it overflowj . ----------------------------------------•-------•-----------------------•-------••.•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 'LL 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 ealth. Signed Gal �__.1 ... .. .. ... ..l!d / .._..7f2,� 2_........_ Application Approved B Date Application Disapproved for the following reasons:-----•---------------------••-------•------------------•-----------------------------------------•-•-----....._ ....-•--••-------------------------•-...82-----��.......----------------- •-•......----••----'------..................................-•7 ••---�.. ......•-•-•----...Date......_....--- //1 Permit No......................................................... Issued_ l..2(// -_. .............•••-••-•-••-•--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................T own..........o F..............Barnstable.................................... C�rr�ifir�t#r ,af f�unt�li�nrr � AT IIRS S T OJR..TIFY, That thi I di 'dual ewa e Disposal System constructed ( ) or Repaired ) ess o ervice, t� s ops a ce, Hyannis, lA 02b01 by..........................................................................- --•--1e ....... e- ------...n--s FIA......---•-2601-------------------------------------------- O;t- 169 Route 6A, West Barnstable, YA O .6tr- Neil Terklesen at---------------------------------------------------------------------------------------------------------------------------------------------------- -----.-.-------------------•-------------------- has been installed in accordance with the provisions of T�TLE 5 of The State Sanitary C9qde described in the application for Disposal Works Construction Permit No......................................... dated-__.7/.12182 ....--................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE"CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FU74CTION SATISFACTORY. � � � 12182 �1- � DATE..........................................................•--••----------....... Inspector.........- -------------- - .............................. `THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 82- 3� .....................Town OF No......................... r� ....................... FEE...$..5.00...... Uispaoal Vorks %Tuonstrnr wm,i atiff Permission is hereby.granted.................A & B Cesspool ServiC4; to Const ( R pair ( X a Individu 1 bSfwage-Dis System Ro t°er o� iestarnsa e, r.A �` �3 - Neil Terklesen atNo................................................................... ........._...__...--•---......--------------••-•----•-•----•--•-••----•-------•--••-•-••-...........-•---...........------ r Street 5 7/12/''2 as shown on the application for Disposal Works Construction Permit NO.."'.... D�ed.......................................... c� 7 12/82 ----------••---•--------•---------•-•------B ,• of-- --••-----Bo'a',rd of Health -•-- ---------------------------- DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS . - .. F- 4.. .. .. TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION 'ADDRESS: q� 1 )(1 ,t �� t : t. %,� PARCEL NO. f G � IAP NO. I "S t OWNER NAME: L4,;`- VILLAGE: l- (c i INSTALLATION DATE: -BY,: _f ADDRESS: I CERT. NO. TANK INFORMATION `j LOCAT I ON OF TANK: t CAPACITY T > TYPE AGE V j FUEL/CHEMICAL TESTING CERTIFICATION C ] PAS. J,)3 FAIL DATE LEAK- DETECTION ;CX CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C ] YES EX3 NO DATE TO BE REMOVED I� . F I RE DEPT. PERM I T �ISSUED ^C 3 `YES •, W C J NO "- " DATE UUNSERVATION Cy] CHECK IF N/A \ DATE BOARD OF HEALTH TAG NO. 7 I[ 'JE ]C ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD iC = La�cR.��a.,� e F T,P,yI� X �K � � � � �� ��fy. TOWN OF BARNSTABLE — U� NDERGROUND_FUEL_AND_CHEM:ICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION �. WADDRESS: MAP NO. PARCEL NO. OWNER NAME: t a VILLAGE: Lv. A/t.v '• %"�c "' INSTALLATION DATE: F, `� BY: ADDRESS: CERT. NO. TANK J NFORMAT I`ON 1 LOCATION OF TANK: 1 ..�► '.'' _ CAPACITY `S '' T1fPEn �`.�� �` " AGE 1 +=r;�- " FUEL/CHEMICAL TESTING CERT I F,I CATION C ] =P.AS.S C,�3 FAIL DATE{IAA. � LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND LEAK DETECTION 1)(3ZONE OF CONTRIBUTION C ] YESj f! ] aNO ` DATE TO BE REMOVEDf1/ FIRE DEPT. PERMIT ISSUED_C—]—YES'` °'C ] NO DATE CONSERVATION C ] 'CHECK IF N/A r' ,DATE t BOARD OF HEALTH TAG 'NO. C ] 7 G )C ]C ] DATE !._ 1 ft(J MA I Lam. -- / W � Z 'PLEASE PROVIDE A SKETCH SHOWING THE .TANK LOCATION .ON__THE BACK OF THIS CARD -.A..;'.". v......_..iS... ...� ., . ,.....,r..t°.rih,_..>h✓,,,ate..wro3 ... .s e. ,.. w* ,._ . ... ,.., .,..,.. .. ,_...m.. ..._, .. 644 3 l<ct,2". THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... .._......_ . ... ..................OF..................................... .................................................. . Appliratiun -fur 4%ipoiiai Works Totuitrurtiun Vautit Application is hereby`made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal ti 1 System at: 1 yl , 2---------k ' .. 04 -----... j£..T_t3✓K gfle kl. ..... S R t t �� 1!f I - .... oeation-Address or Lot No. _... �....� ... . � i �-5 i. ............ 111.Awprv..T._..I ....,OA/0Y y. ffl -. Owner Address Ins er r Address Q Type of Building Size Lot...... feet U Dwelling—No.No. of Bedrooms____-____. _� g— �_ ____________________________Expansion Attic ( ) Garbage Grinder Q() Other—Type of Building ----1W.elYL------ No. of persons...................... Showers ( ) — Cafeteria ( ) d Other fixtures __bAStti_N44....14.4.W-1---------- ---------------------•----------............--------------------•--------•------------------ w Design Flow...........................................gallons per person per day. Total daily flow.......................................... gallons. WSeptic Tank—Liquid capacity._1OW--_gallons Length._67.&-.�,.. Width._°J_•__._.._-.. Diameter_____- Depth....' d._.. x Disposal Trench—No....__ I_-___ ---- Width. '------ Seepage Pit No..fIJZO. ? Total Length.................._ Total leaching area--------------------sq. ft. ._ '?_Diameter____ _ Depth below inlet.................... Total leaching area..___..-._..._.._sq. ft. z Other Distribution box°( ) Dosing tank ( ) Percolation Test Results Performed by-----AJA)v-----__JONL Date.....C6T___��. Test Pit No. 1!�.*. Iminutes per inch Depth of Test Pit...la Depth to ground water... 24�°_.f /.22 ( (xq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------------------- ------------------- ._.. fYi .- _ .- -------•--- • -------c Desc iption of Soil __lh... t :P $�`• " ,�„ 's 1_,. ---- ��-----�-C? 1-S3.df ^ erne..-----(4.:e krzo ...... �=- ��-----• `� - 1-►a An `' tr�� -- ------------------ w UNature of Repairs or Alterations—Answer when applicable.a___ _______________________________ ...�' /- �'.. `���� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage, Disposal System in accordance with the provisions of Article \I 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 the b and of health. Signed.......... - - - - --- Date ApplicationApproved By.__... i.e =A<...................................------------------------------------------- ........................................ Date Application Disapproved for following reasons--------------•-.-_.------_---_-..--------._---------_-----------------_.--_---------•-------Da----------------- �y ate Permit No.---- -lJ Issued........................................................ Date 4 �• .--••��-----••--• U. No tes..............--....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ._ _.... ..........OF....................................... ......... , ppliratiun -fur M,ipu iat Workii Tomitrurtion Vrrntit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at: Location-,Address or Lot No. ------------- ------ ------,//L_�4i-le nry.T.-R--....14M&� ------M&S. Owner Address, Inst er Address UType of Building Size Lot...._ feet Dwelling—No. of Bedrooms----------2.............._---------------Expansion Attic ( ) Garbage Grinder (x) Other—Type T e of Building� YP g L...... No. of persons----------/---------------- Showers ( Z) — Cafeteria ( )d Other fixtures __. -----------------•-•-•--••----___---•------•----••_______________________"-•---•----------------••---•------ W Design Flow............................................gallons per person per day. Total daily flow------------------------------------------..gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width---------....... Diameter__---...-_-_.__ Deptli...-------._.... 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-----Alj_ alt_.k1..-- Date------QC%-_---. . ..�75 Test Pit No. 1_& _NitZunutes per inch Depth of Test Pit....1�,2___S-r. Depth to ground water... (� Test Pit No. 2................minutes per inch Depth of Test Pit:------------------- Depth to ground water........................ =- - --;i•---•----•--------`---------------•--•------- (- �r O Description of Soil----A-t`-------fr'-p---- 0._LL..-- -- W �1'-......q p�.I_(rll<t>------5+�tN_D-----.1_f� ��----•- �^ _._,�! -L�i.►��� `)1n1 �Q -� -1 ----•-------- -- x ------------------------------------------------• •-•-----------•-------;------------•-- ••-•-----------------••---•----------•-•------------------_--___---•-----------------•---•--••--•----___-.--- V Nature of Repairs or Alterations—Answer when applicable.-.-_____----_._.�______________________ __________________� �- __._-_--.___--:` .._ c '' brit j ��a sr r�hi�. �o� -�rF r .zo�r cc.c Gc - ,� i�r ----------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 the board of health. Signed--------------••-�r..v_.(_.-----� 5/4.. ----•--•--.._-- •--• Date Application Approved By..... = /� -----------•------ -------------- Date Application Disapproved for t.e following reasons----- --------------------------........----------------- ------------------------------------ .----•------•--- ---------------------------------------------•------------------------------------------------------------------------------- ----.._---------------------------.-----------...----•-•--•----• Date PermitNo.......��a� ----••-- ...................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS +,t BOARD OF HEALTH o�.``................OF............11f�IzsTti- ........................................ W. rrtif irate of Telimphaurr Indi i�lual Sewa e Di osaI stem constructed or Repaired THIS IS TO CERTIFY That theJ f by .._... ,/: jp _ .. d *P at............. ---- !_1.. T. __.... �- Installer T 7 G 1 r S has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._-----.��� k._'_'_________________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALE. NOT BE CONST ® AS A GUARANTEE THAT THE SYSTEM WILL FU)IC`IO SATISFACTORY. DATE -- ----• ..... ---- -- Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " , ��1•fu'.Siy��c No..... •---•• FEE__._ �_..... MnVonttt orkti �umitrnrtion r ntit x X ...,... _ / ... Permission is hereby granted_._... �..-; "/ - . D-hs ............ to Construct ( )) or Repair ( ) an Individual Sewage Disposal System at No......../-•t =....... ----......-/Lr---......... -----••I,./!27------ - �A�..f.� T�h c -- ----- -- ................................... Street as shown on the application for Disposal Works Construction Pe i NO. ,. __ ated.......................................... r" Board o Health DATE / � v" �h/�� J��h /: FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS /' U� /,li CC 4 G • t i E F 1 y 4 _ } �S t i 1• � _j.- r. -1 � 1 4 .I - .�,I� _., 1 �., ! __...v. •_ -1 '^--,�r -`� i 1 �:S- --i- �i�.� . _ I 1 f ,•1 r : f�- 4 a nil 1,0 T A r--177- - - - -- [ - i— L. t• t S t. I- I 1 I I .� r ± \� l I �.�- --�--`-`—�----�_:•_l �'T,�✓1e4�";-�lAr�,:7,�,f� _ _ I _ � -r-��;,�r� ;.. � i I �` �� � �` 4 a ;A. 'P � • � I � O� J/,�_^ `���i�[/k �� � I TES}R/r`<. 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