HomeMy WebLinkAbout0061 WILLIAMS PATH - Health w aax
TOWN OF BM NSTABLE t
W t l(1 An Ed SEWAGE #
VILLAGE w a ASSESSOR'S M &LOT
0
INSTALLER'S NAME&PHONE NO. rl
SEPTIC TANK CAPACITY cD 20
LEACHING FACILITY: (type) �-- e"�®� (size)
NO.OF BEDROOMS
BUILDER OR OWNER P �C
PERMTTDATE: �2 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 2$ Feet
Private Water Supply Well and Leaching Facility (If any wells exist .r
on site or within 200 feet of leaching facility) / Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
w
T
C�
i7
�s
• � t. tit 11�1= °� G 3 �.� •- ...
No. /�v �7 7 - Fee —^
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for 10igo0ar *pgtem Conotruttion Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address o�I�ot No. Owner's Name,Address and Tel.No.
Assessor's Map/P cel /f� Q � ea�ks.Y�Jc[a G
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
`? '57- Sit it fcj-- 1244
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow yyU gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) A /o0 0 5 ` t—
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 by Bo d ofalth.
Signed Date
Application Approved by Date
Application Disapproved for thYfollowiQ reasons
Permit No. 9'6 / 7 7 Date Issued
TOWN OF BARNSTABLE ¢
LOCATION "� W t<< i A/V15 R d SEWAGE # �D "
VILLAGE CU: "16Z AJ, J
ASSESSOR'S MAC & LOT I - b '-
INSTALLER'S NAME&PHONE NO. IryI cQ
SEPTIC TANK CAPACITY t C)C>O
LEACHING FACILITY: (type) '- U nL (size)
NO.OF BEDROOMS
BUILDER OR OWNER P C
PERMITDATE: D — -��COMPLIANCE DATE:
Separation Distance Between the:
-f
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �$ Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
:within 300 feet of leaching facility) Feet
Furnished by
p iz =p-a .
� 3 {
No. /to - �j7 7 Fee "_.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for 30i!5poar *p.5tem Construction Permit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or of No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel?No.
f 4-
Type of Building:
Dwelling No.of Bedrooms 1S Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer wlien applicable) /v o o M,R. "• ;
C 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 by this Board of�Wth.
Signed Date-5L 2-
Application Approved by 14 4 4 Date
If Application Disapproved for th followiA reasons
I
` �� 7 7 �' Date Issued
Permit No.
1
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS '
Certificate of Compliance
r
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced�_�on
by — /yle Installer
at 1A I 7 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. l0 *77 dated
Date Inspector
THE ISSUANCE OF THIS CERTIFICATE'SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS-
TEM WILL FUNCTION SATISFACTORY.
-—————————————————————--——————————————
No. l — Fee
1
THE COMMONWEALTH OF MASSACHUSETTS .
PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS z
' Miopoml *pgtem Congtruction Permit
Permission is hereby granted to 72/IL
to construct )repair( L)-an'On-,site Sewage System located at No.#
Street
and as described in the above Application for Disposal System Construction Permit.
N. Date
The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions.
All construction must be completed within three years of the date below.
Date: -Z — 9h Approved by i
Board of Health
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L,O. C-AI ION � � SEW A G E PERMIT
VILLAGE
, W e-ST 8,qaljs'Idt, Ay9ss
INSTA LLER'S NAME & ADDRESS
mog
d U I L DI R +Olt OWO ER
CrraT
DATE PERMIT ISSUED 30
DATE COMPLIANCE ISSUED
' .y' - 1.
Fn,o�r% e f-� -
� �"
• 'Tl��� I
o � .
Q, uati
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n� ° p N
r�''"-"`�'s
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t,�`�fi=
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Na �._ FnE... ...
.... ._
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OE HEALTH
........... ..............................OF..........................................................................................
Appliration for Dispati al Works Tungtrnrtiun bran it
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: -% W PAtW\
40
.�1JL.-�-W-Ar...... ' ........................•----------
-'on-Address, or Lot No.
.... C ..- .. iftse..q( = /Z.�i7'' �'!_:. - �` ----------------
�v, a C u e�r, n Q�l�.
O ner ,,��// �j�" , Address L
(S� .tJ � .'1/ i^e/C'Tip- ...:1.!/ µ '-- ` . M i L/.�--�'
a ...................................................J ..................
Installer Address
Type of Building - Size Lot_cj_9t. 4_./----Sq. feet
U Dwelling—No. of Bedrooms.......... ..........................Expansion Attic ( ) Garbage Grinder
per, Other—Type of Building �'AOQ,`c. _a�No. of persons........ .............. Showers ( ) — Cafeteria ( )
Other fixtures -- ..T � .�.7'�� f t l =_t�Y.,�s:. � --�sl-�.-..LO�j---� 4�tw .
W Design Flow.....................................gallons per person per day. Total daily flow.___._-_.._1Y37.4..................gallons.
WSeptic Tank—Liquid-capacity./•;B9gallons Length---FA_.. Width..`:! ! __ Diameter__4/.7e®_. Depth---$'-_7_.
x Disposal Trench—No. .................... Width.................... Total Length.................... Total.leaching area---,___.............sq. ft.
Seepage Pit No........../....... Diameter...........J6..... Depth below inlet......6......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date.............................
Test Pit No. 1................minutes per inch Depth of Test Pit...�': ~ Depth to ground water-----.-_..__...
__....._.uj
fs, Test Pit No. 2.._...._2....minutes per inch Depth of Test Pit---/Y5 ..... Depth to ground waterA __._---�. �i
Q+' ----._...-•-------------------------•---•-:--•---•-------------............._....--•----•-------•-- ---------....-
0 Description of Soil-- ..-. ..5�_.._�4 ..!�u .._Jo e'./---. .Aoe.4:_�i��r-vt
x40
---------------------------------.. - _----c. iL`°�e!'!�1.... `o `;07 -----...------•----------.....-•-----•-----••-------..._
U
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 L I T�U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
oueration until a Certificate of Compliance has Wen issued by the b�iealth.
Signed ...............................................................
Date
ApplicationApproved By............................. -.................................................... .....
Date
Application Disapproved for the following reasons:----•---------••----....-•-•---•--------------------•---------•-------------••-•------------------•--........._
..........................••-•--....•---------•-•---•-------•-----------------•--•--------_._...------_...__.........._...-•----------------•---•--------------------------------•----------•--------•---
Date
Permit No.. ......................q .Issued......... --are G. ..P1`4
Date
- --- -- --- - ---___ - -- ---- ---- -- ---------------------
No. .. ".....J�.L' Fims... i aA
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ ..........................OF....................................... M1
Appliration for Disposal Works Tonstrnrtion rrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: ,
............ r-` , '� 4..... - ............................ ....................... - `-. ":--.--------------.---------..-_----
-cat'on-Address
+ or Lot No.
................................
O�w¢ner Address
W
� Installer Address
UType of Building Size Lot., '.1.�i_/ _.-Sq. feet
Dwelling—No. of Bedrooms............3...........................Expansion Attic ( ) Ga>�age Grinder (t.,Ir
aOther—Type of Building , .c .6( '_ .m aY No. of persons........�............... Showers ( ) — Cafeteria ( )
�
Other fixtures ... },g. ""•--7'�..-- ��.f_�: .---I !�.:t��er-u:�_e�EC---a7--��J . �.l.�.rs.�! .f .!S.. .u.,��,.e
W Design Flow.................i ..� -----------.-------gallons per person p5r day. Total daily flow.....f..`�7."�`..............' gallons.
WSeptic Tank—Liquid capacity.,,e.�''4jugallons Length__Z1t.A_._ Width._V:!+� .. Diameter_d-f.:./.<L. Depth....."..7._.
xDisposal Trench—No. ...........:........ Width....................:Total Length.........:.:.._----- Total leaching area....................sq. ft.
Seepage Pit No....__..__ ._ Diameter........._. . Deh le�ow inlet...... .......... Total leaching area..................s ft.
--- ra g q.
Z Other Distribution box ( ) Dosing tar& ( )
`4 Percolation Test Results Performed by.......................................................................... Date........................................
1.4
Test Pit No. I........2...._mmutes per inch Depth of Test Pit.__ . ! _:: Depth to ground water...fV-r--t...w�
44 Test Pit No. 2---------_...minutes per inch Depth of Test Pit...Z%v/_.... Depth to ground water_OG,u---tsar.'
C4 ------------------------------------ ---•--------••....--------•-•----••-....•-•--•.........-•----.........................................................
O Description of Soil 4 !r , � .�,oc. ...Sv.: ._-.�'e : �tirI*1 Piael...CV&.V.r/.....
--------------------------------------------------------------------------------------------------------•---------------------------------.............................................................
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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b Fn issued by the hoard of health.
Signed. �i -!^ -----•--------------------------- ..........................
Date
ApplicationApproved By..............................--.....-•-•---••--•--------...•--...--•--.......-•................ ........................................
Date
Application Disapproved for the following reasons-------------------------•--•------------------------•--•------...---------------------------•--•--••........---
-------------'---------------•------------ ------ -----Date/--•-----------
Permit ---
��
. r -tee,n C, . �`ce
--•----�-----�--------------------- Issued_------ `r=------------ -�=-------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Trrtifiratr of T-am lionre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by........ ..-wC.r� !t :.:.z�--••••-•---••-•--•--•-••-•-•--•-------••----_..•------•-•••-•-•-•••-•..............••--••-•.._..._._.....--••......--•...--•-•----•-••----
y Installer
at--••-......L A ....... --LiG �s. c?� ?..- t 1....
---------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__......34 ............ dated------- �_�?`"_�9................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUN TIIOON SATISFACTORY.
DATE. - .......
�1....
.....................................
Inspector............. -•--------- . . ............
............
THE COMMONWEALTH OF MASSACHUSETTS
' BOARD OF HEALTH
u ............................... lv v
No...'�..1..........11..... FEE.........................
Disposal Works Tonotr ion rrmit
Permission is hereby ranted........... ��f� set at. ................:........................
Y g t .............:
to Construct ( or�.Repair ( ) an Individual Sewage Disposal System
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated....�....................................
1
' .............................. ---------------•------•---.....
Board of Health
DATE-...............................................................................
FORM 1255 A. M. SULKIN, INC.. BOSTON
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PROJECT NO.
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8,309 4 t
REWSIONS'
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