HomeMy WebLinkAbout0490 WILLOW STREET - Health 490 Willow Street
West Barnstable
'+ A = 130 - 027
I
h
THE COMMONWEALTH OF MASSACHUSETTS
2 BOARD OF H-EALT
I70 .......: �
Applutt#Uan f nx Disposal Works Tonshvdian Vamit
Application is hereby,made for:a Permit to Construct ( z) or Repair ( ) an Individual Sewage Disposal `.
System at
I-..()_!gill.-.... S'T eS7:....a ;,+�'.�SL i9"�r •• . .. ... ........
___ ... ._ ..... _._.
Location Add - 470
�. : L or Lot No .-- ..................
«
Owner Address
.:.. � 1... ..........:.3 t e P..AY,; .: l:...:l�f Addie.�A,?_A�_ A. c
/ - ostaller ,-
ss
.:Ex anion Attic' -
Type of Building Size Lot.J3 a.4._�Sq feet
aDwelling—No. of Bedrooms:. ....r�. - p ( ) Garbage Grinder ( )
p•1 Other—Type of Building ....... ....... ....... No. .of persons...: ......... __._.._.Showers ( ) Cafeteria ( )
p+ Other fixtures
WW Design Flow.:--. - _____-:• •...... •-----gallons per person per day. Total daily flow:.... ........ z-.:..........gallons:
W tic Tank— P uid-capacity/ gallons Len :_ ...._.... Width.....:.......:.. Diameter... _......_.Depth__..t...._..:_..
W •--� �
x Disposal Trench-No ....,.:............. Width......31.?-...... Total Length.....3 .2m...._ Total leaching area_ 1:Q. sq. ft.
Seepage Pit No._.._.__ _.:... Diameter.:___.:. ....... Depth-below inlet...: ............ Total leach' area.................sq. ft.
,z Other Distribution_box ( ) Dosin tank ( v - �-/` - 7�.
M .��....
Percolation Test Results Performed by 11xx�t.... :... _ -_.--•---- ....._:__ Date..._::
a Test Pit No. i.....�.3____minutes per inch. Depth of Test Pit.:.: 1._:. Dept
h to ground water........_..
Test Pit No..2...........:..-:minutes per.inch: Depth of Test Pit.... ._ Depth to ground water.....W__It..........
61"
vw . . teYt
.Q � S .Descriptio of So' �
................ - .. -- -'� s • ............................................. _...-----.....-•-....------....�..°..'_^..-- •'
---
............................................................. ....... ......... .......
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. e board of.health..
n ... .
/aJ ate -
Application,Approved By-• -••C --- --• ............
Date.
Application Disapproved for the:following reasons................. •----• • . ... ...... ........ ..• -- ....-----------. .. .._._.........._
.......................................... ..................- --•• -------- -----•-•--------
Date
PermitNo..................................._..._..____----.... issued....... _ _'��:-`-rw�..�........_
Date
THE..COMMONWEALTH OF MASSACHUSETTS.
t BOARD
i
R.
. ..............................� :... OF....:. :F. :.:...::...:................:...
"Urfif d iaf f�uut tlittar
the individual Sew a Dis osal S-stem constructed'
> � ,P �' ( ) or:Repaired ( )
at.
has been installed in accordance with the provisions L A, The State SanitagrCp as�l*ribed in the t
application for Disposalt.Works Construction Permit o.............. ,............. dated.....................
THE ISSUANCE.OFWTHIS CERTIk'1fCATE`.SHALL NOT BE CONST ED AS A'GUARANTEE THAT THE
SYSTEM LL FUNCTION SATISFACTORY
DATE..:- --- ------- ------: Inspector------ - ------ -
fd
. -➢ THE EOM.MONWEALTH°OF :MASSACHUSETTS a
`� xe.
9 BOAR OF' HEALTH
...... ......
No ............... _ OF. F>�`S .... 4
llam�. # ur#iun on 71
hermit
to: JodiVidual earage:Disposal System a.A
r0 a
ato.. .. ................................ •----•--
Street ~ �r •
as shown on the application for Disposal Works C 5ASttruct fi6«D to
DATE V 2 Board o ealth
'
FORM 1259 HOBBS 8i WARREN!.:INC.LLPUSLISHERS
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9"�[ ?ANC �(,\ ¢3 9 N
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8 CERTIFIED PLOT. PLAN
LOCATION .
EC3YVARD In, ICE!ErEY / 'r-4t�'. . DATE S, g!G iz I
SCALE . . . . .- . . . . ., . f78 .
CUMMAQUID, MASS., C2637
PLAN REFERENCE ��C-"��. .., :. . . .
'wk OF
I CERTIFY THAT THE ... .....
O ..
SHOWN ON THIS PLAN IS T HE GROUND
K AS SHOWN HEREON AN FORMS.TO THE
SETBACK REOUI HE TOWN OF
. . WHEN CONSTRUCTED.
CAC f/eeG W �c': �hE�S v� O
DATE . �. . . . . . . . .
PETITIONER:
REGISTERED LAND SURVEYOR
EL .'�� �`_.. . SHC�C'T 2 0�• 2 SH t'ZKT^s
ToP of=FvuNDR7�ON /Ve7r— CGS i/5 TD QE eE�'1GV&- t FADAj
',� CvNCSE7L" COVE7�5 NG �! A+VD 7E7_ F-&'t"'r&*yc,vA
sM•D �» 8E P.t'�lL-Act` w�n4/ �x� s^•,vD.
4�CAor /eoN -
n PIPET (oit { 4" , „
�AMG�•8
PorIrH I/!,%"PEY•F7' PATCH N4 r�t7e.F'Y ,� LEACHlN� F+t2E7 � ;
s / �/8�= Z'" M/ASNtT� STONE 2t'
off, INVb"R-7
stpTic TiY�IG . /NVE27' DIST' 14 Grr rra�4„ J'A"Sra.it /Zll
°,o /nlv��zT Ez aox
m
io 0o Git c r
--� V leT-
< �• �'=5�=' 43 36 INVPc�T IN t
<•� lJoalE
48'
I4 ,
PEOPLE OF I
32
o, �,10� /Vo 'w/4•T�hir'
56WAGE DISP05AL SYSTEM ryPlco,s. CROSS SW,cN
SOIL. LOG P!o SCALE L LAC H I NG riC&0
DAIS Miil�CM it!978 TIKE. .9 . . . . . . No SCALE
TEs"t HOLE s TEST HOLE
Ec.t-v. _ _ '1 a_ . Ec Ev. _ :0!�770_- DESIGN PATA1 .
off" WASHED11=� f
l7� NVHf3Erz OC BbDfZCaOMS _ S7l>I✓E
WooDdo/►+y WooD4►Mq - • ' t„
�ZM i2~ rorAL ESTINATSV3 FLOW . . 220 • . . GAG/A4>1 4"
,Opp C4.ty T" BOMM LEACW!NG AREA. ,/b 24 SQ, FT 4" /ES"7)c l2
` S2" aae3A D,S�bsRc. . ,�vN� 's/ -/%:wAsti►ta srr'"C . t
P7�ST D�s+w�a
t hixrr.et 9 [L�ACX i,vG AR.E4/PE7ee- Qq�Y .3 3 Sp,FT. 3 Z �Vo�/t
a�ELMUM&ro �
n� THOMAS E.KELLEY CO.
T/" '
ENGINEERS-SURVEYORS MQ WAq*'W.
014w-N APPeovED _--_ --- _BAA2D OFNEALT14 346LONG POND DRIVE
- _ - SOUTH YARMOUTH,MAS
No W*V= CA.C4VkffVZM VATE _ _-- - - - - - - - - -- - 02664
c AGENT vZ INSp�� ��' OFMgssq
W o,rN&J SED 6Y : �? THOMAS G
80APID OF Heft" E.
NKE
No.24260
�o�� �" AaruzV. �'�_ t:Nc�n�EE� ��� a, �� e. Toal,�.so�v _A �� �o�
G"aOIV � �E�GEY QC.s. —8 S7rN C/ACGGC- 9ocFSG/STE
SIONA
prnT/oNt'R: ,QoG�t� / EGG c.pA/ OGOG
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a ,
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t ,ATE , COMPLIANCE � iS3:UE0
No.-W�-� --2 Fee---- = -- ----
BOARD QF-HEALTH
TOWN OF BARNSTABLE
0(ppIication,forWelt Congtruct ion jermit
;f Ap lc ion i h reby ade fora a tt to Construct , Alter ( ), or Repair ( )an individual Well at:
— ddress — — Assessors Ma and Parcel —
�ovation — _ � P.
low Address'
Installer - Driller — Address
Type of,Building.
Dwelling.:
Other Type>of Building--- ----- No of Persons-
C <^c Ca acity=
Type, Well � - - p - -
YP 7--'-
Purpose of Well-----. . - --=--- -
Agreement: r.
The undersigned,'agrees'to install the.aforedescribed individuallwell in accordance with the provisions of The
Town.ofBarnstable Board.of Health.Private Well Protection Regulation - The undersigned further agrees not to
place_ the well in operation un C rtif' at of e h s been issued by the Board of Health.
Signed` - -- - v?
ate
Application Approved By:� t,. -- /L- a
date
Application Disapproved'for the following reasons: -`
•- - — — - - ----- date
Permit No. —T- 7d -- Issued-- _—
date
y
.:,BOARD OF .HEALTH .:
; TOWN OF. BARNSTAB:LE ;
certificate �f'Compiance
THIS IS TO CERTIFY, That the Individual Well Constructed>C ); Altered.(; ),'or Repaired
by =-
c Installer ----- -- --
athas been installed in accordance-With the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for,Well' Construction Permit No.
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 BARNSTABLE
e[C �Congtruction erntt
No. - V tl�� Fee--=
Permission is'hereby granted `'
`to Construct'( ),..:Alter ( ),.or Repair Individual Well,at: y � t
A
e
r
as I et
o
shown on he application for a Well Construction Permit
No Ys _ Dated
=�
and of Health
DATE.