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HomeMy WebLinkAbout0234 WOODSIDE ROAD - Health 234 Woodside71 A= 128—010 W. Barnstable :� b s , LO CAT ION-• SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME & ADDRESS B U I L D E R OR OWN ER . DATE PERMIT ISSUED DATE COMPLIANCE ISSUED _T d. d 1p COX TAW T t 0 .* .. 14� No.. C�_Cl®C� �a 3 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliratinn for Disposal Works Tnnstrnrtinn Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ---- •-----..�-- ''._21.------•----------------•------•-----------...........--•--•---- _�-��•• I49ca'on-Address_ e�--`�—� n or Lot _ w�...`..4i ............... .E��.LSd.�r. .......................... lrL__.. Owner Address W Installer Address Type of Building Size Lot .�_ 32___S feet U Dwelling—No. of Bedrooms.._....................................Expansion Attic 46 Garbage Grinder 46 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------•---------------------------------------•---------••••----•--•-•-••-•-••--••......-••-••......•.......................................... Design Flow............SIS........................gallons per person Ver day. Total daily flow------- .................--....gallons. WSeptic Tank—Liquid capacitylOW..gallons LengthS=j�?". Width4 Diameter................ Depth..��-°f x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NO...._1............ Diameter.....I.1----_--- Depth below inlet....._G......... Total leaching area. ..15_...sq. ft. Z Other Distribution box �� Do ' ank ( ) L �v� CL, .I C�. e Date------••� Percolation Test Results Performed by._. .... .. .. '........................ 2 _.�.��?... _._.______.. minutes per inch Depth of Test Pit....A.............. Depth to ground Test Pit No. 1.__....�...... f=, Test Pit No. 2-_43.....minutes per inch Depth of Test Pit___-.1�........ Depth to ground water___._ . - l� -►? �.......,n..�..�... O . � c-- ,t escr ton of .._.... ... . Z-_� • -. ' t -- i ' $ t� ------- _` Z L.t.....� Z>----------•-•-------------•--------•---------.......-------------- 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued by the board of health. ign . . .. .. ............................................ Da...... �.._: Application Approved By______________ G --¢ e. ----, ---- to Application Disapproved for the l owing reasons----------------•---•----------------------------------------------------------................•-••-----••-••-- ...................•------------•-------.....--•------------...-•-----------------------•-••-------------•---••-•-•._...•-•--••--•---•--•••-••••-•---•--••-•••-•••-•---------•••---••-•-•••••-- ---•-- . . Date Permit No.---,:s---a4------------------- Issued...........�._. �^� .� . Date L J No......................... Fzs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. `�1.. ..... 0F................a.,�' t......�..T`.....0 .. = ........ Appliration for Disposal Works Tonstrnrtinn amit Application is hereby made for a Permit to Construct ( VQ or Repair ( ) an Individual Sewage Disposal System yat: / '..; �\...... ....... . ...... . .............. .. Location-Address --> or Lot ..6'7 �r•��IZ. !`i,.��_..... ... ?< :?a_l_ca......_. ....... Owner Address W Installer � Address -- - ,- Q Type of Building Size Lot_ �'�_t_: �-.Sq. feet aDwelling—No. of Bedrooms...........................................Expansion Attic (A)D Garbage Grinder (Q)�, aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------•-•----------------•-------------•--....--.------....---•------•--•-•--------------•--•-•---.....•----•••-•-•-•---.......-••-•............ W Design Flow............;.>�______________________gallons per person per day. Total daily flow-------.�--- ---.........._..._.__.gallons. R; Septic Tank—Liquid capacity Pa n.gallons Length lam-_' '+_ Width.`!_-«a-Diameter... ........... Depth...�.�:`�_�L W Disposal Trench—No. .................... Width..... Tota l Length.................... Total leaching area....................sq. ft. � Seepage Pit No........ Diameter._.._1:�_........ Depth below inlet.......�:�_�-_.._. Total leaching area__'�_.1P-�__aq. ft. Z Other Distribution box (\6Y 5 Dosing-tank ( ) ~' Percolation Test Results Performed by...�A!...�:* %..=_. ':(t_._�_�-!..�-'_-______.-. Date...gn�t3/�`J��_._______ . Test Pit No. I... �.�......minutes per inch Depth of Test Pit.....1..:.......... Depth to ground water..00!a.. Test Pit No. 2...25�3.....minutes per inch Depth of Test Pit......�Z...._.. Depth to ground water....... ............. ' r a ..................-. x Deser ion of Soil ..............�� .� - ........ y ..Sc�..t- � ..._._i a�c f-t=` !_ '=,�7 I U .....................................................Via•----- ---1......--•---.. .......1--�:.....`r.._/�l�.k_��---------•-•--------------------------------------- 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 b en issued by the board of health. gne --. - - - -- ---- - 1-=•-~I��-lF•+ -...................................... •-------•--•Date ....-•-----•- APPlication Approved By................ --•---- •-- .•. ........ Application Disapproved for the f .l ing reasons:.................................................................................... ..................................•--•-•-----•---•-•-------•--•--•--••--....•--•-------••-•--•---........__....------------•----•-----•--•--------------------------•-- Permit No.._._..Z.�;-.....L-4?---------------- Issued.............6 2-� ate--•- •-----•- ----•-••- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...........................................................I......................... (9rdifiratr of Tnntplianrr THIS IS TQ CERTIFY, That the Individu Sgwage Disposal System constructed ( ) or Repaired ( ) by........................API M _ _ r In alley at 4 Q �``4 ..D-S�t----• - - t1 _1.............a has been installed in accordance with the rovisions�of IME of The State Sanitary Code as described in h P 5 y to application for Disposal Works Construction Permit No.........- ---------- dated_----------------------_....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A 6UARANTEE THAT THE YSTEM WILL FUNCTION SATISFACTORY. DATE--•--....._••--..!�? =.. ..? .................. Inspector __(:.``J ,� . r,,1f 1 = ° THE COMMONWEALTH OF MASSACHUSETTS RL rV � -. BOARD OF HEALTH Ce. pj,4...........................-......OF..-----........................_._.....----...--•---....----..........._............ No.... .,./ FEE............. rks (flonstrudion famit ;. Permission is hereby granted............... ..............................................................C to Construct ( or Repair ( ) an In 'vldual Sewage Disposal_ system at Igo:=`=------ -- ----Z �, � 1 u- '�1' ....-t----------- �a1�5►_IJ1 1�� --•---. ......... �.. , Street as shown on the application for Disposal Works Constru tion Permit No.................... Dated........... ....... - .. + �ird�of h j DATE............-- --------- --....................... ".�ay,,,r-•'FORM 1255 HoeSS & WARREN, INC., PUBLISHERS - J �.E$/G/L/ Z.4 L.16 E 1000 UsE gQ P ;Ti R I Sti1V-W�4LL`. AZ-St4 Z&A S f o SL�tLiVRN tik 6AQAC.tT` ZGq '�, 2,25 = S`jA G P D U No. 29733 N t� WoTTO al , A?- � 'ISTVa������ (AQ�(T-( 59 5~ C 0,91 = 14� C� �s`f� AL 4R�� 77-i.ov✓ 3 30 C-rP t7 FJ vY L N4i m�� NcJ. 19334 ft''�r -50Z Ze3•� T!�-3 g7 p� '1 �� T�aF.v�= ��•C� UFaTbk E o t j taawA IL /.f/✓. ,..i ,J fpl oisr. Box /.v✓. 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C,gQakLt'C`( ZGq �, 2.25 = 6`)-Q G -D U No. 9733 � ' q ADO ISTEa�O���� � �rSc�o�lAt E�G� 61 Z�3•t� -De PT ttOrr 104571 �_3 EIEJssTOr( FG• g7 �1 `► T��F.YQa 2• l Oa 0 sox /.v✓. G.4L '7i 'c�►Sa &A L /7-- )1.b T �K �,t/IaeG N�cD ,, G'E.2T/F/E.O PLOT PL,4�1/ S sit .o t E33• / GE,er/,`Y Tf/.4T rV,5' ,.a',>A:t.. c S.yoW.V .4N1�.SET13/•1G` .eEQlJ/,2ENI�NTS �•�' Ti`/� ,C�.EGisrz�,�c=fJ,Gccio SU,e�Eya,�S C�•v •,��~ � � _...--- _ T//!s i��it/ /.f it/oT- I3.4sE0�.✓,a.v/rY.ST,e- ' � -�/.sf,E�Yr-♦sv,2tiEYQ,cip T.yE aGFS.�� t Ta ES?.�11�L/X/V L O CATION f ��SEWAGE PERMIT NO. VILLAGE a- INSTALLER'S NAME ADDRESS Ile S U I L D E R OR OWNER . DATE PERMIT ISSUED i2S DATE COMPLIANCE ISSUED14 ��� T;a�K f r a&- No. a Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Tipplitation for Disposal *pstrm Const ittion Vermit Application for a Permit to Construct( ) Repair/'Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. d fd d S L Owner's Name,Address,and Tel.No. Assessor's Map/Parcel , b W, ��co,(tit; � LV t C,0 Installer's Name,Address,artd Tel.No. Designer's Name,Address,and Tel.No. S cp V l 3 4 r�-c��•- �- TI -pe of Building: GSM�S M- S, a �f 00ko Dwelling No.of Bedrooms f Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil .Nature of Repairs or Alterations(Answer when applicable) (�5,� (��� h f� C {', J tt d n 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 Certificate of Compliance has been issued by this Board of He lth. Sig Date Application Approved by ( Date 3 Z. Application Disapproved by V Date for the following reasons Permit No. tr o / b Date Issued 3 i No. o"7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y— PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposat6pstem Construction Verml it Application for a Permit to Construct( ) Repair/ Upgra.de( ) Abandon( ) ❑Complete System [golondividual Components Location Address or Lot No. ) R 4 (fl o V d S„�d f_ Owner's Name,Address,and Tel.No. ` Assessor's Map/Parcel ,,. ( u (a. c,,(r,S �• Installer's Name,Address,and Tel.No. Designer's Name;Address,and Tel.No. .Type of Building 4Y'C' i S ASS H O0141 `1 Dwelling No.of Bedrooms I/) , Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) / gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (� .�-� K DUI f 0 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 Certificate_ of Compliance,has been issued by this Board of Health. ------ {' , l ; Signed ,{�, Application Approved by U''i�// _ Date fle, I- V Application Disapproved by Date for the following reasons Permit No. a y .2. o 7 6 Date Issued 3101.) I.) 7 y -- -- --- -- --- -- - - --- ----- - ----- - -- -- ------ -- -- - - - --- ------ - ------- - -------.-.- _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired�6/ ) Upgraded( ) Abandoned( )by �<_n" A �rL-,%, at L j CU lb(3 %,7t j �' _ R� �K) :� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7)dated Ab •) Installer < r. ki t`( �^� Designer #bedrooms ;, ) Approved design flow ,�/ /} gpd The;issuance of this shall not be construed as a guarantee that the system willnctio as designed. Date ` {� Inspector /i J mot . t " v E ? , ,r -------------- - ----------•--- -------------------------- --------- -- - - --- - - -- - -- - - - - - ---. . No. P a , 0�� Fee 75- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS a �=t Misposal .pst�P,Y/t'Y'ConstrUCtion 'permit Permission is hereby granted to Construct( ) Repair( Upgrade( `) Abandon System located at 2 l l C U and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply wi.h Title 5 and the following local provisions or special conditions. Provided:Construction must to completed within three years of the date of this permi� Date Z 1 o 1 Approved b 1 a'°rV c7`}''� ' J .`, t i PP y