HomeMy WebLinkAbout0069 ALLYN LANE - Health LLYN LANE
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39 .7IY7 � - �. 8�0 ��
d TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS �� /0-/7—119y
NAME
ADDRESS C � J VILLAGE
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE:
OR CHEMICAT raj
(Give same information for any additional tanks on reverse side of card)
DATE OF PURCHASE OF EACH: 1. g� 2. 3. 4.
DATE OF FIRE DEPARTMENT PERMIT: 11617 ,5p C ' �...
TESTING CERTIFICATION SUBMITTED:
PASSED DID NOT PASS
0
LOCATION �j� SEWAGE PERMIT NO.
VILLAGE 4
I N S T A' LLER'S NAME i ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSY D
DAT E COMPLIANCE ISSUED /`.y/)
•� ---__---- I
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�¢�.�,�y� �-���� �-ran:.
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THE COMMONWEALTH OF MASSACHUSETTS
r
BOARD OF HEALTH
-tn.wuN .. ...........OF.........�A.1ZWTA.6L�=... ...._.........................
v
Appfiration -for 13hymiat Workii Ton trurtion Vanift
.Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
-------....ZAIW :t!4@!- —.------nA�.s--•-- ------w T.....Ai...--•--------------•-------------•-----------------•------••------•---
Location-Address or Lot No.
Za _R .. ...-----.•'4( r ACe�1[Ir S. - t
caner
a ----•-----------------/<C�`1�,� ------��' 'M/................................... ............•......................................_._............................................
Installer Address
Q Type of,Building Size Lot,7$_W_k...........Sq. feet
V g— _Expansion Attic ( ) Garbage Grinder ( )
Dwelling No. of Bedrooms____________ __________________________
a Other—Type of Building No. of persons._________________________ _ Showers — Cafeteria
p' Other fixtures ------ -----------------------------------------------
W Design Flow------------,5,� .........................gallons per person per day. Total daily flow-------.V j�?_---.__________..__.._--gallons.
WSeptic Tank—Liquid capaciry100q.gallons Length------$------ Widtl--------- Diameter---------------- Depth.....Y� ._...
x Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No-------.--__---_____ Diameter------wt5--- Depth below inlet--------4,_d--- Total leaching areaW-Y::r_sq. ft.
z Other Distribution box ( Dosing tank ( ) qq
~" Percolation Test Results Performed by-------------------------------------------------------------------------- Date-_--•____.-../._ 7�
,a Test Pit No. 1.....7........minutes per inch Depth of Test Pit.../5-!!! Depth to ground water.
f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__.__-________-_____- --
Ix -••--------•-------------------------------------•---•---••--•------------•-- ------------------•---.........................................................
D Description of Soil---------$46...... -------•-------------------------------
x
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 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 by the board of health.
Signed ---- �----------------
Date
Application Approved BY :Ll d{/-1..."---� •.
Date
Application Disapproved•f or Vl.e following reasons_----------_.....................................................................................................
-----------------•-----------------------------------•---------_-------•---------------•----------
Date
Permit No.__...�w_, —
Issued ` ^
- --------------------
Date
.....•...........•..••:•..-w.•+•.r.•••.•a.•..•. .......... ••.•••.•.••••.......••...•
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
w .
0.1rrtifiratr of Tiantphattrr --
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X') or Repaired ( )
4!t V/------------•....................... ...........................•--•-•-------••-- .........................................
Installer
at.:. 10.r r/ , - , AJTIf `/--------------------------------------------------------•---•-------------------
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------��f-"7-_________________________ dated..... �'___________-__---_--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WALL FUNCTION SATISFACTORY.
DATE fn l =- 7 Inspector AUA4A,0-1
•---•-------•-----------
Ek.
It zt_ ,
NO .._. F>�s - ....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_.Q.q).N. .......... .. ..OF.........
Appliraation -for Uiavoii a1 Morks Tomitrurtion Vrrmit
Application is hereby"made for Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at:
_lv............. �_.......n LKS------ ....... k.......l---•••-•--•••--•---•---....•--.....--••-•••••....................•---....
Location-Address or Lot No.q
�.!�12.� � n" �' �'i'5......•.. C�ll� 'c. �.. .......... l=,` � ...Y1(e\i_i1?/P �'crj lvl,`-C:...................................
p, wner Address
FWj •-----•--••----------• 1 �...... '`d�e1/-----------•---------•---•--•-----• ------------------------------------------------------
Installer Address
UType of Building Size Loth}�...............Sq. feet
Dwelling—No. of Bedrooms-------------3----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures --------------------------------
g f' g P P P Y y --------------gallons.
W Design Flow----------- ____________________________gallons per pet
per day. Total daily flow___.___' __._________
R: Septic T nk ,Liquid capacity AG hJ?__gallons Length_--_•_---------------- Width--------J. Diameter................ Depth-----Yf_.. .
Disposal Trench No .... .... ...... _Width................._.. Total Length_-_-_________-_--. Total leaching area.................... ft.
Seepage Pit No __ ___ Diameter...... .'7..-_ Depth below inlet--------4_ -__ Total leaching areagOYI_�.sq. ft.
Z Other Distribution box ( A) Dosing tank ( )
aPercolation Test Results Performed by---------------------- ____.-_------ Date-----------------------------------------
1 Test Pit No. I.....Z:-------minutes per inch Depth of Test Pit---15.v!°� Depth to ground water.l5._---� L='
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__._-._-___-____--------
P4 -.--•---------- ---- -------------------------------------•-•-•--•--•-•--------------------------------•-----•-----------------•---•------•- ---------------
0 Description of Soil--------- ----- 7�� `! 'r -�r'tic'...... pUS------------------------------
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ' sued b he board of health.
4, ly 'f f
Signe ..........................
.�
Date
Application Approved BY � --- . ....•••• ------'---- -----1 . -- �
Date
Application Disapproved for ie following reasons:.......................................................................................................•.......
............................................................................---••-•----•----------•--•..••---•---•----••••-----...•---••••-----•...---••----------------•--._......--------------••-•.
Date
707
PermitNo. ............................................. Issued........................................................
Date ='
� t_,YHE COMMONWEALTH OF MASSACHUSETTS "
' BOARD OF HEALTH
0:11rrtifirate of Tompliaanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ,) ) or Repaired ( )
by .............4�11-1-••---------•-•••• •-•--- .
Installer
at................ d 1^....-//..... ...........!� �ljd� �/-fl sd'!4-------------------------------------------------------------
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' `:} ____________________ dated-.11.-_&
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
-----•---• ••••--_- Inspector �u���.r.✓.�------�
DATE 6 P =
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
If, 7 .........................................
Bispooaal ork Cnoaatrnrtionrrmit i
Permission is hereby granted..........:70i 11 Y.......... ' ' ' 1.......................... .
to Construct ( -/) or Repair ( ) an Individual Sewage Dis oral System
at No.------- ........... f'1-tIlhld .
.- --------------------- -- - - -------------- .
, ti
as shown onahe application for Disposal Works Construction "PermiStreet No. _____ Dated-_-._'-._! _.........................
r
.................................. :y__•
�7 Board of Health
DATE._._.J 7! ��•+.
1 -----------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS J;`:
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER
AND INSTALLER INFORMATION..--Q
ADDRESS: a ! Y A MAP NO. % [� PARCEL NO.O��
OWNER NAME: C,..A P-/, b6 4E-l� ro R's VILLAGE: &19A
INSTALLATION DATE: V / �1 / BY:
ADDRESS: CERT. NO.
TANK INFORMATION
NF�ORMAT I ON
LOCATION OF TANK: � d"-p'--c"Qoow)
CAPACITY TYPE AGE 7 t.+' FUEL/CHEMICAL I CAL T��1 L
C./ OA I L✓
TESTING CERTIFICATION,} C I PASS Cj 7 FAIL DATE
LEAK DETECTION CV/ ] CHECK IF N/A V TYPE/BRAND
ZONE OF .CONTRIBUTION C I YES CV/3 NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED E] YES C 7 NO DATE
CONSERVATION C ] CHECK IF N/A DATE q p
BOARD OF HEALTH TAG NO. C,IOC ]C ]C ]C 7 DATE ® U O
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE .BACK OF THIS CARD
TOWN OF BARNSTABLE .
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
ASSESSORS MAP NO.' d-S'�^ 7 2- PARCEL NO. - /I
ADDRESS' VILLAGE
NAME'..-, (_/14 R/-...__.. Z?(:! ¢^o1e-s_..
CONTACT PERSON �` �` PHONE NUMBER
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL. AGE:. TYPE: LEAK
OR CHEMICAL: - L DETECTION
�� __,....._/�,����,r�l-• "��.��,f1���-...,,. � fly��-_ .SYSTEM!
.DATE OF PURCHASE OF. EACH: .1 `J 2. 3. 4. 5.
DATE OF FIRE DEPARTMENT:PERMIT: 4tv-
TESTING CERTIFICATION SUBMITTED; PASSED DID NOT PASS
"PLEASE `PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON.THE BACK OF THIS CARD.
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