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0040 CARRIAGE LANE - Health
40 CARRIAGE LN. . ,BARNSTABLE _ = MAP-298 PAR-041 6 i *4 r Make application to local Fire Department. - e o partment re_t_ains original application and Issues duplicate as Permit. APPLICATION and PERMIT Fee: for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: `� .��A'yL Tank Owner Name(please print) X s4natute ,80 yang pe-1t Address street Mr stare zip 7Co. lilt Tool tiCompany Name dividual print Print Address Address Pnnt t<7✓ Print Signature(if plyin per it) Signature(if applying for permit) ❑ IFCI Certified Other . ❑ IFCI Certified ❑ LSP# Other Tank Location %�� �'�G [fin Z t r Address city Tank Capacity(gallons) mz Substance Last Stored - Tank Dimensions(diameter Remarks: v- . ......... . 7Mrmtransportl.ng6 waste �''` State Lic. Hazardous waste manifest#. E.P.A.# Approved tank disposal yard \'7;;� 5762&7 '_-LI e.Tank yard# �64 Type of inert gas `, Tank yard address c Lid r f J1 ����2 pa , City N' ` G ! 1FDID# � Permit# Date of issue ` ` .� Date of expiration Dig safe approval number.. 7 7.3�� Safe Toll Free Tel. ber 80022-4844 Signature/Title of Officer granting permit After removal(s)send Form FP-29OR signed by Local Fire Dept..VU T Regulatory Compliance Unit,One Ashburton Place, Room 1310, Boston, MA.02108-16.18. FP-292(revised 9/96) or LOCATION SEWAGE PERMIT NO. 46,� oe 3 . V1 L L AGE9�� gIVA) S724X L INSTALLER'S NAME & ADDRESS BUILDER OR OWNER DATE PER MIT , ISSUED DATE COMPLIANCE . ISSUED /q22 _ or LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME & ADDRESS B .UI-LDE R OR OWNER DATE ., P-ERMIT;- ISSWED DATE COMPLIANCE ..:'! SSUED v V L - J ' i 4 No..-•-......:'. ....... F�$.....�5.. THE COMMONWEALTH OF MASSACHUSETTS /. BOARD OF HEALTH JC ...----- -- ----------------OF.................... Applirati.an for Uiipaa al Works Tonstrnrtinn Permit IV VZ plication is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: a \C A ....` P . \J �c N�o. -�Q ...............__ .... .. .... ............ ... ( CC) on r t . ......... • ... ... ......-• t Address V � i e. ... = --------------------------------------•--•----------...........----.........-•................-•-- Installer Address t of d TypeDwelling 1T'No. of Bedrooms......... ..........................Expansion Attic ( ) Size Lot-- Sq. feet Grinder QVO) U Other—Type of Building ............................ No. of persons_..._................._.__.. Showers ( ) — Cafeteria Otherfixtures ................................................' •-- ------ --------- --- ----- ---- ------------ W Design Flow............... ..................... allons per person per day. Total daily flow.._.._._ .: .C>______ WSeptic Tank-/-Liquid capacity./f�._ gallons Length................ Width................ Diameter................. Depth................ x Disposal Trench—No..................... Wide.. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No_ _____________ Diameter..._...��..._... epth Belo inJt.._. ....._....... Tota eaching area..................sq. ft. 7- 7'7 .z Other Distribution box ( ) Dosing tarxk`�( ) U�.,� Percolation Test Results Performed by..... 1c........................:.................... Date_. . "2 - 7 7.... Test Pit No. 1......y._..minutes per inch Depth of Test Pit............../-_- Depth to ground water..... _G__-_-____. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... P4 -------- _----------------- - �.... .................... ------- Description of Soil..._.__..:.(1.-.._,1..,�.._._ .. W 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 iI'A- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss hoar healt ..._Signed ...t .......... .......................... Dat Application Approved B _ 7— z 7 �e PP PP Y ... P �sr � �--� -------••--------------. ------ Date Application Disapproved for the following reasons:................................................................................................................ ...............................•-•••----......--•...•---------•--•-•-----....•--••••--••-...•--------------••-•--....-•-•-••--•-•-------•---•------.................................................... Date PermitNo......................................................... Issued-....................................................... Date l' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... OF..................... Appliraation for, U6VV i al Works Tnnstrnrtion Prrutit Applicition is hereby made for a Permit to.Construct ( or Repair ( ) an Individual Sewage Disposal System at ti --- _ . . _ ---- -- Location-AddressC +� .,. ..�q�„„ei -'pv°-•-- -- - �'!'_ ..��a -�• .. ID �44ea - �I�'' -� •c.�C�et� W --•..... .................... -----------••••-•....................•---.. ...._..._....---•-------•-------! s Address d Type of Building Size Lot............................Sq. feet U Dwelling p4 No. of Bedrooms_-, . _ Expansion Attic ( ) Garbage Grinder ) pa-I Other—Type of'Building ..........._.�.: _____. No. of persons____________________________ Showers ( ) — CafeteriaQ) P-4 Other fixtures ................................................... Design Flow.............. __. ............... gallons per person per day. Total daily flow_______....................................gallons.W Septic Tank/—Liquid capacity___.__._ _gallons Length---------------- Width................ Dia cl _41........ Depth................ x Disposal Trench—No._..________l idth.::.:..............Total Length______.__.__...____.Total leaching.area_..____________._._.sq. ft. Seepage Pit No Diameter/ th below.inlet________ _________ Total leaching area..................sq. ft. Z Other Distributionoc ( ) f/ t�fi�C''� ,) '-' Percolation Test.Results Performed by. ti..... ......:.o �' r Date_;_ . --••-. y Test Pit Nd 1 minutes per.inch""Depth f Test Pit____________________ Deptn„tX water..____.____________._,_. Test Pit No 2...........______minutes per inch .Depf Test __.__ __ _ Depth to;,gr water........................ 7- a � ' Description of Soil.............0 r U 1> - W . . ..e� .saSi: a. U Nature of Repairs or Alterations—Ariswer when applicable_________________________________ -- ---------------------------------------------------------- 1+ r Agreement: z The undersigned agrees.to install the aforede,scribed Individual:Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code''—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been Issu by the b rdIhalthigned- = -- --- - ---- ••------ -- ------ --............. - ��t-7 Application Approved BY---•--• •r". ...................••----. . Date Alication Disa r PP Disapproved for the following..reasons:-•----•---•••-•••-••--•••••-----------••--------•----------•-•-••--•------•---•-••--•--••---•••--•----•--•----•- -----•-_._......-••••--••-------•----••••--••-•------••-••••---•--•-•-•••----•••................•-•--------...--•--•-••-•••••-•-•-•-••••--••-----•......--••-••-•••••-•............................... Date PermitNo......................................... ... Issued....................................................... Date THE COMMONWEALTH,OF MASSACHUSETTS BOARD• OF HEALTH .............. .......OF........................ ........._................._.................. Tntifiratr of TnntpliFanrr THIS TO RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) byc,.........----- ------ 0 �` Installer / at....... � °-------------- •---- --••--... .........• --------------------------._......_..---------- has been installed in accordance with the provisions of TIT& 5 hem State Sanitary Codi.jJs2d9scri"in the application for=Disposal Works Construction Permit No_________________________________________ dated----.___:_._._____.___.____..__________________- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM IL FUNCTION SATISFACTORY. DATE. ... ...... ...!D../. Inspector ` ._._... .. .. THE COMMONWEALTHyOF"MASSACHUSETTS 1��OARD OF ZH .L T H �, ` No........................ FEE......................... RaposFal ftir Wiionotnuton Virrmit Permission iseby granted....... to Construct f ✓ or Repa ) an Indwld Sewage as ' a at No..---- If G? 'Z ft -- Street �„ 7• f / as shown on the application for Disposal Wo"ro ks Construction PerV ,rD ,............. .......----------- ..............- _••---•-•-- --7.. o" Fr Board of Health DATE , ... . FORM 1255 HOBBS &:WARREN. INC., PUBLISHERS,, y,. TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME �l Vp�)O, ADDRESS do C a r Y`)'a L e 1 r h p VILLAGE I\' D Y Y)S J i A0.) LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL ht SL-Y-p' p CGc1'E oT rrmt )/ O �—(d /, 0 4-ulcer, crrp- 0� (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: ��0� �1�,�� 2. 3. 4. �. DATE OF FIRE DEPARTMENT PERMIT: KNI TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS -.1, X..4�--I -11 �I ,�,- ",,—--...-��P , - -, -�,,, I V,,J,�, -�,, - , - r� 6 —, - � — - �,, - .4 -��.-�-'.4- -- - ,�-,'A, I- ,- -;. '.-.4-1���lf I�� — �,,� ,vt—e,��,7�,� 11 -- �,1 , � , I- . . I . f,",�- , , , k,-� 1� " .,�-, —�I-,!— .' ,., --- . I �- �,. -nq, - . - �* �1-, I- � - �-,-I,,,.--:1" e - - - I I � .. ��-'.� .11 ,� , -�-,�-- �Z,�' . I . ,, , i ,-. . Z,6 �, : � , .. � �l �*il" - . -- . ,— �'I--� �� -- �� , L ......�, - . " , � �n, xfr-�,tU�:���V: �1, ,,�. 4-;,- �,��-,� _Z� �-. �� - � �, - - - - ir- - -W� -. � , � -1. � I - - ;v j.. _ - � �r. �, I-, � . , �., I �".. I-� �1,1�-i -,.�. - - , , --,a:i"-��,. ,.. , - � .�--- �� '...�,, I I ,-,4- 1 , �, I - � ,:, . , - -I '. , -,- - -, . . I .� . - .,- '. - --.�A: , I. . , , . -� ..- : , . 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