HomeMy WebLinkAbout0135 HARRIS MEADOW LANE - Health 13514ARRIS MEADOW LANE
BARNSTABLE
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r;= TOWN OF BARNSTABLE
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LOCATION J 05 J1 9q,, L4ySEWAGE # ScA---
VILLAGE ,��YJ (,5� ( _ ASSESSOR'S MAP & LOT,O
' INSTALLER'S NAME & PHONE NO. r e 4. —145!&�
SEPTIC TANK CAPACITY
LEACHING FACIL.ITY:(type) cIaSTNo (size) "7sp
NO. OF BEDROOMS PRIVATE WELL ORS BLIC WAT -£---
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED_
VARIANCE GRANTED: Yes No
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A�1e
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No.. 0........ /1.. Fax.....C�. ....
_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
pc ..to.........0F�..�....-0........:.. :..... . -.�-----------.-------...-.......
Appliratiort for Disposaf Works Tonstradion rani#
Application is hereby made for a Permit to Construct ( ) or Repair (L_L-an Individual Sewage Disposal
System at:
-•Location-Address --•or Lot No. '
.._.. ........_•-.,.�,� . .................... ____________:__--..�� -. ........•------•---......_.......... ............
y� _ er q r_ Address
a .I► .�?r.�^: 40
�1P ......................... .........rCl.!XLc�.. ...... ... ..........................
.
pq Installer Address
d Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms_."...fit..................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building _____.. No. of ersons__________________ _._. Showers —
Ga4 YP g ........:......:..:.. P --•--- ( ) Cafeteria ( )
dOther fixtures --------------- -----------------•---.............-.._..._......._..:.-.. ...-................................:............................ '
......................gallons per person per day. Total dail flow.-_-_.3�_0______....._____._____gallons.
Design Flow......... ga P P P Y• Y
Septic Tank—Liquid capacityl..........gallons Length________________ Width.................. Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....................Sq. ft.
Seepage Pit No..................... Diameter.................... Depth below,inlet...................:Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results. Performed by..:.................:........ ..... .. Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground Water................_.......
11 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................
x �'t^---•------------------------------------------------------------------•......_........•-• •••..........................................................
ODescription of Soil........C.-� 9r�{ ..ems.... :.. G..... ..........................................._-.....
x11 ---�,e� :_. �cti -----•---••.............................•----------------.::-•----------.......---------.......-•---------._.._..._......
W
U Nature'of Repairs or Alterations—Answer when applicable_.-. ........v-&n____f.I.T7. ________--.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of LI1lU: 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 he board.of ealth.
_q
Si d: __. �.3 -•�
--- -- ------------- -
D
Application Approved BY-'i�-:�_ :i{_C'........... = :.. ..... . ........ _ 1:.
/ Date
Application Disapproved for,the'following reasons:.......•----=--------•-------•-----•-----•------------.-.-...-----•-•-----••--•-----•-••--••--•-----••••------
...................................•--...-------------------•------..........:------------....-----•-•---.._....----•-•----•-----....----...-•------------------....------------...---------•••-•--•-----
Date
Permit No.-___ �: ..... Issued____.__ __� _i1..... ....�.�-------------- --- Date ....
........-•---•--•---• .
No__......--- --- FEB............. ._...._
THE COMMONWEALTH OF'MASSACHUSETTS
BOARD OF HEALTH
Application for Disposal Works Tonstrurtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair (L),,,an Individual Sewage Disposal
System at:
-
Location-Address or Lot No.
.._....... 4 .......L1 writs_ �2<.................••- ..................
---•---•---•--•-�".; Vkrt'==----
Owner .......................................................
a 4 ....- S--c• "'T�C. ^ � ass
►4�-Ya .................•-----•-.. ... ..... ..............................
Installer Address
Type of Building Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms.......3..................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building
yp g ........=------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
-cc Other fixtures .................................
W Design Flow........�L .......................gallons per person per day. Total daily flow......' 5 7,�t-.-2......................gallons.
WSeptic Tank—Liquid ca.pacityl...........gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
E Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
1-3 Percolation Test Results Performed by....--•-------•----------------•-•••----•----•-- *........-••--.......... Date.......
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
94 ...........................................................................................................................................................
0 Description of Soil........ .........................
! a I cl . w
v --------------------------------------------------®.......--------..............................................................
x .................•---•-•••--••-••-••-•••-•-•--............-----•-----•••-•--••••-••---•-•-•••••--•••------••-••-••-•--•••-----•-----••-...-••---•....•---•--•••-•-••-••--•....-••••••--•......-----.....
U Nature of Repairs or Alterations—Answer when applicable...r d sal. ....sS.ls't .......!:,-7 .___`(a_t-7_-:•________-
"Sv.�CtA1� .....................t{Xtc�r�t� � wl � �� _ - ' ................................QlTFn�J < ` JlI/LoLc►ti t ........................ v .. . ....L-r ........� ....... ..-... .........
Agreement: ;3` t=►�WS W�5 .�
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of A ITLE 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 the,board of health.
,.} Signed...._._._............/.�r._ _:\ .. ..... - ..............
Application Approved By..!l':_e�.._/�/ . __!.-<. s/J ...... ..- /-D ....._....
Date
Date
Application Disapproved for the following reasons: ............................•-----------------......--------------------------------..........---•--
-------------------
-----------------------•-•----.---------------•--......--.--..._.....:.......-.-----------------------------------------------
•-••----------
----•------
C (� Date
Permit No.....�?._ .�.............................. Issued. L.� 41..�
Date ... .............
-------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............O F !4-a2 vyp i, t��-2...................
Tutifirate of Tompliana
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
bY- .......... L ' :5L....---.:!�.�'`�!�-"-` - ............ ,
i Installer
has been installed in accordance with the provisions of TT ?�rn.-'7/
5 of The State Sanitary Code as describe in the
application for Disposal Works Construction Permit No.___!� ............. dated_.-.._...�.-- �-_ .............
THE ISSUANCE OF THIS CERTIFICATE SHALL N BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
... r ._
DATE ....._. .--•.................-..................
.. Inspector. ' _.... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No......................... .........OF. � .�At21�5-�.W,o ..---•---f-•............. 70
FEE.... .....
Diopaind Workii. Tonotrnrtion Permit
Permission is hereby granted--------- .�_ i"' .! ?_ ._ .........................
to Construct ( ) or Repair (t-)r an Individual Sewage Disposal System
atNo............. .................
as shown on the application for Disposal Works Construction-Permit No =_...:L.•.. D'ated..............
._�....�..'
1f�l � S �. ��
---- --
' ---•-•........................................................
of Health
DATE---•----1---�-----�--=--------•-----•.:........................ \ /.......... Board
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rx. TOWN OF BARNS"I LE
LOCATION � .� /~ - SEWAGE #
VILY AGE ��/J ASSESSOR'S MAP & LOT
INSTALLER'S NAME.& PHONE NO.
44 SEPTIC TANK CAPACITY //J4
if LEACHING FACILITY: (type)Ar4' 0/ !� (size)
i NO.OF BEDROOMS l
'I. . BUILDER OR OWNER 2� -�i��0 �'
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
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
I' Fdge of Wetland and Leaching Facility(If any wetlands exist
ithin 300 feet f 1 chin facility)
ghed b
Y
LA
3bl 31A\
Ai
oo
';ASSESSOR'S MAP NO. PARCEL
C'A T 10P- LlCrr S E W A G E PERMIT NO.
IV:ILLWGE
INSTALLER'S NAME & ADDRESS
S U I L D E R 0 OWNER
e
DATE PERMIT ISSUED
wd', � �r W / '?70�
DATE COMPLIANCE ISSUED
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Poop oo-r tI>Ac-v- ao.x zlo
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HE LTH
1 �.. OF........ .. ........
, :.. ...............................
-- ........
1
Appliration -fur 43WVviial Workii Tonfitrurttun Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System:at:
l ��91L/c� i
� ��Location .� or Lot No.
7= .../�•-••. .. ..................... .....
Ad ress.............
- Installer Address
UType of Buildir Size Lot............................._Sq. feet
Dwelling-A—f No. of Bedrooms_________________ _______________________Expansion Attic ( ) Garbage Grinder (�
Q, Other—Type of Building ____________________________ No. of persons----------------------------- Showers ( ) — Cafeteria ( )
d Other fixtures =.... -----------
r
L,
W Design Flow----------------- ---�..:'7......_.._gallons per person per day. Total daily flow....._._._.. ..............................gallons.
WSeptic Tank—Liquid capacity-/Sea_gallons Length---------------- Width-_____----...: Diameter................ Depth.-.___-__..._.
x Disposal Trench—Igo_____________________ Width-------------------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------p_1___________ Diameter.................... Depth below inlet.................... Total leaching area-------------------sq. ft.
z Other Distribution box (, ) Dosing tank ( ) D�—
`-' Percolation Test Results Performed b ._.. - . ,....... _____ --------------------------------------
Test
a
Y ! � �:d.`'` Date
Pit No. 1...._�-.....minutes per inch Depth o "Pest Pit____________________ Depth to ground water----------------........
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._._--_.-__--__._--_---.
- --- -------------------
Description of Soil-------0------ / �` . 3......1 after`
/ i�-t ' u
x
W ------------------------ ------------=-----------------------------------------------------------------------------------------------------•------------------------------------------------------------
VNature 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- ed by th 'bo d of health.
Si ed. -
`r/� ^ %�`r t' Date
Application Approved BY „l {/(/ ....._..--•••------
Date
Application Disapproved for the following reasons:--•----•--•--••-•••••-•••--------•-------------•-•--------- ----------------------------------------------------
-----------------•----------------•--------------------------------------------------•-------... -------------.........-•----------.._.._...--------.._........-------------- --------------.........
��JJ >Date
Permit No... .......................... Issued------. ------`• 5p---••----,1� .........
L Date
V-•.•.......•.•....•..•..•••..•.••....•.••..•••.•.••••.•.•.•...•.......•.••;r. -._+ i-.y-•-•-e-e-•-.�-•-..�-..•.•.�a.�.�-t H.ws��f� w�..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH � ��- CL°4A
...............��.............OF.......!��.................... .............. ...............................
"WIrrtifiratle of TITutpltnnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by-------- . -- . ........... ------. ...------- -----------------•---•••......-•'-•---•---•--'-----------'-•--•------•---------'---•----
/ Installer
at'--
has been installed in accordance with the provisions of i le XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No _-------yG_ `dated '_.a-.1..---7-r.---'----.....--
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- 3 ��/-------------------- Inspector--- ----
/ , -°--t--------•-•----------------•----•-••----
-76), ,
No..-•--•'.....G......................... .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HE TH
_ _.... 1--....OF......... .. ......... ... - - z------------..........----..
Apphratinn -fur Uhipoiittl Workii Tnnwtrurtinn Pprutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
systerr►,,aG7 'Cc�?/
----------•----••-•-----•-----•-----•........•----...•------••--•-••-••--•••••--•----• c . ----------------------- ----------------------
C J \ Location-Address or Lot No.
..............................� ...1 ..... ...... Address Owner �/�,�
Installer Address -rt
VType of Building Size Lot....... _.. ..:��........Sq. feet
Dwelling , No. of Bedrooms._-___.----.-.-�/__•-------------------Expansion Attic ( ) Garbage Grinder (�
Other—Type of Building ---------------------------- No. of persons.---•____-.-•-__-_---.-- Showers ( ) — Cafeteria ( )
P4 Other fixtures ------------•--------------••-
d -.._.
w Design Flow................. ... ..`....._...gallons per person per day. Total daily flow-------.-----�_-G!`J-___-__---.--.--gallons.
WSeptic Tank—Liquid capacity----°`--gallons Length---------------- Width--------- Diameter---------------- Depth.-..------.-.---
x Disposal Trench—No..................... Width._.-_-----_--__.---- Total Length.................... Total leaching area--------_--_-..__---sq. ft.
Seepage Pit No------ ......... Diameter.................... Depth below inlet-------------------- Total leaching area.----.--------__--sq. ft.
Z Other Distribution box ( 1 ) Dosing tank ( ) eh_
Percolation Test Results Performed by.......................................................................... Date-.-------------------------------------
a
Test Pit No. 1................minutes per inch Depth of Test Pit..................-. Depth to ground water-------------_-_.-.---.
f11 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-..---------------------
04 -•----------•-----------------------------------------------•-------------------------------•-------•-----------•------•---------------------------------
GDescription of Soil.-------- ---------------------------------------•-------------------------------......-------------------------------- -------------- ---------
x
U
w
V Nature of Repairs or Alterations—Answer when applicable..........j '' '_ -
---------
--------------------------------------------- -.-------•-------•-----------------------•--•------•--------------------------------•-•-•-----------••-------------------•--------•--•-----•----.--..-....
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 een tss-ued,y the,bo rd of health.
Sig ed--------f-a_'I'.� ..` " !< ""'�' fu,_v, s: F' 2 � .._ ':. ✓ ' 4�
1
Application Approved By--- �'= t✓- 1, G I.`a'l Dat7c/,-------
,,/ Date -
Application Disapproved for the following reasons:-------------------`.:_......_._.........-_......._......_..._....__._..................._ ____..
--------------------------------------------------------------------------------------------•••••--•-------•--------------------------------------------------------------------•---------------------
Date
PermitNo...... ----------•----------. Issued.-----�.-- -------g--
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............�'Z-t/�.............OF...... J ,�....��: .........................
Orrtifiratr of fenntphaure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by ----- - -------------------------- - r
/ Installer
has been installed in accordance with the provisions of . f c e XI of T e State Sanitary Code as described in the
application for Disposal Works Construction Permit No._____________4�
------------------- dated---=_-��- 2_y---7-�e .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....---- `,------------?----------- ........... Inspector._. --- - --
THE COMMONWEALTH OF MASSACHUSETTS
7� BOARD HEA
. L .H
�1/----�� ►'1...... ... ..OF........ f. ............................
......................... l
N ........ -- ---••••-• FEE..... ..........------
Birijimitt1 Morkii CIT,n trurtin, t rrtttit - -
----- - � �. ....
..................Permission t reby granted______ .�%":!=_'_'�'Z____L5 f.__.__ �- _.
to Constru ( or pair ( ) aOilndividua .Sewage Dispos l/System
LC Gv-.___....
-- -•-••------•-•-
Street
as shown on the application for Disposal Works Construction Per ' No.. ._._. f Dated......_y................................ t
_
Board of Health '
DATE................................................................................
FORM 1255 'HOBBS & WARREN. INC.. PUBLISHERS
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