The URL can be used to link to this page

Home My WebLink About2870 MAIN ST./RTE 6A(BARN.) - Health 2870 Main Street Barnstable A= 279—008 } Wes:,. A— 133 � s t S M E A D No.2-153LBE UPC 12034 smead.com • Made in USA 9r,� ,. V, cr Our No.. t�: Fa$......Z..�....a.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiuit for Uiripuuul lVarks Cnunutrnrtiun 11amit Application is hereby made for a Permit to Construct ( ) or Repair ( ,*ran Individual Sewage Disposal SY . 6..........0:T..Ca.I4... uft in--a!' , 1 r J ................................................. Location-:\ddress or Lot No. .........Y.......!! ............................................................ ---............_..............._........ o«ner Address .............. 7t?L�G..............---------•-------•--•-•----------•---•••-•••'--- 50 l`✓tcu i.......611'..................................................... Installer Address Type of Building Size Lot............................Sq. feet ►.. Dwelling— No. of Bedrooms............S------------------------__Expansion Attic ( ) Garbage Grinder (! ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity-_-.-.--___gallons Length................ Width---------------- Diameter....------------ Depth................ W Disposal Trench-- No. .................... Width----------------_... Total Length.................... Total leaching area.........._.........sq. ft. x Seepage Pit No..................... Diameter-------------------- Depth below inlet..........._........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date.................................... Test Pit No. I----------------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........................ a+ ---- •... ------------------------------------------------------- -............................................................................................. 0 Description of Soil....................................................................................... ----------•-•------•-------•......._.....---------------•••..................... V ..........................................................----------'--'•-'--•••--..........--------•--•-•-----•----------•----'-••--•----•----••••-•-••---•••----••'...._•----•--............-•--•--••- W ---------•-----------------------------•-----...--------------.....------...._....._........--------------- •T: .•..... UNature offRRep }rs or Alterations—Answer when plicable._.Los.�_r..._.__._..f-.. QC)._......p .............X..? -L:d!//lg . .....:�..-•--/--�- d..'--13dY----- .. .. .�.1 f0 -----14 GS. ._... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 ................... ...... .:.em..s -- -- 2.'D cre . .9Y Application Approved BY ... ... ............................. .. .......................................... ........� ... ... �a�e Application Disapproved for the following reasons: ........................................................................ . ................ ............................................ ... . ............................ ... ... .... ........................ ... ---.............................. ........................................ S� Dace Permit No. Y - Issued ................ ............. `�.... Dace C .� -�{� [x 3C��~ � �� .�� ~ yQ�-'l-+'�_�-�� '/ _~ � �m__ _'__ THscowMomwsxcr* OF mAosAoHussTrs 1 BOARD OF HEALTH � � TOWN Of BARNSTABLE ! ��° 3��~ �� ]��l � �� ^ �� l�K��u �� Vertn1t . Application is hereby made for u Permit to Construct ( ) or Repair ( -'J'- Individual Sewage Disposal System at: ( / ` Location Address or Lot No. -------- ---'--------'------' -------------'-'--'---------'------'----------- ^ n°"= odr"ss .__._.._['.... .. M4;�z---' ' .-----------_-------'-_'--.. � Installer Address - Type of Building S�� S� �� *�� -_____'.__-��^ D��l��--2�n� �� 8�drnonm---_�~�-__------Expansion Attic ( ) Garbage Grinder (y ) Other Typeof BuIlding ............................ No. of persons---------------------------- Showers ( ) -- Cafeteria ( ) Otherfixtures ----------.-_-_---_---_----------.--'--'.--_''.-_----_-__'. Design Flow............................................ alloos per person per day. Total daily flow............................................ Septic Tank--L� oid -' Length---------------- Width---------------- Diameter--- ------------ .. Disposal Trench--No ..................... Width.................... Total Length.................... Total leaching area....................sq. {t. Seepage Pit Nu------.. Diameter-----.- Depth below inlet.................... Total area..................sq. fc Z Other Distribution box ( ) Dosing tank ( ) ~~ Percolation.Test Results Performed by.......................................................................... Date........................................ 0.4 Test Pit No. l-----.minutcsyccincb I)cydh of Test Pit-------------------- Depth to ground water........................ 1-4 44 Test Pit No. per inch Depth of Test Pit------------------ Depth to ground water........................ -- ---.-------.-_-----'--'----._-_'-'--'_---'-------'--------_---'-----'-.. 0 Description of Soil........................................................................................................................................................................ ......................................................................................................................................................................................................... - �� ^ --'--''--'--'--''--'--'----'� -----''''' r........................ .... ...................................... Agreement: � The undersigned u8ceeotoiootuUcbcubocedeuc6be6lb6ividuu Disposal System ivaccordance with � the provisions of TITLE 5 of the State Buvir000ueocul Code--The undersigned further agrees not to place the | system i operation until a Certificate ofComu}i has been issued 6v the board ofhealth. 8igoc6 --. '� � ~ / ��.'�� -'�'�� | )4� �"/\pp)icudnu /\pprove6Bv ----' - -----------------------' --�� '/''�'�-��L/ | ^^� Application Disapproved for the following reasons ----------------------------_------'_------. � ----'-__------------__--_'---'-------___---'_--'---._---'- ........................................ ^� Pernnit ��o. --L'�/'�-.��-l'L------- � leou*d ---'�-----------------' ' �� ----- -----------------`--------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ! BOARD OF HEALTH TOWN OF BARNSTABLE (fErtifirate of Complianre # THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .......................... ,4A-1co ......._ ....... ...... . ............................. ,�. �� at ... .®.............. _.........60--. ........ ..._... 11 ..._....._... ...... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...Y�.-Y......'s....I(...7------ dated _.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE„ SYSTEM WILL FUNCTION SATISFACTORY. �'`e........ _...._ ,;.. .:.. DATE..........,/.... ... 0........._......................... Ins ect&.__. ........._. . . THE COMMONWEALTH OF MASSACHUSETTS A4 BOARD OF HEALTH TOWN OF BARNSTABLE g t� FEE 3e . Ropmal Work.5 Tonotrudivit ermit Permission is hereby granted ---------- ---- , /11 0............. to Construct ) or Repair ( r,�j an Individual Sewage Disposal System atNo.......a� .......)�:. ......41eq.................................................................................................................................... Street ec�� as shown on the application for Disposal Works Construction Permit NoAl t-:5�2,- Dated......5:1.�--2-�-�.......... ----------------------------------C�.- ................................................... / l Board of Health ; DATE................. f --------------------------------- FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS v RMIT KJO. DATE / � � rp - ADDRESS a INSTALLER 275 076?OO- �'nst /i Sdv 9A/0 INSPECTION /E4cll ni-� -4.44Sf DATE MAP P A'9 7f �-� NEW CONSTRUCTION r 1 lay l rt5} THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) A - 111 I m / LI DATA o 0� j `'" 1 ''° ATION SEWAGE PERMIT NO. _v our-GQ, IN'STA LLER'S NAME a ADDRESS S U I L D E R OR OWNER DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED 0 - � Qt \00ID TOWN OF BARNSTABLE m 1�l L V W 9 ! AG UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS ld-0 ASSESSORS MAP NO. PARCEL N0. irZ Z-9-07c-__ ADDRESS: M-f)r Al 36 X S� Z- VILLAGE. Z4RAl-i/I,t3 CONTACT PERSON PHONE NUMBER -76 2.9 6J91r,42' -5i;3`56 Y/ Li,) LOCATION OF TANKS: - CAPACITY: TYPE OF. FUEL AGE: TYPE: LEAK OR CHEMICAL: DETECTION SYSTEM' ti /S—wo x 5510 Qc_ f/cyliw- DiG � S�� pATE: OF PURCHASE OF EACH: 1. 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS ?LEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. ;.✓ `� o i �-� G� � THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IMF�c� C DATA TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. oV PARCEL NO. 0 Ro ADDRESS OF TANK: VILLAGE NlJfgbMr MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) ,OWNER NAME: f�f '� L PHONE: l 7/ -3kzv C ,r INSTALLATION DATE: C�'-� BY: INSTALLER ADDRESS: -CERT.1-40. *TANK LOCATION: tips { "+ L IAA, �� l�(-:, ` (mamcn Z aC TANK LOQAT S ON W 2 TH nmo*&CT TO mU S LD.I N,m) CAPACITY .� TYPE OF TANK # . AGE/q YRS. FUEL/CHEMICAL TESTING CERTIFICATION E 0" PASS [ ] FAIL DATE LEAK DETECTION E ] CHECK IF N/A TYPE/BRAND u e ZONE OF CONTRIBUTION E ] YES E NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED EV YES [ ] NO DATE 44 - (7 - '61� CONSERVATION E ] CHECK IF /A DATE BOARD OF HEALTH TAG NO. E ] DATE /� r PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD 9 9 " k. "oil ��A-,fit✓.S � /� ,6�e Cam. O. t ve..rr' .a' bee f ti 21 f �e