Loading...
HomeMy WebLinkAbout0172 MILLWAY - Health Barnstable 11 1 • • BOARD OF OF HEALTH TOWN OF BARNSTABLE 0[pplicat ion-for lVell Congtruct ion Permit Application is kreby imade for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: LocatioAddress Assessors Map and Parcel Owner Address Installer — Driller Address Type of Building Dwelling-- --------_-- Other - Type of Building—=---_—__--__— No. of Persons--- / _.—_.__--______—_.___. Type of Well Capacity--- - — - --———-- — --— Purpose of Well- ----- -- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. l Signe —- —_ _----- -- C dA. / --- Application Approved By date Application Disapproved for the following reasons: _ date -- Permit No. � �© q _— Issued---- `--� 1 _—__ date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS TO CERTIFY, Th t the Individual Well Constructed �"tered ( ), or Repaired ( ) by-���—_-- ----. Installer at d= -------------------- -- ___- ---- - has been installed in accor ce with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----------------Dated----- ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE— ' ��—�� -_—_ _ Inspector------------------------________—___--___--- co Fee-- BOARD OF HEALTH TOWN OF BARNSTABLE r Zpplicat ion-for Well Congtruct ion Permit Application is,l�ereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: 1 Location(f Address Assessors Map and Parcel Owner Address Installer — Driller Address Type of Building Dwelling Other- Type of Building--=--__—____;___ No. of Persons------.-----.---- -_--_--- Type of Well -L K Ka —�,�------_---_ Capacity------------------------------- Purpose of Well----- ------------_—__---_.__ r Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed - - —- -- ------ -- a7 /--- Application Approved By date Application Disapproved for the following reasons: date Permit No. 0�0/ ___-- Issued—_----!--Al Il ---_____ -------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of (Compliance THIS IS TO CERTIFY,/T,h/� �Al t the Individual Well Constructed (Ltered ( ), or Repaired ( ) Installer at � /l��/ Gf/_ has been installed in actor ce with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------Dated---- ------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WALL FUNCTION SATISFACTORY. DATE 7 1J� -- Inspector -----_---- BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con0ruct ion Permit No. ' ' Fee- - - Permission is hereby granted -- -- - ----------------_--------------- to Construct f�), Alter ( ), or gepair ( ) an Individual Well at: —Street as shown on the application forWell Construction Permit / No.- 7 — — DATE �` k�� �� Board of Health ai SENDER:..=. I also wish to receive the t7 ■Complete items 1 and/or 2 for additional services. F• w ■Complete items 3,4a,and 4b. following services(for an 0 ■Print your name and address.on the reverse of this form so that we can return this extra fee): card to you. ai > ■Attach this forth to the front of the maila ece,or on the back ifs ace does not p 1. El Addressee's Address •� 4) permit. N ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. 0 •0 3.Article Addressed to: 4a.Article NumberCL a0, E /`LQ /!�/ 4b.Service Type 0 f L�Ftegistered ❑ Certified 0 rn N ❑ Express Mail p Insured N J ¢ i/ /�� El Return Receipt for Merchandise ❑ COD 0 I aGr�r� i �Ql 3D 7.Date of Del ive 3 III z ��� -co 9 5. eived By: (Print Nam 8.Addressee's Address(Only if requested I W and fee is paid) ¢ t 6.Signature: (AdUressee or Agent) o X N PS Form 3811, December 1994 Domestic Return Receipt I I ai UNITED STATES POSTAL SERVICE First-Class Mail " I Postage&Fees Paid uSPS Permit No.G-10 • Print your name, address, and ZIP Code in this box • I � I I I Board of Health I Town of Bamstable P.O. Box 534 I Hyannis,Massachusetts 02601 N I 1 II I Z 3LI8 659 869 Receipt for Certified Mail No Insurance Coverage Provided UNITEDSTATES Do not use for International Mail VOSist SERVICE ee Reverse) as Seni to t Street a7 No.n P.O., a and ZIP Code 40 Postage M E Certified Fee / O O Special Delivery Fee a I We`s_t'i,6i 'D'e`I1Jery Fee I- 6I`VePt r"Freceipl`-Stiowi to Whom&Dat i redAA, 1. 16 Return Recei11 Date,and d�a e's bpv s TOTAL Po &Fee ' / , s �J Postmark Da 1096 STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, `CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier:.(noextra charge). M 2. Ifjyou d*;not wand this eceipt postmarked,stick the gummed stub to the right of the return adpdress of the article, date detach and retain the receipt,and mail the article. i /,n*) 1'p 3: 1f you'want e7eturn:recei`ptljwrite the certified mail number and your name and address on a return receipt cardJAM 3811 and attach it to the front of the article by means of the gummed W cads if space permits.Othetwise,lffix to back of article.Endorse front of article RETURN RECEIPT WGUES.T.ED�da`ent't3 Is number. C 4. li you'�wapt_elrve y'restricted to the addressee,or to an authorized agent of the addressee, 4" endorse RESTRIC•EiD DELIVERY on the front of the article. E 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.IS LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. W a � 6. Save this receipt and it-if you make inquiry. 105G03-93r- -B-0218 I f �* Q�O%THE T��♦ TOWN OF BARNSTABLE OFFICE OF MAN&Des i BOARD OF HEALTH � MA/l 00,e,1639. 367 MAIN STREET CEO MAY k HYANNIS, MASS.02601 April 16, 1996 Lois M. Perry 172 Millway Barnstable, MA 02630 Re: "172 Millway, Barnstable Map 300, Parcel 034 ORDER TO CONNECT TO TOWN SEWER Dear Ms. Perry: You are directed to connect your dwelling located at 172 Millway, Barnstable, to public sewer on or before October 16, 1996. The Superintendent of the Department of Public Works has notified us that your property abuts Town sewer lines. The lines were extended because of the density, and the size of the lots in the area, and 'the potential for serious health problems. However, the DPW notified the Health Department on April 16, 1996 that your dwelling has not been connected to town sewer to date. Acting under the authority of Chapter 83-11, of the General Laws of Massachusetts, and Regulation 15.02, of 310 CMR State Environmental Code, you are hereby directed to connect to the town sewer system by October 16, 1996. Failure to comply with this order will result in a court complaint against you for failure to comply with a Board of Health Order. If you should have any questions, please telephone me at 790-6265. PER ORDER OF T E BOARD OF HEALTH iomas A. McKean Health Agent for TOWN OF BARNSTABLE BOARD OF HEALTH Susan G. Rask,R.S., Chairman Brian R. Grady, R.S. Ralph A. Murphy, M.D. TM/bcs copy: Peter Doyle Return receipt requested f FINE Town of Barnstable MWAB Department of Public Works FCMx'A 367 Main Street, Hyannis MA 02601 Office: 508-790-6300 Thomas J. Mullen Fax: 508-790-6400 Superintendent TO: Thomas McKeon, Health Department FROM: Robert A. Burgmann, P.E., Town Engineerx'��j DATE: 4/12/96 SUBJECT: 172 Millway, Barnstable Map 300 Parcel 034 Please be advised that Town sewer is available at the above referenced property and the requirement to tie in to the system should be enforced. Z� LOCATION SEWAGE PERMIT NO. VILLAGE (A b A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� -2 �7= G� - r �, ;l � aZ� _ �, _ Ir THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............7-PYY ..........OF.... �................................. Appliratilan for Diipuiial Workii Cnnnitrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ()Q an Individual Sewage Disposal System at: ................_M! .Y.V 4y.,. ------- --------------------=----------------------------------------------------------------------------- Location-Address or Lot No. �y--------------------------- ---- Y...... s Z Owner Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........2............. ..__..__..Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ...........................• No. of persons.......I.................. Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. ---------------------------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.._-____._-_gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length...._...............Total leaching area....................sq. ft. 3 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----••••- ----------------------------------•--•-----•---•---•----------------•---•-•--•--•--••---.......................................................... ODescription of Soil............ /uo....................................................................................................................... U -•--••••-•-•-•-•••••-•••••••••••-••••••--••••••--••-•---••••-•••.................•-•-••••.........•--••-•-••-------•------•••-••-••-••-----•----•-••-•-•••---••••••-•--•--........---•-•................ W •----•----••----------------•-------------------------••---•------------------------•-••••••••-•••-•--•-•--•--••••••-•------•-•-----••••----•-••-•••-•-•••••-••--•••••-••••••-•---••......••-•------•••. U Nature of Repairs or Alterations—Answer when applicable------16-5 L>L---------/400.Q...... L_E�t i. --------•---------------------------------------------•----•---•-------------...------------------------•--------------------------------------------------------------------------•-•--•--•--••--•-••-. Agreement: The undersigned agrees to install the aforedescribed" Individual Sewage Disposal System in accordance with the provisions of TL Ili LE 5 of the State Sanitary Code— The undersigned fur agrees not t lace the system in operation until a Certificate of Compliance has been is ed by the b ed. •••• •-•--•---•-•--•......•••---••• . ..•. . -- .... .....15133 ApplicationApproved By . . ---••---•••--••-•••-•=•--•.............•--•--•••••-••••••••..........••.... --�,- ----- - --•---•---------- Date Application Disapproved r th o ozxiing reasons----------------------------- ----•--•------------------------------------------•---------------------........... ......................................................------------------.....-------•-•---•---------••--••-••••••••-••--•-------•-••-----••••-•--•------•-----••-•-----•------•----•-••-••••......•--•- Date PermitNo....:��........................................... Issued----------•-------•-------•------........-------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........TVM1..........OF.... �9)�W,.� .................................. Appliratinn for MapauFai Warkii Towitrnrfiun Famit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: ........_. ... ---- ...................•----.....---•----••--------------•----......---------------------.........--- Location-Address or Lot No. j1n�S. /vr 1�r},; n/ /�✓ j�) � ___------ `F _../ `� .. _.... ----- ._? a ........................ Owner �.? Address W to CL.S, 1�C�GC Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........?...............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons.......I.................. Showers — Cafeteria Q' Other fixtures •------------------.-------------------•------•------- WDesign Flow............................................gallons per person per day. Total daily flow...................._....:................__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 ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. D ft!/� Description of Soil -- ...........................................•--------------------•-------••---•••---------..--------•-------------------------_----- x W --------------------------------------------------------------------------------------------------------------------------------------------------------------------•-...._..---•----•---------••---•-•- UNature of Repairs or Al-erations—Answer when applicable......ZA�:-5_:!%.%4--1 ...... Z,*42_s ------- -c .................... --------•---------------------------•------------------------•----•-----------------•--------_-•---------------••------------------•--•-•---•--•----•---------------------•--•-•------•-........-------- Agreement: x-. 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 fu.,tlre~agrees not to the system in operation until a Certificate of Complianc �e has been is ued by the board,`of_health.,/ / ! a Application Approved By--- ... . - -------------••-•-•----------•-----------•--............_......_..-- �� --= �---------•------ p Date Application Disapprove( r th ;f o owing.re4sons:---•---•---------------------•-----•--•---•------------------•--------------•--•-------------•-----------•--•--• t -----------------------------••---•---....._.....----....._....-•••----------•ti------......._..-•-•-----•-----•------ .__------_..---••--•--_...---------------•..------------ -----•------ Date PermitNo..... ......................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH [iiit/..........OF......�� JPJ`/S?!�?� 1. ............................... Trrtifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired O( ) by.. .. C = _�� �t�U L ........ .:�1�C.�:� . = . ...'42, l /- 5 T �2 fr3/�//V 1_s_.............- _ -- ...--- -- _ Instal er at...................... --..... }I2(!/ST../3t..4.----------------------I-'P--r-129`/.� ....................... has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary I�/., as ribed in the application for Disposal Works Construction Permit No.. _ ...:�'. dated-.f.. ------- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRII D AS A GUARANTEE THAT THE SYSTEM WI F CTION SATISFACTORY. DATE._...I'// :' ...................................................... Inspector-•- -- .............._=.......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... 1 .{/LfN...........OF.........�`a /`/:�.�l? -: ..................... ..................... NO.. FEE..�.✓...�.........--- Disposal Workii Tnn#rnrtion amit Permission is hereby granted c-'L-------•--•-----•--•-• to Construct (�4 or Repair (>() an Individual Sewage Disposal System at No......... t /_ /�/1 tL .. S7"603.4 C{ /Z t..............•-•---_.... Stree as shown on the a licat• n for Disposal Works Construction�Pe t o ............. Date:d.._________.........._......._......._.... -•-----------= ---------------------------------------------------------------•-•--...---------•----- MY.A;7 Board of Health DATE------- ---------------------------•--•-------------._..._. FORM 1255 HCB63 & WARREN. INC., PUBLISHERS