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HomeMy WebLinkAbout0273 MILLWAY - Health 273 MILLWAY Barnstable A = 301 007 No. o� 3, Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migpogal 6pgtem Conotruction Permit Application for a Permit to Construct( )Repair( P<Upgrade( )Abandon( ) ❑Complete System [�<vidual Components Location Address or Lot No. /L%+1 L Owner's Name,Address and Tel.No. �J "�A4AN InA77WA-CCs� �11.4/Pic Assessor's Map/Parcel � ® - 0,02 9°7/ /q/<<- 0--41- 3�i,rA, Installl®ler's Name,Address,and Tel.No. j-o S_ 7�,S- -f—ov Designer's Name,Address and Tel.No. 3j,'o I-Y,41A.- fT Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building £S 7— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0,, 0 Z A- L £ 7— 62 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is d by this Board of Health. Signed ��— Date Application Approved by Date J 7P--0 3 Application Disapproved for the following reasons Permit No. �rb,3-— /1b Date Issued f—�'—cJ 7 Q Vi No. 0(, 3 /J, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓cr✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS - 01pprication_for Miopooar 6potem Conotruction Permit Application for a Permit to Construct( )Repair( A<Upgrade(- -_)Abandon( ) ❑Complete System [''individual Components t Location Address or Lot No. 7L Al i C. Owner's Name,Address and Tel.No. Assessor's Map/Parcel w 3 D 1 00-7 Installer's Name,Address,and Tel.No. -f o g ?7 S- p1 or& Designer's Name,Address and Tel.No. C4tiC O 3.So �,41Al fr 4t, `,q of Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building / S 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures a = Design Flow gallons per day. Calculated daily flow gallons. Plan Date `°:'....Num'be o sheets Revision Date Title • f Size of Septic Tank x Type of S.A.S. Description-of Soil\ ° Nature of Repairs or Alterations(Answer when applicable) Date last inspected- , Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on:-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until aCertifi- cate of Compliance has been is d by this Board of Health. t Signed e � - ,%� Date ' �- 3 Application Approved by 41 0_l' /7 Date /,P y 3 Application Disapproved for the following reasons Permit No. W /,b Date Issued `!Y'y 3 ---------------------------------------- p,�R i 1 ,per THE COMMONWEALTH OF MASSACHUSETTS p%JC, 4,ep— BARNSTABLE, MASSACHUSETTS I _ certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( Upgraded( ) Abandoned( )by � 4 4 (4 A/ C o 3j G .4W,4 i.i 3 T" Gti - ` ,? at .2 0 OJ)i C L- w/1 y 13,4,V ti has been constructed in accordance with the provisiprr-.5 of Title 5 and the for Dispos y System Construction Permit No. 2 uo 3-/b dated Installer Designer The issuanc •6 this pey mit shall not be construed as a guarantee that the systen wild f nction a eS'gned. Date LA Il Inspector / , ik No. .7003 - /b Fee J " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Owf5poar 6p.5tem Construction Permit Permission is hereby granted to Construct( )Repair( 4TUpgrade( )Abandon( ) System located at Qq 7 0�/C Gv/4 '�,t�ip A-, �� �� �fyla�•�allnaSv wlna+r�'� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of th7:� Date: ✓Pr,�>D Approved by q`' . Malit.a\C��sC. �� TOWN OF BARNSTABLE 1— O(aZ LOCATION X13 �A\� ® SEWAGE# VILLAGEQo,,R �„�{�1 ASSE .SOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SgAT-W TANK CAPACITY `j Q©0 LEACHING FACILITY:(type). (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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) Fec Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �,.e.��•� ©e�� J— �—[_� �r•.s� v>r��© ® � �; `�` Via ' ( 7 pl pl s©ot, 6Ac -�,�.�� nit ���� �•..,.�. C I e) tS, LA: THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 H EALT .---------OF........... .......... Appliration -for 4 ipviial Vorks Towitriarti - Vanift Application is hereby made for a Permi o Construct r Repair an Individual Sewage Disposal Syst .............. --- -------- . . .......... . ... ....... ............................. ----- ... ............ ——-------------- T---c-a--on ddre;s or Lot t "o. f ..................................... . ...... ....... .. . . .. .............---------/................... pn S 01), --------------- .... .. ................... ........ ........ ........... ..... ...... ---------------------------------I------------------- M/ Installer Address : K\� Type of Building Size Lot.......­n-------------------Sq. feet Dwelli -.,-No. of Bedroom -- --------- --------------------------Expansion Attic Garbage Grinder ( ) g, Othq;�ZType of Building;�--- ___________________________Expansion -- ---- -------- No. of persons------------------ --------- Showers Cafeteria ( ) Pa Other fixtures ..................................................•--------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Se ptic Tank—Liquid capacity------------gallons . Length................ Width_.__.___-_..._.. Diameter........- --_ Depth___.___._...... Disposal Trench—No..................... Width-------------------- Total Length__._.._............. Total leaching area-­-----------------sq. f t. Seepage Pit No...................... Diameter___________--------_ Depth below inlet___.___._........._. Total leaching area....... ----------sq. ft. 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......... ...min es per inch De of Test,Pit D p to ground ater-- -------- -------- o .... ........ 01 Description so -------------------- Descri -- ------ ---------......---- ------------------------------------ 0 xi ----------­ ------ .......... ........................ --------- ------- . ....... ... .............. . .. U --- ........ -- -------- .... ......... ... . ... . . ... ..... .... - - ---------- n er n applicable------------------ 4...... U Nature of Repairs or Alterations - -- --- ------ - Agreement: t dA 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 issued by the and gf health -A--- . . ....... ................................ 4/Date ------- ate Application Approved By......_..... .. .. --------- .. ....... .. a, Application Disapproved for the following reasons:---------------------------------------------- -------------------------------------------------------- Y ------------ ------7 Date Permit No......................................................... ssued..................... ............. ---------------- -------------------------------------- ------------------------------------------------------------------ h ti r j ~ �n l t � �arn-u_-rcc----nn-cn------- -------------------------------------------------- nnnnnunnunnannnn-n.anuann......................... al No: -.... FxX .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTI-1 ......_OF......... ................. .............. Apphration -for' 13iiijiviial Workfi Tonstrurti n Pumit 1 Application is hereby made for a Permit to Construct an ndi7 dual or Repair I v'id I Sewage Disposal System,';;it e- .......zf.......................... on Add ........ ............ .. ........ Lica e on Address or Lot No. /7 . ... .................... —0 ............................ ------------------------------- .............. ............ --------- -----------t ...... .........V .... ........ ........ .... ...................................... Installer Address Type of Building Size Lot-.--__^--------------------Sq. feet U Dwellj*ng,;,-No. of Bedroom-_�,-3------ ----------------------Expansion Attic Garbage Grinder ( ) Othqfe-'Type of Building�� /­.,_ PL4 ---I�_ -------------­-- No. of persons____________________________ Showers Cafeteria ( ) Other fixtures ---------------- ------------------------------------------------------------------------------------------------------------I--------I-------------------Design Flow--------------------------------------------g.dlons per person per day. Total daily flow_.....__._..:-____---- __ --------------gallons. 9 Septic Tank—Liquid capacity------------gallons Length................ Width._._........... Diameter__-.-....-.---__ Depth---.------...-.. Disposal Trench—No........................ Width....___ ;_...Total Length.................... Total -eaching area.............--.....sq. ft. Seepage Pit No_____________________ Diameter...:..........__..._ Depth below inlet_...._............._ Total leaching area------- ----------sq. ft. Other Distribution box Dosing tank Percolation Test Results Performed by........................................................................- Date--------------------------------------- Test Pit No. I................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._.---_..__---.--_-_---_ ---------------------- - --- - - ----- ----- 0 ----------------------------------------------------------- I __ ...........el --- ----- .11 � i Description SO -- ------ ----- - --- ------------ ................. ...... ......... .................. --------------- -- ---- -- --------- -------- ....... . U A _A/ -7,"- ----- - ----- ---------- --- --- --- -------------- - ----- --- ...... ... ---------- --------- ........ ---------------- --- ------�7-------- ations An� er en applicable-------------------- .1�t----- U Nature of Repairs or Alter, ---------------------------------- ----­-----------------------7....... -------- --------------------------- ................................................................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 b'een issued,by the'board?f health. Z 4r Z - ------------ ------ ------------- --------------- X Dat/ Application Approved By--.......... ........�_T........ 0- Date Application Disapproved for the following reasons:------------------------------------------------X---------- ol"' or............. ----------------------------------------- ...............................................................................--------------------------- Date PermitNo......................................................... Issued. ......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ..... .............OF. ... ..... ......... ............... Q.,rdifirate of Tomiliaurr IS IS CEf�_ T That the Indivi T al Sewage'Qifq_Al System -constructed or Repaired y 1* (u JF b .............I..............w in>sj r at....... ----------------110� ................................ has been installed in accordance with Xe provisions of Article X1 of They ate Sanitary Code 7a,/d begin the r application for Disposal Works Construction Permit No._::____ ... &ted------- ...... . .......................... DANCE OF THIS CERTIFICATE SKALL.NOT BE CONSPUM AS A GUARANTEE THAT THE Is L SYSTEM IS L, Z/VL.-I- S EM LL FUNCTION SATISP,4CTORT. DATE----- ...................... Ins .................... ------------------ ----------- --------- - THE COMMONWEALTH OF MASSACHUSETTS BOARD O,F HEALTHNo. ' t ............./. FEE.....ett............. �irr f ,(f, ntr�irtitt nuit Permission h b granted -------4 is r ---- 9 ........ ----------------------------------------------------- .................. ........... 'Sewag lo Const Individtdial/Sewag is,.'' Syst, kU.a P� - - '41, , L ... - -------------- -- ----- --------- ---------------- - ---------------- Streetr. as shown on the application for Disposal Works Construction Permir-N o------- Dated.,,,, ----------------- Board of Health- -------I----/.......00— DATE...... --------------------------------------- 1; FORM 1255 H01313S & WARREN. INC.. PUBLISHERS