HomeMy WebLinkAbout0097 STONEHEDGE DRIVE - Health �s
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TOWN OF BARNSTABLE
LOCATION J-rd�JF {�F-V cc'- Q/Z SEWAGE
VILLAGEhAd SthLE ASSESSOR'S MAP & LOT 3/ _
INSTALLER'S NAME & PHONE NO. C e 71I �~a
SEPTIC TANK CAPACITY logo G \5-r
LEACHING FACILITY:(type) PtcC'4ST (size) /000G -/O
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER JO RICSA/Z2AJ
DATE PERMIT ISSUED: yo
DATE COMPLIANCE ISSUED:: lam/
VARIANCE GRANTED: Yes No
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a� THEBOARD AOF FHEALTH s
....`. ...................OF..:...DA. sM.UF...........................................
Apli iratiun for Disposal Works Tonotratiun Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal
System at:
...q:�. _. .i�A .. �1_ ,�. ...._.. . ,asp fie.. ......._.. .......................... .... .......................................... `
....-
f Coca on,Address ..-.or•Lot No.
---. ___�-�.t� tU.t4`eJ........................................... - . ....------.. ......................
.... ...
• --•-_ ^O ner- Address
..... ..... ----------------•------•----.......- .....- ••--
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms..........___ Expansion Attic ( ) Garbage Grinder ( )
.......................•--- —
`4 Other—T e of BuildingNo. of persons............................ Showers Cafeteria
A4 Other fixtures .----•........................•-.....---------
W Design Flow..............`L Q.......................gallons per person per day. Total daily flow........:.....433.p...................gallons.
W Septic Tank—Liquid capacity.., 00.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 ( )
'.� Percolation Test Results Performed by-----------•-------------•..........-•-------•--•---•••-•---............. Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x --------------------•---------------...........----------------........---.....-----------...........------------------......------------------------........
0 Description of Soil.........................................................................................................................................................................
x ----------------------------••-•••----•-----••....••------••--------------------•--•-_.... ••--••---.........---------------------•--•-----------------•-------:-•---------------........... .•.....
U Nature of Repairs or Alterations Answ r when applicable........0,.A G.-1L¢:_�-C'-__--45�Y�4>rj JG------�?CQ7--i�.......
oh,� ... 1,�-�` ........ a�T.
Agreement:
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 further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board ofoiealth.
Signed....... 4.,.1_.... .7�,4 �-- --------------------•---- � 12
`� Date
Application Approved By........... ._. ..1... ........
Date
Application Disapproved for the following reasons:_..............................................................................................................._.
.................---------------------------------7--• -----. -- ----- -�164t jf- -1�v'e�Lt----•---••-------------•------••-•-•---•----•---•Date-----.--------
ate
Permit No......., `. ,��,?.44 !pe Issued......................................................
-7�a 11-:7z Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- 'r �� oF....... ., . .p s l.441 ........................................
......... ... ,. ......
Trrtif irat a of Toutphanre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ').,or Repaired ( )
by............. ------.......---......A ��G.. ..0.�.7 �; a �p .---...............------............ .....................• -
I staller
at........................ '....-•y '✓• ---�"� --•---------�.... 1; e�s- ----------------------------------------•------
has been installed in accordance with the provisions of TIT I��nfl> �t t Sanitary Code as described in the
application for-Disposal Works?Construction Permit No:... .......................:..........., dated .._......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNC ION SATISFACTORY.
DATE...... ... `" ........` ._.. Inspector,_.. .1........................
w_1.
�y
THE COMMONWEALTH OF MASSACHUSETTS
fr BOARD OF HEALTH
�6 - V7 _f
.d
No......................... FEE....:_k.............
Disposal Works Tons kn lion Vrrntft
Permission is hereby granted... 1�U!c.........._(,:..! .,.,w ra!..................................••--........................--•---...........
r
to Construct ( ) or Repair (Vo� an Individual Sewage Disposal, System
1•9 r l ,U a — /.?';V...........................
� Street D—
as shown on the application for Disposal Works Construction Permit No........... ...... d..........................................
i
........................................................................................................
Board of Health
DATE................................................................................
Fx
.. THE^COMMONWEALTH OF MASSACHUSETTS• "e.lt
n }`BUeRD OF HEALTH ' . 4.
Appliratiun for Disposal Works Tonsirnr#ivit Frrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( /an Individual Sewage Disposal
System at: 1
...q11.. _5 i�a�� :r, ��/l.(? ' " nod. ... ..................•------.........-•--• - ----•----....... .........
( f� n Locatiron-Address or Lot No.
._... .... .....
Owner Address
,su s•:�! . `l..? ..raw.��.. A.:?nr!�... A , ujz!?I
M Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms ft� .............................Expansion Attic ( ) Garbage Grinder ( )
Other—.Type of Building -------- ---•=•- ---- No, of-persons Showers"( ) Cafeteria"( )
QOther fixtures . .
W Design Flow..............!1 Q.......................gallons per person per day. Total daily flow...... .__ �•!'t...._--------------gallons.
WSeptic Tank—Liquid capacity ,J4. !lgallons 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 ( )
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........................
; Description of Soil...... ................... -----------------------------------------------
.............. .......•- -•--•------ ..--•-----•--- ......--•-•--•------• --------.-------------------------•-••--•••••......•••....._ --------------------------- .....
U Nature of Repairs.or Alterations—Answer/when applicable R-�.(,�D_.c i-e—r..._ 4-7-G"r.. 2�.•_` ��?*.�-------.
� ,r➢rtrl�Ti�`.�!_-----•-�±pt�c�_.f�d .--'�1--»n�?�---f-•---�t?Ql) .e!3.�� .�-N•�. �°...-�..�..-:��
Agreement:
The undersigned agrees. to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI:'lE 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.
1 w
Signed.... �� h O
,q
iApplication Approved By........... ----• ,_,-.,: ----------------•-•• � .-----......------. -----..............
Date
Application Disapproved for the ollowing easons-......................................................... .................................................r
...................................:... •-•---............••............ '4 .... . t^-!•-:,a e+r� .e i ........... ...............................................Date
-a 4r'wA --...
Permit No.......� D ----7......7 Issued_ ...................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HFtkLTH
...............OF.... ........ ...... ---_----_---_------
Appliration for Rapoiial Work Tomitrurtion Vamit
Application is hereby made for a Permit to Corptruct or Repair an Individual
Sewage Disposal
Systa --- ..............................................................
T .
. Location ress •-.or•Lot No.
........ __._ ..... ._ ..... ............'-_"'-_ ... .1. ........................................
_ ..... _. _.... .. --- _. ....
Owner re
WA. e•-- ---------. _ .. ...�.._.
Installer Address
Q Type of Buildi a?.-_Q 5�.d._ 'Sq. feet
V Dwelling, ize Lot.
o. of Bedrooms._...............................Expansion Attic Garbage Grinder ( )
aOther—Type of Building ________________--____•--- No. of persons............................. Showers ( ) — Cafeteria ( )
Q' Other fixtur s
W Design Flow................._ .:_.__._..... gallons per person per day. Total daily flow...._.__.. .._.__.._. . gallons.
WSeptic Tank+Liquid capatcity'l�.._ -gallons Length................ Width---------------- Diameter---------------- Depth__._________-_.
x Disposal Trench— o..................... Width..__..._ 4o4a n h......__._.._._.._.. Total leaching area..... ___._.__._.__sq. ft.
Seepage Pit No_____ ___________ Diameter. ow mlet_................._ Total leaching area_-----a -----._sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) �t
Percolation Test Results Performed by................... _..__. ..................C�"s........ ...........__... Date_..____.__.__ /4_�?
a
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..__________________._..
fiq Test Pit No. 2................minutes per inch Depth of Test Pit............._...... Depth to ground water____-___-_--______..._;.
----------------------- �
O Description of Soil......................X----Vt ------� ---- --� ._..r----�t4�-��-----��"_-rr--�-� -----�.
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 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 issu by the board of health.
Sign -•----•--•------------------------------ •......-----------------------
Date
Application Approved By..... �`� . ----- . --- ..-----•-------- --- ------------------ �`� �f-- a- -------
° Date
Application Disapproved for the following reasons---------------------- ----------------------------------------- .........................-.-------------
-------------•-----------------------------------------------•--------------•--------------------------------------•-------•-------•--------------......-----•-•-- ----------------------------------
Date
Permit No......................................................... Issued---.l_ X
ate
THE COMMONWEALTH OF MASSACHUSETTS
BARD ®R HEALTH
.. ........OF.... ....... ........................
A0pliration for Disposal Works Cnonstrurtion Prrutit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System- at
j s Location fire. or Lot No.
-- -_-- ---- -----=-•-
Owner'
w � j T re
tV w Installer �r.. t pr.yj,� Address
U Type of Building V Size Lot_ _ �..tj "Sq. feet
DwellingNo. of Bedrooms----------- ........................Expansion Attic (b) Garbage Grinder ( )
P4 Other—Type of Building ____________ --------------- No. of p ( ) ( )
ersons____________________________ Showers — Cafeteria
a' Other fixtures ......................................................
Design Flow................6A 40_______--_-_-__ gallons per person ° __ _per day. Total daily flow_-__._._ __f ________-_-__ __gallons.
WSeptic Tank+Liquid capacityfi—gallons Length-----------_-- Width---------------- Diameter................ Depth____._--___--.
x Disposal Trench—No-____________________ Width___.___.�____.__.. Total }en-th_------------------- Total leaching area--------------------sq. ft.
Seepage Pit No.....I-------------- Diameter_ " .� 1 ' lei e ow g_ mlet.................... Total leaching area-3-On.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by_____________•_._.__�°..........................(� �� -� "�
a ----------------•- ate
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__._________________._..
-----------•---....... --•--- -- -f........ ----- --- -------- ---
O Description of Soil "= -`� - ' _ -----��-.
x ------------------------------------------------------- =Er- -----.:_: °-�- °--__
w
------------------------------------------------------------------------------------------------------------------=-------------------------------------------------------------------------------------
U Nature 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 issu d)by the board of health.
Sign = = `.. -•- -- ---------------
Date f
Application Approved By..: ----------- � ------------
Date
Application Disapproved for the following reasons:.....................
............................................-----------=--------------------------------•-----••--_._....--••-•------•-•••-•--------------------•-----------•--••---•--•-••••----•---•--•-•---=-----•-•_
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ..,sf;
.
��rtif i tt p of., (iompliattrr'
THIS IS CER FY at the Individuals Sewage Disposal S stem constr tej ( or Repair d ( )
by----- --- -
Installer
at ---- -•---•-_----- r
--- J_... -_-
has been installed in accordance with thy'°provisions Article XI of The State Sanitary Cod described in the
application for Disposal Works.Construction Permit No.._:___�4;7_4.______________i._. dated_-__._ .___1// --------__.__.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GU R' TEE THAT THE
,SYSTEM WILL F CT O AT ORY..
DATE -------- -•---:--•-• ••...-•-_-_-...
--•-..... _..................... ' Inspector........ ........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH .
No.... -�- * , FEE-_ ...__ .�....---
ortttrttrtiaa�t rr�tit ,
Permission,is h y grilnted
L
to Construct or Re air' an ividuaI Sew We Disposa st
at No -
Street
as''shpwn on the application for Disposal Works C91-Ystructio rmit _._ Dated_______ ------------------------
•
Board of I3ealthowe
DATE. f =
FORM 1255 HOBBS & WA•RREN, INC..'PUBLISHERS
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