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0038 SURREY LANE - Health
. ' ' 059 =fie ELLIS BROS C 0 N S T CO . ,TOWN SEWAGE PERMIT NO. q-3-,232- l49s 17ff ' os9 OWNER NAMEd LOCATION �t-19C�y4� i� SC Da ?b _ PERMIT DATE ISSUED Z COMPLIANCE ISSUED BUILDERS NAME WATER TABLE FINAL INSPECTION BY : NEW REPAIR. DRAW SKETCH OF COMPLETED SYSTEM WITH DIMENSIONS ON BACK. 8Ack 4 t M t j�- ELLIS . BR0S . C 0 N S T CO . TOWN � ��b SEWAGE PERMIT N0. f3�,232 OWNER NAME 0)g, LOCATION PERMIT DATE ISSUED 2 COMPLIANCE ISSUED BUILDERS NAME WATER TABLE FINAL INSPECTION BY : �. , � DATE 5-2 - NEW REPAIR, DRAW SKETCH OF COMPLETED SYSTEM WITH DIMENSIONS ON BACK. ?AK�C BAck dvs� i i FIms.............. .. THE COMMONWEALTH OF MASSACHUSETTS '-) ED BOAR® OF HEALTH Barnstable Conservation Department TOWN OF BARNSTABLE +$n ltr r i�� uu l urk� Cnugtu r r#iun ermit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: 1,4 3 -........... � ..: ._.. ----- --- ficatinn-Address ----- or I- No. ...................... n 772 Address ............. � Installer Address UType of Building Size Lot............................Sq. feet t-t Dwelling—No. of Bedrooms-------------3--._.._...._--._-_---_...Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type Type of Building _._------------------------ No. of persons.._........................- Showers ( )p Cafeteria ( ) Q, 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.................... .rotal 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. I................minutes per Inch Depth of Test Pit.................... Depth to ground water........................ Lzt Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth.to ground water.....--................. RS --------------------------------------------------------------------------------------------•-...---......................................................... ODescription of Soil......................................................................................................................................................................... W V ........----••---•-----•••-••-----••--•---••-------------------•-•-•-••••--••••-•-•-•-----•-•-••--•-•••••-••---•--------•....-----•••-•---•.......-•---•---•------•--•••-•-•-•--................--...... W x •-• -------------------- --•--....----------------------•---------------------........•••-------•••---••-•-•--•--------------------•--•-----•----------•••-••••--....................-••---•-------•--- U Nature of Repairs or Alterations—Answer when applicable....... ......... .... -R.�-.g._..._ ............... e : a ........................................................--•-••---•- --------------.........----------•-------.........------.....•--•-..._............. 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 s been... ... .. .......... issuuepd bbyy 1tth�-e boars(of health. Signed _ +gz '�...— ........... ....... ......................................... Date Application Approved By ............ cr�r.•y,....p�}-E: ... ...--- ------ .................... :5r!nA ?J.. Application Disapproved for the following reasons: . .... . . . . .................. ...................................................................... ... . ................................. ................................................................ IC� Date PermitNo. ..... .° ' -------------------------- Issued .................................................................... — Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertif rate of CgompItttn e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ................. s/.5.... /LQS.....G ,uS t` -��--. - .......... .... ......__........_.............. ....._............... -- ...... ........ Insrdler at .�',�.....,5/.i/�e ....... ----IsXi r-1111.................. ... .. .. .... .. ...... .. ............ ....... has been installed in accordance with the provisions of TITI.E 5 of The State Environmental 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 FUNCTION SATISFACTORY. DATE..................._.... 5 _.' )-+.L._` ;...._...- ..........._._. Inspector ._.; .------- --------- --------------------------- ————————————— --.-- ------.-------------------,------------------------- -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rr TOWN OF BARNSTABLE L5 Oro No..l.. :.. FEE.---.....----.......... Uispwial Workv Ton#rudion rrrmit Permission is F ereby granted-.. �d............!I'- .....- �(!/ to Construct (�) or Repair ( Xan Individual Sewage,Dfsposal System atNo...... ........ ..... ......... WW: �---------------------------------------------------•--............. Street q as shown on the application for Disposal Works Construction Permit o.l.-._� 23�Dated.......................................... DATE. ( ................................. V Board of Health FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS / No....7-:.; an V { Firms : o THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,���ltrtttt�u f ur�#t��.�n,�ttl �i url�� C�lagt��r�rtinn �exutt� Application is hereby trade for a Permit to Construct ( ) or Repair ( V) an Individual Sewage Disposal System at: 1�f1 lZ,v Sfl "� Gov ' ..................................... ------------ �-�-�----:--------------........._.. -- -------.. Lbc'ttion-:\ddtrssLIDe - --------------------------------- ............................................................�-c.-: Wit✓ /Z _ /� M IIIStBIICi � Address F+�1 -041 Type of Building Size Lot......................•..•..Sq. feet "../ Dwelling— No. of Bedrooms.........................................__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons._..-_-__----___-.-__.-__._. 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........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-•................. ---------------------------------------------- --••-••-•--••-•--------------•------------- -......--........••-•--••••--... ------------- -•. ODescription of Soil----------------------•--------------•-------------------------------------•----------------------------------..._....-------------------------•--••......•.....----.•... x W U Nature of Repairs or Alterations—Answer when applicable.------ f✓ .._y_!.�?. ?... .�:..:.....G�............... j ; ----- 5•- ------------------------------------------------•-••-•-••••......---- 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 h s been issued by the board of health. Signed �- v ....................... J " ��—�3 ---.... ApplicationApproved By ............� .._5:) _ .........................................................................,....... .-. Dad.-....r. ie Application Disapproved for the following reasons: . . .................`...... ..................................._....................................... ............................. q Dare PermitNo. ...../... ..-.a-,. .' .............................. [ Issued ...............................................-..,-................ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH 2� ..... O F .......... . ... .......... .. .... ............ Appliration -for Biiplaiitt1 Workii Tomitrurtion Vrruift Application is hereby made for a Permit to Co eruct ( ) or Repair ( ) an Individual Sewage Disposal System L .........0. � •� �I ------ - ------ -- - L� Address/J4/,f� or of No. 'PPt•r—W a ......... --- •••...................... -•-----------------------•••--•--•-.._.......---•------•-•. •-- ••--•- ••-••-•---............. Address stal Address U Type of Building Size Lot_4, :...Sq. feet Dwelling No. of Bedrooms_____________ ______________________________Expansion Attic ( ) Garbage Grinder ( ) pi Other—Type of Building ____________________________ No.. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures _-___ ------------------------------------------------ W Design Flow.-/'__ ..__..... ---------- - -- allons per person per day. Total daily flow... --,� ..._-_....____gallons. 9 Septic Tank Liquid capacityallons Length................ Width...---._. -_._-_ Diameter---------------- Depth-----------.-..- xDisposal 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 ( ) Cf-"� — Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- ,� Test 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_..__.__.__._____._.___. a ------------------- O Description of Soil----------------------------- -------- :•--•---------- ` ..... W U Nature of Repairs or Alterations—Answer when applicable..._--_________________--------------------.-----------------------._..._.-_-__.__--__-____-__ ------------------------------------------------- •----------- ........................................... •----------------------------------------._.-__---_.-_. -------------------- --------------- Agreement: The undersigned agrees to install the aforedescribed_jqdividtial Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code e undersigne further agr es not to place the system in operation until a Certificate of Compliance has been i s by the oa health. Sid--------- --- -- -• .... . ............. •-------- - - ------- -------------------------------- Application Approved By-- ------/- - .. -----• -•-• Date Application Disapproved for the following reasons:...........................................•..... .._..._____._________..._..____._.._..__..._....__...__...... --•-•-•--•-•--- •-•------------•-------.-••---------------•--•-------•-•-•----•-------- •------------------------------•------------------------•-- --------••----------------•-----••--------------- Date PermitNo.......................................................... Issued---------------_-_- -------------••--•---•----••--•-• Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M A� C DATA No....... -_•_. � Fay... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH ........-- Appliration -for Uhip iat Works Cnnnotrnrtinn Vnitift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ 1 ! Location Address f t No. -- ---- t ---•- •--.... - r-- ------- •--........................................................ ress "{ j Owner '- Add � ��al erJ✓ l Address Type of Building Size Lot-A .�� U " S feet .-� DwellingV—No. of Bedrooms-------------- --------------_--_----Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtur _ W Design Flow--- '"-------5 _ _______ _______y--gallons per person per day. Total daily flow---.."":. --------------------------gallons. 9 Septic Tank Liq_lid apacity.. ". �_gallons Length................ Width.............--. Diameter-_..:_,-------- Depth---------------- xDisposal Trench—No--------------------- Width-.-------.---------. Total Length--------------_---- Total leaching area---------------.-----sq. ft. Seepage Pit No------_-------_---- Diameter...............---.. Depth below inlet--:-:---............ Total leaching area....-_._...-..-..-sq. It. z Other Distribution box ( ) Dosing tank ( ) 6; Percolation Test Results Performed by-------------------------------------------------------------------------- Date------------------------------------.... Test Pit No. 1----------------minutes per inch Depth of Test Pit........--.-..------ Depth to ground water................._..____ Gt, Test Pit No. 2----------------minutes per inch Depth of Test Pit..............-----. Depth m ground water----------- -------.__-_ - --------------� ,r'. xP ,•�- _-------- U ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ W V 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 issued by the..board,of health. ,�,. .� ,; y t.-f- ,� Signed... ..................................... '------'f=-- -- ,/� /- � / Date I/ s -------- Application A roves B /f ---•-r r �......................�'` ±fir _ --�`--�' c / ` 00'. Date Application Disapproved for the following reasons--------------•----•------------------------•----== ---------- ....-------•-----------•---•--••-•-------------•--........------•---•---•-••---•-------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD—OF HEALTH ..................................OF..!, .,..?.r't !F-.........................................................t 'W"rrtifiratr of Irrmplianrr THIS IS TO CERTIFY, the Individual Sewage Disposal System constructed ( ) or Repaired ( ) "" l by---••-.-1- =----=--- -- .....6 L. 1 ----.. Installer --------------------------•--------------------------------------------------------------•-----------•---------�----- has been installed in accordance with,,the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..--.-- +..... .......'�-......... dated_:• -_--�../1 mil -7 =__.___ Ii - -----• - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. D' TE--------••------------------------------- ...................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r f i"` ' D r' � `y ..P ..dJ .. r:! :'�1..........OF...........'t'.�. i .«..... .......• fr,'^ a............. No.-(:?.. ....... r FEE—...ram:--•••....... . �i��n�tti grk�� (�n��trnrtinat �rrutit Permissi�n�is hereby granted.--- � tii -`��!= to Constr et ( ) or Repair (,- ) an Individual. Sewage Dispo al Systeml at Nb.'Y—.- r �r f 1 r%, �_�t.> . / 5l e-�r-•r-, > �'' (t. ��^s_r _x y-------------------------- - rStreet �---..;----•------•----- - - --•--------•------••---••------•-^--• I as shown on the application for Disposal Works Construction Permit N;o--------------- Dated.e.-..�a_�.-. `'--- --------- ------.---•----------•-- DATE........� �� l �i� Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS v •�a�ta°�� , { f r4'�u 'r aa'. �� �nD�•_x•, i1x:i3 �F7, 'C�E� ..Idh s� � s� _ i '� '. Assessor s map and lot number .E Z9 ��9•• _ Y Sewage Permit number ::... ... ............................................ �SINET� tz� d �•o� TOWN 0 BA]�,NSTA IL�E F � ZASA51'OBL i rig".. :'e� , coat 1639. SftIf Eb TO� R APPLICATION FOR PERN�IT TO ..9.!`?.�..�,.�-...... .r.0 VI 7. ..- ........ y TYPE OF CONSTRUCTION ..................E. . ...........................................................1 TO THE INSPECTOR OF BUILDINGS: 4''' � ,' �• , The undersigned hereby applies fora permit according to the following information: Location ..... .!.moot 3..' ... .2. h lU . ..... ..... . .... .. .. Proposed Use .........5:.�. J. E .. ... . .' .i. ... . .;... U CeC j °0. r r � Zoning District . .:� Fire District. .... . Name of Owner ... �. . T. . u' .I........Address ?.�`�?y. ►S.. ...!Q�J � ?4fZA?ST�t3C 1 Name of Builder 1� Address ................'! ry Name of Architect ...................Address Number of Rooms �:µ �..v c'ti lLc Ga 10 LSE Foundation r Exterior �'G1N .! PRe---ZP............RoofngI (lSLip 7: Kt° Floors A2DwooY.�. ...AAF61. �•!`.t0 ....,�.4ti=...........Interior I.2... .................�t-.T.RoGlG Heating' G.PrS. .IR., ...T F : : >�T fit ....................Plumbing ............. } +� 4 - tac F4repl Approximate-Cos ca U.......All Definitive Plan Appro z f k �� ved by Planning Board 19_01_-------- __ 197_Z , Area / � � s� r Diagra lding with Dimensions Fee I w. ' m of Lot and Bui ri ... ..... ;> SUBJECT TO APPROVAL OF BOARD OF HEALTH ' ' `�t D2oo/Yrs fir= e. V 14 C) N • 4 a_ may, �-..., N�' '�'# ' f• N I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re arding the above construction. t' Name ........... .. ...... .........................