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Home My WebLink About0250 CAP'N LIJAH'S ROAD - HealthV=250 CAPTO LIaARS RD, CCN7,ERVILLC—° �A= 193-114 I i No. 42101/3 ORA ESSELTE 10% ® o o a ,. V C ' No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppftcatton for Mioo!5ai *proem Comaruction Vermtt Application is hereby made for a Permit to Construct( )or Repair(Vf)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Lok 2Y C \ S� ,- L� v S Ulf\ Installer's Name,Address,and Tel.No. Designer's Name,Ad ess and Tel.No. Type of Building: Dwelling No. of Bedrooms Garbage Grinder(� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alte tions(Answer when applicably ` 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 C-ade and not to place the system in operation until a Certifi- cate of Compliance has been iss4!!yl by this Board of ill— Signed c, Date J Application Approved by — I Application Disapproved for the ollowing reasons Permit No.��°�� Date Issued \ — �. I - No. ,...,,. Fee i` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplication for Migo!mt *p5tem Con5tructiou Permit Application is hereby made for a Permit to Construct( )or Repair(�/)an On-site Sewage Disposal System at: Location Address or Lot No. J\'\\A Owner's Name,Address and Tel.No. Luk 2� C� Installer's Name,Address,and Tel.No. IQ Designer's Name,Ad ress and Tel.No. Type of Building: Dwelling No. of Bedrooms Garbage Grinder(0(� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets _ Revision Date Title Description of Soil Nature of Repairs or Alterationst (Answer when applicabl ) C lira c� ko G r (nGil._. -tG Le_ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system F in accordance with the provisions of Title 5 of the Environmental CQde and not to place the system in operation until a Certifi- cate of Compliance has been is by this Boy f eal Signed o Date a _� Application Approved by , Application Disapproved for the ollowing reasons Permit No. / Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance �. THIS IS TO CE TIFY,that the On-site Sewage Disposal System inst fled( )or repaired/replaced(!�)on by n — for, a _ .1 t has een constructed in accordance with the provisions of 'tle 5 and the f6i4isposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below: 1_ - IT) No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x1igPoal 6p.5tem construction permit Permission is hereby grante to SC.CO n - to construct( )repair )an On-site Sewage System located at %Z C,p L\ ' 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. All construction must be completed within two years of the date below. Date: f _ 2 -�� Approved by �tl I Lot Z7 ld N I 1 Nµ r ZC)7 N w o N o �ro TsT (o4't a� 0 M 1 141. 7&' 77 p� �N OF M,U, Lot J SN OF K'18,f ?��THOMAS s�s' TH E AS yG E M T"OMAS E. KELLEY CO. KE EL H b 4GJNEERS—SURVEYORS 346 Z.0-*1G POND DRIVE G K 2 9FG1 E� Q- o�F'�' SOU'f+H YARMOUTH,MASS. < o pFLll 02664 CERTIFIED PLOT PLAN SCALE . . M'3Q . . . . DATE .. . PLAN REFERENCE .. .... . F SLanLc- 6Y Cka:r- fs. Tla-n+ ;8pok .,Z77 .98 . . CERTIFY THAT THE . . SHOWN ON THIS PLAN IS LOCH _ ND AS SHOWN HEREON AND T ,rt.1 TO THE SETBACK RE_OUIR E li WN OF Chczr-{es F. sfztnle� . . . WHEN CONSTRUCTED. ' C tcZ,.t LJ"o-k ra czd DATE . . . .. . PET ITIONER: if�-,tferv<«e /NA. D2�32 REGISTERED LAND SURVEYOR TOWN OF BARNSTABLE LOCATION � 4LOCATION71TiON Sy ��°�re.�.. L\� G.�S AGE # VIL V.77� ASSESSOR'S MAP &LOT / . INSTALLER'S NAME&PHONE NO. CA- ccrni..�C -27� SZ),l SEPTIC TANK CAPACITY t.�o10 CkAu O �1 Sox, G W L E,C FACII.TTY: (ty ) lV �� (size) S"rat r� l C- NO:OF EDROOMS BUILDER OR OWt NER PERMITDATE: \ Ir�� I�OI COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility )*OUC ie C r 1 6 Feet Private Water Supply Well and Leaching Facility (If any wells exist q on site or within 200 feet of leaching facility) U Feet Edge of Wetland and Leaching Facility y wetlands exist a within 300 fe f leachin Feet Furnished by A SAS A o V&5, ��s'G► r�� Pry �� l (34D V%D7� 20 1,�3- o o�c��P` O 3 LOCAL AT10�1� ,�g ' SEW atA E PERMIT N ' C."c� 72 — VILLAGE T� INSTALLER'S NAME . i ADDRESS BUILDER. OR OWNER sdtv DATE PERMIT ISSUED _ DATE COMPLIANCE ISSUED ��x� . �� `-,3� � , � � �� , . � �, fi" e � - ... :.. - - .� ._ No....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO.W,,�)OF..,8 .............................. .................. 19 Appliration for Dhipatial Works Tonstrurtion rantit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: &. L,5- . .. �s 0. ....... ..................... ..9.&..E....... ................................................................................................ Location Addr ss c, 7 t .................... . ... ............................... .......... js L) ..........................................Address..............................0....................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......o............o.......................Expansion Attic Garbage Grinder P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 134 Other fixtures .........................................................................................................................................0...0....... < Design Flow.........................................._..gallons per person per day. Total daily flow............................................gallons. W P4 Septic Tank—Liquid capacity............gallons Length................ Width__............._ Diameter..__.........._. Depth..............._ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.__......__......... Depth below inlet.............._.._.. Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.... .................o........o.......................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water-___---............._.._ ..............0.0................................................................................... 0 Description of Soil.................. ...... ........................................................................................................ U ................................................0.................................................................................................................................................... W ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable....../=-)4 9 ................................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in.accordance with the provisions of LIT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has is d by the boardof Ith. Signed... .. 1 _96'y J' .... .....Vea------------ Date ApplicationApproved By.................................................................................................. ....................................... Date Application Disapproved for the following reasons:................................................................................................................ .................0............................................................................................................................................................................---------- Date PermitNo......................................................... Issued....6... _Z.7 ..................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH u)&. .OF: � . a............................... Appliration for Diipn, al Works Tonstrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,�•� cation-Addr s or t o. (- .....f..c....._...a..; ..d$ l�i ��....................•------.... �'�}� ��" .�� ........................................... • } f /� y, ,p0,,�x°+ z Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers YP g ---•-----•-----------•------ P ( )--- Cafeteria ( ) Otherfixtures ---------------------------------------- ---- ------ W Design Flow............................................gallons per person per day. Total daily flow............................................ W Septic 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........................ fro Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.............. W V ------------------------ ----------------- •-•---•-•-----------•------------------••-.. ------ ------------------------ ......----------•--------•----•--•-------•-•-•-•-----•--------•------------------ W U Nature of Repairs or.Alterations—Answer when applicable_..__,' � � r �.l , .44 1. '`.................................... = -------------------------- ---------------------------------------------------------------------------------------------------------------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITS" 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has `ee issued by the boar of ealth. Signed••- . .. --- .................................................... _ Date ApplicationApproved By.................................................................................................. ................................... Date Application Disapproved for the following reasons:................................................................................................................ .............•••-•---•--------•-•------•-•------------•••---------•••---•-....•-•---------•-•--•----- Date PermitNo......................................................... Issued-....................................................... p Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ' ...OF....iIf.......................... T ertifirat e�of Tlautpliaurr THIS IS 0 CERTIFY That the Ino vidual`aSewage Disposal System constructed ( ) or Repaired ( ) _ ... ��..:...t� r�_ �� '.��'.f .............................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--------..:............................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOt BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....--- ............................................... Inspector...Ic k.............................................I......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No........................ FEE.--.-• ..... Disposal Worku Tun#rnrtwi n rrntit Permission is hereby granted. 10 <:............................................... to Construct (' ) r-.Repair ) an.Individual Sewage Disposal System at No._ _..__.._. .: . �' it :, , � . ".'. .... -•---- --------------•------------....... as shown on the application for Disposal Works Construction P No.. _ v ................. Board of Hea th DATE. . 0 9 w. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ,