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Home My WebLink About0028 CONNERS ROAD - Health E onnors Street rville51-065 L M E A D No.2453LOR UPC 125U amead.com • Made In USA �uaDMn��oouaua SFIOF TK�, " CER11f1ED S�IRONG No. v 1 Fee jl THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS. appIitation for Vsposal *pstem Construction permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.Z$ C6%v� t—% IR6- Owner's Name,Address,and Tel.No. Rce- cur Yah Assessor's Map/Parcel CeAv_", Lk.�M> s� a 'ZS COWN"n, CUIWIA4 VV S Installer's Name,Address,and Tel.No. Utt( 6'1- vnj 5 Designer's Name,Address,and Tel.No. P6,box'7/ ml*s-Wits �+tus�nua aa�/8 ( )776�9a5y Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33a gpd Design flow provided p gpd 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) EQ,elac$ ('al�flSiino oks�al 1, /YQQ gal pbs�_ .�t�L au A-" &� &wok +o w j3ik 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 Certificate of Compliance has been issued by this Board o Signed � Date 5/--2/—(!/ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ��L Date Issued Y�( --------------------------------- - - - -No. Fee THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,-MASSACHUSETTS Zipplication for Disposal *pstem (Cons truction.30ertnit Application for a Permit to Construct( ) Repair(V) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.Z$ CAhV•A:r- Owner's Name,Address,and Tel.No. kke- Cf�1ch+��k mwg>, 28 Covi"'r 14.�. {tevlkr�t�ASS Assessors Map/Parcel Installer's Name,Address,and Tel.No. EEk t STEVC,J S Designer's Name,Address,and Tel.No. pb 2�(sx 7/ Mpe5-ZArs M"j A,Aa OZ616 (r0.°��77(o-9osy Type of Building: Dwelling No of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) 4. Other Fixtures Design Flow(min.required) 33o gpd Design flow provided + gpd s -Plan r Date Number of sheets Revision Date s Title 1 ( Size of Septic Tank Type of S.A.S. Description of Soil r ^L Nature of Repairs or Alterations(Answer when applicable)... 17enr2r e Cd11z j)5%�1 i CICIA r A to ! fit, /`C(l aw a t��a is 4Aok. _-riAa11 A•►xac av,6 Cm iK cA 40 ow 1-11 P' ! Date last inspected: I 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 Certificate of Compliance has been issued by this Board o ealth Signed Date Application Approved by Date C� -Application Disapproved by Date z for the following reasons ,t Permit No. Q<<'' Date Issued r ----- ------ ------------- - TH L COMMONWEALTH OF MASSACHUSETTS f � l 'f �� Alb BARNSTABLE,MASSACHUSETTS 0Crrtificat>e of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( V) Upgraded( ) Abandoned( )by EKIC Sifkiev`, at 2 'i �r nr,•r<_. CP_nth, \o has been cony, e, acco ddnce with the provisions of Title 5 and the for Disposal System Construction Permit No. � ted Installer E—ENC Designer #bedrooms Approved desii�flow gpd The issuance of this permit Ahall not/be p onstrued as a guarantee that the system wd fun�tionn as design d.O/_//� "'Date Y r/4- Ins ectorr_JAWP --------------------------------------------------------------------_------------------------------------------------------------------- No. L� Fee ' -THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( V Upgrade( ) Abandon( ) System located at Z 8 60-mA e re tt. _ Ce.vt�ef uA t_ m w cs and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:ConstructioX must be completed-within three years of the date of this permit. r 1 Date `l ! - Approved by r r i No......... ....... Fxs... ....�1 .. THE COMMONWEALTH OF MASSACHUSETTS � k BOAeR® OF HEALTH U ....................._...................OF..._.......................-----.......------...------•-•--------•---......... a� AliplirFatiou for Ui_npuiial Vork i Cna ntitrurfinal 11amit r� Application is hereby made for a Permit to Construct ( ) or; Repair ( ) an Individual Sewage Disposal System at: ............................................. ation.Address or Lot No. ------------------• ------- ----------- •------------------------- ................................................................ - ner ress Installer -„ Address 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....._. ._......2'.®........gallons per person per day. Total daily.flow...........................................gallons. W Septic Tank—Liquid capacit �___ gallons Length................ Width....... Diameter---------------- Depth.............. •_ x Disposal Trench—NoA .... Width.................... Total Length--------- Total leaching area....................sq. ft. Seepage Pit No.......... iameter.................... Depth below inlet..................... Total leaching area..................sq. ft. t Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_-----_-__-----_-._. L14 Test Pit No. 2____------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •-•-•-••--•-•••••-----•••-••--•••-••-•••-•-••••••••••-••---•--•---•-••-••....---•--------------•••---........----•-•-----•-•••--•-•-•---•--•-••--...._..•... ;I 0 Description of Soil........................................................................................................................................................................ W ____________________________________________________________________•_-.-_-_-_-_-_--___---------.----__--- ----___-_-_ -__ r t UNature of Repairs or Alterations-Answer when licable.- __ �a--✓_____4L--- __� 0 .r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT—E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is ed b tobif health. S. Date ' Application Approved By....... -•-- -- --- -• � -----•-_-----_------ / d Date Application Disapproved for the following reasons:............................................................................................................... ............................................................................................................----•------------....-----•--•---•---•-----•--------------•----•--•---------------------•--•- Date PermitNo....................................•------------•••---.. Issued..........�..... ................................ Date No.�...11!!....... Fimic v�........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _. .......... ...... . --......OF....................................... -------------------------------------------------- Applira#iun for Di,sliuual Works Chou 11 rnrtiun Prrat, Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: '��// • r�ir '. R.�:. ........ ?^ ............... .............................................. 0 ................................................... I ceation_Address or Lot No. Sep.!`.::: ! , • caner Address ....................... .......�1'-_:___ _.----------------------------------- ------------------ -P- .......................................................... Installer Address Q Type of Buildir Size Lot............................Sq. feet U Dwelling..LL No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) Otherfixtures ••---------------------------------------------•_._---••-------•-------•---•--•---- ----•------------------'• WDesign Flow......... _:. ____.._______.gallons per person per day. Total daily flow____________________________________________gallons. 1:4 Septic Tank—Liquid ca aci __ =ggaRons Length................ Width................ Diameter................ Depth................ Disposal Trench—Nof - `� ___.__ A .............Total Length._ ____.______._ Total leaching area____________________sq. ft. Seepage Pit No_____________________ iameter..................... Depth below inlet.................... Total Teaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY------------------•...-•---•-••-----•--•--•-•----•--.-..------fi........... Date........................................ Test Pit No- I ______________minutes per inch Depth of Test Pit____________________ Depth to ground water_____._______________,__. G% Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ P4 --•---••--_--•-:..--•--••----••--•-----•-----•--•-•-•--------•-•-••---•--••-•-•••-----------•---------------------------------------------------------- 0 Description of Soil............................................................................---------------------------------------------------------------------------------------•--. V 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 i i p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ed b� the b , f health. e s e SIg d --•••••-•- ---------•---••----_------ ...... .. ... ,.�''� Application Approved BY•---•- .. •. -/- .... {• ",jat� Date Application Disapproved for the following reasons---------------•--------•-------•------------------------------------------------•-------....................... ----------------------------•----•-••------------------------•---•------•-•-•--------------•-----••---....-------------------..•---------------=----------------_---------------........................ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ,. BOARD O HEALTH .............OF............ .... fe %-Catifiratr of hunt li�anrr TI . S IS ` O MTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by :.. - -- -----•----------------- at.. a L%Ii� F'. f -- -------------------------- i has been installed in accordance with the provisions of , j of The State Sanitary Code as descri ed in the application for Disposal Works Construction Permit N -___ ,.%� _- _______________ dated------- `:_2.—r _'________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE:............................................................................... Inspector.................................................................................... TH•E COMMONWEALTH OF MASSACHUSETTS 'r (/{�}{/it BOARD.. OE�.gHEALTH. fti"'ds"�-"•�6 9 No...._. .1......... FEE.... ✓_................ iu u 1 on , lion amit Permission is hereby granted...-• r to Const ct r • air d 1 an Indivi Sewa Dis VSystemS 6e444-1 Street as shown on the application for Disposal Works Construction P r it N /cn.___ Dated... ......_____________Q-_^�_J_____..._.... t Board of Health DATE---------�--------------------------------•--------------•-----------------... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS, TOWN OF BARNSTABLE LOCATION `2 CO fQ. SEWAGE# Z014.- 1 VILLAGE ['@v��lx��`�•z_ ASSESSOR'S MAP&PARCEL JV, INSTALLER'S NAME&PHONE NO. C—Q.L S17 ve pus SO�77(,-9atrf SEPTIC TANK CAPACITY /5-00 !7l41. LEACHING FACILITY:(type) Did' (size) NO,OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: 4WIPt 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY i 8 � D3 SheL 63 1 Z' C y-38 6f� Iq' �2� 13' C��S� + A LL0 CAT ION SEWAGE PERMIT N0. `-VILLAG I'NSTA LLER.'S NAME ' i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r } b I+� A C.Ve�