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Home My WebLink About0080 FARM HILL ROAD - Health 80 Farm Hill Road 1 Centerville f A= 247 - 095 (i No. 4210 1/3 ORA Pendaflex' ;►moo 100 • • ----------------- u..w.. ..�_� .. . a.� _ n w .......... L 9 No. SY: .ifl...� Fas....�Q..... ..... THE COMMONWEALTH OF MASSACHUSE77S BOARD OF HEALTH , pphration for Uisp oal Works Tanstrur#tun Frruti# Application is hereby made for a Permit to,Construct ( ) or Repair (V-)�an Individual Sewage Disposal System at: ....... _ ._.k1_s��...--- :.................... ...... I: ..................... Location-A dress - or Lot No. .........._. ?- .... j!. ................................ ............... tn'1. ............................................................ caner .. ......................... p� _.....` ` r ss ............. ..-•- ...... •- Installer Address Type of Building Size Lot.......:....................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Pao Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------------------------••-------- Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 'Septic 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....../:0_.____. Depth below inlet_.._l�__......... 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........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.,.................. Depth to ground water........................ W .....................................................=....................................................................................................... 0 Description of Soil.................................................................--._.....__...•••-•-----•--•------•-•----•-....••----••-••••-••--••-•-•--._....._..••-.....•----_..._. U - ----- - -------------•--------....-•---------•----•---...---.....-•-•-----------........_._..----..........---------------._.....-----.._..------•--•-•-----------•---•-----•-•••----••-••._..._...__. W ___ Nature of Repairs or Alterations—Answer when applicable_._� _ &7_�1 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLi� 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 h Ith. Signed------- = --- IF:�V_4. D to Application Approved By ` ' __ Date Application Disapproved for the following reasons:................................. -__-___-___-___-___-._----•.-•-•--.---••_-----_•••_•.._..._..__._............ - ......-•--••--•--•--••...................•--.._...--••---•-•--------.._.....------------•---•---....__....---------------...-----•-----------------•---------------------...---••-----------..__...__.... Date PermitNo.__ ......di-------------------•-•-----... Issued_...................................................... Date � ` -� ' - . - . ..s .. ../.1.. , .z _ - v .. _ . �, � . - —J `-.. � ..�. .��i�.�w1��4�-+..a.�..-.J-l..�,••vw-W�.�•fur.v. -+ - THE COMMONWEALTH OF MASSACHUSETTS R BOARD OF HEALTH `1' �.6�_...... j OF...... ..... . �_t . .....w ......................... ,�ppliration fur Dioposal Works Tonotrurtiun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (1r-) an Individual Sewage Disposal System at: -- d ------------- Locations_Address or Lot Now ........... .:..'! .1_�,.._... ]C i--�-�--F-?•----...-....--•--•------•------- -•-•--•-----•.—S �---s--------------••-----------^ Owner Address w C 14.P r ..a A � ,� j.F--------------------------- ----Pam,. `� .......... -------: �: ?:.��t Installer .. ..... .................... Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of ersons____________________________ Showers — Other—Type g --------•..............•-••- P ( Cafeteria ( ) 04 Other fixtures ----------------------------------------------------------•.....--•-••-••--•----•------•.•-•---------._...._......-• -----_.... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic 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_.__C_._..__. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '_4 Percolation Test Results Performed by......................................................................... Date........................................ 1 $4 Test Pit No.. I................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........................ 9 ---••--.._..•---••••--••-•-•-•-•-•..............•-•••---._........-----..........--•--...._...•--•-•......................................................... 0 Description of Soil........................................................................................................................................................................ V --•-----•----.....••-•--•-•._....••------------------•-••--....•----.._...... UNature of Repairs or Alterations—Answer when applicable_.__�T-.& 5'Tx2d._.___n^ __.__.:.: ,--7--`---__--_ .------•Via^, f1 R, 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 of health 4.1 Signed----•--`-_--� ----••- ---� ��/�-•---- -- c�.3'--•--...---•-------------- ---•-�---•-Date y �. Application Approved B •••- y." * :�� --• a,----•- - ... .!�^ "� '` �'.2- Date Application Disapproved for the following reasons:................................`.............................------------------------._...--_-------•-------- .................•--•--._.........------•-•--•--•---/••-------•---•---•----------•-----------•----•-------•-----------•-•--•---•--•••-•--•••••--••---••--------•••-••••••---•••-•----•••---••--........_. Permit No.. .....9 1/0 V Issu�--•--...----------Date•-•--•--..........Date....-- ------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ill OF i4rea4sT4�e..a............. . .... .......... . �. . ............................. (Inl tifirate of Tomphatt r , THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by..................._ _ -------'----•--------•-------•-•-----------------------'•-•-•---•--------........----•---•-•-......._.....--- ` Installer at.............................. __..C=(�•Y...V............ .......................................... r?T"--------------------------• . has been installed in accordance with the provisions of TITL: 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-___.1-':-_t_Ql_................. _____________________- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ DATE........... f�l -1 -,-I - 4�" -----_. Inspector--------------•-- ~, �- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1T-1'��l✓ .....OF..... ...................... ' a3 No._r�_�.-I .4..... ... FEE.rs•..................... Disposal Works Tunstrudion "fermi# Permission is hereby granted-------- ---------------•---------•------•--------...---...._.._...---._.... to Construct ( ) or Repair (lam)-an Individual Sewage Disposal System at No........................ 1 t--^t?_!M.f:L:+.�.�_._... �� "•_f✓�.!rT'["--------------------------•----------•----...---..... _-•- L -...... Streetl t pp as shown on the application for Disposal Works Construction Permit No. ^1!�?-�__ Dated_._._. ' n': ............... `/_!Z! ((��-q�- �u�„ra of Health � DATE..--_1- -----------•----•----'--------------- ;----------••-- TOWN OF BARNSTABLE LOCATION G SEWAGE # q q,0;)L, G V ASSESSOR'S MAP & LO � INSTALLER'S NAME&PHONE NO. In/O C44K .2 4 4/c 7 SEPTIC TANK CAPAC= LEACHING FACILITY: (type) /yfi /-fOlf/ rays (size) // X2s NO.OF BEDROOMS BUILDER OR OWNS PERMTTDATE: M COMPLLANCE DATE: ri Separation Distance etween 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 '• ' R f -4 cLci—o a �3 �,�3 TOWN OF BARNSTABLE LOCATION ?_6 AA 9 &ZZ11l 9 SEWAGE # � VILLAGE ,�/7�ti��s 02oX7 ASSESSOR'S MAP & LOT ^ " INSTALLER'S NAME&PHONE NO. In CX dQ' ,S'e e� SEPTIC TANK CAPACITY %S a 67 LEACHING FACELITY: (type) f.yfi /r All (size) NO. OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Wetween 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 -- �g, �N /C7 r 0 tl .9 No. r L, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpprication for Migooal *pgtem Cow5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) omplete System ❑Individual Components Location Address or Lot No. ak _ Owner's Name,Address and Tel.No. �-i5�OQ1, Assessor's Map/Parcel 2 V� 15 re", cti v �i Installer's Name,Address,and No� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3�a gallons per day. Calculated daily flow �� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 ry 6-D Zl G`'`-/ Type of S.A.S. G ' Description of Soil Nature of Re airs or Alterations(Answer when applicable) �A �— L t 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 E nmental Code and not to place the system in operation until a Certifi- cate of Compliance has ea Signed Date —4 Application Approved by Date `7_ 9 — 9 Co Application Disapproved for the low g reasons Permit No. �q- t7 L :L Date Issued No. ` ..`. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYtcation for Diopoeal *p5tem Contruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) _*omplete System ❑Individual Components Location Address or Lot No. t— _ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Oct \f Installer's Name,Address,and Tgd.No.` Designer's Name,Address and Tel.No. k Type of Building: � ,. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) .. Other Type of Building No.of Persons Showers( ) Cafeteria( ) j Other Fixtures Design Flow `_'�\/3 gallons per day. Calculated daily flow �� gallons. Plan Date Number of sheets Revision Date ' Title' _ Size of Septic Tank 1 S Type of S.A.S. GZ Description of Soil Ot-� 5\00-10 Nature of Repairs or Alterations(Answer when applicable) A. \G�✓ L��`�'� y C3-s`--� T ''Date last inspected: ' Ag_reement: 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 E nmental Code and not to place the system in operation until a Certifi- cate of Compliance has i ea Signed Date Application Approved by Date "Z_ 9 - Application Disapproved for the lows g reasons Permit No. q9- �"� I �L Date`Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS � certificate of Compliance THIS IS TO CERTIFY, t 00/ On-site Sewage Disposal System Conitl''iicted( Repaired ( )Upgraded Abandoned( )b _ 't -G Ifs rJ� t Q . at O t- L - t g 2 V\ h�asy ee�i•c_onstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. y dated Installer Designer t ,, The issuance of this permits ai not b cc�sfrued as a guarantee that the s ste wtll function as des gne&' Date "1 Inspector r' 'r�� _ il Sf'i lf� �21, � --------------------------------------- No. ` " Fee" `7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Df6pogai *p! tem Con.5truction Vertu Permission is hereby granted to Construct( )Repair( )Upgra ( A ndon( ) System located at U .c.:- A aUk < ,\ 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 this permit. Date: - - / y Approved by �`" NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, a hereby certify that the application for disposal works construction permit signed by me dated —ci cl°l , concerning the property located at U t*� 1 1�` IT 9 6 meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the um adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(1 d) feet above the maximum adjusted groundwater table elevation, Please complete the following: ` A) Top of Ground Surface Elevation(using GIS information) `` v B) G.W. Elevation V +the MAX. High G.W. Adjustment If f _ / 1 f DIFFERENCE BETWEEN A and B 30 SIGNED : DATE: [Sketch proposed p an of system on back]. q:health folds:cen t% !> ;� � ` G v d .e � I