HomeMy WebLinkAbout0145 GREAT MARSH ROAD - Health 145 Great Marsh Road
Centerville
A=210-129-003 t
No. 42101/3 ORA
10%
o p 0
No. t2. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for Mfgpoal *p!tem Com5truction 3permit
Application fora Permit to Construct( )Repair(KUpgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No. ` �)t c>—. �r'y� � Owner's Name,Address and Tel.No.
Assessor's Map/Parcel /��S` . C--%C.,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder
Y
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
Size of Septic Tank V-DW ft;&A Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 Certifi-
cate of Compliance has been issued by Board of Heal��A
Signed Date
Application Approved by Date 3 — 6 — 27
Application Disapproved for t e follo ing reasons
Permit No. — ® Date Issued 2
No. L \ Fee y f
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS, -
s
01pprication for Diopooaf *pztem Construction Permit
Application for a Permit to Construct( )Repair( VUpgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ( Owner's Name,Address and Tel.No.
Assessor's Map/Parcel /9V+6rc G�'� CJ
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
CQ,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building No. of Persons Showers( ) Ca eteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
� C
Nature of Repairs or Alterations(Answer when applicable) Add
Date last inspected:
Agreement:
The undersigned agrees to ens re the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions offitle 5 of the Environmental Code and not to place the system in operation until a Certif--
cate of Compliance has been issued by this Board of Healt
Signed [. �� Date ilk 19 7
Application Approved by Date 9-7-
Application Disapproved for th9ioMb4ing reasons k
/
Permit No. 4'7 — D N Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( paired ( V)Upgraded( )
Abandoned( )by 0 C
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. —dated
Installer !�I<a�e:N. Designer
The issuance of this permit shall not be construed as a guarantee that the sy tem will funct4on as design d./ ,)
Date 2 '_ '� —a, Inspector .d
Ov
———————————————————————————————————————
No. �(7 _ Fee
/ THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mizpogal *paem Construction Permit
Permission is hereby granted to Construct( )Repair(Upgrade( )Abandon( )
System located at /[ r C` (����_ r�� � D d r , _Vc,
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: Approved by N--\
1 •
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
hereby certify that the application for disposal works
construction permit signed by me dated C o lC( , concerning the
property located at �����Stin� C''`Cr'(�,\J\ i r meets all of the
following criteria:
1 There are no wetlands within 300 feet of the proposed septic system
l- There are no private wells within.150 feet of the proposed septic system
The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
There is'no increase in flow and/or change in use proposed
✓• There are no variances requested or needed.
SIGNED : �'�- DATE:
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
jxert
,Z
�X sk
(TOWN OF BARNNST LE
LOCATION �'C�` S� lC SEWAGE # 7 ID
VILLAGE- F1,fj Vcj--J ASSESSOR'S MAP& LOTS
INSTALLER'S NAME&PHONE NO. <CA re\. G�—t,,n��( 7 f�Cf C7
SEPTIC TANK CAPACITY " _ D II Pl1 AV( D [ bX
LEACHING FACILITY: (type)�/ n .lk 1t1�'J (size) � I i C4 S
NO.OF BEDROOMS_ + )LI .!�r-s e;S w-'J'r,r
BUILDER OR OWNER &CkYV
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility y V 0A Af y 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 fee of leachin faci MdntFeet
Furnished by
v�-- 3 f
TOWN OF BARNST LE
LOC:+IJON 5� 2 SEWAGE #
ASSESSOR'S MAP& LOT J it'
INSTALLER'S NAME&PHONE NO. S C:d
Q.EPTIC TANK CAPACITY 4?,)(:( /o oo "L— d Id Pil IU(.t.J Q Q)X
LEACHING FACILITY: (type) kkt'04 ) (size) 0 Q �� S4br-,
NO.OF BEDROOMS 2 + 114 `�t-�`�:5
BUILDER OR OWNER Cs0,f"`L
PERMIT DATE: -3 116 (Cl COMPLIANCE"DATE:
Separation Distance Between the: ,
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �/ `�Q� J 7 Feet
Private Water Supply Well and Leaching Facility (If any wells exist J�Q� Feet
on site or within 200 feet of leaching facility) „
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 fee of leachin faci ' ) Feet
Furnished by VAIZ
4o �k?t' \(,
�, D
A -�o
L"0 CAA T ION� SEWAGE PERMIT NO.
VILLAGE pp
,INSTA LLER'S NAME i ADDRESS
S U I L O E R OR !WN ER
.1"�l
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED /Z���
{ I
� t
s>
r
•' / No.--R.q-:dfy Fizz 73............._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........../0.IUV-------------------0F........ R�.N.5729/�L .............................................
Appliration for Bi-spas al Works Towitrurthin Prrutit
Application is hereby made for a Permit to Construct ( -,,"or Repair ( ) an Individual Sewage Disposal
System at:
.......�.�...... .. _S ..... ............ ............•----..._L .--`'3......-- -•--...------------•-----...-•------------
Location-Address or Lot No.
^ ...... Y EA----•--'----......•..................... ..............��i cuf /' -----------•-------- - -------
wner f Address
Installer Address
Type of Building Size Lot_-/7.e8d........Sq. feet
U� Dwelling—No. of Bedrooms........... ..................Expansion Attic (A/'o) Garbage Grinder (d)
a`4 Other—Type of Building No. of persons............................ Showers
g --•--•-------•-------------• P ( ) — Cafeteria ( )
Otherfixtures ......................................................................................................................................................
W Design Flow................................... S.__gallons per person per day. Total daily flow.._.........._._........... � __--gallons.
C4 Septic Tank—Liquid capacityLS�o.gallons Length.5.�-.C..`... Width._4:_LfJ". Diameter_______________ Depth.
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.___U M...._.__.. Diameter___-_-td`......... Depth below inlet.._.�c7_...... Total leaching area.....e! �Lsq. ft.
Z Other Distribution box (K ) Dosing tank ( )
Percolation Test Results Performed .......ar f.41 (e_.... Date---- -___---•-___-_..
,.1 Test Pit No. 1.....c�.......minutes per inch Depth of Test Pit.....1 4....... Depth to ground water.....
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to grou -------------------
bF
O Description of Soil..._l?`.Z.B°_'T essa%1_ :.S s? :�i-...............I..----------------.......--------•-•-------
...........
Wx � L -- ----•-•.... •.--- -�----STEU - - ` . H
-----7z:e.►_49 _..W �.---._.. ......
L rna
-------------------------- ------. ------------------------- o -----wi -�
---------
V Nature of Repairs or Alterations—Answer when applicable-------------------------------------------- ____ �-M,_3p2.16-- _-- -----------
.e
--•--------•----------------•--•------•---•---••---...-•---••-------------•-•--•--.......------------....----•-•-----•--••-----•--------•----.......---- is _
Agreement: 4`„
. ; The undersigned agrees to install the aforedescribed Individual Sewage Di posa stem i cce n "a` rdance with
the provisions of'TT . .
p 5 of the State Sanitary Code— The un'er�igned furt'1 er agrees not to place the system in
operation until a Certificate of Compliance has been iss by th and of iealth.
Signed _.. . ......
---.-•-- ----.....•----.....---
ate
Application Approved BY -- -- -_ ---•----------•----------------------------------•-- //6 �-.---
Date
Application Disapproved for the following reasons:..............................................................................................................
...---•-------------------------------------•----•-----•-----...---•---•---------.....--......-------•--------•---•-••.......--- ---••----------•......................................................
Date
PermitNo.- .- F .............................. Issued_.......................................................
i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........../Ztjnl_...............OF............ r«U. T.L9 �� ------_...........................
Appliratilan for Eliqpns al Marko Tatti3trurtiun FmAit
Application is hereby made for a Permit to Construct ( L-Kor Repair ( ) an Individual Sewage Disposal
System at:
.........................•---........_ - _•................---------•••-•------ ......................Ge':l_.2------- --.....---•-..__...._.....•--•------------
Location-Address or Lot No.
{owner / Address
a •........ ...1�!ts-5t- is ! -------------------------------- ............... ............. ..._..----------------------------
•......
Installer Address
d Type of Building Size Lot--- _7._66_0.......Sq. feet
U Dwelling—No. of Bedrooms...............5_�.sxt-------------------Expansion Attic (/Jc) Garbage Grinder (kh
pa-I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
0.1 Other fixtures ----•--------------------------- -
W Design Flow..................._...............SS._gallons per person per day. Total daily flow__.____......__.....__......ZZSa....gallons.
WSeptic Tank—Liquid capacity.l.Q�_gallons Length__'&'_.(-`:__• Width._�__'__l_O'. Diameter._:.._._. Depth-- `e_.'1
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............. .....sq. ft.
Seepage Pit No.....0�-------- Diameter......LQ_-------- Depth below inlet------- Total leaching area.....�2.S',?.sq. ft.
Z Other Distribution box (X ) Dosing tank ( )
aPercolation Test Results Performed ............ Date----- `t�Y_ -----------
,a Test Pit No. L_._.t2-------minutes per inch Depth of Test Pit.....t A. Depth to ground Water......... .
�T4 Test Pit No. 2................minutes per inch Depth of Test Pit_--______-______•__- Depth to ground ---_-____.
_..-•-•--•--•------•---------•-----••--------•---•---------------•---------......•-•----•----------------...._ ------
O Description of Soil---v-z - ! �:t1_ __ V la:�ail........... ..:.. -----... ST�PHf ��
-••-------•---•--------•------Z T 71<..--.:5:tnc*t�-fd---lYticc�_�irt__ �e J` cc_v <n
(, X----- -aEUYl�1----•--
••-•----------------------------7Z r Fh l v�n i.�_.l):Ltc�tJy�� `�ia���-------•---•---------•-----------••---•---•--------- W1.�SON
U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------- _ No.3o----
-----•--•------------------••----•-••---•••. �Q
,rc Z.g� k.
A eement: �%� G
The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syst in accordance it�
the provisions of T T L?; 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.
Signed.
--------- --------------------
Date
Application Approved By--- �� `1t r =`" C,`._,------••--•------------------•----•---_.. 1J�1� ��-------------
t
Date
Application Disapproved for the following reasons:------•-------------------------------------•-----------------•----------------•---------------------....._...--
--•••--••••••........-••••-•---------•---•-•••-•••--•-•----•--------•-•--...-------•••-•------------••-----•----•---------•------••-----•--•---•----•---------------•----•----••-•----------•••-•-------
Date
Permit No..�3 ....144 /-----•--•------------------------ Issued_.....................................................
�
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
�rrtifiratle aaf Tnutpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,..")/Or Repaired ( }
by---------tl;Y-7 = :__. �2_<._...--•...............................•-----------..__.....---•--•-----•-•--•------......---•-----•--............---------------•--•---------------
-s fir, 1n taller
at
LzL
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.��_� cl%______________- dated__ jr/,Plf..__._..__.._____.___.._...
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A dUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................•-•--------••---...---------•--.._..........------.........._._. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
_ BOARD OF HEALTH
NO........................ FEE. ..................
wispowd nrk ��n trnrtinn �erntit
Permissionis ereby granted.....................................-•.....--.---...•--....-••••--•-•--•-•••...----•-•••--••••-•-•-•--•................._..._............._..
to Construct ( ) or Repair ( ) an Individua Sewage Disposal Sys-teem
at Nam-oaf f�!' ._.:�Z. _. l x ,: .__�� 6 '�'
Street
as shown on the application for Disposal Works Construction Permit No-P -,_?? Dated..........................................
----------------••--•------------•-••----------------- -•-----------•...................................
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
DY�SIGN DATA TEST' PIT DRTp o ?-7351
Garba-_c_ Grinder
-� Nv e
Sepf'tc Ta.►,lt =?20 x I50 330Gc�11ov�s lt�;+ets_9si_S_T
US E : -
L.cach it
SieQ'tw411_� /7$SF X 256pd/5F _ 9�-s GpD �p�,/� `r6,8
[3ot+om S��ksFx 1,0Gpd SF
P� 94.8
s=mac >r
OF
` IN OF �A�f4aR. Gra�rc I
RICHMD . may'''
STEPHEN '$G $ A. �,`, a
'" c MWE1 s
� ALLYN � � � 72--
WILSON H. N O-24048
.e .Q�No.30216$ gECIS1ER� ¢,fit�� ' 7rtdw✓�
G1N LA
7-s0-8f Top o{
AJjus+ ;rticf cover' Fovnde or1
'b one boo+ below
FI /03.0
' '�tnlsh gra�dc .
1 Nv
� IWV A/st, V I U00 '/00,0
9,2 Ctx INV 4P4"5 Ga//an INV
iJ -d �� 1..
v 95��} . Syotro 94.$
9B,D ?an/k
Botlom o,
,F1,3 Leach ►);t
2 I
S�STEPm PkOF'ILE CNor +a Sc.Rte)
L . CeRTIFY -m-IAr THc 1 oAQsrpt�ous.r= ,SEPTIC SYSTEM D£SIGN
SHOwN HeRs- ►i CoMPL.YS W17-H 7-He L0C,47-10,V
SIDELIQE AND SeTDACK RF-QUlr?GMe.fjT5 C'e��}c✓ le.(l�.
OIL' THE TOWN. OF i4N.D
15 NOT L-CoCAT'ED WITHI#-1 fit t=LOoU(oLr IAJ SC�4L5 1_�=-4-.c�� Z7A-T2�:
�G4N REF"E'RENCE.r.P%d;,4Z�j�--p976 .
1�ATt?
THM PL.AU IS NOT 1BA5i D ON A J a A XTt=R , NYE , rN C,
145TRUME►JT SURREY .AND THie Ot=FSETS R7 .�hiecl A8nsf 50'evec ord
SHO�IP! NtrRlydN 5►to.ULD NOT' f3E UStD Civ// �/nrzr-s
TO ESTAe LI SH LOT L I N LES ., d s r,=/2✓it-Lt,= �I,tSS
SZ�
.Iy ,
1
ZONE: RG
Sctb ac Ic.S Fr a nt
- ..ra o1d,�°wep�yyyi�R+p'-.rD11i+CN�GV�MI
N /oa-
roe_ 1
/as
a:to
/
ci
ci IoS✓ /� / f
IoA
/
1oZ </
,ol
/Op
9$ 1 I �
goo �10F�q
��
lot STEPHEN SG
-10Z i ALLYN rn
c3 WILSON
1 o Q .o No.30216�Q
� o ISTE
'17 �P�c�i- �p / , to S oD�•reF A N6��
Ol
37
0
CO
0
6 / ��• D.9.
LOT 3
1� �//a3.9' � � .6REr7T/l7N25N ROrftj
4
SCALE 1"- 40/
y
e-7 Z 4
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR
(WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on thes forum
at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, I" FI., 367 Main St., Hyannis, MA 02601 o�
the Business Certificate that is required by law. (Tow Hall) and get
r Fill in please: DATE: ZD U�
APPLICANT'S YOUR NAME:
~ , BUSINESS — y
YOUR HOME ADDRESS /y lrR T✓si¢R 2A 6f 71XViLL� v 26 Z
Sp�_ 7 7S�s-3 7
�X- �?S-�s�7
TELEPHONE # Home Telephone Number
NAME OF NEW BUSINESS �,
IS THIS A HOME OCCUPATION? YES TYPE OF BUSINESS
Have you been given a NO
Y g� pproval from t e building division? YES NO
ADDRESS OF BUSINESS /y R C�N ,2vrlC 02432- MAP/PARCEL NUMBER
When starting a new business there are several things you must do in order to be in. compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 M
Yarmouth Rd. & Main Street) to make sure.you have the appropriate permits and licenses required to legal) operate our b (corner is
town. Y p y business in this
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
�
2. BOARD OF HE
ALTH
This individual h�beeormed e mitr e irents that pertain to this type of business.
Authorized Sign /COMMENTS:
3. CONSUMER AFFAIRS(LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS: