The URL can be used to link to this page

Home My WebLink About0069 JOAN ROAD - Health =JOOANNTERVILLE 7/1 Nu 12 34 2�1 3LOR � HASTINaf.UN TOWN OF BARNSTABLEJ LOCATION ��J �- SEWAGEO ..-qq--47 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. a;L EO C,a Q P Si t - SEPTIC TANK CAPACITY 1,5-o 0 LEACHING FACILrrY: (type) Tod ! ' (size) 11 Y 2- {'NO.OF BEDROOMS BUILDER OR OWNER PERmrrDATE: iO—f '-,! 1 COMPLIANCE DATE:41t5l 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 A3if1337-2-. �J�_ v TOWN OF BARNSTABLE W� LOCATION I V uhp- SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. e221 if)Cdp, R SEPTIC TANK CAPACITY ��► LEACHING FACILITY: (type) //IJ ,�T/'�ff r6li (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: l D 1. COMPLIANCE DATE: Separation Distance Between the: I 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 Fee `✓ �- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 2pplication for Migogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(C�Abandon( ) WompleteSystern 0 Individual Components Location Address or Lot No.lQ�( SU��, eye(t Owner's Name,Address and Tel.No. Assessor's Map/Parcel C V 0 Or+T- /ti`LN/ Installe r's Name,Address,and Tel.No.C Designer's Name,Address and Tel.No. IthcO—iLW� SEPAL 57—: ,q"UL�s 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 3 O gallons per day. Calculated daily flow -3`t 67 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I15Q 75) Type of S.A.S. iTl �"ck �_ZT-' �`Trk\_0 Description of Soil Nature of Repairs or Alterations(Answer when applicable) / �� 5� -�� 0�` 1 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' Signed Date 10 -K-5; ' Application Approved Date Application Disapproved for the following reasons Permit No. Date Issued `d°-'/ �P w 7 L. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSA, USETTS application for ]Di!5po!5ar bp!5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( L.<bandon( ) (%Complete System ❑Individual Components Location Address or Lot No. y\yt_ (t Owner's Name,Address and Tel.No. Assessor's Map/Parcel 07D t3 AT fQ- -�✓ ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. (IP—s-ep-7\c_ l5 �nVt Type of Building: _ Dwelling No.of Bedrooms / 5 If?ogSize sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �y gallons. Plan Date Number of sheets Revision Date. Title Size of Septic Tank 175CZ) `'1 (A— Type of S.A.S. t C r, Description of Soil ✓� S <. ` i tr61 Nature of Repairs or Alterations(Answer when applicable) /SOV S-e,0-1 VC V_- 0—t?Cf`" F6ot� S,k G c•—, ee e,�S Datc 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 bee�is i Signed Date Application Approved be —Date-Z,,d ZA977F 9 Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(X) Abandoned( )by at LQ si Mc C I YTEE VC Sf i I — has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated /!1- � 5 Installer Designer The issuance of this p shal /ot be construed as a guarantee that the s fem will function as d ign. s Date l "! Inspector �/7 r /Ir� �U No.--�—�'�-------------------------Fee ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migoal 6pgtem Construction Vermtt Permission is hereby granted to Construct( )Repair „)Upgrade(?e-4 Abandon( ) System located at In 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 mus .be completed within three years of the date of this t. Date: Approved l' ,a 1/6/99 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) hereby certify that the application for disposal works construction permit signed by me dated !0��—� , concerning the property located at �o�l .)6 /� (�� C��- meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 4, 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 sere are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed r . There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum 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(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 7 ? B) G.W.Elevation t�+the MAX.High G.W. Adjustment. Jr DIFFERENCE BETWEEN A and B v /� -;SIGNED : DATE::— [Sketch proposed plan of system on back]. q:health folder:cert ..� Gam/ '� � ` -i . � b d 55 11'1 12' 18'11 14- fV Existing bedroom Existing Existing bedroom 8 Living Room a N f0 N Existing Family Room N Existing Kitchen& Existing Bedroom Dining Existing Bath LLL- 1319 11' 1T1 W2 LIVIN 56,AREA 142ts sq ft No...49.2::� — t IRt...5.............. .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..................... ....................OF.......................................-------------•-••-----------•------------•-------• Appliration for Diipniial Works Tomitrnrfion Permit Application is hereby made for a Permit to Construct ( ) or Repair I an Individual Sewage Disposal System at: ........... ............................................ --....--..............•.-•••.........._.. Location- dd' ss or Lot No. ......A, *A ,�`�........................ ---------........-----------•--------.............-- Owner Address Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............ .. --_-•Expansion Attic ( ) Garbage Grinder ( )�+ Other—Type e of Building mr pi yp g ............................ No. of persons........ Showers ( ) — 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-------------------- 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit............ Depth to ground water........................ ---•------------------------••-----•------•--•---•-----------------•-•-•......------------•---......................................................... 0 Description of Soil...:............................................................... x U U Nature of,Repairs 4r Alterations—Answer when applicable._. ._. greement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'I ME 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n i sued th boar f health. - Signed.......... • ''n .= Date Application Approved By------------- -GO.�__. ... . .. -• .................................. ......6,� .......-- Date Application Disapproved for the following reasons:................................................................................................................ .................................................--...................................................•- Date PermitNo......................................................... Issued_....................................................... Date j i e!' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...-----'... ..... ..................OF........................................ Application for Uiopoii al Work.6 Tonstrnrtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair �) an Individual Sewage Disposal System' at: ation- lys�s or Lot No. / ...................... owner Address Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms... .........................Expansion Attic ( ) Garbage Grinder ( ) '14 Other—T -«•-� a --------_-of Buildin g ____________________________ No. of persons....... . Showers ( ) — Cafeteria ( ) d 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. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed b ......................................................... Date........................................ ,-� Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water......................... fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ....---••---••••---...------••---•••----•••--•••-••------•-----...---•-•••-•---••.................•-........................................................ 0 Description of Soil............................................................................................................................................................_....... V ••--•--•---•-----------•--••-----•--•.....................••--••--•••-•--•.........----••......----._...__••----•-----•----•----•-••---•--------•-•••-•----•-•------•-----------...---••------•--------- W -----------•-- ---••-•------•--•---•------------••--•---•--.....--•-•-•--•-- U Nature of Repairs 9r Alterations-Answer hen applicable...__/,&g2 greement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has born-Issued th boayh9f health. Signed---------- ---L ----- ...._ ._. ...----------- -•--•---------•--•--.. ,�,.' Date Application Approved BY `�'�• � .. -.-=�••----•-•...............•-••-- .....6. r,, °:%....--•••- „". � Date Application Disapproved for the following reasons:-•------••-•--••-•-----------------------••---•-....---•---------•-•-----•--------------. ----•-----_--------- --••---_-•------------------•----••--•-•-••-----••-•••-•---------•-----•---••-•--•---...-•-••-•-----...._----•----------•-----------------------.......-••-•---------•---•-----.........-----••-•-•-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................:...................OF........... ......................................................................... (9rdifiratr of Tontplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....................... ------------------------------------------------------------------------------------•---......._....-------...................---•------•-- �� Installer at............. .7...-••--•.... ..........A--h.,__... --------------------------------------••-------------.......- --------------- has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__9._Z._-.14f.............. dated----------..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................................��1 a:�,l . Inspector........... .............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.. ................................•----------•--.........._............... FEE_: .... ........ Disposal lforkv Tono#r ion rrmft Permissionis hereby granted.................... -------------------•-------------------------------•----•--••---••----•................ to Construct (- or Repaair r) an Individual Sewage Disposal System atNo.--•------ sal. _ _........ ,.. - �' �' � ............-.............._.................. Street . as shown on the application for Disposal Works Construction Permit No..................... Dated........................ ............... "Boap of Health ti DATE................................je __✓'+lz _a ` FORM 1255 HOBBS & WARREN, INC., PUBLISHERS i LOCATION SEWAGE PERMIT NO. G 9 Jr6,4AV VILLAGE 0 CF>G� Y/GC� 10414 INSTA LLER'S\ NAME i ADDRESS 8 U I L 0 E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED I v jr s3 3� �2 �rw