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Home My WebLink About0876 OLD STAGE ROAD - Health LA ILD STAGE ROAD le — 212 _ SMEAR No.2.153LOR UPC 12534 anmwtwm • Made In USA op- Oc 1mmtmNiNIIOO mt" WMHOAMOMMSrl pF11ESRiIIOGYMI s WWWWROOPAMAN TOWN OF BARNSTABLE LOCATION $`)[, O L-0 -TJg, SEWAGE# O - 00 jq� - VILLAGE (2cnAr-ru i 1Ic ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. B,�3 EXCaVa4 i oe\ SEPTIC TANK CAPACITY BOX r% L4 >> LEACHING FACILITY: (type) (size) NO. OF BEDROOMS OWNER 7-06t1 0'Conc�*r PERMIT DATE: 1 - 13 - 1 S COMPLIANCE DATE: Separation.Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility s 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 Al -Tz 81- V AZ•2161 QZ- 29� A3-3y,G.. II3- 3q'/, ' Ay- y°' BH- Liq ' 1. p Fron-i No. 60 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes _�G PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 9ppYitatiou for 30isposal *pstrm Construttion Aerutit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address lqr Lot No.g` ( ®��(�q•� O-w is Name,Add s,and Tel.No. Assess Map/Par�cel � O h R T 5 Co n nv ( 50 `�3 67—L 1 4 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 9653 )",J A 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(min.required) gpd Design flow provided i dgpd Plan Date Number of sheets Revisio ate Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r 1 (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 Certificate of Compliance has been issued by this Boar of al Si a Date11(311 Application Approved by Date Application Disapproved by Date for the following.reasons Permit No. ( -- �� Date Issued I 1 `" 4 a Na ------- __'_ �da / r No. J �U j /' Fee 04) — '" THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer: Yes es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for -Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location nnpAddress or Lot No.g & 0 LDS4aq.e Q f) 0 is Name,Address,and Tel.No. Assessor's Map/Parcel _ 1 JU h n T O Co in rev ( 509 3 -b -H"1`+ Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. + (3 r.Lav��ionSDg - y7--o66`3 I-A 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(min.required) gpd Design flow provided , 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) 2 io id —bo [ o (1 L V `4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 1x accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of 1 . Compliance has been issued by this Boar, of al Signa Date 1 Application Approved by Date 1 / Application Disapproved by Date for the following reasons Permit No. 20 (S- V Date Issued I WV'-rams 1� ---------------------•---- -------------------------- z - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance // THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V ) Upgraded( ) Abandoned( )by at LO S 4 /— v h been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. °/ �' Od dated ! I l - Installer .Po hpa 11 ro Designer #bedrooms Approved design'flb w / / J I gpd 1 (( U,�VA The issuance of this permit shalln'ot be construed as a guarantee that the system will fubction desgned.Date E�J ` Ins ector //� ,i t�/��__�/f l No. )G O UJ� _ Fee / (J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS _D Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(('/) Upgrade( ) Abandon L ( ) System located at e O S--Q()-p (((� �P : p�� 1 ( -e 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:Construction mu t be completed within three years of the date of this permit. Date I ( ! �,�r Approved by v "es TOWN OF BARNSTABLE . � C� D i -� 'LOC:g.T10NrIU - -Y SEWAGE # 4- � / 7 VILLAGE l.��(9��.• ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO'1 r7-3j CJW14,uo -77 FioW4/- SEPTIC TANK CAPACITY /0 00 LEACHING FACILITY:(type) (size) i91c(e, NO. OF BEDROOMS PRIVATE WELL OR PhUBgLIC WATER BUILDER OR OWNER Jb 1, DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes No ---------------- i 25 . - e 1) S*ACI S f I No.... . _ Fxs....l... ........... APPROVED THE COMMONWEALTH OF MASSACHUSETTS Barnstable Conservation Department BOARD OF HEALTH 1 _ ,�; e2 OWN OF BARNSTABLE Applirtt ttntt filar Diti-paiial Workii Tomitrnr#ilan Panfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................ ............... ................... .••- .�- Location-Address or Lot No. e /l...J./...I'.. Owner Address a ... -G�- '�a�� --------------------------------------- � Iustaller Address Type of Building Size Lot......14�,' ....Sq. feet Dwelling—No. of Bedrooms..............�-----------.--..__...Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building � � . �o /�No. of persons ._._ Showers — r� YP g -- - - -------`- - P --------- ( ) Cafeteria ( ) 04 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........................................ a Test Pit No. I................minutes per inch Depth of Test Pit....-.-.------.-_- Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....------------.------- ------------------------------------------------------------------------------ ------ -.----------•------•------•----..... 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 TITLE 5 of the State Environmental 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 ---------------- ---- --------------- -- ...,---. ---------------------- ...... ---------.._------------------ - Application Approved By - = d ..... .. .. ......... / /f ---- - -- -' ........ .......... ... ........ ......C Dace --------- Disapproved for the following rearons: --------- Application ............._...........-......------------.._...------..._. ------------------------------------- ---------------------- ..---------------------- --- ........................... 7... Permit No. .......... .. o ..:........... Issued ------------J r` .. ..................... t /Dare ..�.... 1�.::. 1. No.. ;L 1 Fr;s....�.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9TOWN OF BARNSTABLE Applirativit for Big oottl Works TouBtrurtion Prrutit Application is hereby made for a -Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. .....C�-.-C U%t//,/O .................................................................................................. Own r Address a C�__G�2.. �a Ens Address.. ........................................... Iustaller Type of Building Z Size Lot-------151 ....Sq. feet Dwelling— No. of Bedrooms------------________________________________Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building vr_ANo. of persons----------_�' - ( ) Cafeteria ( ) ___________ Showers — a' 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 ( ) `" Percolation Test Results Performed by.......................................................................... Date........................................ 1 � 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........................ 04 --•-••••••----•..............•-•-•-•-----•--•-•-•-••--......---••••-- ......... 0 Description of Soil...--•-•-••-•-••••-•-••-•---••••'•-•••-•••••••••-•-••••-•-••-•-••-•-•--•-•---••-----'--..----•--•----.... i U ---------------------------------------------------------------------------------------------------------------- _..................n---•-• /- �/_ /. . -••--•-------- -----------------------------•-----... --------------------------------------------------------_ /IV /) - - 7 1//) x ----T. � ,� v;i V 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 TITLE 5 of the State Environmental 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 _... - ---------../.�1. ..-> ---------------------------.!....... /--------- / . / ��, , -...... ------- Application ��' Application Approved By - {��-- ,� i. Disapproved for the following reasons: -. -------------------------------------------------------------------------------------------------------------------*---------- ------------ -- ---------------- ---------........ i----------- -------- ............... . Dace Permit No. ........... ........`'--/...-` --------------- Issued ............. .l.j /-/. f---c / J Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Te rtifi ate of Complianre THIS IS O CERTIFY Thatt the Individual Sewage Disposal System constructed ( ) or Repaired ( ) .... z - . . . --- has been installed in accordance with the provisions of TI"I'LE 5 f e St t nvironmental Code as described in the application for Disposal Works Construction Permit No. .... .� �7.� ..._... dated ......._.............._.............._.__.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE . �SATISFACTORY. SYSTEM WILL FUNCTION SATISFACT � DATE-----------/._-. - - .... Inspector ...- _... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.....1.... .•........... FEE...:.........0... �io�osul ork� ��attotrttrti�n �rrutit Permission is hereby grante -V` �- = � ................................................................ to Construct,.( ) or Re air ( ) an Individual Sewage Disposal Sy tern C ......................................Street as shown on the application for Disposal Works Construction Permit No.,----....... �Dated........................................... •• 4 ------------------ •-•--•---•-•--•----•••••......•.... �- Board'of Health Al DATE f -----•-----------• r� v Ea .��? FORM 36308 HOBBS 6 WARREN.INC..PUBLISHERS