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Home My WebLink About0019 WARWICK WAY - HealthFF19 b ZAVICK WAY, CEN76RVILLE A- 148-067 TOWN OF BARNSTABLE LC ATION i? /- SEWAGE # -- —� LL�� VILLAGE. h Yi / �AySSESSOR'S MAP&LOT S`'1 i INSTALLER'S NAME&PHONE NO.,4�6 r-A016v SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 7-Rs4-'og,3 (size) NO.OF BEDROOMS BUILDER OR OWNER 1710,0ele k PERMTTDATE: ® N'/2--" COMPLIANCE DATE:`®i 3LO " FS'— Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 306 feet of leaching facility) Feet Furnished by 30 ca 38 r-1 � 0 0 7 i�0-1- 0o No. 9'S Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for XDigpo!5a1 *pttem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(vl�an On-site Sewage Disposal System at: Location A)lr/ess or Lot No. Owner's Name,Address and Tel.No. j2aber-i 11021e 011/"e 4/�f - Installer's Name,AddrN,C e1.No. Designer's Name,Address and Tel.No. 350 Main Street W Yarmouth, MA 026" Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations Answer when applicable) 1� 7J`1,4 S�P 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 this Board ea h. Signe Date k) Application Approved byo ZZZ Application Disapproved for the following reasons I Permit No. 'S -740 Date Issued Z� �A of r cxo No. w Fee�r THE COMMONWEALTH OF MASSACHUSETTS_. _ - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTSTl �L/ 0(ppYicattori for Migotal *pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(✓�an On-siie Sewage-Disposal System at: Location Aj dre/ss or Lot No. ,, Owner's Name,Address and Tel.No. //, �y lid b e r f �u a l t (Shn-,e 11a8 - Installer's Name,Addres"76.ICANCO Designer's Name,Address and Tel.No. 350 Main Street W. Yarmouth, MA 02673 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations Answer when applicable) - h f 11 `•�.t �'}'Oi'1-@ d✓1 Si� P S Q.yt a0 �y'' (L/'� c � ,d►"' Date last inspected: 'Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system An accordance with the provisions of Title 5 of the Environ en al Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board ea h. ' r Signed Date 10 -f U- Application Approved by L Application Disapproved for the following reasons s' Permit No. ai �� Date Issued +' �)/T /l t THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance - 4 . THIS IS TO CERTIFY that the On-site Sewage Disposal System installed.( )or repaired/replaced(✓)/on by A f for /2 y 6e r it ,/"t(yt2 1 t y as' d le has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.G 5 ( 7(2J dated '2 . Use of this system is conditioned on compliance with the provisions set fort . w: No. / `y(!/� Fee o THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS '=i5poq;al *p! tem Construction Permit Permission is hereby granted to A f— 6 to co truct )repair( �an On-site Sewage System located at ::4* r� 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. All construction must be completed within two years of the date below. 7 d Date: 12 CT Approved by C"`�- 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 10 —10 — of t� , concerning the property located at (� ��, r,A-) ;tL, A)A-y meets all of the following criteria: ✓• There are no wetlands within 300 feet of the proposed septic system 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 S TE 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]. ' t m sea r—. 350 Main St. • W. Yarmouth, MA 02673 . 775-6264 Division of Canco Energy Corporation Septic Services • Pumping • Installation Ok XD 0 i F$$_..... Y.Q...__..__ THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH ...........OF......... ............................. /' .t ....................... ApVftrttfinn for Uiipnoal Workii Tonstrnr#inn Fiernmi# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at ---- - - ---•---..... ...-•-••.....-•••-•--------------••••----•---•---•--•._.......•-•----•••••---••---•------...... Location-Address or Lot No. ......................_.......................................................................... ................................................................................................. Owner Address W Installer Address � 3� Type of Building Size Lot........r.................. Dwelling—No. of Bedrooms.............9...........................Expansion Attic ( ) Garbage Gri er Other—T e of Building .............. No. of persons...:._........._...._..__... Showers — Caf ter' Other fixtures .........-•--•-••. -•........................•.- Design Flow...............t., ..__....___...__.....gallons per person per day. Total daily flow......... ��. .................gallons. t � Septic Tank=Liquid*capacit .09!a.gallons Length. --- Width.... . ._... Diameter................ Depth.-......... W Disposal Trench—No--------------------- Width.............. .Total Length.._.•..•.......... Total leaching area--------------------sq. ft. Seepage Pit No....:.. ........::_"D ameter_ .......Total leaching area e. :... Depth below inlet...4.::. J�g�� _9q--ft.G .:-.;. z Other Distribution box P ODosing tank ( ) _ aPercolation Test Results Performed by... ..�41.... .4_cL 4- �1..AJ 5:_.. Date...5_:___•l�....8�....... .a Test Pit No. 1...<.Z.minutes per inch Depth of Test Pit-/41 y____- Depth to ground water'777 61?.'' Li. Test Pit No. 2_.-_--•--•.•:-•.minutes per inch Depth of Test Pit.................... Depth to ground water,......"�`.. a ............................... O Description of Soil--------------_5'C" F'[.R ------------------------------------------------------------------------------------------------------•--------------- M ------------------------------ •--------------------------------------------------- .----------------- .----------------------- •------------------------------------------------.:-.--------------- ---- --- - ..............---•------•--•--••----------•--•••••------•----••-•••----•-------•••-••••---•-----••--------••••----•-•-------------••......••-••--•-•••--•----•-•-••••-•••---••--•---•-••-----•----•-••• i U Nature of Repairs or Alterations—Answer when applicable..........................•_---...........-•-•..•.•..._•.......•._..............__.._._.___._.. -------------------------------------------------------------------------------------•....----------------------------------------........----------------=--------_•-.--------------------------•--.--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with y 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 Application Approved BVr : -�f- ------------------------- -- -- - 5 �r� �-.ram---------- Date Application Disapproved e f ollowing reasons----------------•--------------------------------------------------------------------------------------------- ...-•••••..._....-•••-•••••-•......--••••••-••••••--•--••-----•------•-•--••--•••-•••----••-•--•--•••--------•---•--------------------------------------------------------------------------------- Date PermitNo..................................................... - Issued_-------..----------------------------------------•-- Date COMMONWEALTH OF MASSACHUSETTS ARD OF HEALTH $0 No..g.. .............. No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ..----.....OF.........e.11#e/UkS ......................... Appliratiou for Uispwial Work.6 Tonstrurtion "amit V Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 4-0 7'-'*, .3 .......................... .................... .......e........ ................................................................................................... Location-Address or Lot No. ................................................................................................. ................................................................................................. Owner Address ...... .. ......... Installer Address Type of Building Size Lot_-_/')I, S454ee�t Dwelling—No. oedrooms............. . ................Expansion Attic.......... Garbage ri e:r'. U f B paI Other—Type of Building ............................ .Na. of persons............................ Showers af rteri n( / 0.1 Other fixtures .................................................................................................... ------------------------------------ Design Flow............0.5.0.....................gallons per person per day. Total daily flow_.__._._........41.4%.................gall WIons. 1:4 Septic Tank L Liquid capacity/0P4.gallons Length.-46.. Width....'!t�...f..... Diameter................ Depth_4_7....... Disposal Trench—No_................... Width.................... Total Length__.______. Total leaching area_.___ sq. ft. > Seepage Pit No.. 1(No.______I_..____.__............. Diametel-4 0.t...g.... Depth below inlet....4_1 ....... Total leaching area z Other Distribution box Dosing tank Percolation Test Results Performed by.-." Date___$.�!Py............................ ... ......... ................. . Test Pit No. I...."45.Z-.minutes per inch Depth of Test Pit:/191-.1....... Depth to ground water�07745Vo to Test Pit No. 2................minutes per inch Depth of Test Pit._____.____________. Depth to ground watere-0, ...................... ---------------------------I................................................................. Description of Soil______________' _Z!,............. -------------------- 0 oil..............11"ft— ............................................................................................................................... ........................................................................................................................................................................................................ U .......................................................................................................................................7................................................................. p 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 T I T IS 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. ign P011-1 .... ................................................................................... ... Da ...................................................................... ......- --------- Application Approved By Date Application Disapproved fi6lrtle following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntifiratt of fin mpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ®r Repaired by . , ................ :---- ---------------- ..................................."---------------------*--------------------*------------ at. --- ...... ...................................................................................... ---- �vis- 11 5 of The State Sanitary Cgdp,4,s ......... ----------- I:!;_�l..... lt4 has been installed in accordance with the provis' ns of TITLE cr.. in the P ion rm, application for Disposal Works Construe/tion rmit .J./j............ dated Idt P?,/,W.-3--------------------- .UA THE ISSUANCE OF THIS CER ATE 'SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2. ................................I.........OF..................................................................................... FEE.J�ea............... Disposal Workii Tonotrudiou "Prrmit Permission is hereby granted............... ... _VeeA_ ------I----------------------------------------------------------------------------------------------- -.-_Pl or it an In ua Sewage Wl;ssal System to Construct ------------- . . ...................................................... ....... ................ P ..................................... at No.................. eet as shown on the application for Disposal Works Construct* Mit No___________________ .............. ..... ................................. .1 ealth DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON l. N/\KAE (Property Owner) - ---' 2-' ADDRESS (Pumping Locotkon) � ------^-----� � 3 VOLUME (Total Volume �o|k�ns) � . run+**� ' ......................................... 4. TYPE OF FACILITIES PUMPED � u) Septic Tank ---------- "vmuv ` b} (a) . .............................. number ' c} Leaching Pit(s) ---------- number 5. REASON FOR PUMPING � o) AAo,intenonco --------,---' b) System Failure ----------' c) Other --------------------------------- --------------------------. f'----- * ' VEV,J1 3.