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Home My WebLink About0100 YACHT CLUB ROAD - Health � 100 YACHT CLUB RD, CENTERVILLE. _ A= 210-035 No. 42101/3 ORA ESSELTE 1011/0 o 0 0 Ok +� sun r _t l� DTHE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uiupuiul Wurk,6 Tunutrnrtiun thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( P<an Individual Sewage Disposal System at. Ci ---------- ------------------- ------------------------------------------------------------------------------------------------ Loca iot -:\d c Zr Lot No. --------------------- a.. O ncr A dr Installer Address Type of Building `� � Size Lot............................Sq. feet �-, Dwelling— No. of Bedrooms---_.-.-----ICJ--------------------------Expansion Attic ( ) Garbage Grinder ( � Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 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--------------------------------------- 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........................ ODescription of Soil........................................................................................................................................................................ W V ...............•----...---•-------------•----------••-----.....---------•------------------•----------•-----------------------------------------•-----------------------------------....--••-•--•-•'.... W x •-•--••-•-••-------------- ................................................... ........... -. U Na re of Repairs or Alterations—A wer when applicable__. . C-i ._...... � � li�, y 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 Compli e as be ed by the board of health. .p Signed '.... -n- > ---------------- / .j....... Dace ' Application,Approved By .................... .- Application.Disapproved for the fo owing reasons: .....................--------------------------------------------------------..........-------------------------------------- ........................................ .......... ........................_..... .......--------------------_---------...._..-------------------------------._...--- ----- --------------------------------------- Date Permit No. ........V, j .. .. ... .... Issued ........ �T r��~- ace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of QTamplianre, wis is TO the n I ua,CERZIFY, That h I d*v*d I Sewage Disposal System constructed or Repaired ..... ........... - ---------- ------------------------------- E ---------- - ---------------- '—------ ------ ------------- by -----E-R\Nl� .........Ito.... at .... ----------- ...... . ------- ...... ..................... ........ - --w provisions has been installed accordancewith the provisions of TITI,E 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -Xf /6— J—g'.- dated -7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r sI.fir ---------------- I......... .. ---V--- ---- Inspector --------------------------- --------------------------------------------- -————— ————---————————- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N0.35-- Ilia? TOWN OF BARNSTABLE FEE......... . ......... Permission is hereby granted......t,...... ...........I .................................................................. to Construct or Repair ("") an Indivadual Sage. Disp Syst S CV-A-- at No.ICYOL.........4.[Pv�,u� ..... ---------3-- ------- -------------------------------*-------------- Street as shown on the application for Disposal Works Construction Permit Dated________' —�,-(.•�./'t2..... ...................................... ............................................... Board of Health DATE--------------------`- ............................. FORM 38308 HOBBS&WARREN.INC..PUBLISHERS No.__I_�l...'- -�° •O �,�1 FI:s..... fir. ...... L.. r THE COMMONWEALTH OF MASSACHUSETTS '✓ BOAR® OF HEALTH H TOWN OF BARNSTABLE Xplitiratinn for Diljipmial Work.6 Tomitrnr#'inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( P<an Individual Sewage Disposal System at .1 lf�A\6------------ - Loca iol -:\ c or Lot No. o � ACch O ncr A drgs _-- ...... . ............. ..... .........................�. __...-.....-_.-.._ 6 InstaIleT Address \ Q Type of Building Size Lot............................Sq. feet t" U -_...Ex Expansion Attic Garbage O Dwelling—No. of Bedrooms-----.--.--- ,,�-------------------- p" ( ) � g Grinder (N} 04 Other—Type of Building ---------------------------- No. of persons-----------------1' �4.- Showers Cafeteria ( ) G Z�K v . Otherfixtures . ... --------------------------------------------- •-•--------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. 1:4 Septic Tank—Liquid capacitv------------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 W Test Pit No. I----------------minutes per Inch Depth of Test Pit_-----_---------_ Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ x ------ O DescriptionJof Soil........................................ U ---------------------------------------•-•----------"-----------------------------------------------------------------------------------•----------...-------------------------•------------------------ W x U Nature of Repairs or Alterations_A wer when applicable-.. _. . . ,.--..... .. Q �,�..., ----- -------- U 1 �� .'`..... :1,. ----- �i------ ' �5 ---- IKE ......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envirbnmental Code—The undersigned further agrees not to place the (system in operation until a Certificate of Compli ce as bey-ist ed by the board of health. n Signed . - . ... C` -.. .:..... , Dare Application.Approved By............... --� - .......... ......- K.. a �� - m Application Disapproved for the fo lowing reasons: --.._-----------------------------------_--------- ..-...------.-......-..-..------------------------------------- ............................... ................ . ........:-.-------------..----------------------- -------------_-..-----------------------------------_....._..------------- ._---------------------------------- t e Permit No. .....�"--'---..l-.��... ....... Issued �i: - oFTHEtc TOWN OF BARNSTABLE w OFFICE OF BaaB9TSBt i BOARD OF HEALTH 1639-� NMe, ej o Mpg k 367 MAIN STREET HYANNIS, MASS.02601 April 28, 1995 NOTICE TO ALL LICENSED SEPTIC INSTALLERS RE: EMERGENCY REPAIRS Licensed septic system installers may obtain approval of disposal works construction permits for emergency,repair work without engineered plans with the following conditions: l 1) The disposal,works construction permit application must be fully completed, including number of bedrooms; garbage grinder information, soil conditions, etc. r 2.) The installer must submit a sketch plan showing compliance•with the new Title 5 arid ,, all the Board of Health Regulations. If this is not possible, maximum feasible compliance is expected. 3) The installer must sign the Certification of Sketch and Application for a Disposal Works Construction permit form(copies attached). If you should have any questions, please fell free to call me at 790-6265. Sincerely, Thomas A. McKean, RS, CHO Director of Public Health TOWN OF BARNSTABLE BOARD OF HEALTH cj,:4 9nD- I L. l Icf t_OC&70N SEWD.C,E PERMIT UO. 6-21 "�/� i IW57T LLER 5 ►JWE .1,:: ADDRESS BUILDER 5 Q &MF- ADDRESS DATE PERtv�IT ISSUED �_�� D ATE COMPLI &&ICE ISSUED : - 7 / I 1 n, iJ I F 1 i S E ri r C TOWN OF BARNSTABLE LOCATION Vf��- Uua� ;�6., SEWAGE #% VrLLAGE ti'`..C.JE-, ASSESSOR'S MAP & LOTa/d MS INSTALLER'S NAME&PHONE NO. V<-. —�" ` SEPTIC TANK CAPACITY LEACHING FACILITY: (type) f l �l (size) NO.OF BEDROOMS BUILDER OR PERMITDATE: V7 o�A COMPLIANCE DATE: 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 300 feet of leaching facility) �;'°` Feet Furnished by A N 0 6 N .................... o......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH _4�-.....OF --- �-................... Appliration -for Bwvoiial Worbs Tonfitrurtion Vrrnift Application is hereby'made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ............................................................. or Lot No. ... ......................................... ..... ..... -------- .................. ........................................................ ..........06w;n` Address .............................. ................ ........................................ staller Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder 0-1 Other—Type of Building ---------------------------- No. of persons-_________..___._...._.__... Showers Cafeteria Otherfixtures ...... .......................................... ----------------------------------------------------------------- ---------------------------------Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity............gallons Length________________ Width--__.-_-...._.. Diameter___-_----__-____ Depth-_--______-_---. Disposal Trench—No. ..................... Width____________________ Total Length____________..____-- Total leaching area--------------------sq. f t. Seepage Pit No..................... Diameter____________________ Depth below inlet____________._______ Total leaching area---------------_sq. f t. Z Other Distribution box ( ) Dosing tank ( ) 0-1 Percolation Test Results Performed by------------------------ ------------------------------------------------- Date---------------------------------------- Test Pit No. I----------------rninutesperinch Depth of Test Pit__-________________- Depth to ground water-..___-__-__-__-__-__- �_q �14 Test Pit No. 2................minutes per inch Depth of Test Pit-________.____._..._ Depth to ground water------------------------ Ix ............------------I----------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil--------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- U --------------------------------------------------------------------------------------------------------------------.................................................................................. --------------------:-------------------------------IN----------------------------------------------------------* --------- Na re of Repairs or Alterat U 2)nsjz�er when a livable._. ----------- -------------------------------------- -- ------------ - ------- ----- -- ---- _aA7 - ---------------------------------- greement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be�issued he bo rd dofhn Ith S, �X"t, %_ _�J__ Sig ----------- ......................... -Late ... . . . foreement �,ig 4Z5 Application Approved BY----- - ... ...... .................... ... Date Application Disapproved for the following reasons:---------------------- ------------------------------------------- ............................................. ------------------------------------------------------------------------------- ...... .................................................................................................................. PermitNo......................................................... Issued.... 6- ----- .... ......... Date ———--------------------------—-------------—------------------------------------------ ----- ----------------- ------ 1IM------------------------------------------------------- issuea ! ........................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OJIT HEALTH y.................OF........ C t . .r . .... Trrtifiratr of Tompliattrr THIS IS,TO C TIF , That the Indivi al Sewage Disposal System constructed ( ) or Repaired I era----41-------g:',a---It �:ZZ:K has been installed in accordance with the pro ions of :I,,r 1 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N00__...._ _.Q4 ............... dated----- .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....- --�11yR J --------------------------•--------------•---- Inspector.--- ...... ------------•----••--------------------•---•--- THE COMMONWEALTH OF MASSACHUSETTS 7a BOARD HEALTH ��. .. ........O F......... ... ` No.......� �1-. ._ FEE---2............. BisVwia ,,nrk,i on Ururtion rr it Permission is hereby grante - ---- - -----` --.-•--t - - ----•-• ---- -- -... to Const t ( ) or Repai ) an I divid al 'Sewag sp _�] s. ... at No.----0 ------ f r u�i. �`' -- ''1 Street // as shown on the application for Disposal Wo - Construction e it ;N0 Dated__.,11-.-"--X'-75__....._.. -- -- - - k --- ------ DATE................................................................................ .--------••................................................... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -757 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Location- or Lot No. Z Other Distribution box ( ) Dosing tank ( ) Ix -------------.'��----''------------- .----------..-----------.�''.....................'.........................' ~~ Description of Soil--------------------------------------------------------------- ................... ------------------------------------- ---------- — ----------—'------ ------------- ---------------------------------------------------------- ........................................ =~--------------------------------------------------------------------------------- -------------------------Na U _tLire of P\,epairs or Alter;t* ns—Answer when applica'�1e.::.,"'- - --- - --------- -------------------------_........... ... ... - ------------ a_ Ov The undersigned agrees to install theufore6escri6ed Individual Sewage Disposal System ioaccordance with the provisions of Article XI�of the State Sanitary Code—The undersigned further agrees not m place the system in operation until u Certificate u6Compliance Application Approved By /^..-- �* --- »*, Application Disapproved for the following reasons:--------'------.--.-----'----.—.---.----------- - --------------------'----'--'----'--------------'--'—'---'------'----'----'--------'' K ~~~