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Home My WebLink About0069 ARBOR WAY - Health F —` :� �69'Arbor Way f�=�t t Hyannis. -- - - � L� `fib,cam � !M fi. d� r o a�, TOWN OF BARNSTABLE LOCATION16 PC SEWAGE# rJILLAGE ASS SSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. ®J,/la SEPTIC TANK CAPACITY /SQ .41(�ie.. 1 - LEACHING FACILITY. (type) .;(size)— NO.OF BEDROOMS + =" OWNER PERMIT DATE: z—, h COMPLIANCE DATE 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�C P-4 M Ct, ... ., � . `Y_ _ � o�� - °e'er 'r 04, is` . � Nol X THE COMMONWEALTH OF MASSACHUSETTS FEE I D�� BOARD OF HEALTH � �W OF APPLICATION FOR DISPOS L SYSTEM CONSTRUCTION RMIT Application for a Permit to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) - [:]Complete System ndividual Components oca n 04 ner's N me Map/ arce/lq Address 6`-/t/u s ller's m Designer's Name Addres. Address Telephon q Telephone q Type of Building: %/�7 1 I Lot Size /Q(— Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(mIII-it required).014 gpd Calculated design flow gpd Design flow provided33 d Plan: Date Number of sheets Revision Date Title Description of Soil(s) i Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF RE AIRS OR ALTERATIONS FM The undersigned agrees to install the above descri d Individual Sewage Disposal System in accordance with the.provisions of r % `r t - TITLE 5 and furth agrees not place a sys m in clion until a Certificate of Compliance has been' sued by the Board of Health..' 'r Signed Date ' Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 , . N4 6 1131 r� THE COMMONWEALTH OF MASSACHUSETTS FEE �O r BOARD yOF HEALTH {'� S w� OF1'rC� C71 APPLICATION FOR DISPO�Upgla L SYSTEM CONSTRUCTION RMIT Application for a Permit to Construct ( ) Repair ( de ( ) Abandon ( ) - ❑Complete System ndividual Components ocaC n a''s Name M p/ arcel# Address �� ^ Lot#��0 ele # �=r - �lostaller's N m Designer's Name Addres Address i ! Telephon # Telephone# i Type of Building: L`o nt-Size '` (— Sq.feet Dwelling No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria Other fixtures 1 Design Flow(min required). gpd Calculated design flow gpd Design flow provided5 d s Plan: Date IN Number of sheets Revision Date Title a r Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above descrilMd Individual Sewage Disposal System in accordance with the provisions of -TITLE 5 and furthe agrees not place the sys m in o tion until a Certificate of Compliance has been i sued by the Board of Health. Sighed Date u> Inspections J . -'FORM I APPLICATION FOR DSCP DEP APPROVED FORM 5/96 �No. �� THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH `-� k C TIFICATE OF COMPLIANCE Description of Work\ Individual Component(s) ❑Complete System , The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired(V ,U' pgraded( ),Abandoned( ) at has been installed in accordance with the provisi s of 310 C 15. 0 tle 5) and the approved design plans/as-built plans relating to application Nn / ��/ date �� Approved Design Flow (gpd) Installer L4'- `/ d \ k Designer: A. Inspector'. t \ t Date q I sa) ) 1 � The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96" No.�"`� THE � 21_j COMMONWEALTH OF MASSACHUSETTS FEE �dy _074 "i BOARD OF HEALTH DISPOSAL SYSTEM CONST CTION PERMIT Permission is hereby granted to C n�str ct ) Repair ( Upgrade ( ) Abandon ( ) an individual sewage disposal system at 65,qW'{`L as described in the application for Disposal System Construction Permit No. c � dated Provided: Construction shall � 7b—ecompleted within three.years of the date of t ' ermit =11oconditions must be met. Date Q I / ! Board of Healt r FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON i TOWN OF BARNSTABLE .00ATION 9 Arbor' Wf y SEWAGE # V- 3 7 VILLAGE ASSESSOR'S MAP & LOT g�_ D D INSTALLER'S NAME & PHONE NO. /1-p Yc207 SEPTIC TANK CAPACITY - 3 i LEACHING FACILITY:(type) 0,71- (sue) e v t NO. OF BEDROOMS e _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER G� /�c fr1^12 R `. DATE PERMIT ISSUED: 3 DATE COMPLIANCE ISSUED: -',""* VARIANCE GRANTED: Yes No } - J k'4 o-i Q ill i r o •nJ • G� A No... �✓ Fi 2k__12..... �� _OWVE THE COMMONWEALTH OF MASSACHUSETTS OAR® OF HEALTH w DM TOWN OF BARNSTABLE IE Appliration for Dhipaii al lVarkii Tnnitrnrtiun flamit Application is hereby made for a Permit to Construct ( ) or Repair (lan Individual Sewage Disposal System at:// ff�� ) ................_i?.� ~�O`... 7�dda,. �.. Y.0 .... !� ........-•---------------------------•---••-----------•-----••-----..........--------............. / Lo tion ess or Lot No. /J �i (y!! .... !! -�a.......................... `.. r�orwp .....�`JLs_h!►�i:.t.._._..._..... ow A dress a cT0 .../ a........................................ �{SO Lt/w/s...✓7 s f �/�l+r! ----........•---•-••...................... . .................---•-••---...-----•-- ---- . ------....-----•--••-----%...---- ............................ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building •- No. of persons............................ Showers a YP g -------------------------- P ( ) — Cafeteria ( ) Other fixtures . =------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 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. l................minutes per inch Depth of Test Pit---.............--.. Depth to ground water.---.................... GX4 Test Pit No. 2................minutes per inch Depth of.Test Pit..----.............. Depth to ground water......---............--. 9 ............... .............. ---------------------------- -------------- ••...... ----••-------•---•-----------...... O Description of Soil................54: 1.4 h ..-.!�---------------------•-•----------------------------------------•-•----- U --------•-•--•-•-•-•-•--•--•••------------------------•--•-••--•••..........•••••-•--------•-------•------•-•---•--••---•------•---•--•-••----........ ................................................. W -------------------------------------------------------------------------------------------------------------------••-- U Nature of Repairs or Alterations—Answer when applicable...-- /`---............-!."7 w..-.L. ...................... --------••-•----------------•--•----------------------------------------------------........__•----•--•--------•••••-•---•-------••-•-----•••--••••-----•---••••••................•--...._......-------• 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 bee issued bythe board Rf health. Signed ........ . .... . . ..:. .. ........ 1. ...3�.....92.. ' Due Application Approved By ..... ... :...... .. . .....�� Application Disapproved for the following rea o : ....................................................................................................................................... ..............................................q.9-----------..._..... ... ....................................................................-----...------------------------............... ......................................:. DaPermit No. . .. .......... .... ..........I......... Issued ....----......----------------------------..................-------- Dace No......1 � Z. ........__ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applira#iun for Diipusal Works Tonstrnrtiun umi-- Application is hereby made for a Permit to Construct ( ) or Repair ((/<an Individual Sewage Disposal System at: ................_>a ..............................L ,t' lV !..J_ ..-- ... - --••--..•-- t Loc tion- ddress , / / ^or Lot No. I ................... ..•..............Gf.� .? ---- .. .. 2........... Own _...__.. Address �? .................... ...... ...� G1/v Uk/w�sr`..7 S�i, �Lrr)/�`' . /N/��5 .......................•-._..........•. --•-/S .........F�._.._..... ..... -•-•....... Installer Address Type of Building Size Lot...........:................Sq.'feet U Dwelling No. of Bedrooms.......................... ...._Ex Expansion Attic►•+ g— -•--•-------- p ( ) Garbage Grinder ( ) Other—TYP e of Building ............................ No. of persons............................ Showers Cafeteria a Other fixtures ...................------•-•••----•----•---------P--.- ( ) — ( ) d W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. C4 Septic Tank—Liquid'capacity.....__.....gallons Length................ Width................ Diameter...-............ Depth................ W - 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Grr Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to-ground water........................ 9 ................... ............ ••----------------------- *........... *-------- •....... ---------------------------- --------------------- -.------------------ Descriptionof Soil.................. 4� -----------------------------------------•-------.-----••-••-••-••-•••-----•-•-••••------••-•-•-•---••-••---••--•--•............._.. V ........-••--------•---•---•-•------------•..._..--•----------•---------••--•----••-•........-•-••........................•-----•- -•-•-••-•---•-•••-•---•---•-•----•-------••-••••---•--•-•---•--•- W U Nature of Repairs or Alterations—Answer when applicable------l.ti.£�_��.__.....d !.�.{��......L.� .. -•-••----------------------•-•--------•----•----••-•----------•---.._.._.._._.........---.......... 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 bee issued by the board f health. Signed ...--. ..-- .. . .. . .. ��....... ............................... ' Dare Application Approved Byh�,./12 �... .. ....... .. ..... � J . ....................... ... 3 - Application Disapproved for the following rea o ....................................................................................................................e..---------------- ........................................................ ................................................. ...................................... . Date PermitNo. .....-r ..... .......................... .... Issued .....................---............------.......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifi a e of (fan lianre THIS MO C TIFY ThR t Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--........-- 1. .... L�..1... ............................................. .......... ':..........................---............----...------------------...........------------------ ` )Inst II�'- at `.( .. ...... 1 ..1�t,1. 1..:.....f Y..... ..1 ,. ..... ............ has been Installed In accordance with the rovls�ons of TITLE of The S vlronmental C de de cr e n p S y o the application for Disposal Works Construction Permit No. ...:...�7�. dated ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B 'CONST� AS A GUARANTEE , H T THE GU SYSTEM WILL FUNCTION SATISFACTORY. , r DATE............................... ....—:J�1 '.- ------------------------------------ Inspector .................................... - ........................................... i~ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 37TOWN OF BARNSTABLE No. q .. FEE........................ n fir, ' n rrmit Permission is hereby granted ._.. ---- ---• 11 1 { to Construe ) o epa'�>J �-,an Inndiivj'd Ial ewag 'ys osfal fe� atNo......... �� , l s --•--1 AA ....... �St4.eLt' V.------------------•�.......--•----•----- -•---•-....................... as shown on the ap licatio for Disposal Works Construction Perm .: /Dated!�.�__. _ / Board of Health DATE..----------f ......�---•..................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS