HomeMy WebLinkAbout0078 ARROWHEAD DRIVE - Health --- 73'-ARROWHAD DR: ,HYANNIS, _
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LOCATION: 'Zff14V ot, ) 61 e I
VILLAGE: �(//!�/S. pan—
LOT # : p PERMIT
INSTALLER' S NAME:
INSTALLER' S PHONE # :
LEACHING FACILITY: (type) , 3Lf V (4D Y (size)
NO. OF BEDROOMS :' 7✓'
BUILDER OR OWNER: -
PERMIT DATE•
COMPLIANCE DATE:
i DRAW DIAGRAM ON BACK
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i TOWN OF A 01 /O
i LOCATION: "7�
VILLAGE: to A1,01, S
LOT # :
PERMIT
i INSTALLER' S NAME:
INSTALLER' S PHONE # :
i
LEACHING FACILITY: (type) 3,fu (4) S( f. (size-)
i NO. OF BEDROOMS : 3
BUILDER OR OWNER:
PERMIT DATE: I l.3_ d 6d
COMPLIANCE DATEc
I, DRAW DIAGRAM ON BACK
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - `"
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpplication for 30i5pont *pgtem Congtruction permit
Application for a Permit to Constrict( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Locati Add ss or Lot No. Owner's Name,A Toss and Tel.No.
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Assessor's Map/Parcel
a,71 o r �wc�
Installer'l Name,Address and Tel.No. Designer's Name,Address and Tel.No.
461`�
6,�,���, ,4--. -
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title t
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 of7i e of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued y his oar. of
Signed e
Date
Application Approved by Date
Application Disapproved for th following reasons
Permit No. L-Peq — 0 Date Issued
J
No.—Oc - (1.3 -5-- Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pplication for Miqual *psstem Construction Vermit
bEl Complete System El Individual Components
Application for a Pen-nit to Construct Repair Upgrade Abandon.('"
Location Address or Lot No. Owner's Name,gs and Tel.No.
-7?, -Assessor seapig/Pa-rc�el ��
L o<'F
ty
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building No. of Persons Showers Cafeteria(
Other Fixtures
kr
Design Flow gallons per day. Calculated daily flow gallons.
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)
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 y this o of
1. Vt�ph. _ , . /-.2-3
Signed Date
Application Approved by Date
-
Application Disapproved for thVfollowing reasons
Permit No. 4542 — 6 2, Date Issued
- ----------------------------- - -------
-7
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site,Sewage Disposal System Constructed Repaired Upgraded
Abandoned( )by.
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System ConstructiA Permit No. 0_Q 13 3 T dated
Installer Designer An
The issuance of this permit shall not be onstrt cL s a guarantee that the system will nctipheas es!i At&
Date Inspector
-- --------------- -------- -------
No. L-0 Fee1
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
hn
Miqo0al 6pelem Construction Vermit
Permission is hereby granted e L )Abandon( )
System located at :7 to Construct( )Repair()o UpgradF7 e
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes hisiher duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date: Approved by
Q
11669
NOTICE: This Form Is To Be Used For'-the Repair Of Failed
Septic Systems Only. -
CERTIFICATION OF SKETCH kND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERNtiBT (W=017-T DESIGNED PLANS)
h — hereby ceairy that the application for disposal work-S
construction permit signed by me dated �- concernins the
property located at 4 —. '
meets all of the
fotlowinz criteria: . f
• The failed system is tonne`ed to a residential dwelling only. There are no commercial or business
uses associated with the dwe!lins.
• 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 oroposed septic system
• There are no private wets within IfO fee;of the proposed septic system
• There is no increase in flow and/or change in use oroposed
• There are no variances requested or needed_
• The bottom of the proposed leaching facility will not be located less than five fe_t above the
ma.-dmum adjusted groundwater table-!c/acion. (Adjust the groundwater table using the rrimptor
method.when applicable]
• If the S.A.S. will be located with 3-�0 fey;of anv vegetated wetlands. the bottom of the proposed
leaching facility will not be located less than .'ourzeen(14) fee;above the ma.-drnum adiusted
groundwater table:t!evadon.
Ple3se complete the following:
j
A) Too of Ground Surface 3'.evatian(using GiS information) 60 T
B) G.W. Elevation. _the nigh G.W. Adjustment . _
D and 3 U_ S
SIGNED D a.TIE
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(Sketch proposed.!an of on bad-J.
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
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�?r..........0 F.......... ;fir...........-....
Application -fur 43hipwial Works Tonntrnrtinn Prrnai#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System
._.._•--•. 4:
7••--Q••-•--.
••-ocation•Ad / or Lot No.
...................... ••._._..:.. .................................... •---------------•----•••......._..._..........••....
Owner Address
Installer Address
Type of Building ZI Size Lot....... /9.�_______-Sq. feet
Dwelling—No. of Bedrooms............... ...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ... No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .......................................................---------------------------.._.._...............---...------------....._.................--•---
W Design Flow...........�"'y _________________________gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity"'—gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .. tame WidtWidth ....... .......... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No....L�a______- r�_.._.._......___. 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 "lest Pit.................... Depth to ground water........................
rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..._..________.____.._.
----------------------------------------------------------•-----••-•----------..........-••••-••--•----•-••---•-------•--------------------................
ODescription of Soil.........................................................................................................................................................................
x f-i?A- - �1�tvF� .
.................------. ---•-------•---...---- fC-1'- ���.._.,.�.��_._......_..._._..._._.. r '
C' T
W � ------------------------------------------------------- ---- o S
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been • sue by he board of healt .
Signed..-- 1.........................'
------------------•-------------------------
/� Date
ApplicationApproved By---- -------------•---------------------------------------.._..--------------
Date
Application Disapproved for•the-following reasons----------------------------------------------------------------------------------------------------------------
..........................•------•---------------------------.....__
Date
L
Permit No.......... `s/ Issued..... .............:.
Date
F,s h ! r�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
ppliration-fur Bitipuml Marks Tottstrnrti�n • rrutit
Application is hereby made for a Permit to Construct ( ) or Repair!( );;n Individual Sewage Disposal
System a
-- ----:........-7-- Q --- ------ ---------- .
•Addr, i` or Lot No
x J
Owner Address
rt
W ....................................................' .r--� ...... .........
a �'' --- --- --------
Installer U Address
Q Type of Building .; ' Size Lot {'�r-��. Sq. feet
U
Dwelling—No. of Bedrooms---------------- _-__----. ----Expansion Attic ( ) Garbage Grinder ( ) s.
Other—Type of Building ''���"- No. of persons- -_._...................... Showers Cafeteria
Q Other fixtures -- ----- - •------
W Design Flow----------- �--------------------------gallons per person per day. Total daily flow -. _ -gallons.
WSeptic Tank=Liquid capacity-�dgallons Length---------------- Width Diameter-_- Depth
x Disposal Trench—No- --------- ------ Width ._- Total Lengthy Total leaching area.---- sq ft.
Seepage Pit No....- o-�ia em to � _ Depth below inlet_--__--_ ___sTotalleachiug area---- -----------sq. ft.
Z Other Distribution box ( ) Dosing tank
~" Percolation Test Results Performed by _ . -.--_-------------------- -__-__ Date_-- :----_-
aTest Pit No. I----------------minutes per inch Depth of Test Pit..................... Depth to,'-round water ..------- _----
11 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth`;to ground water-----------------------------------
--------------------------------------------------------------------•- ---------------••--• ------•• ------•...........................................
0 Description of Soil-------- ---------------------------•--------•--•--••---•--•------ -------- ••--- •... _--- --- --------------------------------
,t _
U --••---------- ---- --------- -- ------------•------_ --_----__-_` _ --f d A.`,/----------------------------------------
---------------------------------------------------------------------------------------------- --- ------ --------------- ----------------- - - ------ �� �� -- z - -------
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 Article XI of the State Sanitary Code— The undersigned further agrees'not to place the system in
operation until a Certificate of Compliance has been sue by. e board of healtl .
—y
Signed. -. .. � 5 Y Date
ApplicationApproved BY---- .. ... •-----------------•-•---•--------••---•- •._........................ ----- - - -----------
Date
Application Disapproved for the following reasons------------------------------------------------ Y_----_---.-__._....._-._._-_
----- ------- --------•-
-------------•---•--------•-•---•---•-----•--------------•----•--------------•----•--- ----••-------------------•------------•--•---------------------------•-------------•--------------------------
Date-
Permit No......................................................... : Issued. .Z/ '-
Date
THE COMMONWEALTH OF MASSACHUSET,TS ' -
BOARD OF HELTH
A
......................................OF:..................................r................. .....-7
...................
V. rrtifiratr of (to lianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal,System`constructed ( ) or Repaired ( )
by-_ = -=?'� =`s G [A?� 1�
------------------------------------------------•-•--•••-
Inst111er r ` {
at.............. --------------��----- ---�3��i&u._ /r C_h------------ "-'-�h--�--- -- -----------`------------.,�_-----------.-_--_-_-.-----------------------.----------
has been installed in accordance with the provisions of :Article XI of The State Sanitary Code as described in he
application for Disposal Works Construction Permit No-------!y__P. .. .._.-_ dated. ---_-/ % -/_��.-_-`�! 2
THE ISSUANCE OF THIS (CERTIFICATE SHALL NOT BE CONSTRUE® AS GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SA_j[SFACTORY
DATE------- '......... -----�.................................... Inspector ---- l .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
7I 6' -Ix, OF s,3'd,1,1 .S719be,
-..-----No.--------t1f"= •--•• FEE
Permission is herebyranted - ,� .................................................. _
- e g t.�"'10' .�'r a+"„ � ^ #fit" �"2�•r
to Construct O or Repair ( ) an Individual Sewage�Dlsposal System,
r �
at No lhf�.• _ �(
., er [% d ' wMaa -'" q Street '
as shown on the application for Disposal Works Construction Permit`No Datedr �r _� ` `-_.:
• � � B dr'of --------------------------------
'DATE ,� "� ` oar Health •, _
,.. FORM 1255 HOBBS tk WARREN'ZINC PCIBL'I HERS - �` a
B DATE SUBJECT........................................... . ...... ...... ... SHEET NO. .. .OF .... .,,
CH ...,. .. x DATE ...,....., .... .................._.. .........._...... .. .............._. ..__.. JOB NO........................... .... _
,.....................�...w-.,... ...._...............I ...........................................................M.....................:.w............«...... ....,,. '.q.........r................f...,,........\............":..........
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