HomeMy WebLinkAbout0130 CAPTAIN ELLIS LANE - Health 130 CAPT.ELLIS RD. ,HYANNIS
MAP-250 PAR-119
I'
I
TOWN OF BARNSTABLE
L OCA"MN SEWAGE # ? 7 — -3 Z
VILLAGE ASSESSOR'S MAP & LOT q
INSTALLER'S NAME&PHONE NO. /9 Co 13 C SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) / (size)
NO.OF BEDROOMS ,
BUILDER OR OWNER
PERMTTDATE: �/ ��I COMPLIANCE DATE: 1'
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
TT
Cn
6�
Gj L �✓_ � I
No. / �� ! Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zippitcatton for Dtgpozar *r5tetu Conttructton Permit
Application is hereby made for a Permit to Construct( )or Repair( �an On-site Sewage Disposal System at:
Location Address or Lot No. / n Owner's Name,,Address and Tel.No.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Abe--y -s7 "77s/ 3G,
Type of Building:
Dwelling No.of Bedrooms 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
Description of Soil
Nature of Repairs or Alterations XA swe/�jwhen a licable. /qd� "� r4 A 7�0 2 F'
7d ZX JSii 1/17 Z v 9A%S'7�c_ /mil
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 issu b this Board of Health.
Signe Date
Application Approved by
Application Disapproved for the Filowing reasons
Permit No. / - 3 !./a Date Issued
i
———————————————
rr
TOWN OF BARNSTABLE
LOCATION 130 PT, L- l�.S /�. SEWAGE #;<I _ 3
l S PASSESSOR'SVILLAGE ':LOT
INSTALLER'S NAME&PHONE NO. —Co>✓sT 2 5 / a-:-
SEPTIC TANK CAPACITY.)-45:k`5 /Cow G`/9 �/C,"� '
LEACHING.FACILITY: (type) y �`� T 0 s (size)NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: �/��g 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
C
�o
i
M.�
��4^. :c.r+.r,�..^7Y� .{a'�+.: -.,. �.wa^+nov'er-a..-,wr.Y>s+w -•• ,., .<.:.�-..,,,y, .o,. . .. -.. -. ,..-. ...r. -et+,., fi•..._
No. z Fee
THE COMMONWEALTH OF MASSACHUSETTS,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE} MASSACHUSETTS
ZippYication for Miopaai *pgtem Construction J)ermtt
Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
7 1—/--A, lvwz:��
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.,No. ,
Yyx:
Type of Building: '
Dwelling No.of Bedrooms 3 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
Description of Soil
Nature of Repairs or Alterations,(A swe hen a licable) .
�4, � i v 174A,7v 2 r "74 �S 7.1 /,_
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 Certifi-
cate of Compliance has been issupd ty this Board of Health. '
Signed Date
Application Approved by
Application Disapproved for the fo lowin reasons
1
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-s a Sewage Disposal System installed( ),pr repaired/replaced O on I
by for
a19" 13 o C 4 7, S has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. Y,7- Y dated
Use of this system is conditioned on compliance with the provisions set forth below:
No. — Fee— —`'—
r
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS
]igooml *pgtent Construction Vertu
Permission is hereby granted to ,
to construct( )re i ( an On-site Sewage System located at
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. \
Date: "9 7 Approved by
4;
NOTICE:*Tflis Form is to be used for the Repair of Failed
Septic Systems Only
CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS).:"
hereby certify that the application for disposal works
construction permit signed by me dated /�' concerning We
property located at Z 3 y Cap�7, meets all of the
following criteria:
• There ;
are no wetlands within 300 f f feet o the proposed septic
t c stem
P Po P sY
• 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: Ar
LICENSED SEPTIC SYSTEM INSTALLER IN THE TONVN 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].
E'
�/•✓eta IT 2 Ard
V
� t w --
5EW&.C,E- _PERMIT_.UO.
Vew
VILLAGE -- - --- - - - ---
- IWST-QLLER-S -UWE--6 A_D.DRESS
- - BUILDER S-
DATE PER"I-T 1.55UED -/2 LZ4�-
- DATE--COMPLI.�.t�10E _ LSSUED :_ - � -7
sJ
'V
v ( ,
NJ
sr !/
iINNJ
4
i
j '
Y � 4
No....._10 FEE.....14).................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF......., �.u>3 .... .. .........................
Appliration -for Bi,gpuiittl Workii Tows rurtton Punift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sy at:-
ib4 � . r ..
-
---- ....L.O.C.A ---------- --•................ or Lot No.
Fw1 �/l /(� � ! eSV J n/lV C�s Address
Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
U ,.
Dwelling—No. of Bedrooms.............: . ........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
p' Other --fixtures ------------------------------- --}� ------------------- --------------------------------------
w Design Flow•_ _------- `�'------------------------- Mons per person per day. Total daily flow.-__.____ . _._.__.___.._._.._..gallons.
,.,
WSeptic Tank Liquid capacity_ - allons Len9 th Width................ Diameter__._........_.._ Depth----------------
x Disposal Trench—No. .................... Width................---- Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..."?............. Diameterl�I_ _ b to nl t..._._._.x::: Total I Thing area-.-_--..----.__---sq. ft.
z Other Distribution box ( ) Dos i tank � i��/!//� �, `2
aPercolation Test Res s P f rmed by----------------_---- -_-----._-- Date.......................��� �,/
Test Pit No. l ,mutes per inch Depth of Test Pit-------------------- Depth to ground water--------- --•------
rs., Test Pit No. 2................minles per zinc De f Test Pit...........y�..__.__ De h to roan water_:.
Description of Soil-------------= � �/ .'
---------------
x
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 Article NI of the State Sanitary Code— e undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ' try the boa
Sign e -------- - '- - ---7�� __......---•----•-• ` � ---L --
d�.-!° D t
Application Approved B .-._-. _ „
PP PP y------=- £
Date
Application Disapproved for the following reasons:----••----------------------------------------.................................................................
...........:...•----•-------•---.---•----••--•---•--.----•--•-------------••-----•--•--•-••--------•••-••'•--------------•---------•-------------------------------.•-----•....----------.-----•.••---•••
Date
PermitNo......................................................... Issued...... ...................
Date
`--- ---- —------ ----------------------------'-'
No.......-�8 3--•-. Fizi& .Id.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ............OF.......J3..
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sy at:
ff Jj tf Locat r or Lot No.
W er Address
„i Installer Address
Q Type of Building Size Lot................ q. feet
U Dwelling No. of Bedrooms--------------Q ___-Ex Expansion Attic�-, g— p ( ) Garbage Grinder ( )
aOther—Type of Building- ---._-------------•--_-__-_ No. of persons............................ Showers ( ) — Cafeteria ( )
Otherfixtures --------------- ---------------•••------------------------------•-----------•-•-------- --------------------------------------
W Design Flow__ ____- ...:..................:.......gallons per person per day. Total daily flow--_-__--9040 ...........gallons.
� Septic Tank Liquid capacity_ allons Length________________ Width.--------._._:.. Diameter---------------- Depth_._._._._.._....
xDisposal Trench—,No-___________________• Width--------------_ _ Total Length_:_-_____-__--._---. Total leaching area...............-----sq. ft.
__:__ <�'�. b loyal tl�lg�../............... Total leachin trea.----.-.------_--sc ft.
Seepage Pit No____ _______ Diameter. ___. _ .: ,i ff_ O,ff P leaching area 1.
z Other Distribution box ( ) DosiAf,tafik
aPercolation Test Resu�s�,/ PSormed by-----------------------------------------------------------------------•-- Date--------------------------------- ---
Test Pit No. 1 �_ .01!linutes per inch Depth of "Pest Pit.................... Depth to ground water..-......--_---_-.-.----
, (_, Test Pit No. 2................mint es per.�inc De ,,of Test Pit......_...��______ De th to roan water... ..�,-----
-'I
a - - -- o- .- —, � ---------�=
-- ---
Description of Soil-------------4; j-_t_ _ ,r.,_g:_..._.. ._._ �.__
U --------------------------------------------------•-•...--•--•-••----••-•••---•-•=--•----•--------------------------•----•---•-•--------••-•--•-•----------•--------•--•••-----•-•---•------------.
W
UNature 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—I-I e undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n by the bo t
VV ..Sig ---- .. ------ - 'a -���f'
Application Approved B - �;1 . --•--• -•
PP PP Y---------- -•-GE-'.�-v-'-- -
Date
Application Disapproved for the following reasons----------------------------------•----------- --------------------------------------------•-------------------
...----•••------------•••------•---•------•-••-----------•-••••-•------------•---------------------------.. ...........................................................................................
Date
PermitNo........................................................ Issued...............................------------•---•------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARDZHEALTH '
. ...........OF....... ........................ .......................................
Owrr#ifiratr of f�um�li�tnrr
THI 1,9 TO CERTIFn That the Individual Sewage'Disposal System constructed ( or Repaired ( )
by:!:- ----
stiller
at.........77._, .......
........................................................
has been installed in accordance with the provisions of :Article XI he State-------- .Sanitary Code as descri in the
application for Disposal Works Construction Permit No--------------y__.- . ___.__...... dated_..�.�._"__�_ --- _ y.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........U.............--............................................... Inspector. ------OF................?
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Pf
HEALT
.........7. --le . _ ...... .....O F....... .... ........ .......�
l
f
No..`Y-.�.y-•----- �.':.�- FEE_ . )._-. .:.
B V1#Vf Arkii TV #rurti t rrmit
Permission is hereby granted !�h�J----. -- -- ---- - -- - -------------------------------- .........................
to Con str (�or;Rep )�a�dn ' a 9ewag D' sal S st
0.
at N
Street
as shown on the application for Disposal Works Construction -'mit ,__J___,____... Dated.l_-..� rJ' .�._�y-:_....
_ _ L _ _.
DATE_ .Z / Health C
FORM I255 HOBBS &�VGARREN. INC.. PUBLISHERS
.M
13AN T4 LF
ELLI S L/jNE
14 Y4 mq ��
7
FT
Lo-r 2
,47
ey
11-r
Q
U
3o,
TO: DATE:
FROM:
k �
}
1.-. _ —.. — — t. . { _ _ .. _
i
,
w
I _
,
1
}
I
F i
y
PR�SCOTT... REPRESENTATIVE
a.. H. I�. �R�SCOTT � SKIM
50 aomog 0@0 m acr m@
�u STANLEY R. HOLDEN
hl
Se+uiu 165 HARTWELL ST. WEST BOYLSTON, MASS. 47 VEGA DRIVE
Tel. 617' 835-4431 SHREWSBURY, MASSACHUSETTS
617-844-6267'
AV
i J