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Home My WebLink About0047 COUNTY SEAT STREET - Health 47 County Seat St '291-166 Hyannis 1 TOWN OF BARNSTABLE .� LOCATION, r` Ps ,hl;7-le SeWT— Sd SEWAGE # VIL=:AGE ASSESSOR'S MAP&LOT2 y, INSTALLER'S NAME&PHONE NO. 4!7J SEPTIC TANK CAPACITY LEACHING FACILITY: (type) !�'e' ��'�� (size). NO.OF BEDROOMS BUMOMR OR OWNER Mt4 PERMITDATE: ff 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 e C �s r, G r _o � sJ 5� No.. _...._.. FIcs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diripuuttl Work.6 Tunutrnrtiun Urrmit Application is hereby made for a Permit I.Q,,Construct ( ) or Repair (1\16) an Individual Sewage Disposal System at: ��'d(1��< c�aB�"� W40 P�/ L Locati i-Address or Lot No. i ....------lti----------------------------- f^ Address U -- .. . ............ IiistalIer Address Q Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms__------------------_ __ -Expansion Attic ( ) Garbage Grinder ( ) _----_--_-- No. of ersons____________________________ Showers — Cafeteria pa-, Other—Type of Building _________________ p ( ) ( ) Q' Other fixtures --------------- --- ----- - W Design Flow.........' _ .......................gallons per person per day. 'Total daily flow...:C?Q...__......_....__.._._.___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.-/---I............. Diameter.._ r_..__,___ Depth below inlet_.d-1........... 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........................ GZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------•---•-•-••••••-••••---•-•-••--•-••--•----•--•-•-••---•--........._------......................................................... ODescription of Soil........................................................................................................................................................................ x U -•-•-•-•--...-•-•-•••-•-•-•------••-•••--•-•-•--••-••-----•••••-•-•-••---•--•••••-•-•---••-•---.....--•-•-----------•------•------•••--•-•------•------••--••---•-•••-•••--•--•...............••-••-•... w x ••-•-•-•--------------------••---•-•----------------------------------------------------------------------------------------------K-----------------••................................................ U Nature of Repairs or Alterations—Answer whe}7�applicable._�V-`�r�k�_...M ......CC'C h..(Ji a ........ ---•----••----_ ..............-'.Sz-"`J .115tS1j S ,��5�- IQ"`"�•---Ufa--S�Gr�,�-------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with _ the provisions of TITLE S of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Corn lia e s bo d o alth. Signed -------- ---- _----- --- --- -------- ----p ............... ...... - .... ..` . e ?12 Application.Approved By .. --- -- ------------------ ------------ --- ---o.-...... -- -- .... . ......................... �E . .�....... Application Disapproved for the following real ............................... ............................................... ........-------- .. Dare ......... . Permit No.,. ... ................ ..... Issued Dee THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifi ate of CZornplittnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� ) by _................ G"-----...-----...----...--------_-...-----------........---------------------------------------------------------------- Insrulle�_ at -------------------------------- yl.---- 1'--�.7`------ ---------- ....---------_.-----...------------.......------------..._._...-----------..---------- ... has been installed in accordance with the provisions of TITI.�j�yo e St to nvironmental Code as described in the application for Disposal Works Construction Permit No. �L.J'... _ --.--- dated ----------- THE ISSUANCE OF THIS CERTIFICATE SHA LL NOT E CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. J DATE........... ' ... /- . ... .... Inspector^�� % ...:... ...._.. -�-- -y -� ------_---.----------- ------- —---—_,-------...._,_,--------------------------------- --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r -� TOWN OF BARNSTABLE No.•- FEE --••---•------ �ispanta nrks 1,111,nrnntrurtion "Vamit Permission is hereby granted----------------- - L- t�..S 2��1 to Construct ( ) or Repair O a Individual Sewage Disposal System K at No............................................... .-- . ...._. __ !' -------- - St-ceet / (,� � as shown on the �pplicati"n for Disposal Works Construction l�� rmit No__ _ ____________� ed___.,&)y __�/�`.!.../.l�...�... Board of •ea ch t �-•— DATE------ f/ fl 1= --------------------------------------- -F FORM 3890E HOBBS 6 WARREN.INC..PUBLISHERS ai ., No.- --••---•--__...._. Fps.............................. THE-'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Alip irativit filar 11itpw3al Works TvtII' �rnr�inn rrmi� Application is hereby made for a Permit�to�Construct ( ) or Repair Q-6) an Individual Sewage Disposal System at: CUlJrrY N 7 y s� • iqn-Address or Lot No. Deaf .....�4(1 �1 P V rest'y/� I W 'f T ( J Y ( C O \1 V Installer Address ill U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.-____-__-__--_-------.-_- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow..........5..1 .......................gallons per person per day. Total daily.flow_ �....... ..............gallons. /. -* WSeptic Tank—Liquid capacrty__---__-____gallons Length................ Width.---_---.-.---. Diameter_.-------._...-. Depth��._....... x Disposal Trench—No- -------------------- Width--_._ -------------_ Total Length.................... Total leaching area.....................sq. ft. 3 Seepage Pit No../-------- ------ Diameter...lQ.-..__..... Depth below inlet___4,.�........... Total leaching 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 ground water---__----.--_-__---_---- G Test Pit No. 2----------------minutes per inch Depth of Test Pit__-..----_--__-__- Depth to ground water.._--__.----___-----_-_. ---------------------------------------------------------------------------------------•••-••-----••......................................................... Descriptionof Soil....................................................................................................................................................................... U ---------•------------------------------------------------------------------------•------------------------------------------ ----------------------------------------------------------••----•--...... --- ---------------------- ------------------------------------=------------------------ ---------------------------------------- ----------- -- ---------------------------------------------- U Nature of Repairs or Alterations=Answer whenzapplicable.-� '.`.;T_A k._-__---I-.�.'.._.L. h 0t p4... -----------------------------------------------------•......--•_.--•--- 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—has e . 'i'ssued-by-t-h bo d o_f.-health. Signed - - . 6 `..`.�......._.. � ; . ................ YAPPlication,Approved B ...... ----------- .............. ----- ........................ .. ......2. /VV../. Application Disapproved for the following rear s: ........................ ...... ............................................... ----------------------------------- --- ---------- (/ I /... ...... --------------------- Dare j Permit No. ..�.. Issued ... / Daa ...................... ':OWN OF BAFNSTABLE y L(')CA"'I0N Lkl &C40% _ � SEWAGE #0 8"�J O VILI.AGIiQ��S _. ASSESSOR'S MAP & LOT INSTALI,L'It'S NAME ra PHONE SEPTIC 'TANK CAPACITY_ O�-Q_®_ � �.__ LE11CHJNG FACILITY:(type) (size)__ ��1tyLv NO. OF BEDROOMS PRIVATE WILL OR PIJBLIC WATI3R__ _ BUILDER OR OWNLR DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 3( `�� VARIANCE GRANTED: Yes i�Na_ r/�- _-- 1 No�" (90 THE COMMONWEALTH U /^� MONWEALTH OFMASSC AHUU—SETTS . Y d i ' ................ .............OF............ ..... .................... ' Appliratiun for Diupuual Works Tunutrur#uan Fumit Application is hereby made for a Pe mit to Construo�or Repair ( ) an Individual Sewage Disposal System at: ..... .. .._. .. a ... .......... Locatio -A ess r Lot No- - -.� . �........................... S__�b 4,.�.---e ---___�__�---^� ` 9s f'ci.-----.. • O ner � Address-� VV .. ....:. - ..... �.s - Installer Address l d Type of Building Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers P� yP g -----------------•---------- P ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------•-----------------•-----•--•-•---••-------••--•-•-------•-•--•---••---•••-•••-••••-•--•--•-•-•-••••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. R: Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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_____._______________--. Li Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-.________________.___. -•--•------•------------------------••-•---...-•----`..--•-•-----...---------.....--------•--...--......................................................... 0 Description of Soil...................................... ° `! _ - --------� ---------------------------------------......................................... U r� ______________________________________________________________________________________ 6 W ___.................._______________________________________________________________________________________________________________________7.._._._ _._.____.._____._____._____________.--.....- x Nature Re or Alterations—Answer when a li ble......... _ U P. PP - ' `•---------- ` n - ----- Agreement The undersigned agrees to install the a . edescribed Individual Sewage Disposal System in accordance with the provisions of TI T I.E 5 of the State San' y Code—The undersigned furti:er agre s rot to place the s stem in operation until a Certificate of Compliance , s be is ed by th oard healt ......... Date Application Approved By-•-••-••-•-- \J. -` -----••--•--••-•-•--•---•--- ............ D te Application Disapproved for the following reasons:--- ••--------•----------------•----•-----------------------•--------------------------------•-•••••...--•----- •-•----....--•--•--..._...--•---•-••--------------------•--•----•--.....---------------...._..-----...-------•--•------•-----------------.-.---•-----------------------•----------------------••------- Date PermitNo......... --` - --------------------- Issued....................................................... Date ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --•......... ........... ...........OF........................................... ...... .... Apptira#ion for Disposal Works Ton,strnriion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat:..................... .......--•......------••--•-------•------•---•------ ......• •... -- --- Location-Address or Lot No. --...•....----•---•-•................................................... ••........------------••••---•--•------................---....._._.__...........•----•---•-------- owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria QOther 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. a Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --•------------------------------------------- ----------- ••••............. •-----•------ ---•---• ----------------- •----------------------------------..---- 0 Description of Soil.....................•--.............................-•-•--••••--•--•--••-•---••----------------------------------------•------------------------------------.....•••... x U ----•---•....••--••-•-----•.................................•••........•-••-.......---------•---••--••-•-----••-•....--•....•-•--------••--••---------••.....•----------------•--•..._......-••--•••.... 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 TT/'14•� the provisions of .T t L!-: 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. Signed.-... Q Application Approved B v ___ Date Application Disapproved for the following reasons------------------•------•-------•----------------------•-------------------------------------------.....------•. ............................................••--•-------......._..-------•-•.....------••--....-----••----•-•--------------•-------•--•......--•--•-•----.............................................. Date PermitNo......................................................... Issued....................................................... Ds,te THE COMMONWEALTH OF MASSACHUSETTS < � BOARD OF HEALTH 1... G. :Z ..........OF............... �. :...`..................................... f (Inrfifiratr of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by_.....-•-•-----••-•......................•-•----•----------------........_...-•--••-•••••---••-• -•.....••••----••-•........--•--•--•---.......-••••---•---•••......----...........---._.....--- . Installer at....................................................................................................................................................................................................... has been installed in accordance with the provisions of TITI?t -oyrfe,�$tate Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated............................................ .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... �J. .:. . ............................... Inspector.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n/� 3( �SS GCS .. OF........... ... ll! .............................. �^ ...................... ..A........... NO.... ................... FEE....................^ Disposal work !iYa1o#r rrm' � it Permission is hereby granted................L..sue: 1....... ........................................................ to Construct or Repair (>e) an Individual Sewage Disposal System at No............. ..... �/ j Street as shown on the application for Disposal Works Construction Permit No. __� .... Dated.......................................... ......--•••-•-•••••••--•-••----•-------------••--•---•-•------•--••--•--•-••----•••-----•---•--••---•---- Board of Health DATE_ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS