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HomeMy WebLinkAbout0034 CROCKER DRIVE - Health 34 Crockerd, Unit 1 & 2, Hyannis A=306-210 (Sea Breeze Cottages) i i i i J I i SEWAGE PERMIT 140. v �.o e.. o p � 1 z5 4 TOWN OF BARNNSTABLE ..C, L�CATION �f '�® �_ ` ¢ SEWAGE # VILLAGE ASSESSOR'S MAP &LOT')D& INSTALLER'S NAME&PHONE NO. 26 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: 2- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facili Feet Private Water Supply Well and Leaching Facility (If any wells eau 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 �J ��I �� a !� j � "`� ��� c� w I:. ,' �, ,� / � � _ .�' �.,t, i �, 'a / j i �' r �'; ( �,. !, i i e��l� � 4 '{ I' � 11 �� i y �� � , ��� < I t � '�. � � � � - �,�.,� i .� ..t� i ~o �--� { '° � `� � �- � `� � . - S— z T9 VN OF BARNSTABLE I OCATIO // SEWAGE # F?/7 3 VILLAGE —fJ ASSESSOR'S MAP &LOT ' 0 INSTALLER'S NAME&PHONE NO. Z, I r2e s F-7 7 4 SEPTIC TANK CAPACITY ,/o&-0 LEACHING FACILITY: (type) 3—N 2 a r S—P-d2-G-G (size) /;I—.35— NO.OF BEDROOMS �f BUILDER OR OWNER PERMITDATE: e " � COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bo/sexist Facility Feet Private Water Supply Welland Leaching Facilisexist on site or within 200 feet of leaching facility Feet Edge of Wetland and Leaching Facility(If any within 300 feet of leaching facility) Feet Furnished by 1 b � 4 a No. C / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for -Misposal 6pstem Const union hermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(,X ❑Complete System ❑Individual Components Location Address or Lot No. 3LJ G"C.lueV_DRZ H4 Owner's Name,Address,and Tel.No. txopl6Wc: Cam[-dD U Assessor's Map/Parcel P Go& 553 (S , Installer's Name,Address,and Tel.No. j 0!$ 7—1 Designer's Name,Address,and Tel.No. CtAOG;W 1*D 5� 1PAK&I LLCN f� Type of Building: / Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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 Certificate of Compliance has been issued by t ' oard o S ed Date Application Approved by Date 1i Application Disapproved by Date for the following reasons Permit No. � � �� Date Issued 6 No. Fee G7 ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpIitation for Misposar Opstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑Complete System ❑Individual Components i Location Address or Lot No. 3 L C"C1Lc DR N Owner's Name,Address,and Tel.No. IXO PI G UE CzA4,tP64U Assessor's Map/Parcel36,6 f 1S OfL.T i Installer's Name,Address,and Tel.No. j 0B—�t't?—n?-1 Designer's Name,Address,and Tel.No. � AOWI Gt�Zc3 N/G Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date i Title Size of Septic Tank Type of S.A.S. Description of Soil r Nature of Repairs or Alterations(Answer when applicable) Date last inspected' Agreement: Y The undersigned agrees to ensure the construction and maintenance of the afore described on-st 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 Certificate of Compliance has been issued by this-Board o S' ed 1 Date Q Application Approved by Date r Application Disapproved by Date for the following reasons Permit No. ^� Date Issued N P'1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned A)by �A�L a JL �l�1��L� -L. G_. at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N&P 3/6)dated l C� Installer 0:MGyi(D9 f,y✓r�rc[AfS ( L)f— Designer iO A #bedrooms Approved de-flow gpd /! e C The issuance of this permit7shlallnot b co nst Ad a a guarantee that the system it fiz i as si ne . Date Inspector / +'}= J 1 ( = ---- --------- =-- =-= ---- ------------------------ --- ----------------- No. ,ice / '7" / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(X) System located at ��� � U H yk) and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. y Provided:Construction must a com eted ithin three years of the date of this permit. ��Date Approved by ■.,. © � . ski 'S�„�.. � ���; '�� �-.. • • • a ru lti nj ri OFFICIAL CO Postage $ /rye S nj O Certified Fee ce) C Return Receipt Fee Postmark CJ (Endorsement Required) Here C3 Restricted Delivery Fee �t. O (Endorsement Required) 1=1 Total Postage&Fees $ / r� ru o Monique A Galipeau M1' PO Box 553 Hyannis Port MA 02647 Certified Mail Provides: - A o A mailing receipt o A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. .e Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT. Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 - 1 0 Complete items 1,2,and 3.Also complete A. ianature item 4 if Restricted Delivery is desired. 4�1 v ❑Agent m Print your name and address on the reverse Addressee so that we can return the card to you. B. eived by( inted Name) C. Date of Delivery 0 Attach thiscard to the back of the mailpiece, M,� or on the front if space permits. � 'O tvi V D. Is delivery address different from item 1? ❑Yes 1 Article Addressed to: HYANH If,YES,enter delivery address below ❑No ✓qy ii ��' . Monique A Galipe u !� PO Box 553 " C". 3. Se '•e e Hyannis Port MA 7 �er ❑,ti. ail Express Mail U �tered ❑Return Receipt for Merchandise = .s ed Mail ❑C.O.D. R ricted Delivery?(Extra Fee) p Yes 2. Article Number 1 (rransfer from service iabeg 12 1.010 .0000 2851 12 7 2(�� I PS Form 3811.February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL.SERVICE First-Class Mail Postage&Fees Paid USPS" Permit No: ®Sender: Please print your name,address, and ZIP+4 in this box• Town of Barnstable" I Public Health Division 200 Main Street II Hyannis-, MA 02601 ! I ii,i,lliillililiil:i1,1111 fill f1111liii:illllilii.l"Il1illlll+ll 4 Town ®f Barnstable T3arnstable Regulatory Services Department ;micaC 1 anfuvsrABU MASS.: ,�� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70.12 1010 0000 2851 1272 January 13, 2014 Monique A. Galipeau 34 Crocker Drive IMPORTANT NOTICE Hyannis, MA 02601 Map & Parcel 306-210 The Department of Public Works informed us that public sewer lines are now available in your Ineighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, atC34 Crocker Drive,Hyannis, MA,to • public sewer on or before 3/30/2019. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see enclosure. PER ORDER OF THE OARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health II • Enc. J Q:\SEWER connect\Sample order letters for sewer connection\34 Crocker Dr Hy Jan 2014.doc 16 No. � Fee$50•00� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: e. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for 33igpogar *pgtem Congtruction Permit a Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) 0 Complete System E)Individual Components Location Address or Lot No. Sea Breeze Cottages Owner's Name,Address and Tel.No. 7 71 —2 5 4 9 34 Crocker Dr, Unit #1 &. 2 Monique Gallipeau Assessor'sMap/Parcel 397 Sea St Hyannis, MA 02601 Hyannis, ► Y mA Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Septic Service PO Box 1089, Centerville .MA 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( no 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 Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) New Tit 1 e 5 Leaching consisting of a new D-Box and three 500 gallon H-20 stone packed leaching chambers- 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 by this Bo d of Health. Signed �,�_-1� Date �!57 Application Approved by Date PL -(I ^9Q- Application Disapproved for the ollowing reasons Permit No. g. Date Issued -- -Y- - - - —————— • —————————————————— TOWN OF BARNSTABLE _= .LOCATION�� G ►�o t�G,2 /-a' SEWAGE# ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO.dit SEPTIC TANK CAPACITY )1,6-a LEACHING FACILITY: (type)3�� �-,G , (size)f b �O -�- NO:OF BEDROOMS �--� :BUILDER OR OWNER S',;;-.• hart-,0 G.o lr PERMTTDATE: Z/�- COMPLIANCE DATE: paration Distance Between the: .Maximum Adjusted Groundwater Table and Bottom of Leaching Facili Feet Private Water Supply Well and Leaching Facility (If any wells exi onsite 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 'Fuhiished by lit1; ' 1-9 j ow.;/ i ` Iv `' :13,0 No. Fee 00 � $50. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZIpprtcation for IDigpogar *pgtem Construction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System 11 Individual Components Location Address or Lot No. Sea Breeze Cottages Owner's Name,Address and Tel.No. 7 7 1 —2 5 4 9 34 Crocker Dr, Unit #1 & 2 Monique Gallipeau 4 Assessor'sMap/Pazcel 397 Sea St Hyannis, MA 02601 Hyannis MA � Y Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Septic Service PO Box 1089, Centerville MA 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( no Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ".'_ 9:� 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 sand i Nature of Repairs or Alterations(Answer when applicable) New Title ft Leaching consisting of a new D-Box and three 500 gallon H-20 stome packed leaching ': chambers. 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;��=fealth.Signed l-c� � Date - Application Approved by Date :Z -I cd Application Disapproved for the ollowtng reasons Permit No. 9 Date Issued ———— ——— ——11-— ———— ————— —— ——— ———— —————————— THE COMMONWEALTH OF MASSACHUSETTS .11� SeaBreeze Cottago�� ' �STA�LF�„'-MASSACHUSETTS / ..?- 9 Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(x )Upgraded( ) Abandoned( )by at 34 6eocker Dr, Units 2 a 2, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Installer W E Robinson Septic SrV Designer The issuance of this permit shall not be co sstr�ued as a guarantee that the system will function as designed. ' Date Inspector Cl --------------------------------------- No.�9 8 Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BAR STABLES MASSACHUSETTS SeaBreeze Cottages _ Qt�pogar *pgtem C 5truction lermit Permission is hereby granted to Construct-( . )Repair(X)Upgrade( )Abandon System located at Sea Breeze Cottages 34 Crocker Dr, Units 1 &2, Hyannis, ,MA Installer: W E Robinson Septic Sry 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. Provided:Construction must Cb�e completed within three years of the date of this permit. Date: - j 3 " / Approved by .� f NOTICE.- This Form Is To Be Used For the-Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated a2 13—9 9- concerning the property located at SeaBreeze Cottages, 34 Crocker Dr, Units 1&2 Hyannis, MA, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) v� B)Observed Groundwater Table Evaluation(according to Health Division well map) ` t I SIGNED: 4 �'! �.✓�L DATE Q r LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). e Ch e 0A `` r i �, ) No. Y— / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zfpplication for Migaal *pgtem Cow6truction Permit Application for a Permit to Construct( Repair )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Seabreeze Cottages, Monique Galipeau Assessor's Map/Parcel Hyannis , MA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089., Centerville ,MA Type of Building: Dwelling No.of Bedrooms 4 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 Size of Septic Tank Type of S.A.S. Description of Soil S and. Nature of Repairs or Alterations(Answer when applicable) D—box and 3 leach chambers . 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 by this B.,par400f Health. Signed Date 9—C- Q Application Approved by Date !j Application Disapproved for the ollowing reasons Permit No. 173 Date Issued y. .. v .. V e, No. Y Fee Entered in computer: s THE COMMONWEALTH OF MASSACHUSETTS ' 'ta , Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 0(pplication for Migpogaf *p!tem Construction 3permit I Application for a Permit to Construct( Repair )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Seabreeze Cottages, . __Monique Galipeau Assessor's Map/Parcel Hyannis, MA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville ,MA Type of Building: 4 Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtunes Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets4 - ci Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) D-box and 3 leach chambers. 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 by this B ar f Health. Q Signed �.�L t d. Date 9—C`- q / Application App oved by Date 4 Application Disapproved for the ollowing reasons Permit No. l 7 Date Issued 5 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS j Galipeau _ BARNSTABLE, MASSACHUSETTS d�� er�ifcc�te_of THIS IS TO CERTIFY,that the On-site Sewage`Disposal System Constructed( )Repaired(x )Upgraded Abandoned( )b Wm. E . Robinson Septic Service at 397 Sea A. , Hyannis has been constructed in accordance with the oons of it 5 and the f64 Disposal System Construction Permit No. l`�- 7 dated Installer m.visi t' ob ins on ar. Designer The issuance of t permif sha of be construed as a guarantee that the systerr�w ll fu,atio as designed. Date / Inspector `--� / 1 --G-G�------------------------------------ No. 7 /-1 Z,3 ti Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Galipeau PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi.gpogar *pgtem �tCongtruction 3dermit < Permission is here)§�nt dtoo CS�s�rucl.( a)Repair( )Upgrade( )Abandon e ( ) System located at �� riy' m 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. Provided:Construction must be completed within three years of the date of this permit. Date: u - cfo w 9 Approved by A' l` TOWN OF BARNSTABLE LOCATION ,�9') ,S in I—) SEWAGE # OQ/7 a VILLAGE f l y`(1 c; ASSESSOR'S MAP & LOT - 0 INSTALLER'S NAME&PHONE NO. ,� ��,s .� ��,�� F-2 7 4 SEPTIC TANK CAPACITY i o a-o LEACHING FACILITY: (type) c (size) / 2—,-3S 2-- NO. OF BEDROOMS L� BUILDER OR OWNER PERMITDATE: -- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leachin Facility Feet Private Water Supply Welland Leaching Facility (If any w sexist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetl sexist within 300 feet of leaching facility) Feet Furnished by { 1 i / r y. c � � o t 'V D b� vZ of NOTICE: This Form Is To Be Used For The Repair Of Failed Septic Systems Only, CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated "i concerning the property located at 397 Sea Street, Hyannis , MA meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) �— B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: UG DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). �F --�.D c> w VIN ' OF BAR STABLE DJCATION F-F SEWAGE # 7' VILLAGE ��� 1 ASSESSOR'S MAP & LOT 30& 9 ,INSTALLER'S NAME 6: PHONE NO. ; -Qt? - &amp ZS.S- 0 7D Z SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER PUpZXC BUILDER OR OWNER I b}4 yU X A& DATE PERMIT ISSUED:' DATE .-COLiPLIANCE ISSUED: t5 S "7 VARIANCE GRANTED: Yes No (� t � �~ `? -.r' o � � �r °� � h_ � � . O x p O �� �� � (V�l � � ` ��L. - �-�` t�9 ��'� _�fa 1 u' �' i .� � � ti ASSESSORS MAP NO: No...:V..:.Z�I PAROEL NO: LCJT ..?® Fes$...............!........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH :Y - of App rntiou for Di"ag al Works Tomitrartiun Vanfit Application is hereby made for a Permit to Construct ( ) or Repair (V<an' Individual Sewage Disposal System at: CRdetE. ST ............................................................ •.... ---------------........-----................--••-....--•••---•-••.. ,� �/ ® /] 1 y1 /L�ocatiL../�:L.. ,I�(Z.yi_�1...... /1 ,tf /� ..�iJM f r�n tG G!-s ...f.?.IG_[_..1.^_�.....A ^- W �C Otjy cfiT__R_LL•RA10 oW � '�`�LYZR:7..Gr0 lli` �,V_ dress 1`1� WS 1 Ek aI.....•............... ..............-- ... --•---•--^;.. .. .---- ------YV•O-JG•------•------------...----•----•------ Installer Address d Type of.Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) ~ .............. No. of ersons•_•••___-•__----.-__-__-____ Showers Cafeteria= a Other-Type of Building ______________ p ( ) ( ) a Other fixtures .---.._..---•-•----••---•--...•• ... - W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. GG Septic Tank—Liquid capacity_______--.-.gallons Length..:..:.......... Width................ Diameter---------------- Depth................ W t n Disposal Trench—No----------------_-- Width.................... Total Length.................... Total leaching area_................... q. x _..s 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........................ ----------- ----------- -•-•-------------------------.....-:.. " Description of Soil...........M:-E-.�_..............lN.a ./..�i$• U ------------------------------------------.... ---------------------------• •------------------------------•----------------•--•----------••---•-•--•----------•-----=-------------•-------------•-------•-•....----•-•-------•-----•----------•---•----•--•----•--••-•--•--•---•-•- U Nature of Repairs or Alterations—Answer when applicable._-__---__-UO.Q(D....(a MI.�r:.___Z-YI to K.._�....................... TO rV Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iyT 5 of the State Sanitar*CoThe undersigned further agrees not to place the s stem in operation until a Certificate of Compliance has bthe b and o hSigned - ........ . ----.--•-- _ Date b Application Approved By••-•. •• -•-•--. •--•-- ....•-- --- ................... ............... -- 5 -a Date Application Disapproved for the following ons:--••--••-•--•-•-••••--•-•--•--•-•-•---•-•••-•-•-•-••-•••---------•••••••••••-•-•-•--......••-••.............•--_ ----------•----------------•-------------------------------••---------------------....-•-------....----_..--•------...---•------------------------------------------------------------------------------- Date PermitNo......................................................... Issued....................................................... Date 306 Cottl�� r # No..� .Z... L 0� 3 O Fps..a.... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH fJ . Appliration for DhipugFa1 1911rkii Tomitrnrtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: cgc)C kh'6z S ......_.. _. .... .................................... .............. ----------••--••------- -----------•---.....----------.........-- cat' n-Addre r Lot No. t .................. o �v. o ..��. ..•..... .................... wnter� ... ........ Tess4... Installer Address Type of Building Size Lot............................Sq. feet U U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures d . -----.------------------••-----------------•------•......... W Design Flow............................................gallons per person per day. Total daily flow..................................... Gd Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter-------_........ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x , Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed bY.......................... .............................................. Date........................................ Test Pit No. I________________minutesper: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........................ --------------•--•-• ---••----••••.-• - -yy... -----••-••--------••-••---......................................................... Description of Soil..........:�r�....sS.�....� �� �� F g V ----•----------•--------. - •. --•-•---------------------••-•-----•-------•-•-•---------•--••--•-•--•••••--------•----•-•--•---•-•••---••••----•--•••-...-------•---•-•--•--••••- W -------------------------- U. Nature of Repairs_or Alterations—Answer when applicable..._ _T /V/F_ 4_ ...................................... ............................................................... - -C' �r o '-f aV Q-FS-Tow - Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of is Ti. y g g p' y �`of the State Sanitary Code The undersigned further Tees not to place the system in operation until, a Certificate of Compliance has bee i s d ythe boaWohth. -' Signed--- ....... ....... t f ate ---- -----------•.--•--APPlication Approved BY Date Application Disapproved for the following ons:......... ---------•----------.•......-•----•-------•-••--•••----------•--......•---------•----------•-••----------------•--•---•-•---•••••-------•-------------•-••-•--••--------••-----•-...--------•••--------- Date PermitNo.................--------------------------------------- Issued.....................................................- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............O F............. .. ...... ......... .................................... TrrtifirFatr of (gout ltattrie THINS�TIFY t the Individual Sewage Disposal System constructed ( ) or Repaired ( } at ........ck. , ----------------------- St uer `-----------•----•------•------.................................... n has been installed in accordance with the provisions of ii i i� �'/� State Sanitary C as describ in the application-for Disposal Works Construction Permit No.___��...... ..!. :..._._. dated......... --:-S------........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. t_rJ_�...................................... Inspector..... _ THE COMMONWEALTH OF MASSACHUSETTS BQAR' F HEALTH `r No.. ............ FEE:........'.......... � n 1 arrk Ton tan rrmit Permission is hereby granted. :.......... ........ . .. .......•.... ..................... to Construct ( or Repair ( ) n Individual e�age Dispo System at No.••-•-- - - ------ ----------------- S�reet U ti r_ L, as shown on the application for Disposal Vl'orks Construction'Perk 't Nog ............... Dated•- __. ':_ --..... --------••---- -�S ....... ° oard of Health a DATE------ ---------•------ ---•-•--••- y(F FORM 1255 HOBBS & WARREN. INC., PUBLISHERS,'.. _ r rum J 1 �NIO15 f nu 4000 071�-� of 14AltA �01 000� o e o 0-- AR 01 TOWN OF BARNSTABLE LJCATIC I�%c�¢r D (� 39>(SeA SS7ney--)SEWAGE # �iE�abLor3A VILLAGE E � �nASSESSOR'S MAP & LOT 4(57-L>7_ INSTALLER'S NAME & PHONE NO-X� w-mr d 10,61f W114 p SEPTIC TANK CAPACITY /0 0 0. 2,f/149•c45 LEACHING FACILITYAtype) /06D 9Ai/o;J _ (sue) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O OWNE To`iN GgG�, c-4 o DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No_f� -'" m � .,00 -- ASSESSORS MAP NO: � C D NoT PARCEL NO: .••-•---------�... Fss......................... ._ THE COMMONWEALTH OF MASSAC-HUSETTS BOAR® OF HEALTH ...................OF......... .................................................. Appliratiun for Bi_qpuual Workii Tunitrnrtiun rprmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal r System at: _ C iROCKER ST ----------------------------•----•-------....--..................-------------------••-••-•-...••. ......-----•-- y� ----------------------- Locan-Ad`ss'�p= or Lot o. — •- ... Owner Address a a ►= -r_...Y�L� _Rb_:.__V%RTCj....I .L� RtoGa ' } '�!'� -!v ST ..a-.Rrws`j ... Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_.____.._._____________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons------_.•.__--_____.____-___ Showers ( ) — Cafeteria ( ) Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 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...................................... . aTest Pit No. I................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........................ P -----------------------------------•-•---•••••-•-- ••••--..,_/......----••----......---•--------...........----------------------------------......-----•... O Description of Soil -m _ ... S 111 .............................................................................. x U .................................-••--•-•...-•-•-••••---•----••-•-•--•-••---•-•---•••------...-•---•--•-•--•-••••-•-----•-•-••••-••--••••----•-•-•••---•-••••--•-•-•••••-•-----•-----•--••-•-•......-•-- x ------------------------------------------- -•••--•-----------------------------••••--•-••••-•----•••-•-••-------...••-••-•-----•-••-•......-••--•------. ............. ---------------=----- V Nature of Repairs or Alterations—Answer�when applicable-.___ o QQ___G_l _ -_...._T .. ................................. 1 Q o o GAL ,. w o-t -t- a 0 r- S rb vt C Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii TL :1. 5 of the State.Sanitary Code—The undersigned further a rees not to piace the system in operation until a Certificate of Compliance has be e the b rd h Signed ... . . ---•------ --•-------------•---- `.. -�.�...�._ ApplicationApproved By-•.•....••-- •----• •-•-• ••• . .....................••-•---------•--------•--•-•-• e . Date Application Disapproved for the f ollowin r asons:---•••-••••---••----••-•....._..••••----•••---••••-••-•-••-•-•-•--------•-•-•--••---•-......•----•............•- --------------------------•-----------------------------------------------------.....-----••--------•---•-••-••-•--••-••-•------•-•------•-•-•-••-•--•---••----•-•••--•-••.........--•---•---••-- Date PermitNo......................................................... Issued....................................................... Date 1 C 0776& —F tk L. L 0 T 1 0 No.�... .z....... Fxs.............`.............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l 0.3 --------------------OF.......... .......................................................... Appliratiun for Disposal Murks Tonstruriiun Vernti# Application is hereby made for a Permit to Construct ( ) or Repair (V) an Individual Sewage Disposal System at: C.R.o C-K-- ... S T ................. ..........' .... .....----- -----------•-•---- Locatio -A dress or'Lot o. ----------------------�o t t�'---•--� .� 1p.p-�'•'-•---•---••-•... .. .�.o..:.� S T ..... Ownez / a C�Qx�_r.RY_. .LLnO.._. }.QTJ[3LI.Yj� Ct�•--........_ .�_ .} ..X!�lNaaSsTR.. .ws.J.. 2.. Installer Address . UType of Building £- Size Lot............................Sq. feet Dwelling—No. of Bedrooms___---_-••-- ------•--------------•-Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building _...._..... No. of persons............................ Showers a YP g --------------- P ( ) — Cafeteria ( ) Q' 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_N?o. .................... 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 S .................................................... - 117 O Description of Soil.................n lQ.••-! .AIV.......----y I x W UNature of Repairs or Alterations—Answer when applicable......90_QA__Czry�....—M&N-_.' ................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TILE '5 of the State Sanitary Co — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is d the board of I Ithe Signed . . . ...--'-'-.12" '-•--- . • • _.. Date Application Approved By......... . . . . ........... -' • ......................................... ........ �---� Date Application Disapproved for the followi g easons:.............................................................................................................. ..............---'--••-•--....----•-•-'•----•-'----'-----•-•--•------'-------------"•--•----•-•----•---•---•••--.....••••.....-•-•.............---•--•••---•-•----•-----'••--......••-----•----•. Date PermitNo......................................................... Issued............. Date lie' - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............OF...... . ............. .............:..................................... Trrtifiratr of Tuntplianrr THIS IS TO CERTIFY That t e Individ al Sewage Disposal System constructed ( ) or Repaired ( } ...... . C, ---- .......................................................................................................... nstaller has been installed in accordance with the provisionNI 11 t j of he State 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 YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................5�..:c_ .__-_SS_. .............................. Inspector--•---- ..."... ........................... THE COMMONWEALTH OF MASSACHUSETTS x� " BOARD 'OF HEALTH .� OF...... FEE.. O S No. Disposal Work (90 to ttdiun rantit Permission is hereby granted':` . '.......... i_ ....:....._ to Construct ( ) or Repair (: ).an Individual Sewage 91sposal System ' at No...., - - t---- ............................................................ e ,Vr. VV"��" 11 4 as shown on the application for Disposal Works Construction ermit No. .. .............. Dated.._._.._ '".J—_ ....... �lM •--- •--•-------------------•- yy of Heth<.� DATE...... f� ......................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS