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Home My WebLink About0020 GENERAL PATTON DRIVE - Health 20 General Patton Dr � l 29,2-107 Hyannis - TO P ARNSTABLE ,-.,:. . It A;TION �f-(� :a rn` w SEWAGE # rI 18 VILLAGE ASSESSOR'S MAP &LOT - 167 , INSTALLER'S NAME&PHONE NO.e4--fI h�� P � �`, 1 1 / "2, SEPTIC TANK CAPACITY O 1 a S LEACHING FACILITY: (type) r I c w S- (size) f'f NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: I �� t0 ' J5 COMPLIANCE DATE: Separation Distance Between the: / Maximum Adjusted Groundwater Table and Bottom of Leaching Facility f Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) IQ Feet Edge of Wed d Leaching Facility(If any wetlands exist within 300 eet of lea ling facili A A Feet Furnished by Q1\.- �t .5- ,� � .;�[ '� y _ 1� � ', � .� s� � � � ® ! I � J y � � � a � e V R y ' 9',` ' � J t - r _ No. 9T— ��0 $ .... '! Fee (� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for 30f 5pogal &p.5tem Construction Vermit 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. RJ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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(Answer when applicable) S - 1-c Fj Date last inspected: V e `�^'�{ ,�• ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisi of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been'ss My hl* Board of He�th. Signed Date eD Application Approved by Application Disapproved for the following reasons Permit No. Date Issued —d-6^gs / Q ` 102 j No. Fee F THE COMMONWEALTH OF MASSACHUSETTS 6 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS � 3 Zippil" ation for Migpool bpgtem Coitgtruction Permit Application is here,by"M' ade for a Permit to Construct( )or Repair( )an On-site Sewage DisposalrSystem.at: Location Addreessss or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. i 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 a, Revision Date Title Description of Soil i Nature of Repairs or Alt\grations.(Answer when applicable) ` — va YvA L( CcY-O,4 y 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 provisyof Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been(ssd6d by this Board of H_en lth. Signed � Date Application Approved by Application Disapproved for the following reasons f p . Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certifirate of Compliance THIS IS TOtER ,that Oe�On-site Sewage Disposal System installed)or rep 'red/replaced�on /C)--W?'TI� by ��c Fv \ for ()1 l L as has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction P rmit No. s 7�� dated Use of this system is conditioned on compliance with the provisions set forth below: +ate No. L�` � 6 Fee 3 o'b THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogal *pgtem Congtruction Permit Permission is hereby granted to two_onstruct(Repair an On-site Sewage System located at f4- w, 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. Jr— i Date: l> '" o� V "�" 9 Approved by Y�l CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, tx�+ tiJ cl�� hereby certify rt fy that the application for disposal works r ' construction permit signed by me dated bJ . )w Q Q,S , concerning the property located at t ,0 (��„J�.�-�� , �fzll . meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • 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. l SIGNED : DATE: I® - LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN 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). ■ ONE ME SEEM mom MEN MEN ON M M ON ■No ME m � ■ M loom o 88 on No ION ME so MEMEMOMM min No no a�a ■ ■ 1� ■ ■ 0 mom � . HO11 E � � �' �' ' : : C� .0 :S'C':..... � :C :� :: : : : C C0,0 CIXT ION SEWAGE PERMIT NO. VILLAGE INSTALL R AIAE 8 ADDRESS BUILDER OR OWNER � DATE PERMIT ISSUED DAT E C 0 M P L I A N C E ISSUED 0 1 o �~ No..1_.4 5-3 Fimic .. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... ...........................OF......................................... Appliration for Diopmal Work o(rk 'Tomitrnrtion amit Application is hereby made for a Permit to Construct )) or Repair an Ind>v>duai Sewage Disposal System at: .k . ---- ••-- . ... .. _•_._.. Location- dd e — or t—No -------- -- staller Address UType of Build Size Lot............................Sq. feet Other—Type Type of Building _______________________ - •-Expansion Attic ( ) Garbage Grinder ( ) Dwelling No. of Bedrooms_________________ __ ____ No. of persons____________________________ Showers ( ) — Cafeteria ( ) W 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—No..................... Width_:__�______________. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... Diameter.... ----------- Depth below inlet____._.......... Total leaching area....330......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........................ fro Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' ------------------------------------------------ Descriptionof Soil-........ ---------•---------------------------•------------•-•-•----------•----------------•---...----•-------- W ----•--•---•---------------••-••--•------=------••----------�- --------•-----••••••.-••.-----••---•-•-••-•••-------= --- -------------- U Nature of Repa'rs or Alterations—Answer when applicable.-------- ..... -- � � s sr f1--•••• TZNZ__ .ZZ2.--------------- -------------------• ••----•-•••-••••••}---•--..........----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:i':LE 5 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. ed...................................................................................... •.. ........... e ApplicationApproved - .-- -.... .............................................................................. Date Application Disap o f o the following reasons:---•---•-------•------------------------- -------.............................................................. ........................... ...•• ---___-------Date-------------- PermitNo......................................................... Issued....................................................... Date IV Wj FEs...... _............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. .......................O F........................................------............................................ Appliration for Uiipnsal Works Tnnitrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �.. N 0 z0 .,.f a�,� ...--.1�.......... •------ --------------------------------- ......---.............---••--••.......... ocation dc(�/e�e-',� ,.-�o'r"�jjob N. ��.� ..... / � e�� t�:.��.. ..._ TdvCL9 1y.!1....1..�, ...v +��..... ....... O r _ ddreSs ...... a .......................... -- ----------- ......................... ....--•• ^ :. ...... 3 ?aa!er Address d Type of Buil ---- Size Lot............................Sq. feet Dwelling—No. of Bedrooms..... !" .........................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures ..--•------••----••••-••--...---••-•--••-•.... <11 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...40..._...... Depth below inlet........ ............ Total leaching area.... 35'?......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---•---•---------------------------•---•-••----•--•------...--••--••---.............--•-------.........--•-•--•-------•--...--•-------•-•----......•--.-•--- 0 Description of Soil.....................................................................................................-•------...-•-•---•-------•----------------•--•••-•.......----•-•- x ` V ---••-•--------••---------------- ----------------------------------------------------------- ----------------------------•---•-----------------------------.-------------------------------- W ---------------------••-••-•------- UNature of Repairs or Alterations—Answer when applicable.........CJ'1J- _.__ :__ ...../.. ......... -------------------- ----------------------••-----•------------•----•----------------••-•-------------------------------------.........--•••......--•••-... ---........................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti T 1E 5 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. S' neds..................................................................................... ....... . .................. Application Approved�BY` -•--.................................................. ........... Date Application Disappro, e. f o the following reasons:..........................:................................................................................... r .....•--•-•---------------=--------•-••-•-•-••------•--•---------•----------------•---------•----...--- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................I................................................... Trrtif irtt#r of Tumpliatta IS IS E Y, That the Individual Sewage Disposal System constructed ( ) or Repaired (&--r b . ..� � ............... .................... ---...4-K__---------- ------•----------------------------••-----------------•---•------•---------•-- / at--••---'(n-_.T..----- ----- --------- r / ---------------------.._.__......._....-------- ..........------------ s been installed in..accordance with the provisions of TITLE 5 of The State Sanitary Cod as escribed in the ._ application for Disposal Works Construction Permit:No._ ...............•... dated_ � � _�-____-_-____-_._.__--.-- THE ISSUANCE OF THIS CERTIFICATE.$HALL NOT BE C S SUE® AS A GUARANTEE THAT THE SYSTEM WIL FU CTION SATISFACTORY. DATE.....1�.3. .. -----------------------=----------------------•----- Inspector... o '1/ T1-iIE COMMONWEALTH OF ASS HUSETTS i BOARD OF HEALTH ..........................................OF.............._..................._....:.._.......................................... N.......................3 ?.... `��.�... FEE.. .................. Distil � k �an� rnr#uan prmi# w Permission is hereby granted::-•--••-•....._.._• ...................... to Construct ) or Repai 1 an Indio' a AlCo-Dis al stemat No .--••-- •--. .... =...-. �- a _....._ .... - Street -. as shown on the application for Disposal Works'Construction Permit No.�7.451.. Dated.._..,::z' .......................... ..................................................................... ....A_.._..._ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS -