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HomeMy WebLinkAbout0028 GEORGE STREET - Health '28�GeorBe�Stree� ann�s� r 'i i e No. Fee " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS r;.;. . OppYication for Migpoga1 *p!tem Construction Vertnit � Apphcapon for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) LJ Complete System O Individual Components Location Address or Lot No. `� }p�j� n Ow is Name,Address and Tel.No.. Assessor's Map/Parcel ��������� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. G�/'�Coffl 7 71 9 Type of Building: _ Dwelling No.of BedroomsJa — Lot Size sq. ft. Garbage Grinder Other Type of Building PAC�S/ ��1GG 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. lD Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 1 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 this B d of ealth. _ Signed Date 7/Zu�,> Application Approved by Date 7-.D-3 Application Disapproved for the following reasons Permit No. Q 7—s ? 3 �,, Date Issued 7— a 3 512 y TOWN OF BARNSTABLE LOCATION g r;7 SEWAGE.# VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. !x/� G41 �� 771 SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) LKl tea rJ Ly�(size) /O jd NO.:OF BEDROOMS c3 BUILDER ORWNER: . . PERMITDATE: 7-ZJ? -17 COMPLIANCE DATE: :Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility J - Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /t' . Feet a Edge of Wetland and Leaching Facility(If any.wetlands exist within 300 feet of leaching facility) Feet Furnished by 8 Rea.- 00 ...-...�-....�r.,i+•h�r-F..r.r.-...r:�,i.,,�.,.4 rv..h'r wii::�ti'ty;�p,�"-.r,W.-...,�r'+r+..-.,4: - t. .-. ........w.£._._ ._}. • _.. .. . (�. D9 3 No. ; Fee v HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for �Dtoponl *pmem Construction Permit i } Application for a Permit to Construct( )Repair( )Upgrade(►�)Abandon( ) LJ Complete System ❑Individual Components Location Address or Lot No. CI� ,�j)';` Own is Name,Address and Te No. Assessor's Map/Parcel 11ye7,0 5 1W 7 Z ��/', ��� Installer's Name,Address,ang Tel.No. Designer's Name,Address and Tel.No. $ /'fdLOff i C4`ls�: , 7 7/ 9399 Type of Building: Dwelling No:of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(YW Other aType of Building e9/ ewl_e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 116�2 gallons per day. Calculated daily flow 3 30 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil it J j f Nature of Repairs or Alterations(Answer when applicable) � Date last inspected: r 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 b this B39gd o ealt _7/Z_7/d7 Signed ,. Date T Application Approved by. Date 7— Application Disapproved for the following reasons Permit No. 9 7 3 7 3 Date Issued 7— 3 7 —————— —————------------------------ THE COMMONWEALTH OF MASSACHUSETTS Z Z �O3 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE •TIFY,that the On-ptte Sewage Disposal System Constructed( )Repaired ( )Upgraded (PI) Abandoned( )byD/���/ DJf� at Z G eDr9� ST ����/S has been constructed in accordance with the provi ions of Tine 5 apq thefor Disposal System Construction Permit No. 7 73 dated 7 Installer D/�D 1 C D� f' " Designer The issuance of e t shall o e construed as a guarantee that the s telji ill function a�/�tesi ed! DateP � Inspector y� / Y 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS lwigaal *pgtem Congtruc ton Permit Permission is hereby granted to Construct( Repair( )Upgrade(( Abandon( ) System located at Z �r4�'9� �� /� i 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: a 3— 9 2 Approved by ��1 s. NOTICE: This Form Is T® Be Used For the Repair Of Failed Septic Systems Only. CER'TIFICA'TION OF SKETCH AND APPLICATION FOR A DISPOSAL WORDS CONSTRUCTION PERMIT M THO TT DESIGNED PLAN$j I. �be �, �fDl� / hereby certify that the application for disposal works construction permit signed by me dated 712Zl?7 concerning the property located at Z� �BO ��, lj meets all of the following criteria: /There are no wetlands within 300 feet of the proposed septic system There are n private w w'o p i a e ells Whin 150 feet of the proposed septic system The observed groundwater table is 14 feet or careater below the bottom of the ieachina faciiirv_ fThere is no increase in 'low and/or chance in use proposed There are no variances requested or needed. SIGNED : 4e DATE: 7�Z—A/ LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARN STABLE NUMBER ' [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan; this plan should be submitted]. q:health tolder:cert J � oq) t4-AO) O O O �� 9 D wince GAS TOWN OF B ST LE , �r LOCATION ��'p'r' S' r''e� SEWAGE 36 VILLAGE t'100,J V14 .•S \ ASSESSOR'S MAP & LOT" Q INSTALLER'S NAME&PHONE NO.Gve 1 1v►., kV.Ae, 1-1-LS 4-7 83, SEPTIC TANK CAPACITY I-5 O'O a1\O-v"S LEACHING FACILITY: (type) L4- S-,3 IS• (size) NO.OF BEDROOMS 3 ' &*V c per,iM L Z BUILDER OR OWNER \D"r-'e-P CD 10. p� e�r 0 PERMIT DATE: q- / -R COMPLIANCE DATE: ��^-' '—' 94-*A Separation Distance Between the: Maximum Adjusted Groundwater Table.and Bottom of Leaching Facility /O� Feet Private Water Supply Well and Leaching Facility (If any wells exist on. J site or within 200 feet of'leaching facility) N N 1 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet�!, achin facility A Feet Furnished by \= 3q/ , � r r ASSESSORS MAP K(k No. PARCEL NO: Fee ()- 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Roorication for rigoogal bpgtem Con! truction i3ermit Application is hereby made for a Permit to Construct( )or Repair(�n On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. ^ , ivo r%7 S • fy Installer's Name,Address,and Tel.No. Designer's Name,Addr s and Tel.No. L4-77.-9,¢Sd� 1 S R .13'0 S�VI C , f° � t3o 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(Answel'when applicable) vJ I. S w _tk1-e Sri:s� Less o -^ 3 0 let'e� Date last inspected: � m���s .3 ' -5A,awe e. w, ' 1l �er�va�-e� m� 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 i ued by this Board o Health., 2 Q Signed \CQI� � Date 3 1 b Application Approved by = Application Disapproved for the ollowin reasons . Q Permit No. %6 ��.7 Date Issued No. © F - V J i 0o+ —3 Fee O• 0 j THE COMMONWEALTH OF MASSACHUSETTS UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z(Ppiication for Mig0ogal *pgtem Construction Vertu Application is hereby made for a Permit to Cotruct( ).or Repair(k4an On-site Sewage Disposal System at: Location Address or Lot No. t Owner's Name,Address and Tel.No. ` 36 G�r9e ` o (o 1 cz r�,S fy) Installer's Name,Address,and Tel.No. Designer's Name,Add re sand Tel.No. Q y717—a 93S C c0 -\ Vow Type of Building: 7 Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Cali ulated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil �\ 3� �.Nature of Repairs or Alterations(Answer when ap licable) �.�, A C�vl Z S w Less J 1 x Y. Date last inspected: C1 �erS 3 �'�-owe Gt`-011-'a �t°Y , n,P 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 isyed by this Board o Health. Signed ��('IJ 1CMn t Date Application Approved by Application Disapproved for the Pollowin reasons Permit No.�� — Date Issued 76 ————————————————————— ————- THE COMMONWEALTH OF MASSACHUSETTS i PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance S IS T �O CERTIFY,that\ a On site Sewage Disposal System installed( )or repaired/replaced(�on 3 C, t? S e by C( ^t`° for OSe o In as 0 w vJ e-- has been constructed in accordance with the provisions of Title 5 and the for Disposal ystem nstruction Permit No. — dated `"'\ Use of this system is conditioned on compliance with the provisions set . rth below: No. //il" 2 Fee 40 .0 D J6 � � cvrO THE COMMONWEALTH OF MASSACHUSETTS �{ PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS t9 P 'Migpozal bpgtem Construction Vermit L._permission is hereby granted to r to construct( )repair( L.,)*In On-site Sewage System located at S t� 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: 7 Approved by N:�M r ; r• 4 s 4 CERTIFICATION OF SKETCH AND APPLICATION FORA DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) h 4 9 r hereby certify that the application for disposal works construction permit signed by me dated�p�o` �qb , concerning the property located at e.a 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 0 There are no variances requested or needed. 2 SIGNED :_ DATE: 41— ! "9 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]. t O O 1 V � fb z 1. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3G GEO/'GE sTi Owner: H/is �sE'�'•'1 LoGA�°'/r"T.t'p v^[' 7` Date of Inspection: w L? SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' f ca P1T 5' i / Y ' \ i REAR DEPTH TO GROUNDWATER Depth to groundwater: a_6 feet I method of determination or approximation:._a/9Q bji e FI4Ui. i /- r' 7HE T 1-0 Agh 7-PX i0iT a F.o. iNe 47AS 'vsry A- iYrf/. J v�if' /951• S/,'ow� �/�,f-: lc�drl/.� T/'.4LA' /"T �C..r vr��;�'� . .Z� TN,E v5 G c. ca/�.�"ii r ric✓J /S by' Irevised 6115195) 9 LOCH ION SEWAGE PERMIT NO. VILLAGE INSTA LLERIf NAME i ADDRESS S j I U I L 0 E R OR OWNER JAAA DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �-- -� �: ` ,` / • � ��. /M .: p +� .. 4 w� ` �� I `' � �t • 0 � ##� ��1 �:,� t� �. tr � 23 `� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .......................Town........OF...........Barnstable ......................................................... Nlip iration for BiipooFal Works Tonotrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: .....Q?..6.Qi-------------•-. Location-Address or Lot No. Joseph N�-.Colapietrq................•----•-•-. 389..F9xter..Hs],...__ Owner Address a A & B Cesspool Service 128...B9ps..Texx �e,..�iyaxtn3s----P�A_.._Q2EaQl---•- Ins taller Address Type of Building Size Lot............................Sq. feet .. Dwelling—No. of Bedrooms....................3......................Expansion Attic ( ) Garbage Grinder ( ) ............. Showers — Cafeteria p., Other—Type of Building ............................ No. of persons............3. ( ) ( ) a 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..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........ -•-----•-•••••••-•-•...•••••----•-----------•....--••--•--•••---- Date........................................ . a 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.__.....__........._____ ....-•••-.... ....................•-----•-•-------............--•--••---..............................--------...-----..................---_..... ODescription of Soil.......................... aI�•----...•-•-••--------------•....•••--•-•----------------••--------•••--••-•••--•--...-•-••-••-•-•---•--•••-••••----•........---••--- x c, x ...............................-....................................-................................................................................................................................... U Nature of Repairs or Alterations=Answer hen applicable_.installation--of_a._1s000-_gallon_.�ra-=-c?�s_t .................stone paced leach pit---(overflow ----------------•------_... . . ---------•-----•---------------------------•---•......•••-••................ Agreement: The undersigned agrees to install, the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ', : 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 bo d of h th. Signed ` Gt�fiL.t . .5/16,180 — .t_Y.!-.. ate - Application Approved By................. ______._.. _________,��.6�6Q.............. Date Application Disapproved for the following reasons:................................................................................................................ -----•--•-•------•---•-----------------------•-----•---•---------•--------.....---------••-•-----•-----...__....._...._....------•----------------------------------------------------------------....... Date Permit No...........8O -------------------------------------- Issued-...........................5,116, .8._Q...._------ Date 2.3 q FEz.........t._5.0a... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................Tara.......OF............Barnstable Appliratiun for Diipuoal Works Tonstrnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: - . .Goorge._`�t,,..H3 a:,.. .....42 ... --•.... ................ ..................... - - Location-Address of Lot No. -Josel)h rig.Co]ap tro---------------------------------------------- Owner Address a B Ces�an©1.S'6:L�vitm ' .............. .'........ Via..&1��ppg..�� Installer Address QType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms....................3...................... Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons..........__.3............. Showers — Cafeteria QI Other fixtures ---------------------------------- WDesign Flow........................................:...gallons per person per day. Total daily flow............................................gallons. t, 0 Septic Tank—Liquid'capacity............gallons Length................ Width............---- Diameter................ Depth................ x4\ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area..------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching,areaj.................sq. ft. L' 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........................ ------------------------------------------------•----------....----------------.................•---......................................................... 0 Description of Soil------------------------Sand....-------------•----------------.....-.------------------------......------------••-----`-----=----------------------.....--------- ----- -------------------------------------------------------------------------------------------------------------------------------------------------------------------.....••---- U Nature of Reoair or Alterations—Answer when applicable..1X8tall&tlon Ot i 1A.00©__9_aUOA-pz� cars atone pac�Q Uach pit (overflow). --------------------------•-----------.....----------------------------------•----------------- ............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �'1' the provisions of t•1 T _7 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 boa d of lie h. " /a 6t� Application Approved,By----•.-- '/fir -- -----•---------------------------•- �1 . ' Date Application Disapproved for the following reasons-----------------------------•----------------------------------------------------------------------------------- ...................................................._.................................................-•------•-------•------•-----------------------------------------------•------•-----•---........_ + Date 16 80 PermitNo............ -------------------------------------•-- Issued-...--••--••---------------g�... -•---•---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Y� .........................Town......O F..........Barn Ba=.aft.ble................................................ Trrtifiratr of Tontpliatta � I IS TO PCEggT Y That tnv$ ual$ tge D�isposal�yste�m,Eonstr to Off( ) or Re�aed '( X) a Cess col eTftCe rm rail 7756264 by .................................................. •-••••-•--..................--.... Insta er at__..36..George St._,__Hyannis,__AIA__._0260T____---....�©Seph-N,__Cola►►_pU*O.......................... -------------------------- has~been installed in accordance with the provisions of TITIjD_5 of The State Sanitary Codj As bribed in the .._. application for Disposal Works Construction Permit No................... .. .Y dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUJlg7AOON SATISFACTORY. alb is DATE................................................................................ Inspector----.... ..... - ............................................ k � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z3.y=' = Tarn Barnstable ........... No.......... Disposal Workii Tonstrnrtion Permit r A B Cesspool Service. 128 pis s Teerrace . ................ Permissiont. to Cons t )) or Repair�_(x l n Inaaivldua ewage Disposal System Gorge st...._! a nIS. IRA- 02�6 1 ..-- Joseph_N. Colapietrv. at No. •---------- Street as shown on the application for Disposal Works Construction /Permit No... Dated----------- x61. .............. --- - c f-----------------------------------•-•---•------- ard o Health5/16/8o -- - DATE------------ - Y: FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS `r� �Y v t � _