HomeMy WebLinkAbout0108 GROVE STREET - Health 108 Grove,Street.".'
I� Hyannis.
A 310A 159
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TOWN OF BARNSTABLE C ®
LOCAN ZO G �
1110 SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME& PHONE NO. (.L�
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OW�NF,R �olti
PERMITDATE: � � o°� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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) `'!t' Feet
Furnished by
ow `� ➢-� �
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1
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No.�U�2 ',s _: Fee /
P. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpplitatton for �Bfigpogaf bpgtem Comgtrurtton Vermtt
Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 67,ro ble Owner's Name,Address and Tel.No.
y :,OprDada �d7�
Assessor's Map/Parcel 3V a opi,�sv9v�.,d e 7*
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
3 43c�'O'Cuo�
Design Flow 3 gallons per day. Calculated daily flow gallons.
Plan Date S;— 7 Number of sheets Revision Date
Title
Size of Septic Tank .7 Type of S.A.S. -4�� �� -2
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 Certifi-
cate of Compliance has been issued b this Board of Health.
` Signed Date o�
Application Approved by Date 0 a
Application Disapproved for the following reasons
Permit No. Date Issued y / Z
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
/P1.161 IC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppfication for )Digpozaf dip.5tem Construction Permit
1J.,"
Application for a Permit to Construct( )Repair( )Upgrade(,'IA�ndon( ) ❑Complete System O Individual Components
Location Address or Lot No. 008 6:orb!/e J'j WY, Owner's Name,Address and Tel.No. 76
Assessor's Map/Parcel' . �`9 ,yam�,Tvc•�c`c 7'
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
CTi;. G.f-•�ocZ`v/r` 77 1' o7aj .O.�v',p ,�. ,/9j�fcw
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Type of Building: '
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
;en.w•. Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Sim •7_oa Number of sheets Revision Date
Title _ w
Size of Septic Tank Type of S.A.S. S'',• 91' .X �� 'ii�.�"� Zr'�c1
;icy+
Description of Soil
t
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 t_he 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 Board of Health.
Signed - Date �/�"
Application Approved by Following
IV. a ' Date 7 `���0 2!
8
Application Disapproved for the Following reasons
F
Permit No. Uua - Date Issued
------------------------ ---------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE;MASSACHUSETTS
Certi irate of Compliance •
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(
Abandoned( )by e owz>,e-C/
at -C'oliE'' ,S'T has been constructed i accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. D UU?-/S/ dated V / G
Installer l7"inv Designer &,
The issuance of th is permit shall not be construed as a guarantee that the syste, -will function as designed.
Date ! 1 m m(� Inspector
I
---------------------------------------
No. 'U C/J Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
x1h6potal byMem Conotruction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade(Abandon( ) \
System located at dro°o,O-e J'T. .3��•
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: Con truction must be completed within three years of the date of thi ermit.
Date: ! �(/ Approved by
.F
TOWN OF BARNSTABLE
LOCATION �O G�o�� SEWAGE #
/,i.ti�'11' ASSESSOR'S MAP & LOT
VILLAGE
I L
INSTALLER'S NAME& PHONE NO. (7)w► CC��'o�'yJ�" ��7`"07�'�
SEPTIC TANK CAPACITY �� pile ;
LEACHING FACILITY: (type) f/��� (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE:
—//- COMPLIANOE DATE: " -rah
Separation Distance Between the: /
Maximum Adjusted Groundwater Table to the 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
. A 8
---------------
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039
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A�
ASSESSOR'S MAP NO. PARCEL
L0 AT10 SEWAGE MIT. NO.
67-
VILLAGE
ytz a>rtit�;,
INSTALLER'S NAME A ADDRESS
78 LINDEN ST.
OR OWNER '
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
vJ i
d /
- 1
I'
No.._ .:. Fss.._. ....:.-..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ApplirFativaa for UiipuiFal Works Tvaautrurtivaa 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal
System at:
.......... ....eg,atP � - .....................................•--- -•--------------------- ......_----•-
/�/' Locati -fldresV or Tk61p�r
---......!1r•--a it 1NO.D:�........ ................•---••-•--•-•---•--- v"`.........._...---••-
Ow r e _mil2 /T L•' res.................
" 'Installer Addressd Type of Buildin Size Lot___________________________Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons____________________________ Showers — 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................
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........................
GT4 Test Pit No. 2.............___minutes per inch Depth of Test Pit.................... Depth to ground water........................
9
0 Description of Soil........... ----••------------------•--•--------------------------------------•..-----------------------------------•-••-•----_-----
U --------------•-----_•----- ---- ¢� .._.._........
-----=--------------------------------------------------------------------------------------•-••-••-------•--•----- /o
---- --
UNature of Repairs or rarion//s�� Answer when applicable___________ ___,.____ ___-__._. _____________..____ _
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITi iZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en issu by the board of health.
' G
Signed-- -----....
------•- ... .....
-!.'-� --- -------•-•------------------------•- •---/......
-............
.._...
Date
Application Approved By-•--•-••------ ------ ...� -------•-•- ........ 6 k
Date
Application Disapproved for the following reasons-------------------------------------------------------------...................................................
----------•--------•----••••---------•----------------•-•-------------------------------•...---••••....•-••-----••------------•-----•-------•---...---•-------------------------------------------------
o Date
PermitNo.......0- .= ......................... Issued.......................................................
Date
No—IL.. FEB..... �...."
THE COMMONWEALTH OF MASSACHUSETTS
BOARD CIF` sHEALTI-I
.....€ . .._................OF...-......`.......................... ............................................
Appliratiou for Disposal Works Tonstrurtion thrmit
Application is hereby made for a Permit to Construct ( ' ) or Repair ( ) an Individual Sewage Disposal
System at:
• - - ......... Address ..........--•-...... -•----
�j
Location Address / ++' �- �?i or Lot No. -�
Wl Its: t Ir .. >t t /' � .. ... I.c.-........ .
Owner Address{
W 1. f { a ; 13 � L 1 'R ti
...................._......., a...... ...-.:r....-.:....... ...._...._ ..........--_________.... ......... .. .... ......,, __-_--_-._.........._...._.....
w Installer Address
Q Type o Building Size Lot___ _____________________Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( )
Otherfixtures ------------------------------------------•----------••••----•••••-•••-••••-•-••---------......-•--••-••--•----••------•--._.....-----•.....---•-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic 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__-_.______:___________-
44 Test Pit No. 2........._......minutes per inch Depth of Test Pit.................... Depth to ground water........................
a =:_...---•--••••••-•.............••••---••-•-.....------.._......--••-------------_.....-•-•-----••-•••-••--...-•----.....----•-----••---......•-
0 Description of Soil--------••---_-- =="4==-' "`=--•--•-••---------•---------•------------------------
U -......................•-•-----••--•-•------•--......__...•.---•-•----•-'7...----.._....------.._..._-----•---------•-----••------•--------•-•----•---••------•-----------------------•------------
W ••-•-••••-••----------------••--•--•-----•--•-_._._..--•-•- -•• •••--•. f •F
U Nature of Repairs or Alterations-Answer when applicable-------------- ..........................�` f �� '�� __f`-�"-`
M � _ T � -i........................................................... = :a.1 _ -
•--•--•--...--•--•-•--•--•-•-----•-----...-----•-------•-•-•••---•-••••••.............__.
r
Agreement.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT 1L4 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. _ >
Signed- ;..... ` ;Date
Application Approved By.............. �...=2-•• ------•--••-•••. ....................•-•---..............
-
Date
Application Disapproved for the following reasons:----•-------•-------------------------------------------------•-----------------•--------------------....._...._
...-•-•-------•------------------------••---•------•-----•--•---•-------------------....._...••-_...._....__.._.._._........•...••----•••---••-••-••---••••••••--•••----•--•--••••---••-••••-••-...._.._.
p Date
PermitNo........D-_f...... ........................ Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF...... .--.... ..............................................
dw
%luntifiratr of TOutpliattrr
THIS IS TO CERTIFY, jTJhayt the Individual Sewage rHD sposal System constructed ( ) or Repaired ( )
by .r.......w-+" r i f V 1. C �Z./'s-.E..G'�" w
` _,. {
�t Installer
at.......
f �'
I
•
•- - - -----------------------------------------------•--
..
has been installed in accordance with'the pro 'ons of TIT .T, 5 of The State Sanitary Code as described in the
application for Disposal Works Construction .ermit No--------- F5...... _.`l' ..... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
-7
DATE................. l .... r-- -- ........................... Inspector -_-•---_.----._-------
THE COMMONWEALTH OF MASSACHUSETTS
-- BOARD,OF HEALTH
PG - ... ............. .. OF...... "',..............................................................
No...U.9."3y. FEE.__ -_
Dispima1 Works Tons wtr on Fermi#
Permission is hereby granted.........................................•�-� z �-
to Construct (• r) orTRepair ( ) an lnd jXidual�Sewage Disposal System
at No..- r x -�-t�>r� -- G~� f✓ $ l.. r,� '
Street3�
as shown on the application for Disposal Works C ______Construction Permit No. Y__ Dated..........................................
----•...................•---....�.;-D..........................
Board of Health
DATE............................................--•-•-•••-•---•-
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
III I 1I �
I I �� j
ASSESSORS MAP .
-0 -*
TEST HOLE LOGS l �j,
PARCEL . �J -- _ __ _-- - - - LL I �1� �,-�---pl-4--v-1-b-I�-P 1--lp(--I-:,--�-C-cC,---I
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0 PC./C C.O S01 L EVALUATOR._ Avl m C ,
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REFERENCE: G'E�, C I 1 �. D �� �"-
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