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Home My WebLink About0075 IYANNOUGH ROAD/RTE 28 - Health (2) 75 !yannough Road — 343-007 Hyannis 7, o � a 1 1 N, M1 d i i 4 r r e X I }• o FROM :down cape engineering inc r FAX NO. :^15083629880 Dec. 12 2005 09:04AM P1 s ,F Town of Barnstable Regulatory Services $ Thomas F. Geiler,Director I YAM is Public Health Division ' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508462-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Designer: Ll Address; - Address: )Q On I 11 was issued a permit to install a (date) ins er W septic system at based on a design drawn by ( es ) / a.r dated esigner) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that.the septic system referenced above was installed with major changes (i.e. greater than 10" lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified -built by designer to follow. IiA OF gt4s� AR NE H. Dastaller S ignature) CIVIIL No. 30792 F 0% ST F • s/oNAI. r, 4esiper's ignature x esi p ere) P -TO TABLE PUBL.IC iiW TH D ION. ERT CATF O BE SSUED TIE B TH TIIY FO AND AS- WELT C AM CEIVED&Y THE BA STABLE P BLIC HEALTH DMSION. Q:Health/Septic/Designer Certification Form FROM :down cape engineering inc FAX NO. :1508362geeo Mar. 01 2006 09:1eAM P2 Town of Barnstable Regulatory Services Thomas F. Geiler,Director l ' KOM $ Public Health Division 36s9 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form. Date: `� V De Z signer:: nstaller: 1t , ✓l rp �i Address: I"lCl 1� Address: � t- 5" &ornhlab 42b- On 3'" Z A 4 was issued a permit to install a (date) (installer —7 7J di d b based on a design drawn y ` septic system at ! � ... - (address)_) . G Aia dated-- signer X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater 10, lateral relocation of the SAS or any vertical relocation of any component of the se c system)but in accordance with State &Local Regulations. Plan revision or certifre as-built by designer to follow. XIa��N of tklss, ARNE H 'c o OJALA er'9 ignature)� civil_ o� No. 30792 �0W�I FOI S T SPONAL V tam Here (Designers Signature) �p y (Affix Designer's Stamp ) PLEASE RETURN TO BARNSTABLE PUBLI_`HEALTH DIVISION. CERTIFICATE t S FORM An AS- OF COC RD RwEC IYED X TI3E BARNSTASLE PUBLI TIL HIHEALDIVISION. YOU Q:Healtb/Septic/Designer Certification Form � r I` . TORN OF BARNST L LOCATION EWAGE # VILLAGE ASSESSOR'S MAP &1101 `INSTALLER'S=CITY AME&PHONE NO. SEPTIC TA3N C./C/ LEACHING FACILITY: (type) I u f�(size)�o�r 01 6 NO. OF BEDROOMS BUILDER OR OWNER 1 R 'mI'Lo J- -W)C-s I C��d o r1 —•� PERMITDATE: 1, — — D 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) Feet Furnished by RoN-r s_- se 4- 4 --2-T $ " No.C7 Fee ✓ �— �� ® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mi.5pogar *p5tem Construction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.7s Z r nxu,0 Owner's Name,Address anji Tel.No. — N74n's"s,1?M C0109 Colo 11)(A l u� Lt�I.�GR r hhc— Assessor's Map/Parcel 3 7S rye , P / (�»» I 1/�c y�/ Installer's same,Address,and Tel.No. S(As Designer's Name,Address and Tel.No.Sf 4 f-- S.f�iL/�c% a S t+Scu l 114 squ C, &M, . (W. PW.")Clne_ All.Zinc- ,&AG;k �;re_sfclfc,L mg. k(cnh Type of Building: Dwelling No.of Bedrooms 0 Lot Size to sq.ft. Garbage Grinder(lVq Other Type of Building HlAe-J USYL No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow AZ 5 gallons per day. Calculated daily flow �V3_� gallons. Plan Date -I1-0-Y Number of sheets a Revision Date Title Size of Septic Tank /s�j Type of S.A.S. Description of Soil fefi A.n 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 [tie.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. Sig Date Application Approved Date Application Disapproved for the following reasons Permit No. cQ-4x)5 c2--5 7 Date Issued 1 AN No.C)40 15 C) y'. Fee LJ D "1 THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION —TOWN OF,BARNSTABLE., MASSACHUSETTS ZippYicatton for Mi!5poga[ *p!5tem eongtruction 3permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.7 S r yc.nnc,'w,,,b c Owner's Name,Address an Tel.No. - 0911F (Col I JCIV:r/T)V,J ' Assessor's Map/Parcel if . Installer's Name,Address,and Tel.No. 5� 3 Designer's Name,Address ands Tel f No. G 3(-0� -11 Rr�• 7 P, Iit,act,U C((Cl SE. C�ppn�. ` `� I (�tx .,, <(,)e((r��,,. T/�e ��ll t �D 7, 1!5Lh V)� I'—c ST(!L,�� , 1�7, Vv� `1 Jl 11',Irf )�• iG,-r7701 '�Xlf� o t.r✓��1 Type of Building: s Dwelling No.of Bedrooms (2( --.- Lot Size w 9•k/ o? s ft. Garbage Grinder 0 '~ Other Type of Building NI' -ct (f:Sj No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .3 c)3,S` gallons per day. Calculated daily flow g Plan Date -U}/ Number of sheets 1�2 Revision,Date Title .' r l i Size of Septic Tank /SZ/p Type of S.A.S. _A/ - .Description of Soil �F L �qc.r1 Nature of Repairs or Alterations(Answer when applicable) Datt last inspected: t;• Agreement: inLThe undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system c'ordance with the provisions of Tit 5 of the Environmental Code and not to place the system in operation,/until a Certifi- cateof Compliance.has been issued b this Board of Health. Sig g Date -v- ! f Application Approved Date Application Disapproved for the following reasons NA Permit No. c� C�5 �. �-- Date Issued —----------------------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ' Certificate of (Compliance THIS IS TO CERTIFY, that he On-site Sewage Disposal System Constructed( Repaired( )Upgraded( ) Abandoned( )by 1J01 at i S has been constructed)n ac or dance with the prov` •ons of Ti e 5 and the or Disposal System eonstruction Permit No. S dated Jr Installer Q I► �m Q� Designer r, The issuance of this permit sh I n t e construed as a guarantee that t syse m willfune'on as designed. Date > v Inspector____ nspector ------------------------------------- CC !��,/� Ja No. Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS 1wizpazat *p5tem Construction permit Permission is Hereby granted to Construct(N R79V Upgrade( )Abandon(M) System located at 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 Tust b completed within three years of the dat of this Date: Approved b Lam0CCATyION ' �� 5EWO,C,E PERMIT UO. IIvS-T&LL -RS U&ME ADDRESS BUILDER 'S Q &MF- 4, ADDRESS DATE PERMI r DATE COMPLI &KICE ISSUED ; .-- t9 . r "' �t � .�,. > I ��' �` -. . ;, THE COMMONWEALTH OF MASSACHUSETTS �/ BOARD F HEALTH �D _ .. � � ........OF........ :. .../�....._.. Appliratinn for 43inpnttl Workii Tnnntrnrtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (&I�an Individual Sewage Disposal System t: r G �`sx��lf i.... t...'. ............. r��5 ...._... _L ati ddress or Lot N r /-- Installer Address UType of Building Size Lot............................Sq. feet �-, Dwell i g No. of Bedroom�s�/)____ _______________ ______ _________Expansi n Attic ( )Showers GarbageCG index ( )p, Other Type of Building .�t .Q$ o� of persons._ ----� _____ ( ) ( ) Other fix ures .............. ---------- - W Design Flow.................___...-__._._.._______ 111ons per person per.day. Total daily flow..._..____._.._�`- ___ WSeptic Tank/-Liquid capacity/ allons Length--------------_ Width................ Diameter................ Depth.._._-._-.----- x Disposal Trench—No_____________________ Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter_._`..._....... Depth below inlet........... �1 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 "Pest Pit-------------------- Depth to ground water_-__--__-_-.__-_.___.. f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------.------ W --------•••------------------------------------------------------------------------- --------------- ---- •--------------------------------------------------- Description of Soil______________________Sai_` - V -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W U Nature of Pepairs,or Alterations Answer woe appli le._._.___i"'t--S*u��____ �'-re t�JC -----------------------------------------.. ------------------ - :5 '� ----------�-'---------___._-_---------------------------------------------------------------------------... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en is ued by t//hee board of h alth. Sign ... .... .......... r -------------- ------------------------ -------------------------------- Date Application Approved By--•...- --- D44- ., - - ate Application Disapproved for the following reasons:--------------------------- -----------•---------------•-•---------------------------_-----------........... - _...•-----------------•...--•---•----...------------......__.---------...•--•---------------•--------•---...---------------------•-•--•------------•------•-•-------------------._....---------------•--- Date PermitNo......................................................... Issued........................................................ Date rTHE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... ................OF......................................................................................... Application -fur Bitiputitt1 Works ( omitrurtion Vrrui t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •----------------------------------•----•-------•---•-------...----....-----•--.....•-----......-- -••----•--•••--•-•••••----•-••-••-••••-----•------•-•--•---••-•------•--•----•----..........•---- �,gcatio dpdress / or Lot No ........................... =-•: —==f �4�i��'4 t- /�h ...iJ! i yj�Gl --- h O er j,/ A d ess Installer Address Q Type of Building Size Lot............................Sq. feet U Dwell ityg� No. of Bedrooms_ __ ________________ --_..Expansion Attic ( ) Garbage Grinder ( ) 1L I-r Other T e of Buildin !��-� t,��EP�_ o.-of ersons../.�................. Showers Cafeteria a YP g' P ( ) — ( ) d Other fir ures ---------------------------------------------------------------..---------------------------•--------------•-•------------ ---------- W Desi n Flow................... ___ __.__..._gallons per person per day. Total daily flow--------------- '� Mons. g -- g P P P Y Y .... g< WSeptic '17ank 4 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`( ) -- r. aPercolation 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------------------------ W -------------------------- ----------•--------------•••--------------------•--••-•---•---•-----•--•--------------------------------------------------------- Description of Soil ,Sti H• y------------------------------- U ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W ------------------- -------------- V Nature of P.epairs.or Alterations Answer whew applic ble..._____ ..s.*G��__.__ f '7- --_-- -'?�C.......................... -------------------------- h-. = , ---•---- TG -------...------....-•----------.........---..........--------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en is ued by the �,board of lipalth. Sign ....... -• •--..... G� l---`----•--•-•--------••------- Date -------------- Application Approved B .. --�( " 7 Date Application Disapproved for the following reasons---------------•--•----•-•- -•--- --•-------•------------•-----------•-•----------•----.-----------•--------- --•-•----------•-•---------------•-----------------------------_-_--------------------------------------•-----------------•-------•--•-----------------------•-•----------•--.--•----------------------- Date PermitNo......................................................... Issued........................................................ Date - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ......\...... . .....OF............... ................. rdifirote of f omplitturr T S I TO CE T Y, the Individual Sewage Disposal System constructed ( ) or Repaired by.... . ........................ �-'�=----•••- -------- �,M,e,j __- -::..........------- � _..` staller / ha. been installed in accordance the provisions'of Art' e I.of T State SaWry Code as /de abed in the application for Disposal Works Construction Permit No.� --�.....•--••...._ dated........ _fn G � r`'� THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL—FUNCTION SATISFACTORY. DATE------------1..-• ------ .............. Inspector_ THE COMMONWEALTH OF MASSACHUSETTS BOAR. .. ..... HEALTH ....OF... ._...... �.- ►"✓� FEE• .............. Binvolitt rkq v�ug&urtivuPermission is hereby granted (19 ------ ----••-•----•- •-------------- -------------•-•-•- �� to Co/nstr ct ( ) or pair ( atrf Ind' ideal Sewage j i oral System 4- at No------7-¢ n�� f.�'t t J`�� -�d. G-c!-�t .. ----- • Street as shown on the application for Disposal Works Construction rmit IN .......!- _____. Dated..: ..................................... 7 ...•. --- 'L• � -------------------------- "� ��`�/ � Board of Health DATE J- ---------- ---- -------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS — _