The URL can be used to link to this page

Home My WebLink About0300 MEGAN ROAD - Health -.-300-;MEGAN.RD ... HYANNIS A, - 291'wY 277 f J I TOWN OF BARNSTABLE i_OCP O � t�� C� SEWAGE# VILLAGE 'ASSESSOR'S MAP &LOT 7 r IN`TALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f 'n�I� size C) r—f S'�l1✓�D LEACHING FACILITY: (type, ( (size) �{ NO.OF BEDROOMS BUILDER OR OWNER r, PERMITDATE: f 99r COMPLIANCE DATE: 715 9 Separation Distance,Between.the: Maximum Adjusted Groundwater Table and 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) V ' Feet F' Furnished by f ,,• •t e y '\ , f y J n B • s Po C-j = 1 w D ty a l.� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Digaal *pgtem Construction i3ermit Application for a Permit to Construct( )Repair(1/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Too c-N, r G� � Owner's Name,Address and Tel.No. Assessor's Map/Parcel CCU t�_c� (,ZJ-�cr.!�"C �C�r � � V ` !ten f2Mln/ C t` �s Name,Address,and T�`o. Designer's Name,A dress and Tel.No. v+�c"C 7 Co � 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /GVC) Q)eO:� Type of S.A.S. Description of Soil Nature of Repairs or A erations(Answer when applicable) , 4 ctx�trs 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 Environ to place the system in operation until a Certifi- cate of Compliance has been issued this Board of ea Signed Date Application Approved by 1. Date t Application Disapproved for tu folio ng reasons Permit No. - d2 yd Date Issued .•+wl�. `♦�` �` 'ems No., — Feed _ - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / , Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[pplication for Mid onl *pztem COnftructtoll 11it Application for a Permit to Construct( ) pair(v)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3d� � _ Owner's Name,Address and Tel.No. " Assessor's Map/Parcel v �o � ` —IZ)C_�_�� G G . (��A e`�W C1 C i (` �taller's Name,Address,and Tel.No_' Designer's Name,A dress 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 Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revisyon Date Title 1�� Size of Septic Tank /GUO Q sc45 Type of S.A.S. Description of Soil -- 1Vature of Repairs orA erations(Answer when applicable) K ( `wS 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 Environ n al p and-Erot to place the system in operation until a Certifi- cate of Compliance has been issued this Board of ea Signed Date `7 Application Approved by Date- Application Disapproved for t12 folio ng reasons �� +: iPermit No. Date Issued •l THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE TIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by 9 -- at L C , , r G r r k) ..Z3 has been constructed in accordance with the provisions of Title 5 and�he for Disposal Syste Construction Permit No. - dated Installer ,��c� M�c c-r.J��_ Designer The issuance of this permit shall no be construed as a guarantee that the system 11-f-unncctiion as designed. Date `f t Inspector � .Us No._ R -z L Feed THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS i Xi.5po.5ar *pMem on.5truction Permit Permission is hereby granted to Construct( )Repair V )Up&rade( )Abandon( ) System located at r\,,r .. MAN"C� C 1 C`C [ � � 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. 1 Date: 7- �'` Approved by i 10/9197 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) T - t I, y certify that the application for disposal works construction permit signed by me dated_ ? �l Cj�concerning the property located at Cc�c�,�� C c ('Cu -- meets all of the following criteria: ere are no wetlands located within 100 feet of the proposed leaching facility ere 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. �f the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will n.01 be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. r Please complete the following: 1 A)Top of Ground,Elevation(according to the Engineering Division O.I.S.map) Jc� � r B)Observed Groundwater Table Elevation(according to Health Division well map _ SIGNED: DATE: 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]. q:health folder:art lip ,t. 7 �� )a � i Q J J � � � �)�(a � � •� �0/_/1 - �,f' �/� �- �n 5EW&C.4E PERMIT U0 IMSTQLL.ER S U&& AE F, ADDRESS BUILDER 'S Q &MF— ADDRESS ziz DNTE PER"VT ISSUED — d DATE COMPLI ht-lCE Y 45,Orv�y� �Rs! 7 7a . No.... .................... Fick . �U........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w .0.W �. .....-----OF... �.2.1��.1...f't:.. -./�............................ Appliratinn -fear Ui.ipuiittl Workii Tnnitrurtimn Vaniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -----------Ga�� .�z..� 'lY�G�A ' a� _�UIW IJ/�__/�I.....................ko- .........� ....................................... _ - yet; , Ada .................... l J (± _ _1o�Lot= -----•� � i. ?S...... --- ••--_... 4 . O er A /47 re A. � Installer � Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-----------A--------------------------Expansion Attic (kc) Garbage Grinder Wo) Other—Type e of Building C _ p �................ Showers (�) — Cafeteria (VQ) a YP g"�-- A-��°--------. No. of persons Otherfixtures ...................................................... W Design Flow.................................._.........gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacitv&V----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 ( ) p—/0CJ4— 3—X— 76O aPercolation Test Results Performed bY----------- .......................................................... Date---------------------------------------- Test Pit No. 1................minutes per.inch Depth of "Pest Pit-------------------- Depth to a -round water------------•------__--. �%q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------- -------- -- - - _I. _ -.`_./-- -..._._._..._--- - t s----•--------------------- ---- ------- O Description f Soil , /` p Z Z 5 x �y W ------------------------ -------r' .�.�--------- --. x U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ --------------------------------------------- ------------.__--•------------------------•-•-----------------__-_--•-----•-----------------•-- 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 been issued by the board of health. /j 76 Application Approved By.—.- Y �,fe!6/L ��:"/.�ie�.7�. " Date Application Disapproved.for the following reasons--------------------- ----- ------------------•-------•------------------------------------•-----------------•- ......................................•-------------•--------•---------------•-•---------------------------------------------------•-•-•-••-------------------••---......_.._...._.......-----_._..---- Date PermitNo........................................................ Issued........................................................ Date 1 2 b IMP w/ /�7 7 7 No..... t• .......... Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH To ,, y .. . .............OF... .a.a..4 J . 4_ _./...d.P`. .....------ ..-.......... Appliratinn -for Diipnnal Workii Cnnnitrnrtinn Vrrufit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: A �� Locates-Ad dre or Lot N .. _ :. O er ,..- flre� -_- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------- ...........................Expansion Attic Qv) Garbage Grinder 1�jo) Other—Type of Building ' r p �________________ Showers (fi') — Cafeteria (opt+) b'�,---�-�-t'�--------- No. of persons --- Otherfixtures ----------------------------------------------------------------------------•--------------------------------------------------- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacityf0Q.ti..__.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 ( ) al)-Pc 4-, - 3- 2, 76' Percolation Test Results Performed bY.......................................................................... Date-------------------------- -•---••----- Test Pit No. 1----------------minutes per inch Depth of "lest Pit.................... Depth to ground water----.._-.----.---.-----. f14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--.-.._---_-_----.-. --- --- -:--- ----------•-- L / O Description of Soil .:. 1�=.v---`-�'-�-- ...... Z� �; -..z... ----- ----- ! � - �`�e -•---------------------------------------------------------- � ---- � - U Nature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------. --..--•-•----------------------------------------------- =--•-••---•-------•-------------•-••------------•------••-----------------------------•----.------------------------------------------------- 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 been issued by the board of health. S ned.._., _ .. .M.�._t;11. ._lr€--- �.---••-- .........�`• -�-�-�e-- Apphcatlon Approved BY �� ' �j rfr e --7G Date Application Disapproved for the following reasons--------------------- ------- - -------------------------------------------------------------------------------•- •-••------••----------------•-----•••-•--._..._....---------•-•••--------••-•------••-------•--------.••.I-------------•--------•------•--••-------------------.-----------------------------------.----- Date PermitNo......................................................... Issued...................... ................................. Date THE COMMONWEALTH E LTH OF MASSACHUSETTS BOARD OF HEALTH :... V..A)..........OF.....773 Ive;�'�.�....T/�..�✓j f...................... Uprrtifirnte of 0,11mpliaurr TLU TO CERTIFY ,That the P;Individual Sewa e Disposal System constructed ( ) or Repaired(( ~- by------..- 1 -------------`"--'-............�`1 ,' ----------------•--------------------------------------------------------•--------•----- V /- Inst111 s� has been installed in accordance with the provisions of rti XI of The State Sanitary Code as describe in the application for Disposal Works Construction Permit No. ___.___cf:./-------------------- dated � .�-.. - __'__. .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE-THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------•--� r--3---0----- �� Inspector.......... ... THE COMMONWEALTH OF MASSACHUSETTS BOAR4D-w F HEALTH 7. !..A).... OF.-.:< .... .rR ............ / -------••------------- •------- FEE .............. n. .l nrk� C�nn�trnrtinn �rrntit Permission is hereby granted--�-- f f ;-----•--. � _ . to Construct ) or Repair ( ) an Individual Sewage Disposal Syste at No. ( I`� ' - �1 ► _f1.i _j .1i 1',�I r`�/�� .. .----/2(_Z� ....••--- Street as shown on the application for Disposal Works Construction r it No. Dated___,' G.'7�_._.___.___. C= � � Board of Health --� DATE.......---•-3.0--`----- .................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _ t•.t...sass. ,..r. .,,, .... �._..y..... ...-.�.,..w.+....r�..�.,- r. _ 1 . k'.'^•.. � 'iv 0 r dev j, .l+�� f �4 ✓ ail :,�' ?Nor ff - <ror' k•••� •r�JL. 3+'@.✓ /4i•h„ 1`_"i�'�,� �'��rlaY« �hnr'� �•�;. l� J L �r'�' • ._� 1 . i` i ,., i..a' /1, ILL • tJ � � r r '- M,. •? t�; ,�,yi LJt ,,11i' r"1•/ - � i t` k ,__•� C....._ ....__._ _r_ �.,, f-,+ t� � !�i }a � .,.. 1. � i i t. � fl. 1�5 Li �` '.�.. � c i f..'`z' '�,�4 .✓.. r.1.. 1:..r......�r t �. T,, \ �� •t. g� r i ,.. i.... � / �� GCt.JRG ��1 \��''•: c> LUVdr JR. $> r.