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Home My WebLink About0086 OLD TOWN ROAD - Health 86 OLD TOWN RD. ,HYANNIS = 268-086 i" Y E 4_. r.Fes. TOWN OF BA��YBLE (� LOCATION SEWAGE # — VILLAGE < SSESSOR'S MAP & LOT -6 ( lee. INSTALLER'S AME&PHONE NO. SEPTIC TANK CAPACITY sr LEACHING FACII.TTY: (type) r¢ (size) G NO.OF BEDROOMS BUILDER OR OWNER V e- U..)i ) IE1 PERMTTDATE: %,- �2COMPLIANCE DATE:-- fv"CI 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet I 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 f s' `, a a s�� i� �6 a a �° � oa �, � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for 10iopoeaf *pgtem Construction Permit Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addre s or Lot No. Y& ®�� y,a � Owner's Name,Address and Tel.No. Assessor's MipfParcel ^^ 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 Fe!r, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow jf6 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �. aa Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when ap licable) r-errla�e ��r3� �. Yed p1 'T -'i,jVr, �-Q�K d-o �ffi-�;b�/-e Y (yeo�- -fa 2 �e�i-ta 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 Environme 11 Code and not to place the system in operation until a Certifi- cate of Compliance has been?* y t ' o t f It . Signed Date ,//—,2 Application Approved by Date �l-- - /� Application Disapproved for the following reasons Permit No.�'� . �- Date Issued s S LITI,: �q �zt fCB,� No. '9.97-1,6 q Z _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Migozaf *p5tem Construction Vermit Application for a Permit to Construct( )Repair(4/Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addle ss or Lot No. 06 L �� c�,� ?4 Owner's Name,Address and Tel.No. 1dI¢N�rS SSAr r l Assessor's Map/Parcel f 0 Installer's/Name,Address,and Tel.No. �p Designer's Name,Address and Tel.No. -A7 e-0051-rucdloAj TIC- Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building 1�'�'1 enS. No. of Persons Showers( ) Cafeteria( ) f Other Fixtures Design Flow PAO gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank pL��' Type of S.A.S. t! Description of Soil Nature of Repairs or Alterations(Answer when applicable) 7 -C r jj;t",f A 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 o thf,_Environmen6l Code and not to place the system in operation until a Certifi- Cate of Compliance has been i y t ' f It Signed QhA-c� Date ,/-.2 Application Approved by - - t Date Application Disapproved for the following reasons J f Permit No. 7'6 y'7- Date Issued �/�" -Sf' t/ -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compriance ^ THIS IS TO CERT that Xt /On-site She `age Di offal System Constructed( ) Repaired ( )Upgraded Abandoned( )by (OvS D'Y t)C- r a R; =Aj G at <v 00 �/U u-r ry has been constructed in accordance with the provisio s of 7itle 5 and the for Disposal System&nstruction Permit No. 9 7-C q Z-dated InstallerC.DrtIS �c! a,C Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector -- �— No. � � "(j LfZ°,,:-.--------------------------Fee � 0• W ,THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Owiopool *pgtem Construction Vermtt Permission is hereby granted to Cons ct(�epair(VUpgrade( )Abandon . ) System located at r� 6U Aj 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 o�tfthhjisCet,Date: ` r Approved b � r 7' 10/9/97 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) b I here that the application for disposal works , Y certify construction permit signed by me dated l f. ^vim' , concerning the meets all of the property located at following criteria: t/• There are no wetlands located within 100 feet of the proposed leaching facility G-1 • There are no private wells within 150 feet of the proposed septic system V • There is no increase in flow and/or change in use proposed There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will n.9.S be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGN oilDATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER ch a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, [Attach p p p Y this plan should be submitted]. q:health folder:cert ,, ►, —�, � � � -- �.. � e � � � � - _ L \r -, �l � Q . _ _ 4� i � � �„ L .� � c H 1 TOWN OFBARNSTABLE LOCATION - SEWAGE# — VILLAGE SSESSOR'S MAP&LOT . U, INSTALLER'S AME&PHONE NO. / SEPTIC:TANK CAPACITY S 00 r I d LEACHING FACILITY: (type) (size) /U r 64 NO.OF'BEDROOMS BUILDER OR OWNER PERMIT:, ATE: /�- � COMPLIANCE DATE: I j - /a "CI 7 Separation Distance Between the: MaximOrn 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) Feet Furnished:by • ��I TOWN OF BARNSTABLE LOCATION V6d P SEWAGE # 8 6- 11 z 8 VILLAGE t/9�v/V!s ASSESSOR'S MAP & LOT g[o INSTALLER'S NAME & PHONE NO. /Z0 SEPTIC TANK CAPACITY /t/�,4 - �) LEACHING FACILITY:(type) ,P- / l (size) 4X (, X IV NO. OF BEDROOMS 3 PRIVATTE WELL OR PUBLIC WATER Zo �; L BUILDER OR OWNER DATE PERMIT ISSUED: G DATE COMPLIANCE ISSUED: (5—, VARIANCE GRANTED: Yes No >\ __ _ _ _ -� �. �Q �� s� �� ' �'�� s SSESSORS MAP NO- No. .. .�..1..Z 'ARCEL NO.. Fes$..Z......'............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1... .�"f ................OF... !. Apli ir�ation for Biipuaal lVark.5 Cron rurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair Zan Individual Sewage Disposal System at: t ..._.... 1?_.......:/.k. ...-;- •------ ...............A ......................... Llfcatio�ress or Lot o. ... .._... �/....._../__ .. . ... .. .................... .......................................... ...................................................... O ner Address .....-•--------------•--------- Instal r Address Pq Q Type of Building Size Lot:__ .....Sq. feet V Dwelling—No. of Bedrooms_:________.�3_- _____________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers a YP g -•--•-•-•--------•--•------- P ( ) — Cafeteria ( ) 04 Other fixtures ---................................................................................................................................................... W Design Flow...........`/1a_:..........gallons per person per day. Total daily flow,___________��..Z?...................gallons. WSeptic Tank—Liquid'capac>ty_ gall.ons Length______:l�__._ Width_._.__._______ Diameter________________ Depth--It........... 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------------------------ rXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water________________________ P4 •-••• -••••--...._.._•-•••••-•--._. .----•-------------------------•------••----......._..---•--------....----•----------------••••••--•------------....•- 0 Description of Soil..............Q-hA. L_'r......---..6- 8lrr�._...-------...•--------------•---------------------------------------------..••.------------------•---.. x U -------------------------- -------•---___---------------------•---------•--•---________-___--•--••------•---•-•-•-,•-•--•----------------•••--•------•---•-•---•---••-- -••---••---•••-••--•-•-••_ U Nature of Repairs or Alterations—Answer when applicable___....0.1/_�1 __ _4.4 W........la_e%.________=__16.I1_� - ----------•--•----------------•----------•-------------------------•--------••••-•-•-----•--•-----•- ••-•• ••-•••-••-••••-••......_•-•------ Agreement: 3' ` The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wi I the provisions of i T',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 Iby the board of health. Signed._ t.... ......................................... Application Approved By........ ............................ ..._••----••`J•Da�'-.. 14 Date Application Disapproved for the following re ons:------•-••••----••-•----•-•-----•-----•••---•-----••--•-•••••••••--••-•-----••---•----•--••----- .............•---•••----------•-•----•••••---•---------••-I•-•-------••-•-...----•----........------•--•----•••------•------•••••--•-•-•-•••-•----•_._..._-••--------•--•--•-•-•-----••-a•--•-•-•----••--- Dte Permit No. � � Z�b-•-•--••--- �----..._•--------_--- Issued_--•--------1 -••--•. —8 Date LZ l Nos..c, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.. ._... .. _..............OF.... -• ................................................ , lyfirFatiou for B44posa1 Works Tonstrurtiurt Famit Application is hereby made for a Permit to Construct ( ) or Repair (/an Individual Sewage Disposal System at: �; ..............��a w- � - / l ==... ... .._... = '-k.7-0-------------------------------------- T4catio�ress or Lot o. 3.L�!..1 l --•-•--------------- -----------------•-------------------------•-••-•-----------------------------•---------------------•---........_ ---- r '- O ner ---••------------------------•--Address--. Insta. r Address Type of Building Size Lot...X°a._.b e 52_.....Sq. feet Dwelling—No. of Bedrooms........... •-.._.•--------------------•Expansion Attic ( ) Garbage Grinder ( ) Other—T e of B ' din No. of persons............................ Showers — Cafeteria Q, Other fixtures .._..---•.............•......••. . W Design Flow.............if*00q9:v/1A............gallons per person per day. Total daily flow ............�,�5�_Q....................gallons. R; Septic Tank—Liquid capacity_ gallons Length....... Width............... Diameter__-_D__--__---_ Depth_ .._.._._... xDisposal Trench—No. .................... Width.................... Total Length............ Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.__...6........... Depth below inlet......k_......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---•----•--•----••---•---•.............•---••......---------••--•------.. Date........................................ aTest Pit No. I......:.........minutes per inch Depth of Test Pit.................... Depth to ground water_____________-__---___-- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----_----------_----- .................................................................................----------------------------------------------•----------------------............ -----.._..------.......................................................... O Description of Soil-•---------C-hAi�...-----.. -•--------•--------------------------•-••---------------- U ••••--•-•--••---•••••••-......---•----------•-•-•-•••-•---•--•----------------•----•...........-•-•-----•-•----•---••-••-•-••-•-----•-•-•••....-••-••---•••............-----•. .................... �4 •••-••----------------------•-----•-------------•--------•---•••--•---••-•--•-•-•-----•••••••-•--••---•-•-••••----......••••----•••----•-••--•-------•--•••---•••••--•- ......................... U Nature of Repairs or Alterations—Answer when applicable.....Q_Ur.2.__f _4.9GJ____...pZ............../.0__ T�Z --------------------------------------------------------------------------------------------------•- Agreement:The undersigned agrees to install the afor eddscribed Individual Sewage Disposal System in accordance wi i the provisions of iI Tf:a. 3 g g p y 5 of the State Sanitary Cdd�;— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issue by the board of health. Signed.<::Z--.. Application Approved By....... .Li.�_....... _ �. � Da� Date :Application Disapproved for the following re ors:--•----••-•---•--•------•-•--•--•-••--•-•---••--•-----•-•••--------•-•-•-•••-•--•---•--•---••---•-••-•---------- .... D `�� Date . J Permit No.---. 6 Issued_ / Z Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................I..........'.......0F...........7-'1.`.... ................................................ C�rrtifiratr of ToutpliFattrr THIS IS TO CERTIFY, TII4 the Individual SeNyagq Disposal System constructed ( ) or Repaired tt��by..............$-_(,...........� ,�.........--- 1' = .... Installer at ... has been installed in accordance with the provisions f ii'"i j ofhe State Sanitary Code as describ in the application for Disposal Works Construction Permit No----��?_--_-1_��.............. da.ted_.....w.!_��.�.__��?........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM V►/ 1. FUNCTION SATISFACTORY. DATE '.1 - ..................................................... Inspector!.:!:._........_.... .-....... tl THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.-.1......--i- ....... .. ................OF..,-....... ................... FEE............vt.. R11111asaalrk ��aat Ltrtuatt �erutit Permission is hereby grant ed_.......... ................................................................... to Construct ( ) or Repair ('.)_an Individual Sewa Disposal System jt�>v t & 1__ �De Stree as shown on the application for Disposal Works Construction Permit t o�,�-�.1_1 Z_ _.-._ ...... G(� . - �: Board f Health DATE.................................. :'-• ------ FORM' 1255 HOBBS & WARREN, INC., PUBLISHERS Y