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Home My WebLink About0013 SMITH STREET - Health 13 Smth St 288-012 t Hyannisf i j ° a TOWN OF BARNSTABLE LOCA'?:tON SEWAGE VILLA;iEiuNuo ASSESSOR'S MAP & LOT-2 ?? . O� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY _162 92.gip �¢ LEACHING FACILITY: (type) (size) GiU 'L NO.OF BEDROOMS nA BUILDER OR OWNER PERMITDATE: 3 — q 1 COMPLIANCE DATE: 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) Feet Furnished by r , a i • > w �. r� ti � z �� C -- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplitatfon for Migooal *pttem: Construction Permit Application for a Permit to Construct( )Repair(�pgrade( )Abandon 4K ❑Complete System ❑Individual Components Location Address or Lot No. /3,5f I j4 Y 5/ , ��,Y,t.pS Owner's Name,Address and Tel.No. Assessor's Map/Parcel OFF-01 Awlk\rf" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. QQ 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 2_>3-0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 19z-`t 5�t4::f tnv�o Type of S.A.S. I /I Description of Soil J ,&e d Nature of Repairs or Alterations(Answer when applicable) -:00—STAA Nv-" 6—�>Vc 6ZO, 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 by this B Signed Date Application Approved by Date- .2j _ /3 —F 7 Application Disapproved for the Mllowing reasons Permit No. I 1 Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE C.. `" VILLAG ASSESSOR'S MAP & LOT JL • O I a INSTALLER'S NAME&PHONE NO. Ln d Ren" SEPTIC.TANK CAPACITY LEACHING FACILITY: (type) +e 4+�' (size) �X U NO.OF BEDROOMS BUILDER OR OWNER 11&6+1 S AA-VA, PERMIT DATE: 3 ' l 017 COMPLIANCE DATE:—, " 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 Feet within 300 feet of leaching facility) Furnished by I E: H�� ....a�....�..�.73 .lt...,.,r-.__--�-wn..�....-...:+...«ad'r3J�'+,.-•�� No. I 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Z[ppricatiou for Migooal *pttem Con5tructiou Perron. Application for a Permit to Construct( )Repair(�pgrade( )Abandon$ ) ❑Complete System ❑Individual Compbnents Location Address or Lot No. 13�/yj i`1f yl �T, rl1 G.v�wL S Owner's Name,Address and Tel.No. Assessor's Map/Parcel 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 �A - Design Flow �� gallons.per day. Calculated daily flow 3 gallons. Plan Date Number of sheets -� Revision Date Title Size of Septic Tank I C.e�)n Type of S.A.S. - Description of Soil M 0 D 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 B d-of-Me>alt ` Signed Date Application Approved by Date 7�5 Application Disapproved for the vilowing reasons Permit No. — 0 Date Issued i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of QCompliance THIS IS TO CERTIFY hat the On-site Se age Disposal System Constructed( )Repaired( )Upgraded(✓I Abandoned( )by at 1 a .5/h`i�. ST 14!, -`e S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system 1 function as designed. Date LJ 9 7 Inspector . No. 7z— liq --------------------------Fee e--) / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Oizpozar 6potem on5truction Perron Permission is hereby granted to Construct( )Repair )Upgrade( )Abandon( ) System located at S—Y 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: Approved by 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 DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated3 1c9-'`7--2 , concerning the Pro i S M; r�51 } r..�. �> meets all of the 'Y property located at 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 • There are no variances requested or needed. 0000�— 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]. jxert k \l !� �� V\ `}^\ �� ' v �� \\ t.i � �� '\. O O �U 1 �' ASSESSOR'S MAP NO. PARCEL h 1 L U i A T 104 SEWAGE PERMIT NO. VILLAGE W6 peg- INSTA LLER'S NAME i ADDRESS "� &g E: Q)96�- BUILDER OR OWNER DATE PERMIT ISSUED �-ggq DATE COMPLIANCE ISSUED � 2J1 l IY K .0 � Y _ rs J t � G _ 6 No..... . .�� ` . I � Fxs.... �r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ^T- w----.-....0F... 1.7-s ................................ Appliratiun for Disposal Varks Tonstrur#'inn 1rrniit Application is hereby made for a Permit to Construct ( ) or Repair (Individual Sewage Disposal System at: _ .. Locatiott.�ddre .......... .................ss or Lob No. .�-�-� - .. .......a1►.1 e �.`.�. . 5r. ........... ................. !?-V.-I-1...................................................... .................................................................•--_... ......_...__ .._ t!v! �:.�e 5'.. _� Tl ........ ... Installer Address U Type of Building Size Lot.................... .....Sq. feet a Dwelling—No. of Bedrooms_________ _______________________________Expansion Attic ( ) Garbage Grinder' ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other figures .•--•---------••----••-••-•--••--•-•---------•----- =•----•--•--•----•-•- W Design Flow....... _________________� _gallons per person per day. Total dailyaflow____.__._�-.�-D.......... .......gallons. W Septic Tank—Liquid"capacitylb_______gallons Leength__.... .... Width..... i------ Diameter________________ Depth................ x Disposal Trench—No......A............. Width___._.......... Total Length...(�.2....... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft: Other Distribution box ( ) Dosing tank ( ) a 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 a -•--•-----•-••••--------•••----------•---------••----•••-•---•--•-------•----.....•-••--•-•••----•-•........................................................ Description of Soil..................................................................... V ............ .•-•-••---------.........................................................•----•••---------••--•---------------•--------------•-----------------•------------••--•-•••-•-•------------•••-- -----------------------------------------•- - --------•-----------------------------••-----....------------------------•-------------------...................................... U Nature of Repairs or Alterations—Answer when applicable._______ ------_j_��!C-- '�-�i!�J K Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITi.I: 5 of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance b the b d of Signed- ---------- --- �2�� ....................- C5� - - ---• - Application Approved By............ - ... - ---•. .......-------------------------------- :"'Dt :-S? �' _---- Date Application Disapproved for the following re ons: -- -•-------------•- ................................... Date PermitNo................. -----------•--•-•----- Issued ......................................................_ Date No.... ..._ `�� d �{ Iy� ` - .. Fins...-Z 16b THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tonstrurt on Urrntit Application-is hereby made for a Permit to Construct ( ) or Repair ((—) a-•-S Individual Sewage Disposal System at: 1 -Location:Address or Lot'No. 1 ----•- -• -- = 7_-- A�>.v�?;lld1...........` ........... .........•.-•-......�--......-........... r -`''> Owner - ................... Address ............. _ ............ .... ........... ...... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......... ...............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildi a yp ng ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures w Design Flow....... '___`-------------------------gallons per person per day. Total daily iflow-._.......- .. _ ?.................gallons. j WSeptic Tank—Liquid capacity.f)P�gallons Length....-.�-....F..... Widt ......�_...-. Diameter---------------- Depth................ x Disposal Trench—No. .....i............. Width...`��........... Total Length...- !..... Total leaching area....................sq. ft. 3 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. I................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.................................................................... -------------------------------------•--------------------------------•-•-••••......-••-----....... x U -•-••••••••--•--•••••••--•---•-••......•-•-•-......----•••••---•---------...•-•-••-••.....•--••-•-••--••••-•-•••---•-•----••••••-•-••-•--------•-------••••--••-•-.......--•••-....--••-•-•----••----... w U Nature of Repairs or Alterations—Answer when applicable .... C`3OQ....... :._•. ! s .................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha-s--been-issuedyby the board of health: --------___Signed.--------� :--- .'. . .. Application Approved B PP PP Y -n-----••--•. --.' _----•------------_--- --•---------sn !t_ l�Date Application Disapproved for the follons:--•-•--------••-••---••-••-•--•••••••••••-----•-...••••••-••-•--•••.....---•-••---•--••••-•-••--•--------------- " .............................•---•------......-----------•----.....------.....---•-----•---------•----•--............................•----•-••-••......----......--------------------.....••--•.....----------- Date PermitNo......................................................... Issued-...................................................... Date —._...__..._.__...— -— _._ s... �..,.�.--._ --. . .�- —,..._ -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '..� Chi�'✓ OF....... .....r ..,Y.Vt ,"vim �1, ............. ....................... .................................................... �rrtifirtttr of faoot�rltttnrr THIS IS TO CERTIFY;. That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ' by............ 5 ........ �:..................... ..�� - ------..... •-----------•---•-----••----••-••-----•-------....._-••-_..•-••--......-•-_..........................---...----------•---- Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ .....!:...!4 -1...... dated..../..�..`.;��`------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL-FUNCTION_ SATISFACTORY. DATE.......`? . ?� � Inspector........--r o..............•- ---------------•----...-----------•--•._...................... THE COMMONWEALTH OF�MASSACHUSETTS ^— —�--- ^" ' BOARD OF HEALTH i No... .................... FEE.....__.57'......... Disposal Work Tonotrttrttion "prrntit Permission is hereby granted .t� -- ------ r`- ✓ ::) to Construct ( ) or Repair (4...)a-an Individual Sewage Disposal System ti -Street as shown on the application for Disposal Works Construction Rermit NoQ)_.O.............. Dated-.-�........r......Q....�1......_..._.... X z ......-_-- Board of Ifealth DATE............._.v.-- --..L-l._ .-�.--v----------...------...------ ,.