HomeMy WebLinkAbout0069 SMITH STREET - Health 9 SMITH ST., HYANNIS
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_TOWN OF BARNSTABLE
ON M._�z"1, SEWAGE #
AGE �'1� �#l� ASSESSOR'S MAP & LOT
I
STALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY too 0 nn rr
LEACHING FACILr Y: (type) �CCJ7 �a�YN (-(size) �.
NO. OF BEDROOMS C t
f BUI.DER OR OWNER ��C�t�A[�.. (•�Vd f/��
PERMITDATE: COMPLIANCE DATE: od _
Separation Distance Beween the:
Maximum Adjusted Groundwater Tabre 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) y _ Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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ASK L3.53su 1-'9'.Zu.s V&ZV V I
12-23-2008 a'1 09 22 12at
DEED RESTRICTION
WHEREAS, PAUL A MAHAN and DONNA M. MAHAN, of 53 Santoro Road,Worcester,MA
01606, owners of property at 69 Smith Street,Hyannis, MA 02601under a deed dated I 1 z! w
and recorded with the Barnstable County Registry of Deeds in Book/3L79 ,Page
and shown as Lot(Parcel)T on a plan recorded in Plan Book Plan
(the"Property");
WHEREAS,PAUL A MAHAN and DONNA M. MAHAN, as the owners of said Property have
agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms
which can included in any home bult on said property as a pre-condtion to obtaining a disposlal works
condstuction permit in compliance with 310 CMR 15.000 State Environmental Code, Tile V,
Minimum Requirements for the Subsurface Disposal of Sanitary Sewage;
WHEREAS,the Town of Barnstable Board of Health, as a.pre-condition to granting a disposal works
construction.permit for a septic system in compliance with 310 CMR 15.200 State Environmental
Code, Tile V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and
•4 authorizing the issuance of a bulding permit for the construction or re-modeling of a single family
home on the Property, is requriring that this Deed Restriction limiting the number of bedrooms be put
on record with Barnstable County Registry of Deeds,
NOW THEREFORE,PAUL A MAHAN and DONNA M. MAHAN do hereby consent that the
following restriction in favo,} of the Town of Barnstable Board of Health, be placed on the property
recorded in Book 7`� ,Page which restriction shall run with the land and
be binding upon successors in title:
Un
,o
There may be constructed upon the Property a dwelling
containing no more than two(2)bedrooms.
Witness our hands and seals this day of December, 2008.
Paul A. Mahan Donna M.Mahan
COMMONWEALTH OF MASSACHUSETTS
Worcester, ss. December �� , 2008
On this (9 day of December , 2008, before me, the undersigned notary public,
personally appeared Donna M.Mahan and Paul A Mahan . proved to me through
satisfactory evidence of identification, which [ X] photographic identification with signature
issued by a federal or state governmental ag ;as
y, [ j oath or affirmation of a credible witness, [ ]
personal knowledge of the undersigned,to l" the per es ar 'signed on the preceding or
attached document, and acknowl to -rneY ed it o y for its stated purpose.
JQNATNAN FINWASTEIN
NOTARYPUBUC n an Finkelstein,Notary blic
�wM"Nov" ,r` My Commission Expires: May 26, 2011 `
h►Gonrr�seioo���,1bA1
BARNSTABLE REGISTRY OF DEEDS
CoMMONWLQ T`•H OF MASSACHUSETTB
EXECUTNE OFFICE OF ENVIRONMENTAL fiXF 07'
I)Eg'A MEW OF OIOMN TAL PROTE C
ON$t>I►VMR STREET, BOSTO14 MA 02108 (617)292-6500
DAVii)B.STRUMS
ARC-,go)PAUI.,CELLUCCi Commiruncaer
Gaysrror gA;GAiUA ACE B&W"E OlSP®3AL sY$T>SiA�I TfDM hTORM
t C13119WATfOM
�( 1trae11s e f I'C
Frorratir A#drans: Q m 1 T� t�r A4dp"W of Ow M-.,____
Osae etF brgaor;+an: l O t{�t V t'!�.y�
limp tof IrMllsoa l o s E�'Iaaaa FMrtt1
em � PINEM"�� on 15.E of 1W*5(510 CMR 15-MO
,
Cssrliasattl 11�r1u: 't � Od.G�t
MWr+ll AYvs,s:
Oaf grht�Mur rbslt —
��F '�li 4rL t�sawws disposal syatam st this add,.*$$Mind that this infersosa�an reps+tsd below Is tnu!, aorumts
I csrl0j,Chet I -lave parSorlaYy Inspected _ rrienco Ir►thle proper 9lancth iw1 and
am1 ceMtlpiste ,w rN Ins tl�of disposal syetems�TM system:
was performed bossd on my treirtArlg and s�ipr
malrMN9albCe 41 On-alte Sewage
CorwYtlonaNy►asses
Nsads Furdw Eve)ustlon By the Local Approving Audrority
._ Fab
breparmisrs sMIe�4:
an report to the Approving Authority l5awd of Nealth or DEP)wlth)n thin:; (360)691A1,of
The System Irspuctor shell submit a copl of this inspeotl
.00plsting thl.1)nspectlon. If the systems Is a shared system or has•design flow a4 10,040 ppd of gnatar,the inspeetor and this syat4Mn ctirnar
shall rpslimit 010 report 10 the approprlats regional office of the Dope.to nt of fenvitonmontal Protection. The original should Ile W d to tMr
syeterrl owner and 14pNs Sent to the butrar,if sppHeside, and the approving WOMI y.
NOTES AND COMMENTS
revised 9/2/98 TrgrlofIs
40 Pnnted 00 RrgKMd Paper
- 1
AFRIB RFACE SEWAGIS DISPOSAL:YS"M DNMCT10N FORM
P"T A
CERWICATWN toonlinINA
Owner,
taw a�bry.aiia t e 1 a-t�a
Immix.=si.maimmy: Coo A. A, c. of P.
A. VOSTa I'll:
I hems next found any informstion which indicates that any of tM failure conditions described in 310 CMS 15.303 exist: :A MY f10ur4)
alter s not evaluated we Indleavid below.
IL S'y'STW I:MOTTiO11AUY!ASSES:
_ One :,r jiNere system components as described In the"Conditional Pass;Abotion need to be replaced or repaired. The symom,up3n
�._ camt cation of the replacement or repair,as approved by the S 4I'edth,win pass.
I n kite yes, n:e, or net determined IY,la, or NO)• pesedb is of dote►mination In all instaneos. if "ne►t determined",explain whr not.
The septic tank Is maul,unless nor or operator has prov"d the system Inspe-:tor W"s COPY Of s CfwtiIlost"of
Compliance(attached)indicad the tank was InstMed aalthin twenty 1201 years prior to the date of the ine:pettl0n:or
the aeptit tank,whottiw or t meta, Is tracked.strue�raliv t nawnd,shows substsntlai Inflltrador er ertfilt►sAion,+se' In
future is Inendnent. Th stem will page Irespettion if the existing septic tank Is repisteW with a coM%PIVWO seWic U Ak ss
/dumebroken,
of Heath.
skout or high static water level observed In the distribution boa Is dus to broken ar'obetn.etesl piPrl sI
Gel
..attled or uneven distribution box. The system wgl peso inapgctiun if twhh approval of tdw itesrd et
*en pipets)are replacestruction Is removeitributioe box is levelled or reputed
The system required pumping mare than four tires s year due to broken or obstructed pipelsl. The systom wII pass
lingpecdon It(with amwova of ft Sewd of Heath):
broken pipets)are replaced
obstruction Is removed
ze-�rieed 9/2/98 Prpaof11
l
SUBSUMACg s&wAAE DISPOSAL SYSTM WSPWTW"FElf1911
PART A
CWTp9CATNON foeeSrsreM
PoWityOertta ��i r,
paw. 'aff.: rOWOO
C. IRokili 1 IiNAWWATI M 10 VWAUp Mi BY THE SOAIID OF I*ALTH:
cond+dons axial which require h1thw evoundon by the Bosrd of Health in ardor to del
P the system is 'to PrS;past tlMlI
_• pubW Nwalih,safety and flee srmllronmerrt.
t l SVSI'lt'Nl HILL PASS UM.ESS
S1�A110 OF FILTH DETlA�S'By ACCORD WITH 310! 9fe.90a f 11tb1 THAT''W SY!L'TIMI
0 NtiT MWT1D1l1N0 N A 11014111d91 WWAM WLL PAOTECT TW PUi IiALTH AND SAf�T1,r AND THE 4NNIMi iwt :
easspoot or P&V is wia"SO Peet of surface water wadand or a self marsh.
Cesspool or pdvy is w0in 50 fast of a bordedno
aN SYS 118R 1NLL FAL UAS.ESO T1P IUD OF HEALTH IAND PtMX INAT11H SUPPLER.IF ANY)DEMLW# s THBIT TV!E g:1iG1 W
FUN;e10NN0 N A NAZI M
T pI1pTECTS THE PUWW HEALTH AND"FOY AND THE MIT:
_ The system has Mlle tank and soli absorption system ISMS)and the SAS is withifs 100 feet at a surface wrstar 244PIIV Of
t7ft"ryr to a wow supply.
,rho system a septic tank and sad absorption system ant the SAS is wkhln a rage 1 of a public wotw &vps,v wtoll.
The sy has a sefnie tank end sod absorption system soli the SAS is within SO first of a private we"11 9110611y wed.
The sys Ms•sgrtle table end sea absorption system and the SAS is less then 1110 fast but BO fast or nler r from it
l water supply'well,uNas a wolf watar snMysis for crodfann bacteria and voiarils organic ccorr�paunds lnr:lea4ree+f►at tl►s
s flee horn polk�tian bolo that hp:flitlf and 4fee preaencs of arnmonis nitrogen grid nitrate nitrogen is ecias! to e1r Leos
5 ppm, Method wood to detern4ne distance + tesNdl-
3u OTM B
revised 9/2/98 Fsplof11
• S WSURFACE SEWAGE DWO"t SYS TWA MSPWT10N FORM
'ART A
CWTE9CAT1011 COMMMwd)
Ffaprrrtlr yes: 6��m`� c��
Dome tt immi= l O
0. vital 1eAB.Si:
You rreuat Indiaste 4*dar"Yas"Or'NO" Iw each of the following:
I have d,rtermined Viet ono or Riot*of the following fatiura conditions exist es described In 310 CMM 16.303. The IsoN `or tills
�P dsWininstbon is Identified below+. The Board of Health should be contacted to termine what will be necessary to corrm.t tho fsiture,
Yes No
lookup of sowpa irrtr facility or system Component to an overloaded or clogged SAS or coasgocl,
... Cwaeharge or pending of effluent to the surf* of the grounds or surface waters due to an overloaded or cloggel; SAS or
cesspool.
._ S�tosic liquid level in this,distributic x above outlet Invert du*to an overloaded or clogged SAS or cesspool'.
liquid depth in cossprwl is a than 6" below invert or availabie volume Is lass than 112 day Row.
Required pumping m then 4 times In the last year Ij du to clogged or obstructed pipo(s).
Number of tine* pad
Any portion the Soll Absorption System,cesspool or privy Is below the high groumlwatsr elevation.
Any of a cesspool or privy is within 100 feet of a surfece water supply or tributary to a su:facs wrift?1 apply.
lln portion of a cesspool or privy is within a"one Lot a putric veal(.
_ Any pwden of a cesspool of privy Is within 60'feet of a WIM11 a water supply well•
Any portion of a cesspool or privy is)ass-then 100 fact but 1lrester than 50 fact from a private water @upgolY W+e5 With T3
ooeeptabls water quality analysis. If Vn welll has been anstysed to be acceptable.as,rorh cry of wry wz:tcr.a ysls!cr
ooliform bacteria. voi+rtils organic compound@,arnmonis nhragsn and nitrate nitrogen.
E. UU M 511`11 I M FALS:
You rest inamou either"Yes" or"No" to each of the WW
The lWowing erIWIS apply to large syst addition to the criteria above:
The tnystoln serves a facility with a ign flow of 10,000 gpd or grautM(large System)and Tina system to a 81WOicent hreeR ti Public
nd host a safety and the onvir nt because one or more of the following conditions exist:
yes No
_.. /Jos"teon, ithin 400 foot of a surface drinking water supply
ithin 200 feet of s tributary to a surface Wrikkng water supply
reatedl in a nitrogen seraitive arse(Interim WoNhead Protection Area:IWrA)or a mapped Zone II of a lwitac
as)The ewnw orh system shall upgrade the system in accordance with 310 CMR 15.3134(2). friar*consult the locale ngirnN
oflk3n s portmsni for firrVa►Intainsdon.
'� revised 5+/2/98 rwdorii
i
SIMUMACE SLO WAGE OM M LLS YSll E7A MS''EC 1 �C MICKLOT
Deftsd 6,
i .r: to(a 160
Chsc6 if the fodtrwlnpi have bean done-, You must indicate either"Yes" or"No" ss to each of the fdtowinit:
Yay No
hintpina fnforenatlon+wee provided by tt+e owner.oecupant,or llomrd of HeMth.
P&pw of the eyotem cor+vponents have been pumped for at Isaat two weeks and the system has boon'rMi0mil WMW f W
nice durkq that period. Lerge volumes of water haw not been introduced Into the systsm recently or ad pert of this
Inspection.
As bunt plane have been obtained and examined. NOW if they we not available with MIA.
The fealty or dwsuire wee inspected for signs of sows"beck-up,
The system does not receive non•sanitery or industrial waste flow.
Tha oft@ was inspecUd for signs of brook".
.�. /all system componervts.excluding the Soli Absorption System, have been Located an the We.
yho septic tank msnlwies were uncovered,opened,and the Intorior of the septic tank:was Inspected for candl,ion of Imlfles
cot teea.material of construction, dimensions,depth of liquid,depth of Sludge, depth,)f scum,
1'he size and locstiori of the Soil Absmption 841stom on the sits has been datw--Wnad based on:
Existing infopmeMon. For example, Han at S.O.H.
Determined In the fbid(if any of the failure aritarlo related to Pert C is at issue,approximation of distancio in rs-.WacUptabe)
11111.302430))
'rho fealty owner lend occupants.If different from owner)were provided with information on the proper mauntenenco of
Sumurface mmal Systems,
re-lrisled 9/2/98 ryrstofla
I _
W ! w= 4 S
N i w
aq
43
fill
1p
y
?
06
' • g P° 3
At
1, 121
• • > w ' • $
N lot ; y
Pr
• a
w w
s _ M
c
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1 l
SUUt1RFACE GEWAGA WPOSU SYSTM M FGCTION FORM
PART C
8YOM WPORMATON toondmom
`---►�.«a ��b�1 S vet i��+
Oum
tOVIAW
@&Isom fiSEtlrr;W
(Lows,on of Irlen)
Depth bsiow e141,119CAO
Materiel of aenr•auetion:_coot;ron�'49 Pvc_other(expleln)
Diateoov from 1,dvoW wetar supply well i►r auction line
DISINItor
Cowtoevwi too-Witbon of jaunts,venting, sridenee of 441ekaee.etc:.)
ffe'T'C TANlI�,�
docoo on tits l:rd
Depth below gad :_L
Meteiid of aonutruetion:X concrete_inetal^Fiberglass �f►otyethYlaca_uCher(explaln)
if SWA Im.natal,INi age_ Is a"eordlr I by Certlficets of Compliance (Yes/No)
DI measens:,
Mudllo depth:_. y
Dists7ras from rop of eludes to bottom of outlet tee or befAe:a ,_ '
sawi thicknesu: I It 1 I
Disunoe from ::op of mum to top of outlet tee or befllo:_� g I(
oistsLnce ham Ii min of scum to bottom of outlet too or baffle:_
tow dbrandoro weue deft nh ed:1's Qbag rec-C
,�Comornents:
(raccommondet on for pumping, eoeditlon Io a outlet toes or beffles,dap"A of S id level in r silly a to ould invert ueturid iartagrll y,
evido e nes of lot46 ,stc.) N H IC WO.E.
Uecone an alto plan)
Dew below ereds:�
Metedd of coristrnetlon:_concrete_!metal_Irlbereless _Po"*Vlsn _Other(explain)
DI*wntiona:,,,, �.
`ewm fteknee:&:_
UsUnce from•top of seurm to top of outlet toe or baM
Dlatunao from battar+of scum to bettors of outlet or bade:_
Dots of lest pt Mons:
Come
(veeerat nendat on for pumping,eonditlo f Inlet end outlet teem or beffies,depth of liquid love[in relafto►t to outlet Invert,mtructunf inteerfty,
eviAsmc�of lenksip.ete.l
rev3.sed 9/.>/98 FW7ofit
r
IMMUMACE BEWARE CWPOEAL SYIITM WSPECTIOM FOM
PART C
SYWM/WORMATIOM 1(owMYWRIN
Ow
--'Plaosett�
eeef:
Data of ieR: to �a"VOO
TOOT 43N MDI:DM TANK: (Tank rtkest:bepumpe<Orto, of n time of,inspection)
(loceis on eke IAan)
Dwh belowMatwial of aor Itwcfion,„�,conersta—Imetel glae"ons_other(expleln)
dnNeMienR:�ie�`
palloneJdeY
A)arrm prssent,
Alarm level:_,_Alarm I arkinil order:Yea_ NO—
Oeu,an previou(pumping:
Confnrtwrnts:
(condition of t'Aal tee, of alone and float switches,eto.)
DI81'I lil SOM
petite on sm.pheol
Depth of 11*61 love+ above wjtw Invert;
Coriments.
(noca if level and dnrtribu.�' nn�is��oQu®al, wildence of solids carryover, nee oil leakage into or out of bra
PUMP CMAN 1M.
peceRs on elal glom
Pueipn in woeirin0 corder:(Yes of No)W—
Alrr-ie:s In wo-king order IYes at No)__
Coramlents:
(nmo condidal of hemp eharnber,condition pumps and appureeneness,eto.)
revised 9/2/98 �ys�aril
I
SL ACs SEWAGE 08POSAI STSTIM INISPECTM FOOM
PART C
SYSTM I"C MATM M{oondnis"
6 q S m tgtt 5- -°
Ck~:: >>
tams.all 100
SM/►a"Ol"m sipsTENI
l/ed,l
ilosots,at site p on, if possible;excav000►l not fequoestlon may be spprotahnated by nondrrtrusive maRhods)
If not located.ostpapin:
Type:
nimi—
issohi•19 chambers,nuct+bw-xa_
leoem p iliMeries.nundw. _
looWigl wenches.number,Wrath:
}eseldisg floats,nwn* r,dmonsions:
overflipw oswPooi,nub:__
A ksmstive system:
Mann of Toohno '.
Cwmnents:
(note a of soi.signs f►+ydraulle failure,1 Val of po g, damp s il. y#ition of veg�ptstiero, at'.)
(tows on she plan)
tlluebar end conftolr W&M:,�
IWO-i-top of V:pAd tip irdst Invoft.
spth of so & layer.
--,*Wh of scum few;
plmcxnions of sosspool:.,,
MsmisH of a<ralavotion:,�„.„e_
indesMen ofg'oundorster-
inftove (cotspool must be pump�48�PM—Itlf Imspeetton). _�—__••+.,
Comownts:
{note eonfton o1 still. sign f hy**UPC failure,love!of pondno, candid of vegetstion, etc.)
wtN,'ar:__
(!owes en mho plan)
MOUNWs of st nstna;tlon; birmsnsiorpa:
Owh of soQdir—�
Corrntenes:
(rwhr oendtlor of OCIP, signs of 410 feftre,level of ponding, oondtion of vagetetion, etc.)
revised 9,/s,/98 �r9ofta
SYI{StMACE MWAAE OMPOSAL SYSTIN WSPECTMW FOAM
PART C
SYSTEM WOFMATM("o wnMt
Owner:
SWC14,OF SEINAOES OMPOM SYSTEM:
in kw,l dos to at bast two Psrmmnent reference iandinerks or crs�h into hoots)
k� ap wogs widlin 100' (LOU"where PubNe water supplyo
w
revised Si/2/98 r�.�aefti
S%xlStlRFACE SEWAGE D PC"L SYST11iM 111 "C" M FOAM
PART C
�+ SYSTEM PrO MEATdOM deawlinuadl
ovrrar: ICE W�� ,
o�a..f � to\arl oa
NRCS Reportname
Soo Tv;e
Ttrdlosi depth to groundwater------
US48 Dave w obalts visited
Obsemrtiun Wells checked
Gram arster depth: Shallow_ Moderate _Deep
SITE EXAM Slope
Suhtsee wanr
Cheak Ceder
Shallow webs
Esonstecl Depth to at-Kandwatar____Feet
Rase Indcate sit the methods used to detrrrmine High Groundwatet Elevation.
tlltte rk f-orr,Des*Mans on record
I?Ixwved::;3*.,(Abutting property,obioervat)on hole,bssemwK sump*to.)
INrlwwWno:l from local condition
Chocked v!hh loosl Dowd of health
�p
Checked FIWA(Naps
Chocked pimping records
Mocked k+cal excavators,Installers
Uimd USG'l Data
Descrilmo hdw you established the High Groundwater Elevation. (NM be completed)
�t e `
i .
rew.s ed 5,/:2/9® Fwgr it of 11
LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME R ADDRESS
BUILDER OR O� MNER
Maze- Ql)ldh=, r-
f
DATE PERMIT ISSUED / / ,�
DAT E COMPLIANCE ISSUED "P,& �
-T
Q
D
�w
ih
Q
v:
No...$2-= ---- Finc $.... 00.......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Town...... .....OF...........Barnstable.....----------- .
(�� ApplirFation fnr Dispos�al lark, �C ouidrurtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
Q System at
�01� Smith-St,:�„Hxannisport, MA 026? �
Location-Address or Lot No.
Mey_ex..C�4�.dhexg. - Q._Bxidle..Pth_. :,._Rajdolphs ......
Owner Owner Address
W A,& B„Cess-Dool-Service•-•-•-_•••._-___-__-••••••___-_____-_ 12$..Bishors••Terrace-,...Hyannis_.MA....0:601......
Installer Address
Type of Building Size Lot.... ......... .........Sq. feet
Dwelling—No. of Bedrooms..............2.............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons....... ......._._..______. Showers ( ) — Cafeteria ( )
a Other fixtures ---------------------_- ------ -
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—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 ( )
0-4 Percolation Test Results Performed by.......................................................................... Date........................................
aTest 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........................
P4 ----•----•---------------------------------------•-•----•--•------------------------._...._.._••----.........................................................
O Description of Soil........... and___________________
x
V
W ---••-----•----------------------------•---------•----•-------•---•--------••---------------------------••------•----------...------•-••--------------------------•--•--....-•----...................
U Nature of Repairs or Alterations—Answer when applicable_.installat ion--of 2-.flowdifussors•--_stone-.
.
packed (overflow .
---------•----•----------•---•--••-.--........................................................................................................
Agreement:
The undersigned agrees to install, the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of it:I- 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 ofh th. .
gned ...... ........... �`! .J4 1 1182...
q
Application Approved By. 2�.. 1.82.
............................•-•-•----------------•---Date
Application Disapproved for a following reasons______________________________________ ..............
-----------------------------•--------•-----------•----------------------------------...---•----------------•-•---•----•------------------------------------------------------------------•••-••--------
Date
Permit No.-----...82- ��-----•.....................•-.. Issued 2�11�82---••--•-•-••-•-----•-•-•-•-•---
Date
.No.8+2-................ Fzz..$....50.0........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF .HEALTH
....-::..... T.o n..-....:-......OF.-.-.".... asxistable...... ............
Appliratila i fur .hipatial Works Tonitrurtinn Vanfit
Application is hereby"made for a Permit to Construct ( ) or Repair pc ) an Individual Sewage Disposal
S�stem at:
la.�saih_St..:r..H.�Cann3s �nz .,...MA.....02647............... ..............................•-•-••-----......---------------•--••-----------•--........---------
Location-Address or Lot No.
t P�leYL �o�'� �t�".............................................................. 6a..Bridle._P_ath C'-"aq-Ra.ndDlph._.,MA Qom$.....
Owner Address
aA e--------....................................... 128..Rishnps._Te. ce,.. iy�ztzai�._. (1Q .......
.Installer Address
� Type of Building'• Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.............2............................Expansion Attic ( ) Garbage Grinder ( )
aOther Type of Building ____________________________ No. of persons_._..�l:.................... Showers ( ) — Cafeteria ( )
dOther fixtures -------------------------------•-•--------------------------•-•--•---•-•----------...----------------•--••-•••-•-----••--•-._...._-•-------•---------
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
w Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
x
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........................
Gc, Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................
............................................................................................................................................................
DDescription of Soil..........Sand....................................................................................................................................................
x
U .---------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•-------•-•----••----•-----
w
U Nature of Repairs or Alterations—Answer when applicable-inatal],&tIOri...4#'_2-•f1owdifussors,
packed_--(omern aw)...................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT r E 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 he th.
Si --------------•- fi -----?/1# 82
. -
` I�
Application Approved B Zorthe
"'� 2l 1pa?DateApplication Disapproved following reasons----------------••------•---•------•----------•---------...----•••--•-••--•-------•. ........Da
--............--
---••---•••--...----••-•-•••-•--•-•---•-•--••--•-------•...................•--••••----••••----------...---------•-----------••-••-•----••-•-••--------------•--•---•----•------••--•--•---•---••--------
d Date
-
Permit No........8 C..................................... Issues.....2t11/82•---•---• ••-••-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
?'.o?�m.........O F.......Bamstable...................................................
(9rrtif iratr of Tautplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X )
U601..........................................
Installer
at...... ...............................................................
has been installed in accordance with the provisions of TIT--' 5 of The State SanitaryCode a de-cribed in the
application for Disposal Works Construction Permit No. (fir ____________________________ dated............. �182..................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....... .................................................... Inspector..-•--- ......................................................
THE COMMONWEALTH OF MASSACHUSETTS p
v
BOARD OF HEALTH
........................Town......0F.............-Barnstable............................................. 5 .40
No.......-................ FEE........................
Disposal Vorkn Tnntrurtion rrntit
Permission is hereby granted.--......A_-&__B_-.:eSaspaol:_SeY_Yice_...............................................................................
to Construct ( ) or Repair ( X) an Individual Sewage Disposal System �
at No. ..�-----021:2-•-- Myye��yer.C-414�b4x
as shown on the application for Disposal Works Construction Re it N :;�?,�„�_ :___ Dated..
.. s•
. Board of Health
DATE _-•--`••-----•-1 .........................••---....•__---
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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