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Home My WebLink About0045 BANFIELD DRIVE - Health 0,745BANFIEfD DRIVE IT -- 023 032 No. ��n � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Digpo bpgtem Congtruction Permit Application fora Permit to Construct( )Repair( upgrade( )Abandon( ) f Complete System ❑Individual Components Location Address or Lot No. Yul-e� Owner's Name,Address and Tel.No. Assessor's Map/Parcel 6a-3-off Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. <A i Type of Building: Dwelling No.of Bedrooms 3 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 73 1-k`- gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t�4b D J y 7(4- (L_ '� /7 Type of S.A.S.!T 5�A,�,_ Description of Soil: i9►�k�_/ M-e_O SAY/ Nature of Repairs or Alterations(Answer when applicable) *s7gO C'o f •-G/I�SS 7-- 6M tC, j4A C'7 iti L ✓!�— L a j f ( S GG.-r? 7` 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 le 5 of the Environmental Code and Certi fi- cate to place the system in operation until a Cer - cate of Compliance h n issued by this ealth. Signe Date `""Qo Application Approved by Date 17 r 2G- Application Disapproved for the following reasons Permit No. l� Date Issued `�Q' TOWN OF BARNSTABLE LOCATION � �✓ SEWAGE # ( ASSESSOR'S MAP & LOT VILLAGE— IL- !� INSTALLER'S NAME&PHONE NO. (nI( SEPTIC TANK CAPACITY i LEACHING FACILITY: (type) T�/Q� (size) NO.01 BEDROOMS BUILDER OR OWNS �+ -2 V f PERMITDATE: DC� OMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well Leaching Facility (If any wells exist. Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by. i T zil� � 77z�l ��/` z � i r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS ZippYication for r)igp at *pgtem Cootruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 'LJComplete Systeriv, ❑Individual Components Location Address or Lot No. Cv rem ' Owner's N e,Address and Tel.No. Assessor's Map/Parcel 63'3—(Q_?_�)`' Ins er's Name,Address d TcLNo, Designer's Name,Address and Tel.No. JV�1 -Gift Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtur D 1-k CA Design Flow gallons per day. Calculated daily flow 3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. �� z i Description of Soil s r� e Nature of R7pairs,o Al erationsenswer.Then a pli,�b e �r Y� t Date,last iinspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with thepr u4sions o t f the nwir-onmental-G a and not to place the system in operation until a Certifi- cate of Compliance h&b-ee,n iss ed b dl f Health. _ Signed Date 4 ��'? Application Approved by Date Application Disapproved for the following reasons Permit No A Date Issued —' ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIF k the�e�ua � posal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by ��!— �C i at sbeen cons ct in acco da ce with the provisions of Title 5 and the for Disposal System Construction Permi o. IW dated � Installer , t Designer.� "'The issuance of this pe t hal no onstrued as a guarantee that t e syspe�n wil � tion As des'gne Date p I V� Ins ector/�-', � 9�4 1, � �Y - Fee ee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH-DIVISION - BARNSTABLE,, MASSACHUSETTS lwigogal *pgte5__Cottgtruction Permit Permission is hereby granted„ypfCPtstruc le ,(,- )Upgrade( )Abandon( ) System located at /i L�"� 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: nstruc- must be com leted within three years of the dateyof-0128 ermit. ��Date: Approved ,. .'r 1/6/99 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 dated g=�O—� , concerning the property located at meets all of the following criteria: L�This failed system is connected to a residential dwelling only. There are no commercial or business C / uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. here are no wetlands within 100 feet of the proposed septic system 6.o There are no private wells within 150 feet of the proposed septic system here is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] •�If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 66, B) G.W.Elevation 37 +the MAX. High G.W.Adjustment. DIFFERENCE'BETWEEN A and B SIGNED : DATE: [Please Sketc opos p an o system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert a V 1 g & TOWN OF BARNSTABLE LOCATION J SEWAGE # a000 VILLAGE . �t�'�t �� (, / A . ASSESSOR'S MAP & LOT `0, G� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 4n,�f Z!!!� 75?"7Q1 (size) J NO.OF BEDROOMS BUILDER OR OWNE � -e SA PERMIT DATE: 06 OMPLIANCE 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 4 291 a . TOWN OF BARNSTABLE LOCATION A1-4 Ki e`0 Ord. SEWAGE # y VILLAGE J 1 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY �-- LEACHING FACILITY:(type) (size) U-6� NO. OF BEDROOMS 3 PRIVATE WELL OR V' BUILDER OR OWNER DATE PERMIT ISSUED: `s DATE COMPLIANCE IS'SUED:_/, VARIANCE GRANTED: Yes ' No I _J � \ , -� �-� OF B STALECJ e G, LOCATION Lo — SEWAGE # VILLAGE CAL)l I' ASSESSOR'S MAP & LOT 2 —�16l INSTALLER'S NAME&PHONE NO. ZrW o Rs (xi4alt ko11 771_ 1321 SEPTIC TANK CAPACITY 1 V &I - LEACHING FACILITY: (type) " Sala l LA a (size) NO. OF BEDROOMS BUILDER OR OWNER aon Psi A PERMITDATE: <2 a 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 A, Ag ' As 3� Aq s3 ' 3 As y ' 31 `� _ Bq NL 6 No.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Dispoiial Works Tomitrnrtinn ranfit Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at: ....L7.�A. ions...... O�.V��--------•..................................... Loc ion+A ress r Lot No. ............g::�..T't�4. ...... �.e 7,---------------------------- ------------------ 5_ t ... ------.....---------...............----------- wner -•.Add ss ��------------------- ..................................� `q.` (10.................................. Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms___..3.....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------•------------------------------------------•---------------------.....--------............---- w Design Flow......... L-__ -•-•---___._.•--- _--_-gallons per person per day. Total daily flow.._...�3-D....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width..y.__...._._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------I------------- Diameter...._0......... Depth below inlet_.(0(..._._._... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ..a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fX4 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a •-----------------------------------------------------------••--------•-•-------•---•-------.....--•......................................................... 0 Description of Soil........................................................................................................................................................................ x U w ----------------------- ---------------------------------------------------------------------------------------------------------------------------------------- - - ---------------- Nature of Repairs or Alterations—Answer when applicable ,,//�� U P PP Ld ------ . . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code The undersigned further agrees not to place the system in operation until a Certificate of C has b@en issue and of health. Signed .......... ...------ ---------------- - ------- --7 .� Date Application Approved By - - .... J V o )- . --�, ..................... ..--------.-.-....--'-'------...-..--................ ....--- Dale Application Application Disapproved for the following reasons' ----------------- ---------------------------------------------- -------------------------- ----------------------------- ---------------------------------- -- -- ------------------------ -- ------------- --------------- --------------------- ------------ ---- - ----------------------------------- ----- ........................................ PermitNo. ....... = ,- ------------------- Issued ................................................------.Dace Dace No.-- -..a:yv - FEs. • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 I70WN OF BARNSTABLE Appliratiun for Disposal Works Tonutrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( Qfan Individual Sewage Disposal System at: n .............. --- ............... . ..... ... -•-• ................ - - - ._......................__.._. __ Loc'tiont-'Address -~or.Lot No. Owner Address Wa�l -�" �..., � (.................... . 3'` �.. -1,��1�c .............................. Installer Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms___.�--�........................ _Expansion Attic ( ) Garbage Grinder ( )t Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures -----•--------- ---•-•--•---•-- - W Design Flow___..____.4!E�zS________________________gallons per person per day. Total daily flow-------_��'�_-_ .n....................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.......V----------- Diameter___ ........ Depth below inlet__-&........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results . Performed by.......................................................................... Date........................................ W Test Pit No. 1_______________minutes per inch Depth of Test Pit____________________ Depth to ground water........................ Lt, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ x /- -----------------------•----------------------------------.......-------------------•--•-----------•--------•---.......--•-•--.....-------•---•--•••--•--•--- O �7 Descriptionof Sofl------...-•-----------------•------._.._.._.....------•--•----•---------------•-----••--------•------------------------.............................................. W _ 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 TITLE 5 of the State Environmental"Code—The.undersigned further agrees norto place-the system in operation until a Certificate of Compliance has been issued1by the board of health. Signed - — .�j----- Date Application Approved By .................... /�/ -ate.... ---.. ...._-. _.._-� l�.._.--------......................----------.._..-- _.._....C.__'_-Dace Application Disapproved for the following reasons- --------=----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------............................ ............--- --------------------------------=--------------------------------------------------------------------------- -------------------------------------- Dace Permit No. . ....... -..... .L�.. ....... Issued Date THE COMMONWEALTH OF MASSACHUSETTS— 1 BOARD OF HEALTH TOWN OF BARNSTABLE Cfelrtifiratr af (foutylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by r��..►c.. ..( 64 %�..........~`I ........---------------- ------=-------------------------- ---------................................................ ..........................................- at -------------------------------------- .......6.6� l... �.. t. d }-� ------ L. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... __ ------ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A_ .GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. S- r' \t DATE............................. ............. ...!"............------------------------ Inspector .....................------"` .......................... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.... --.S .f �) _ TOWN OF BARNSTABLE FEE_�3If ..:.. . Disposal Works Tunutrnrtiun frrutit Permission is hereby granted------C Qf J. Mm/15F)�71 L----•--------------------------...................................... to Construct ( ) or Repair ( _)'an Individual Sewage Disposal System at No---------------------L ---•--l�.,4AI41 r�%�/ 1 ' ---..... ------.-•----- --------•---------------------------------•-----•--------------------------••-•....... Street as shown on the application for Disposal Works Construction Permit ye-1,Dated.......................................... DATE.................. j---•-•-•----•--•-•------------•- Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS r