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HomeMy WebLinkAbout0018 HIGH STREET - Health 18 HIGH S7AAAT61 - --- - - - ----- ---- A No. o Fee ZS THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_AZ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliYatlon for Misposal *pBtrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(V/❑Complete System ❑Individual Components Location Address or Lot No. �S �ty� v`� ''�'f Owner's Name,Address,and Tel.No. Assessor's Map/Parcel *a3 a- 0%+ o ez - t` Installer's Name,Address,and Tel.No.to L✓i\`�j r-to Designer's Name,Address,and Tel.No. &9 it�i�TMre 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Vac�Z a�� Syr .r1 hoc � Oa,.S ► 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 Certificate of Compliance has been issued by this Boar f Health. yC Si ed Date_ J?`rN3�r Application Approved by ` Date Application Disapproved by Date for the following reasons e Permit No. Date Issued —t No. Fee �5 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for Bis#bsal 6pBtrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(vx) Complete System ❑Individual Components Location Address or Lot No. ��^ Z<< '^�' Owner's Name,Address,and Tel.No. cwr., -•-r Cad r G \ Assessor'sMap/Parcel 01y — V�o ILAN."\ 1rcC �'4� cwvw, Installer's Name,Address,and Tel.No.-Vol o Designer's Name,Address,and Tel.No. i"-4rS.xA1r's ftV:o'E5 4a rtFL -1'1`t 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets. Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) � �'►�� O *y*,t rt;M"� r'*r N ®�,� +�., ye" , 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 Certificate of Compliance has been issued by this Board of Health. X "Si ed Date 06k\1y s Application Approved by y Date `f/t t Application Disapproved by Date for the following reasons Permit No. ) ( Date Issued s F - ----- - - --- -- -- - - - --- -- - ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS k,,j,, 3, BARNSTABL.,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandonred(%I by +al1«9 .���t�t �.k n �. a �- �' "�L'x-t.t A at 5,-rre , - nZ•r has been consttructed/M accordance'If , irwith the provisions of Title 5 and the for Disposal System Construction Permit No.O�djt' 7 dated / t Installerit^— 6\,*h-C c y. .) &wc- Designer y #bedrooms ` {�V/`f Approved design flow y" gpd The issuance of this permit shall dot be construed`.as a guarantee that the system will function as designed;; " Date Inspector ` tG - - ------- - - -p- - - - - No. a 0� O � C�-�-------- ---- --- --- -- ------------ - - ------ -- --- - ------ - - - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction J)Prmtt Permission is hereby granted to Construct( ) Repair( _ pgrade( ) Abandon( System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Const, ction must be c thpleted within three years of the date of this permit. <P_ - L�a5Date !'' V Approved by s TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE e'VIV4 5� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 44 �,'�o�s�• �d y�B �$�7( SEPTIC TANK CAPACITY 4W C46 LEACHING FACILITY: (type) X;o tf-1 (size) ld'x NO.OF BEDROOMS 4, BUILDER O RAced PERMTTDATE: �D ^ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by' 6 �� �"�" � �T, � . � 'h�' �6. , 3a,6, a�,b.. C) O �.•r �� o° �`' cv� TOWN OF BARNSTABLE LOCATION SEWAGE # 9 46'" ��yy VILLAGE 60,/V4 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. o��ilo ��' �oestroio✓ y�$ .,$ � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) le'-< NO.OF BEDROOMS BUILDER O R PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility st Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) -q Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 6�T O U ` q.st: 9 Gf .oh tl 0 -1y No. / — (9 l® f _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Z �/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for �Digogal *pgtem Congtructton Permit Application for a Permit to Construct( )Repair(V )Upgrade( )Abandon( ) 0?Complete System ❑Individual Components Location Address or Lot No. Owner'sri��Addres d Tel.No. z1 je;�l Assessor's Map/Parcel C D,74--a`' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'gel-ml/;V-1 e—l"OeJ9T 7/- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(le�Q Other Type of Building r L�lT�No.of Persons Showers( ) Cafeteria( ) Other Fixtures IJ Design Flow gallons per day. Calculated daily flow l® gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /✓4_0® Type of S.A.S. L�DX Description of Soil 6 ! / e�p� 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 by iV of ealth. Signed Date Application Approved by ' Date Application Disapproved for We following reasons Permit No. , 9— &6& A Date Issued No: ~ "G _ ��Fe_e � I ' i THE COMMONWEALTH OF MASSACHUSETTS 'Entered in computer: Yes ` PUBLIC HEALTH'DIVISION - TOWN OF BARNSTABLE; MASSACHUSETTS Z[ppYtcatton for Miopo6ar bpotem Conotruction Vermtt Application for a Permit to Construct( )Repair V U rade )Abandon T/ �pp' p ( ) pg ( ( ) L�Complete System ❑Indi Gidual-Components Location Address or Lot No. Owner's Name,Address d Tel.No. jell Assessor's Map/Parcel 0 /� T Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. 8D/-loze 10ei, Zl Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder'(�� Other Type of Building RP_ S% t�l9CeNo.of Persons Showers( Cafeteria( ) Other Fixtures J Design Flow /162 gallons per day. Calculated daily flow � I l 0 gallons. Plan Date Number of sheets _ Revision Date Title Size of Septic Tank Type of S.A.S. l DX/��X Z- Description of Soil .'`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 by t 's B of Health. Signed � Date Application Approved by, ' Date /e, _ - 99 Application Disapproved for Re following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS Q 3 TO / BARNSTABLE, MASSACHUSETTS Certificate of Comphance THIS IS TO CERTIFY, that he On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by �D 1O at /4, has been constructed in accordance with the provisio s of Title 5 and the for Disposal System Construction Permit No. —1( dated Installer Designer �( The issuance of this permit shall of be str d as a guarantee that th s 'ste will function as design Date f Inspector A 1 A a ----------------------------=--�j------ l-- No. l 0 3 5^62 9f Feel THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 30igpogai *pztem Conotrurtton Verna Permission is hereby granted to ConstTuct( )Repair( )Upgrade( )Abandon( ) System located at lo 5T CD 4617— 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: o -- ex • C1 Approved by ) 1 it 17 _ Q h r \ f NOTICE sThis Form is To Be Used For the'Re air Of Failed ' .;Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION-PERMIT(WITHOUT DESIGNED PLANS) I, !✓r°i1r� ✓ © � /, hereby certify that the a lication for disposal works PP P construction permit signed by me dated 1�!ill Q� , concerning the property located at / /fJ`j �5 CDT`�1T meets all of the following criteria: +' The failed system is connected to a residential dwellin g.onlY. There are no commercial or business 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. b' There are no wetlands within 100 feet of the proposed septic system (� There are no private wells within 150 feet of the proposed septic system b' There is no increase in flow and/or change in use proposed iJ 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 when applicable] /ethod 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) 't B) G.W.Elevation +the MAX High G.W. Adjustment. 77 ! 'z DIFFERENCE BETWEEN A and B SIGNED DATE: h*,/✓/l [Sketch proposed plan of system on back]. q hnhh Lolda oat €,nY CAPE COD BUILDINC 'chard Davis INSPE AY 1.5 1992 30 Newtown Road RECEIVE. otuit, MA 02635 � PoIISTABLE 08-420-0260 r0 HE4«oEPr. WN OF BARNSTABtE LETTER OF INITIAL LEAD NON-COMPLIANCE DATE 3 ` t 7 Cl a Dear Qo PcX 11 cu This letter is to certify that I inspected the property located at f �� 4 P� ,apartment no. , and relevant common areas, in the city or town of ���F�� , for dangerous levels of lead according to 105 CMR 460 .730 (Aj through(F) : Procedures For Initial Inspection,Regulations for Lead Poisoning Prevention and Control, and determined that there were VIOLATIONS. The inspection was conducted on 3 -1?- I?z ** Please be advised .that Massachusetts law requires that only certain residential surfaces be free of lead paint . (Deleading must be done by a licenced deleader MASS. state law) NOTE: A copy of the report .must be on site at the time of re-inspection which is after the deleading process . STRIP ALL WINDOW WELLS OR COVER WITH FLASHING. SEE NOTE FOR FURTHER REQUIREMENTS. DO NOT PRIME OR REPAINT UNTIL THE INSPECTOR HAS SEEN THE BUILDING. NOTE: MASS. GL CHAPTER 111 S.S . 190-199 Requires that : .On both the interior and the exterior of any dwelling, loose offending paints or putty, regardless of surface or height, must be removed. The surface should then be sanded, reputtied and repainted with a non-leaded material in order to reduce further deterioration. Any chewable surface within (5) five feet of a standing surface must be stripped to the bare wood and repainted with a non- lead paint . FEDERAL LAW 24CFR Part 35 Dated 1 April 87 requires stripping be done to the (5) five foot level and as above. ** As of above date of regulation Sincerely, it will be the responsibility of the owner to be aware of any future changes in the law. Richard Davis I 1074 Inspector Licence # . Report # At the time of inspection children under 6 were living in the house 13 YES 13 NO INCONCLUSIVE L.00-Q-T-1-O-1�� SEW- 464E-P-ERMIT U-O.- 1-N-ST QL- 1R-5 u-r- .4. -E- - A D-D-R E-S S - -- - 16-U i-LD-E-R ,DATE-P-ER-N41T 1.55UED 7�7 . 1�.T-E-C!N_�-�t`:1-�.-t�l-C-E-I-SS.U--E-� _ - v....__.. ... _ • a i�.i.� \\\\\\ ,. n �'. ...... ... ... .. �.. / it ...( .. .... � 1 ... ..... ,-.... e .'�*t ,.. � �� . �:.. p I � 3 No. L Fa$.. ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH OF......... . ... .�.C�li --..... ...- Appliration for Uhipuiittl Workii Tonstrurtion 13rrmi$ , Application is hereby made for a Peerrmiitt to Construct ( ) or Re pai ( } an Individual Sewage Disposal Sys.... ..at* G � ,/d �' oc ion-'Address or Lot No. Owner Address W / + !.... __.:--- . _ ....... ....... .. .. .....I..............._.................................____............................ Installer Address Q Type of Bui dial ���/// Size Lot____________________________Sq. feet U t Dwellin�No. of Bedrooms______________ ______________________________Expansion Attic ( ) Garbage Grinder ( ) a4 Other—Type of Building ---------------------------- No. of persons.................._--------- Showers ( ) — Cafeteria ( ) P4 Design Other fixtures ---------------- ------- - Q ��� - ............. W .... gallons per person per day. Total daily flow________ _ ___________________ n Flow.._. . _ gallons. WSeptic Tank—Liquid capacity_/_-;2:—'C;gIlons Length................ Width---------------- Diamet r.__....._.___.. Depth_------_-._-... x Disposal Trench—No..... ............ Width------------___.__ 1 ngtl _____ ._.___ 0 1 Ching area........ ft. Seepage Pit No.___ ameter._� 7� ep h elow ' et__._r`L'�_____ Toleaching area.. Seepage It. z Other Distribution box ( 1) Dosing tank ( ) aPercolation Test Results Performed by.:------------------------------------------------------------------------ Date-------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-------..-.---__-. ----- rX., Test Pit No. 2................minutes per inch epth of Test Pit.................... D pth to ground water------------------------ -------------------- ---------------�( ----------------------- ---------------------------- ODescription of Soil- •----- ----®{ --- ......` -t--------- ------------------------------------------------------------- x wI. -- ------------------- U Nature f Repai s or AAl_teration swer when a ,livable---- __ _- --__-_-..._ . r l Agree e, - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI of the State Sanitary Code - The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue ,y the b and of filth. Si g �.; A lication A roved B /Dat PP PP y. . .. ----------------------- Y 7 Date Application Disapproved for the following reasons-------------------- - -----------------------•-----••-•--------•••....---•---•-••--------•••--------••-------- .. ----------------•--------• ---------------------------------------------------------------------------------------------------------------------- _ Date PermitNo......................................................... Issued---�--. ..... ace--��............. .,�------ ------- --- ---- --- ---- ---------------------------------- --------------------------------------------------� No.......................... F>ts .. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH s' .............................................. f OF -for is o�ttl park Cnoit� tt rurti rruii�Application is hereby made for a Permit to Construct ( ) r Repai ( an Sewage Disposal Syst t: �- 1 ............... = o ion ddress � or Lot No. ... ._. -------- ------------ -- - ___ __ •....._............_.___........._....................... Owner Address W '. - - L r La Installer Address Type of But dinSize Lot----------------------------Sq. feet U Dwellin No,. of Bedrooms------- -------------------------------------Expansion-Attic ( ) Garbage Grinder ( ) a4 Other—Type Of Building ----------------------------- No. of persons.._-.._-__-..__-__._-____--_ Showers ( ) Cafeteria ( ) dOtl x ur --- -- =--------------------- W Design Flow....................... : g,llons per person per day. Total daily flow------- -------------------gallons. P; Septic Tatik—.Liquid capacity , ,dons Length-_..•_--_______- Width................ Diame r_-._ .. .._-: Depth. .._.__ _._ Disposal Trench—No............ ....... Width .....--.. . -y ngt Ching area--------------.-----Sq. ft. Seepage Pit No:_-___:-----__ _ iameter f:,!F:!'..'_ e 66 et._;..:_ of leaching area...._..__._._._..sq. ft. Z .. Other Distribution box ( ) 'Dosing tank ( ) -Percolation Test Results Performed'by----------- -----------------------------=-.......................... Date--------------------------------------- ,� Test Nit No. I................minutes per inch" Depth of Test Pit......_------------- Depth to ground water...-_--_.__---.-__-_.__- G>, Test Pit No. 2................minutes per inch .Depth of Test Pit........__.__..._... D pth to ground water------------------------ � Description of Soil- ----- --------------------"-----............_..._. -------------------------- O I x- W je --- - ----------------------------------------:-___----. ------- - VNatuRep ' s�or.-Alteration . wer when applicable----__----- ....... _ ----- = r--•-----------------•----------------------•------•---------- --- Agreeme . 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 is ue the/bard of lth.Sig . ----- • ------ --------••----• •-•-• . --- -- -•-- .--•--• ................... •• Da Application Approved By. •---- -- l'['±![11--- �.- Date Application Disapproved for the following reasons:..........-------- ---------------------------------------------------------------------------------------- ...-•------"-•-•--•-----•-••---------•-•-•-------------------•-----••------------'-•-------•----------'----••--'--•-•--...-------'--•-•---•-------•----'------•----------------------•••-----------•-•- Date PermitNo. :---:------------------------------------ Issued:....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F- HE4j,,TH tr .... ............ OF. .. .. ............ .... ............ ........................ r• `�. � ft �rf'ftffosptiSaf RTI Th e Ind ew �st,.em c s d ( Rep it Iryst ... , at has been installed iti accordance with the provisions of ArtiS ,XI of The State Sanitary Code /ss escr ed in the application for Disposal Works'Construction Permit No----.4744,/......::..:....:.. dated.... ...f. _._ ... ............ { 'H�, 'ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE`CONSTRUED AS A GUARANTEE THAT THE rSYSTEM�WILL FUNCTION-SATISFACTORY. :. DATE--------------- J Inspector--•-- -----------'-----------------------------------------• MOTHE COMa-W �. ALTH OF;tMASSACHUSETTS � I BOARD F HEA H d' :. .... ............O F..... ._......._ No...---.................... ;` . � FEE- ................ k11 on Permission is hereby ante T!9 ... ,. !- to Conct ( ) Dr-ffi air an ual s sal Syste at No n .. � ..,..n..-.,. - tseet ! , •.V�,. as shown the a plicati n for Disposal Works Construction mit Dated.. _ :. — :< Board of Health DATE FORM 1255 HOBBS A WARREN. INC.. PUBLISHERS Y 1 s � . t `� J. . , � , . '.� ' �` � x . ice. _�