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Home My WebLink About0025 HIGHLAND AVENUE - Health 25 HIGHLAND AVE ' , COTUIT l MAP-02.0 PAR-044 TOWN OF BARNSTABLE 1'� LOCATION «�J SEWAGE # l , VILLAGE ASSESSOR'S MAP& LOT '04 INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY 156Q P, LEACHING FACILITY:{type (size) (l� lO ' .5� NO.OF BEDROOMS BUILDER.0 'OWNER PERMTTDATE: ��^.�T COMPLIANCE DATE: L(?� 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ':' Feet Furnished by ' l l _ �2a _ z L� t-� TOWN OF BARNSTABLE LOCATION �V SEWAGE # � 1 VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. (- 'SEPTIC TANK CAPACITY 150 0.0 A'L-) _ l LEACHING FACILITY: (type. ( (size) (lJ x CG+ 50 II NO.OF BEDROOMS 'I. BUILDER O OWNER ��-�- PERMIT DATE: 7- COMPLIANT 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 /�`/q - - - l I _ � � i� � . .� ____l � = a�- . _ �- � " �v �� 3 a � . � � � � - 37 � � �� = � 1 �rj � - h. �� t �. (ZQ_ 0(.XCLI- 3 �� l � - No.T 7- 3 7 Fee �_ v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for Mig o of ipgtem Con!Aruction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components LocaattionAddress or Lot No. �a lvvlJ �+ Ow is Name,Address an T No. VJ Assessor's Map/Parcel A Installers 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 Design Flow gallons per day. Calculated daily flow gallons. 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) a J 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 n d not to place the system in operation u til a ertifi- cate of Compliance has been issued by this B of e �J 7 Signed Date / l Application Approved by Date 7- 7- � 7 Application Disapproved for the fol6king reasons Permit No. 3 Date Issued /* No. % - M-7 Fee d { Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWWOF BARNSTABLES MASSACHUSETTS Application for Mig 7upgrade ar 6pgtem Congtructton #eimtt Application for a Permit to Construct( )Repair( .(' )Abandon( ) El Complete System,. El Individual Components ...7 • i..� kl a- Location Address or Lot No.a5 kPil lf\yb Ow s Name,Address an Te.No. Assessor's Map/Parcel Installer' Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. f Garbage Grinder( ) Other Type of Building No. of Persons / Showers( ) Cafeteria( ) Other Fixtures r- Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil t' ` Nature of Repairs or Alterations(Answer when applicable) IS00 _ IF Date last inspected: J XF4 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 nv 1.Ge d not to place the system in operation u �1 a ertifi- cate of Compliance has been issued by this B . of e 92 Signed Date / 7 ,Application Approved by Date '7 - 7- j" -7 Application Disapproved for the foll ing reason Permit No. 2:2 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS, Certificate of Compliance TH IS TO CER that the 0-a--site.,Sewage Disposal System Constructed( )Repaired ( "Upgraded( ) Abandon y C-- at4 has been constructed in accordance with the provis' of ritl e for Disposal System Construction Permit No. 7�. dated Installer _ C_ Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date --, 04 Inspector . i ———— --� — No. �� ———————————————————— 7/(r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lw gposW *pgtem Congtructton Permit Permission is hereby granted to C nstruct( )Repair('V�pgrade( )Abandon( ) System to ted at MA 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 ermit. Date: 7 Approved by Q. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M A- I DATA C) — CA4 ....... ...? ........ APPROVED THE COMMONWEALTH OF MASSACHUSETTS n pel=D"Y" BOARD OF HEALTH , o TOWN OF BARNSTABLE el ' 3�� lirtt#ioii for Uirpoowl Wor1w Towitrur#"ion f ermi# Application is hereby made fora Permit to Construct ( ) or Repair ( 14"'an Individual Sewage Disposal or Lot No. • s................. ia- .......... nc �l.J .-1.•......1. .. ------- ---- - Add Installer Sq. feet Type of Building Size Lot............................ U Dwelling— No. of Bedrooms.......................... ..._....__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building No. of persons---------------------------- Showers ( ) — Cafeteria ( ) GltOther fixtures ..............................................................................................----"""-""""""-""--"....._............_....g...ons. d allons er erson er da Total daily flow...................................pth...gallons. W Design Flow.._....-"----.--•.................•---.... g- P P P Y 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 ( ) Z. .............. Date........................................ Percolation Test Results Performed by....................... 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........................ ------------------- -"--.------------" 0 Description of Soil.............................................-........... ............................................................................................................... W ............... .......... ........................................•-----------------._.-•-----•- �.- "--......... ............................................. ...-- 777 x Nature of Re airs or Alterati ns—Answer when a plicable._...�...�- - U ....."-.-".._�.. . .o.."" " c f t��s. ..... Agreement: The undersigned agrees to install the aforedescribedwIndividual Sewage Disposal System in accordance.with the provisions of TITLE 5 of the State Envir nmerit ode — rsigned further agrees not to place the system; in.operation until a Ce u ' at, of Comp , a en 'ss ci the oard of health. ....... ... � C.. .. :.:.-�Signed . ........ . ......... .... . .................... �. APPlication APProved B ....... ...... .......... .......... g . Application Disapproved for the following reason • ........................................................................................................................................ ........................................ ................................................................................. ............................................................................................. [hte Issued ............ 9 Permit No. . .. .................. Date --------------------------------------------------------------- ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ( w1jertifirFIte of V'Z ompliance T CE F , That the Indi ual Sewage Disposal System constructed ( ) or Repaired ............................. by........ ..^ . ................ .. .... .. ... ...................In tell has been installed in actor ante with the provisions of TITLE 5ROSTRUED Sfate,,Frnyir nmental Code as describe in �� dated ......................... . the application for Disposal Works Construction Permit o. ....... ......THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Inspector ... ............................................................................................ DATE................ .................................................. ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (none#ran Ppruttt � Permission is hereby granted_....... to Construct ( ) or-.��epair ( an Individual Sewage D sal System -� -- ----------------------------------------------- 3 atNo.......................... �----- - V -�• street f as shoe n on the application for Disposal Works Construction P ymit No to ----- -- 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 )YITHOUT DESIGNED PLANS) hereby certify at the application for disposal works construction permit signed b me dated 3 Q'T , concerning the property located at �� _ «� Tmu��- meets all of the 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. SIGNED DATE: ?//7 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]. j xert w ,. � CJ r 1 � No __...--- ........ APPROVED THE COMMONWEALTH OF MASSACHUSETTS ns eCon BOARD OF HEALTH rc� ,0 TOWN OF BARNSTABLE fto Appliration for Divjipuittl Works Towitrurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( P3"'an Individual Sewage Disposal System at. • o ca' d e s or Lot No. - ---- -- ---------- -------------- ......----- . O ne s a Installer Add s UType of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—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 ( ) 14 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I----------------minutes per inch Depth of Test Pit...-..-.-.--------_ Depth to ground water..---.---------.-----... Grq Test Pit No. 2................minutes per inch Depth of Test Pit.--------.------.--. Depth to ground water......--................ a --------------------------------------------------------------------------------•---••---•----------......................................................... 0 Description of Soil........................................................................................................................................................................ x V ---------------------------------------•--•-- -------------------------------------------------------------------------------------------------------------------------------•----------.......--------- --------------- ------------------------------------------------------------------------------------------ --- �+ U Nature of Repairs or Alterati ns—Answer when a plicable---.-.�...I.' l Q---------------�4--- � U E Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir nment ode—Tzqr rsigned further agrees not to place the system in operation until a Cer ' ' ate of Comp a enssti the oard of health. Signed - ----- ..... ... . . ...... .. ................... ........ ---.. ` - - ----- PP PP Y / Application Approved B - .......... ..(�(t ----- -P....... .............----------- . ............................... ... ... e - � Da e Application Disapproved for the following reason • ............ ... ........ . .. -- .................................. ........................................ ------------------------------------------------------------------ --------------------- ---- ----------------------------------------------------------------------------------------------------- ----------- --------------------------- Permit No. .......9.Z�.__,3_b1 ................ Issued ......................................................... ........ Dare '—————————————————————————————————————————————————————————————— —————————— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BAR((�.NSTABLE LLPrtifirate of (11ompliance T CE FY, That the Indi ual Sewage Disposal System constructed or Repaired y --------------------- ------------------------ ------.--- ----- at ..-- .... ----.. ....... - ... �-, --��----°..... - - - t. '1� -- J has been installed in actor ante with the provisions of TITLE 5FState �nijrnmental Code as described in the application for Disposal Works Construction Permit No. ....... dated ..___....._....._.._._..._----THE ISSUANCE OF THIS CERTIFICATE SHALL NO T BE STRUEA A GUARANTEE THAT THE SYSTEM WILL FUNCTIONS TISFACTORY. DATE............................... /�7 �. .._.._.... Inspector -------------------------.---------------- -----------------------------------------...----- 09 4 No.. .............. Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V '�'/'�Ox/TOWN OF BARNSTABLE Applirativit for Diripw3al Works Towitrurthin ramit Application is hereby made for a Permit to Construct ( ) or Repair ( L-,ran Individual Sewage Disposal System at 0 or�)��--------------------------------------------------------c-------- .................................. or Lot No. ----------oa ... .......... .......... -------- 03'A ...... ..... . ..................................................... ............... Installer AdA s Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms............................................Expansion Attic Garbage Grinder PL4 Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria 04 Other fixtures ----------------------------------- ------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity------------gallons Length................ Width__---_.-.______- Diameter_.._.__..._..._. Depth....______..._.. Disposal Trench—No. .................... Width.._...___._.___._... Total Length.____.._.___....._.. Total leaching area---------_--------sq. f t. Seepage Pit No.--_____-_-_--_._._ Diameter____________________ Depth below inlet_._.___............. Total leaching area.................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Per-formed by------- .................................................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-___.------__-_____- Depth to ground water__.__....._._._...____.. GT4 Test Pit No. 2................minutes per inch Depth of Test Pit__.____....._....... Depth to ground water._.____......._.....___. ................................................................................................ ---------------------------*'*"*...... 0 Description of Soil........................................................................................................................................................................ x U ........................................................................................................................................................................................................ ------------------------------------------------q-----------------------------------------------------------;;—--------- - --------------------------------------------------...... () U Nature of Repairs or Alterati n,—Answer when am)licable------ ----- i�:--- ..................................................................... .....t............. ........... ............................................................... .............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir nment 1 ode—The-undersigned further agrees not to place the system in operation until a Certificate of Comp I - eha een .le&by the oa'rd of health. VASigned .......... ............. ---------------- ....)...... ----------- -- ------------------ I 1 1/'- I I/ I Application Approved By ............................11&��----------------- ------------------------------------------------------ ......... ------------------------- .................D- ce Application Disapproved for the following reason - ---------------------------------------------------------------------------------------------------------------------------------------- ....................................................................... .... .............................................................................................................. .........................----------- Date Permit No. ------ - .. ................ Issued ................................................................... Date ---———————————---———————————————————————————------—————————————————————————- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Compliattrie TO CE FYY, That the Indiviqual Sewage Disposal System constructed or Repaired boNi. -----------_----- ----------------------------------------------------------------------------------------------------------------------- y ----- ....... at --------- ......... .................. ...- k, - — - ------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 rf State,-Environmental Code as described in . .6 ---------- the application for Disposal Works Construction Permit No. ....... . .. . -------A,�� --__ &-/ dated .---------__........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE TRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �/,/�/7�7 DATE------------------------------- ..................... ------------------------.................... Inspector -------------------------------------------------------------------------------------------------- ------ ------------------------------Z------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEEJ( .. ...... ...... E411vo3a, 19ork3 Tomitnut' it "t1r.Kutit C-) Permission is hereby granted_..._____. ----------------------- ---- ------ to Construct or,- -epair ( an Individual Sewage Dhosal System W", V-' --------U - _... 1-1 1 ------ ----------------------- at No................ ...... -_Ako V'kJL_).Pr__t�. .......t � )?--- �* - - Street as shown on the application for Disposal Works Construction P"It Nov at d--,,------------- _P4— 4111, ............. ........ ..................................... /�(� ------- Board ellith DATE................Z.....•...-............ .............................. FORM 36508 HOBBS&WARREN,INC..PUBLISHERS