The URL can be used to link to this page

Home My WebLink About0153 MOORING DRIVE - Health 153 MOORING DR., COTUIT A=024-120 LOT 102 4 �� tr-bi N. Fee — THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppliCotion for Xkgosml 6potem Con6truction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. �,Z O�vne�'s NamtdT 1. o. Assessor's Map/Parcel 0;1+ — / Installer's Name,Addrlss,and Tel.No. Designer's Name,Address and�Tel.No. J\✓ 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 730 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S.R d 5 Description of Soil o iC' 4aymn I "''1 COY-3 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 Marf iron ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue this —p / -p Signed Date !'G;"— Application Approved by Date—? _10 — Application Disapproved for the ollowt g reasons Permit No. — Date Issued - - - - -- - VU'' No. �!' f, Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i+. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIpprication for rigpoml 60gtem (Construction Permit Application for a Permit to Construct( )Repair(�/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �Q� OwneC�:'s�[Vam�A_pdress Tel.No. Assessor's Map/Parcel Q�" -:0 "l.. / I�t,v'M((//�nl'l`ly� Par�fk q�e— Installer's Name,Address,and Tel.No. _ Designer's Name,Address and Tel.No. 90 TREE�v�° OX �� /�'lAks�o/`�S �i�. 5 �Ao-SSB _ Type of Building: DwellingNo.of Bedrooms �, �p'l 1 £'�; Lot Size",., g'' sq. ft. .� Garbage Grinder( ) Other Type of Building F/�(.c Nb.�of Persons Showers( ) Cafeteria( ) Other Fixtures , to ` �3v Design Flow f It gallons per'day.r'Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title e, Size of Septic Tank 1G04 i` Type of S.A.S.a.500 5 Description of Soil —0 "CIA A dV-�.2 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreemen; r 9 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 nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue thijs B f H / c, Signed Date 7— 7 9d Application Approved by Date _1x�-, Application Disapproved for the llowi reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (tertificate of (Compliance THIS IS TO CE IFY, that the On-site Sewage Disposal System Constructed( )Repaired (f�Upgraded( ) Abandoned( at ,/4MM1416 4A ////� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date /,\ k 1 Inspector 1 d P No. I..� r3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miqozal *pOtem Construction Permit Permission is hereby granted to Construct( )Repair(J)Upgrade( ®)Abandon( ) System located at 20 M ORTN� OR 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. i Date: -7 Approved by Q r � �• 108/97 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 ENGINEERED PLANS) 4 t ,hereby certify that the application for disposal works ` ,� construction permit signed by me dated ��'/�� concerning the property located at meets all of the following criteria:. , • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system„ • There Is no increase in flow and/or change in use proposed !� 's There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will mi be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) /_ B)Observed Groundwater Table Elevation(according to Health Division well map) w SIGNED: DATE: LICENSED SEPTIC SYST INSTALLER IN THE TOWN OF BARNSTABLE NUMBER I [Attach a sketch plan of the proposed system.Also If the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert `t s � �L, � l •,� R �. � tJ r TOWN OF BARNSTABLE LOCATION I�` /'°��li`l Q SEWAGE # — VILLAGE—, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO: �it '= SEPTIC TANK CAPACITY LEACHING FACILITY: (type)NO.OF BEDROOMS BUILDER OR OWNER L � (� i PERMIT DATE: :Z - 17- L 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 � o p C:� 7 T-- �j TOWN OF BARNSTABLE �67 LOCAbONa 153 P900AZ114 POK SEWAGE # e VILLAGE '' ,r _� . ASSESSOR'S MAP & LOT Cu. _ INSTALLER'S NAME&PHONE NO. to, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) y® zL L6& Si iAn62_5A_ /7% NO. OF BEDROOMS BUILDER OR OWNER-'— LA> ..PERMTTDATE: 'Z 17- COMPLIANCE DATE: �3i - 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 � � _ . �,i �,C,' _ .<r �b --� � �' ' . � y �� .F LO"CAT�ION _ SEWAGE PERMIT NO. VILLAGE INSTA LLE ' , NAME B ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� o �U� O �._ �� W \ v �_ � , v��_ `�. i .-.. � NoFmc... ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H_ ..............OF................ Appliration for Dispavial Works Tow3trurtion ramit Application is hereby made for a Permit to Construct X or Repair an Individual Sewage Disposal System al: ....... NVO......... ------------- ..... .......... ....... ............... .................................... ,�Locati res.. . .................. .. ........ ... ........................................ Owner ......... ---------- ------- ss . .... ......................... X-.. ----- ----------- InstallerAddress ...... ------------Type of Building Size Lot,� _OVV......Sq. feet Dwelling—No. of Bedroom ----------------------------Expansion ttic Garbage Grinder ( ) Other—Type of Building1 ;4AfV,_ .... No. of persons .............. Showers Cafeteria ( ) Other fixtures ------------------------------------------------------------------------- ------------------------------------------------ , -----------------*---------- Design Flow....155"*------...----------------gallons per person per day. Total daily flow..A;4----------- ........ ..g-allons. Septic Tank—Liquid*capacityMgallons Length Width.//.g4. Diameter................ Depth__...__..__.._.. Disposal Trench—No..................... Width-------------------- ro-ta?Iength.................... Total leaching area....................sq. f t. Seepage Pit No......./......... Diameter....../0--------- Depth below inlet.42-S --- Total leaching are a,_0_ _4__7sq. ft. Other Distribution box Dosing tanl!,O�� - *1 — WAA I-----010 .. ..............W Percolation Test Results Performed by ----;kko ....IV Test Pit No. I----- inutes per inch Depth of Test Pit-_____--...____-_--- Depth to ground waterj_V_10----a-As Test Pit No. 2................minutes per inch Depth�qf Test Pit.................... Depth to Wound water..X*.. .................. .... ...I------ ...S............... 0 Description of Soil........... . .......... ----4 -................ --------- ...................................................................I....... ---------------------------- ......loo. .... ................ ........�.0,-� - ------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U 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 TLIIP12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by th ard f health. Signed.... ..... ... ... ....................... ................................ Date Application Approved By........ . .... 0 ............... ........................................................... ............:�47t7l.�---------- Date has bee n e d ..'0........ ............... Application Disapproved for the following reasons:............................................................................................................. ....................................................................................................................................................................................................... Date PermitNo......................................................... Issued----. ................................................. Date No(:....f_......Y�''.. Fes$.. ............. THE COMMONWEALTH OF MASSACHUSETTS _. _,...- BOARD OF HEALTH ti !` ..............OF....... -- ,Appliraation for Bispoii al Workfi Tonstrurtion Permit Application is hereby made for a Permit to Construct (k) or Repair ( ) an Individual Sewage Disposal System . .. f` - . . ................. -/-^j/ Locatio Addresses' '/� / 'Lot No. . .....Z��./......•l�A�`�` .......f_. !. ...•'/l ress Installer Address dType of Building Size Lot_,;),�__4e?%�...._..Sq. feet 1 Dwelling—No. of Bedrooms........... .........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building / r' 1't"t _.... No. of persons.......-/' .............. Showers ( ) — Cafeteria ( ) Otherfixtures . .......................................................................................................... W Design Flow.....; ------------------ ---------gallons per person per day. Total daily flow..�-442..._..............__......gallons. WSeptic Tank—Liquid*capacity+ C'�gallons Length_?6 '�_- Width.•!f_.f/4. Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length..................._ Total leaching area....................sq. ft. y f, Seepage Pit No________ _________ Diameter.......]_.____.__ Depth below inlet._; ._..... Total leaching area.. ! �` q. ft. Z Other Distribution box ( /) Dosing tank Percolation Test Results Performed b ............. .' 11u � ,_ Y - ................... Date.✓ f.._ ....... Test Pit No. 1..... ,. ._minutes per inch Depth of Test Pit.................... Depth to ground water.A? -.//At_ . fil Test Pit No. 2................minutes per inch Dept f Test Pit.................... Depth to ound water__ +!. _. % ---------- O Description of Soil------•. .....: ............ 1 .... ----- -------- -------- -------- . .� --- V _......................•---.......... �_ ....: /' ?'! e"✓_ -•--------•--•-•-••.........................•------------- W UNature 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 TITIE 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 health.� Signed ! . ----------- --------------------- -------- ... ApplicationApproved By..........................................................------•--.._..........__..._..---------- --.....---------------ate--••---------t Date Application Disapproved for the following reasons:........................................................................... ........................ ✓.. r.a Date ;Permit No......................................... -=--------_. Issued-•-...•------------------•----.....--------•---•-••--- .,..,� z ----------- Date "�r••eecer: THE,�GOMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .,� . ' .........OF.......:..�........................................................� �. • .. ;- - .................. (grrtifiratr of f ompliFanrr z` . TH IS T T"I O CF 'FY,/hat ,the I -ividual Sewage Disposal System constructed ( or Repaired ( ) b) '- ..... ............r1 . ?fir'/1.� ..•.---------------------------- --------------------------........----------------........._._....---- ,� ,� 1) ] Installer has b en installed in accordance with th" rovisions of -flE r of The State Sanitary Code as described in the applicatiofi for Disposal Works Construction,',Permit i o.___ ______ ............... dated ..._ "_,- C-�f_--------------------- 1, ell THE ISSUANCE OF TH41S'�'ERTIFIC:ATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL .FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH � •/!�' .....................OF.I..... ' ?. � l....✓ " .................... 0 Msposal-iVorkv Tonptrud on Permit r Per is hereby granted.....,.,,. .. /T. ✓? 1 " ?"'�f ` to Construct ( or Repair ) an Individual Sewage Disposal System at.No... -- _ / e.. �' 'r � `-� -- --G' ".. �......._.. �.. . . Stre t as shown on the application for_Disposal Works`Construction Pe No____ _____ ________ ted_.__. " ". ........ ----•---• _---------••- t DATE---- j - --••---•--•-------------------•-------••--- oard of alti +% t FORM 1255 HOBBS & WARREN, INC., PUBLISHERS , M lk � 1 c :. 1Y�lMISH 6PADcr• .^�. . T J i UvBtl1 T/1 NK �w") � G✓&R. 1t°iT it .s�?"!�.. To 0,9 f~iupro. �JL a <0 i �"a .�'mil:� J ,$Ma, � • �t f -- r L7Yr+6LL(N G 4 C Z'._.. �d1 �.?_. ,�.- ._.L.,�'..."^"'_`.."� -^r N�� a�� .�D'aa►�.L _ f 1��14,KFiL�L J=PiASs.r rY't . _r GEtcAte t j, f i:!3p0 6.4L � -�- -, ' f JPa�/�vre��a co.�c � 3� rs T. r3 o x '} � '_ ► � � f� � � �� ,��r,• C .,S E'FaTT"!G T.4N K To to Le VACU t , A N p .�Gats' AT - �� ..err' �'rs .3��c,�` �-.-..•-.__ _....I_.._,__._._.__ � - -�__..__ _'� �,�, ... GN' CAP/ r'eAFIA ' ice• , '� R1 .`.,... -y ...�.r"`.. .r7 .o a f-d VIVA1".D .r ' ♦* -'1°t/'Ji� YV/^ i J 1L C,..I7 ,� �'P",• ° ..� �ifJ' I'" ' t ...�°" k t _ ., 4.x Vj ILw 26 CO. 1441 /IVSO CtT�'d �. PIDlJG /!l�ltE',��_.. �c� ._ 15'!.�• �h. '-a�'=;r�:: s'�' �r,,.. ii;'��_.�✓et//v ' 014re : i4r IZ4) /979 f��-•�tTE � 1. /t'.l i x,�li.tlr,ft, S�At.E:... fir"•�3 0" O?T E.' �. -� 4- �� ow ti,4:[e Z- 7i/ _• 12, ;, 3-k;�' �, �..1 v n�a Av 6.r2o ss rt l\►, f? E _ r` '