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Home My WebLink About0010 GARDEN LANE - Health 10 GARDEN LANE HYANNIS A = i No. D Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 10 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Apprication for Mtgaar bpotem Comaruction Vermit Application for a Permit to Construct( )Repair(it)Upgrade( )Abandon( ) ❑Complete System 4elndividual Components Location Address or Lot No. Ae Owner's NAWe,Address and Tel.No. l f t 3>B61 C Assessor's Map/Parcel 09 !1 a►( / je09,e7)tRv AA- y InsX49 Address,and Tel.No. s®10101w �� 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 a plicable) go oar /P r PLyc em 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 ky this Board of Health. Signed ,o ' Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNST B E R LOCATION I D *rA C.�,t'�rw 1- SEWAGE # VII.LAGE N ��/y/S ASSESSOR'S MAP & LOT a ✓Z � INSTALLER'S NAME&PHONE NO. P/INt° 77�- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER bAv' / Sk£'C PERMITDATE: COMPLIANCE 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 0 0 0 o � e x 1 _ ~�. / ; z No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for ;Dioonl *proem Cow6tructiou permit Application for a Permit to Construct( )Repair(y)Upgrade( )Abandon( ) ❑Complete System trindividual Components Location Address or Lot No. f W j n/ Owner's Name,Address and Tel.No. Assessor's Map/Parcel G)/1 6 ` t jr Installer's 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( p) 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) 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 this Board of Health. Signed / - Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal,S:ystem Constructed( )Repaired( . Upgraded( ) Abandoned( )by 8I 664&0 S (/ *,lj4y 5 7- 44,,, -"ye at J 0 6:�Olf 2 r t, At, /0. I has been constructed in accordance with the provisions of Title 5 and the r Disposal System Construction Permit No. �dated Installer Designer The iss ce of this ermit shall not be construed as a guarantee that the syst ill f�tio a desigr1ed �' - Date 4— 1 7 -9 Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi0o5ar *pgtem Con.5truction Vermit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at /r r J!';joR:)f,(- ) 4" and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his er duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructio m st be c mple d within three years of the date of t is pe 1 Date: Approved by V 1 ASSESSORS MAP NO• No._`-` '._! �� PARCEL NO. Fxs......�v.... ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 9�-.2a(� TOWN OF BARNSTABLE Appliration fur Di�ipuiul Wurkii Tomitriartivit Trutt# Applicati bv mad for a 13 1Ii t ist uct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............::......... ............ .......... -•--------•----------- ..... --•-•----•-----•---------•--••----•-•---•-•----------...-•------------------••--.........----••••- ocataon-Address or Lot No. .... ..14(!....._._.. ...!S e?�rz............................................ .................................................................................................. a O,cner ..........................Address Cv1J' - - Installer Address Type of Building Size Lot.................... Sq. feet t., Dwelling— No. of Bedrooms_____________� _______...__-__----..-.--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of .Building ............................ No. of persons----_-.-_.--_-_______-_---- Showers ( ) — Cafeteria ( ) Otherfixtures ----------------------------------------------- --------------------------------------- --- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. 1:4 Septic Tank—Liquid capacity___.-_--.--gallons Length---------------- Width___-_-_------_ Diameter---------------- Depth................ 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 ( ) ~' Percolation Test Results Performed by-------- -------------••••-----••--•--•-•................................ Date........................................ a ,.� Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •----•---------------------------------------------------------•---•-----------------------••........................................................... ----. 0 Description of Soil........................................................................................................................................................................ x U w -----•------------------ --------------------------------------------------------------------------------------- ........ ......................................................................... U N ture of Repairs r Alt e ations—Answer when applicable.__T� _ r4_j ._...�..-__.1_C?4Q._. :�....... �. GG_.. h �1 i �V(!L.....�tJ 1 �.-'/d .-.-.J- !_._._ /C_>CS IYI •- --••�d-Ua......L.)...�•t�� • .. • .................... The undersigned agrees to install the aforedescribe 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 Compliance has been issued by the board of health. Signed .............................. . .. ..b......Q-t.. . ------ ...... Due Application Approved B ............ . - - - - - Dace Application Disapproved for the following reasons: ........................ ............. .. .............................. ............... ....... . Dare ................................................... Permit No. ... - -- ` "� '��.. (................. Issued ....�- ..-*------- - ��.. ..�.�....-�`� .... Date a 9� Fa$......:Z�.... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9, _�a (© TOWN OF BARNSTABLE Appliration for Ali►,pooal Worlw Tonotrurtion trrutit Applicari h-reby made for a I'e mit to Co tst,uct ( ) or Repair ( ) an Individual Sewage Disposal System at: P Il/ '.' �/ ................. ::"...` .................. ----------��`-�.... ..........................................•.........---.......................................... /j�.,ocat ion-Address a -------•--------------------or Lot No. ow Address .......................................................... ---......_._ Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of B N Attic ( ) Garbage Grinder ( ) aOther—Type of Building -......................''. No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 0 Septic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter_............. Depth................ 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 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........................ a ----••-••------•--------------------•--••-----•---------••-•---•-•-••-----•-•--••••-•-•...---•--••....••--•-•••-•-•••-••-•••••......--•-•-••••......._.....-- 0 Description of Soil........................................................................................................................................................................ W -- ------------------------- ---------•---------------------••---------------------------.............------------ -------•---------•-----•---------------------•-•-------•-•-•-•••••......•-•-..•••- U Nature of Repairs or Alterations—Answer when applicable-._ .¢A_. . _._...�..-_._�_�/� ..�1� 4.(.......—P 1?Y.Cr.... �J�/.i�-130- -.....�)-----c �c_;•r� -----�.r'....!a_c�n �� :�. ` -? .._G:..._... 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 Compliance has been issued by the board of health. ......Signed ................................. .. 1......... ........1��1 n� .� � . ......._....._ Dare Application Approved B != �. .............................. ..��..: .- Application Disapproved for the following reasons: ..................................................... ........ .------------------------------------------------------_- .. .......... . ................................................................................. �.---� � Dace------.�. Permit No. 9 �,.'� ..� �.�......... Issued .... _.. _��.. .... ....�. ..... Dare — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V.Ertiftrate of (11ontylia ve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( c/)' by............................................��do-o1 _-6..........................------..------------ -----....----- ----------.......------------......................................... ... // n Installer... at ... ............... ./1....... { ....------------ ---------------...----------------------------------- -------......_......---------------------------------- 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��=..- ] 1 /.. datedr�.:_: '�G THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE . Inspect,(, ......... ......._ -''�..��.�l —_,_ --_.—__---—_.__o_—______ ---__— —__—_—__�- - __-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C�-5 � � TOWN OF BARNSTABLE �d �i��o��tl orlt� �Itai�trl�rtion �rrmit Permission is hereby granted-------------------- ek ... to Construct ( ,) or Re air ;ti Individual Sewage Disposal System at No..4�....•-- _ ------- ----------------------•------------------- .................................... Stree as shown on the application for Disposal Works Construction -----/ / ]r_ -------------------- Board of Health DATE............. .............dn...........1..o__ . FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS /dOU Ste• A�� '