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Home My WebLink About0022 MARK'S PATH - Health 22 MARKS PATH, HYANNIS A= e TOWN OF BARNSTABLE G LOCATION-1 � �cs ,�a SEWAGE # 97 -3V VILLAGE ASSESSOR'S MAP & LOTA7.1 09V-661,7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 66 i LEACHING FACILITY: (type)fi1��zAfizZPi-S (size) J y S ?DrAe, NO.OF BEDROOMS BUILDER O -v— PERMTTDATE:_ (6I�c�r7 COMPLIANCE DATE: _T��7 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 lea ng facility) Feet Furnished by - s �--- Q� i _ , - �o ____�.� 3 � � r t - . �, �� ' � �� !�� ® � �� N i ,,._I y TOWN OF BARNSTABLE LOCATION ) MR,,7 15 AZOVQ SEWAGE # I "� VILLAGE IS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY `/000 67 - 6/U7A16i LEACHING FACILITY: (type tl C 5 (size) 43 NO.OF BEDROOMS BUILDER OR OWNER f�KA e-Y'f e,,P'rk PERMIT DATE: c ;a �a �iI COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Ad 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 o eac 'n cili� � � Feet Furnished by ��J11� '7dgtr 41 c pr, 6 s < g Q� No. 1 (/ 4; - Fee�- • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS Zpplication for ' pogal *pgtem Construction Vermtt Application for a Permit to Construct( ` Repair( � )Upgrade( )Abandon( ) ❑Complete System .❑Individual Components Location Address or Lot No. (� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Fs �o x•• 4 � r..�o 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) jp N`n r,q Yh�x�•i•�v t.�3� �l S nowt, c 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 d 9 Application Approved by Date /,Q pplication Disapproved for the ollowtng reasons it '�1o. 7 Date Issued No. / -�. Fee ,Tli COMMONWEALTH OF MASSACHUSETTS Entered in computer: � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0pprication for Mizpooal *pztem Construction Permit Application for a Permit to Construct( ' �ep ( • )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. ` Owner's Name,Address and Tel.No. 2Z V,Av-" Qom` 1A lAhh%� Assessor's Map/Parcel 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( ) 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) �� ` eY �T\K g �"� A�•d �.� Date last inspected: Agreement: �. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage isposal system *' in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation u�* iba,_Certifi- cate of Compliance has been issued by this Board of Health. \ — Signed �� ate .. Application Approved by r Date le� _ /l Application Disapproved for the ollowing reasons s Permit No. 7 — g q Date Issued ——————— ————— ——— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( ) Upgraded( ) Abandoned( )by Hie Icily �o�s t" �S at 2-z has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 5�7� 9 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 7 �/ Inspector --------------------------------------- A No. � 2 - �� = � / —0 —3 Fee; .,. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS Mtgool *pgtem Construction Permit Permission is hereby granted to Construct( p�Repair(161TUpgrade( )Abandon( ) System located at 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: �� Cv — Approved by �l -003 t _ 10/9/97 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) hereby certify that the application for disposal works construction permit signed by me dated 1 l ,.I 'z 7 , 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 • 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 not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: he Engineering Division G.I.S.map) l pv A)Top of Ground Elevation(according tot g g B)Observed Groundwater Table Elevation(according to Health Division well map) 4&% SIGNED DATE: a LICENSED SEP;TIC 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]. q:health folder:cert TOWN OF BARNSTABLE LOCATION SEWAGE # 97 .Td� VII;IAGE ASSESSOR'S MAP & LOT27J 09y-ae,7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1406 d EE/tCHING FACILITY: (type)/ry4?°Cjv/ztrs (size) (•�.� Y S 1(DhG NO::OF BEDROOMS_ _ 13UII;DER OR�� P"rrDATE: (6��_COMPLIANCE DATE: �97 9'e" tion Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet PrivaCc 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 ithin 300 feet of leaotg.facility) Feet F."r hed by W n y f Y. ail-q�f 3 . L,O ATION ' SEWAGE PERMIT NO. VILLAGE HYKN s I N S T A LLER'S NAME A ADDRESS s U I L D E R OR OWNER apwoC� , DATE PERMIT ISSUED r DATE COMPLIANCE ISSUED t� Iol 'l r L m �w � r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH �G .4,r..............OF....... .gam /S7 ------------.-..-•-•---•------- Appliration for Di-qVnoal Worko Tomitrnrtinn Vernfit Application is hereby made for a Permit to Construct (.�) or Repair ( ) an Individual Sewage Disposal System at: ...mew. '.. i 5---...... ......... ............. -•--•--•----.........a.. .---•---•............•............................................... Location-Address or Lot No. .._..... _................... ---...._..._...._..._.._... -------- ........._... W Own Address -a .�Is1�IQ..--•---412 ---------------------------- Installer Address PQ UType of Building Size Lot_.!f�e.AAP.......Sq. feet Dwelling—No. of Bedrooms........................................... Attic ( ) Garbage Grinder (No) W`4 Other—T e of Building No. of persons........................... Showers YP g ---------------------------- .----- --�- ( )--- Cafeteria (--•--)- +� Other fixtures ..---------•----`---------------------•-- W Design Flow...........s^ ......................gallons per person per day. Total daily flow-------- � ®...__._.__._.___._____..gallons. WSeptic Tank—Liquid capacityl._9Po_.gallons Length8`� Widths'�o_'`.. Diameter---------------- Depth__ '_`4.v x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........L--------- Diameter___... ----- Depth below inlet__3:07.... Total leaching area..2A ..... ft. Z Other Distribution box ( ) Dosing tank ( ) '—' Percolation Test Results Performed ................... Date_.ee.-------------------- Test � Pit No. 1------:;!;n....minutes per inch Depth of Test Pit___ Depth to ground water__N � N.QF G4 Test Pit No.-2................minutes per inch Depth of Test Pit.................... Depth to ground water---- ��_ ......:.. $ Ri ...ROGER Gr O Description of Soil. ?. Gvr✓. S:,S�!csSe�c�._.- `-- •„ AwccA PATJL - .Sr t)-tom-,C �"�e,. MICHRIEWICZ Sid"-/ ... sSe.V-4------------------•-•----•-•----...------------......-------•----..........----- No.30420 u w ;off"pF L U Nature of Repairs or Alterations—Answer when applicable-_-------------------- _________ g AL _ ------------------------------------------------------------------------------------------------------------•--------------------•------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i cordanc wi the provisions of i mg° 5 of the State Sa • "ry Code— The undersigned further agrees not to ace the sys em in op until a i cate of Compliance e issued by the board of 1 th. D to Applica ion Approved By-----•••. •--•--. - - = -----a. � ------ Date " Application Disapproved for the f ollowa g reasons:--- -----------------•----------------------------......--------------------------------------...._------ ------•------------•-----------•---------------------•-•-••--------••-••-•----------••-•-------•---...------------------------------------------------------------ --------------------------......--- Date Permit No.---. i.I M V..-------....... ...... Issued ate ,. No................_....... Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS z t. 4 BOARD OF HEALTH iRa '.............OF........E3-:4 ............................... Appliratiou for Uiijtaaal Workii Tontitrurtion itumit Application is hereby made for a Permit to Construct (a , or Repair ( ) an Individual Sewage Disposal System at: .... .. ............. ............... ' .._._. •-- --•--•-•---------------• Location-Address or Lot No. ................................................................................................. ..........—...................................................................................... I Owner Address W Installer Address Type of Building Size Lot-_/'0•.r-*.0.......Sq. feet Dwelling—No. of Bedrooms_._...___"_.. ____,•-_--..-_••-_______--Expansion Attic ( ) Garbage Grinder (vc� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ---------------------------------------------------------•-••-•-•---------._._._.....-------•--•-----•-......••-•- :..... W Design Flow........... "50.....................gallons per person per day. Total daily flow____.....�'7 _________ .._:__._____gallons. WSeptic Tank—Liquid capacity p.gallons Length '�1"_... Width.�y..,!,r _ Diameter________________ Depth__:; .,`�..'r x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------/---------- Diamete ---- Depth below inlet---` '_ /.... Total leaching area..................sq. It. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed .................... Date... ......... Test Pit No. 1...._'�r`..._._minutes per inch Depth of Test Pit...,OM!...... Depth to ground water.- OF�y, (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water______ a •-----------------------------------------------••-------------••-•---------•--..._____..._........--•----._.....-•-----•-•-•.....•••--• �yc O � -•-- dGER Description of Soil-Q.-_z4"__ s� ie�t._ . 'v�t3a�t..--- 9y=..9�_•,_wyeGficq-�.a ------------------ PAUL x 'WCMEWICZ U S?4�, + ¢• .__�S�stir�/s5-----------------•... NO_ C420CIO C1. L UNature of Repairs or Alterations—Answer when applicable._--____._____________________ �o ---------------------------•--------------•----------------------.................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in rdance th ! the provisions of 1-1 r p 5 of the State Sanitary Code— The undersigned further agrees not to place the syste in operation until a Certificate of Compliance has been issued by the board of health. ' Signed.................................-•----••-•----- s _-.,_ Date ApPlication 'Approved' BY - ----------------•- ..••--•••--•• ••-----•---------- . .. . _ - '+ ... i' Date ,. Application Disapproved+for the following•reasons.%= -=---------••---------------•----•-----------------•-•------------------------------._......_-•-----••--••-- -------------•-----------...------•-----....----------------•----------••-••-----••------•-•-------- --------------------- ate Permit No. - • ------ _---•---_----- s Issued_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................. Trrtifiratr of T amp haurr THI S TO CERTIFY, T at the Individual Sewage Disposal System constructed ) or Repaired ( . ) by _... �`�.t .........................................tau at-•••••••-•-•---Via------•••_ - -------------- -------- has been installed in accordance with the provisions of -1� j of The State Sanitary Code as described in the application for Disposai-Works Construction Permit "To....... ----------.- --•-._-____• dated_-_,_ -N .-_-_I_��__ ___...... THE ISSUANCE OF THIS CERTIFICATE SHHAkL,-NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... ........................•--•-----•-----__•---....-•---••-•----••---• Inspector...........='- ✓ MASSA'CHUS THE COMMONWEALTH TS k BOAR.D. OF HEALTH �� OF.........................:..........................................• --.......,. C� Permission is hereby granted----•---....e/.....^'1--...._. Ll to Construct y�( ) or Repair ( ) an Individual Sewage D- osal System atNo.••--•-kT�-`_...._4..�............#" -------f'�_-________•_--------Street---------•---•---------••-------•---------•--•---• •_____-___-_- as shown on the application for Disposal Works Construction Permit No'25-_11 G Dated----- _-_1 S._-65.......... •...........:...••-•••-•••-. =................................................... oar dd of Health DATE..... !_. --•---•----------------------•-••-•---•-•-•---- FORM. 1255 HOBBS & WARREN. INC., PUBLISHERS �•"-h,,,� Z.