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Home My WebLink About0151 STEVENS STREET - Health `p 151 Stevens St 309-239 Hyannis i I o , No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for �Digogar *potent Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( _/II?Complete System ❑Individual Components Location Address or Lot No. ��iv'T/��J� �C wner's Name Address and T L No. 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 Rep :rs 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 " Signed Date Application Approved by Date.Tl. Application Disapproved for the olio ing reasons Permit No.9 7— Date Issued � z _ �-No. � Fee I? I` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mizpooar *p,5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon /) V/Complete System ❑Individual Components Location Address or Lot No. /JC 5 ewe�.�� 5' Owner.'s Name Address and el.No. 11 Assessor's Map/Parcel yrwe/ G� 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 a Nature of RE airs or Alterations(An/saver when applicable) . i Date last inspected: j 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 thi B d o e / Signed Date .3113/91`1 Application Approved by Date —i V Application Disapproved for the ollo ing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS { Certificate of Compliance THIS INTO CEFY, that/the On-bite Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned(�)b P4/ 1,'IDfl,S7-. at tS /�f7 S has been constructed in cc dance with the provisions of Title 55/and the for Disposal System onstruction Permit No. Z 7- /1��1 dated Installer - ly 2`D / &Z Designer The issuance of this permit shall not be construed as a guarantee that the system i11 function as designed. Date Inspector ----------------------------------------- - ..r No. 2:7Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Digpont 6potem Construction Pe 'it Permission is hereby granted to Construct( )Repair( )Upgrade(, )Abandon( System located at l 5_,Z,`�" �L'Y� 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: 41 ' 7 Approved by }1 LO CA T YON j, SEWAGE PERMIT NO. �. off VILLAGE) I A �kleS NAME A ADDRESS ® U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � �l �� r yam- � 0 �. Z- �, � � vo . s ue .r• _, Fxs.Z ............. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH ...---.....................................OF....................................... ....... Appliration for Diipnsal Works Tonstrurtinn thrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •--� __Sr- -�l.�E_`f` S -s ..................... ...................•--�-----`... -�----....................-•--------•------......._�e Location---•- -Address or Lot No. n 0 ner Address p Installer Address � feet Type of Building Size Lot...........................S q. U Dwelling—No. of Bedrooms............ .....Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures ---------------------------•----- W Design Flow..............1_.�..0..................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................. Diameter._._-__.--_-_-_- Depth................ Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..----------I........ Diameter....... Depth below inlet.... ............ Total leaching area...............---sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.............. ......................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of ,Test Pit.................... Depth to ground water........................ �74 Test Pit No. 2................minutes per'.inch Depth of Test Pit.................... Depth to ground water.,_-•._--_-.___----_-_-- R+ .............................................-........................ ----------•-----.-•--••---......... ------------------------- •••••-•••------------------ ODescription of Soil........................................................................................................-----------•---•-------------------------------..........•-•--- W V .........•-----•.....•--•........----•-•.......--••••.............................•--••--•......••••-••-•-••-•------•-•----•-••-•-•--•••---••------••-•-•-•-•••-•-•--•••--•--•-•-•---•.........---------- W U Nature of Repairs or Alterations—Answer when applicable----------t-------- a-0.0......Ck-.S!�.Ak,=.........#?`:S.�....•........ ------------------ Agreement: The undersigned agrees -to .install the .aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi:, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianc has issued by the board o ea igned._........ .. ---._.....-••• -- ••---•-•-• .••• _ _7 Application Approved By--•- ..:..... ,1� ----- tikr Application Disapproved r t e Date following reasons:................................................................. . -----_-••----_--_--------•------•-- ,. ....-----•--•-•-----.....•.......................••--------•-------•-•-------------....----••--------•------------------------------------•-----•--................................................... Date ' PermitNo............................................------------- Issued....................................................... Date L .�".. � FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•........................................O F....................................... ApplirFa#ion for Dhipos al Works Corm rnrtiun Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........................_._.................--...............-• ............._........... Location-Address or Lot No. ......................__........................................ ..........--...................................................................................... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms............................................Ex Expansion Attic a g— p ( ) Garbage Grinder ( ) aOther.—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------•---------------------------------•---••••-•--------•----•••••......•-- ••••-•--••-••••-•-••-•--•---•---.....-•--•-------...--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lr, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------------------------------ ---•------------ .------------------- _........---------- ••.... ____------------------------- •--•-- 0 Description of Soil........................................................................................................................................................................ x U ....-••••••--•--•-••-•------••---•-....-•--•••-----.....--•--•-•------••-•-•••---•-••......-•--••••.............•••••••------••-...•--•----•••----•-•-•••-••••-•-•--•--•---••--•-••-••••-•.....•--•----- 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 TIT12 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complian . as been issued by the board of health. Signed---------••----==••••----:..--=- �/ �' -ell� t'CoDate ApplicationApproved BY .._ _....� -----------------••-•----•----••---------------------.....••••- ....................------.............. Date Application Disapproved f r the following reasons__________________________________________________ ••--•---•••--- ..............•-----------------------------•---•-•----------...-•-•-••-•-----•---....----••---•----••••----•----------.....----••----•••••••--•••-----------•---•-•-•-------------•••----•-•••-------- Date PermitNo......................................................... Issued--•-----•------•--• ................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F..................................................................................... (9rdifgrFatr of Toutph anrr TI� 4RT,FY, That„thhgi In idual Sewage.Disposal System constructed ( ) or Repaired ( ) by:...............................� ........... /Y/ � -�i2� Installer has been installed in accordance with the provisions of TIT 41-5Af�I"lf State Sanitary Code as described in the application for Disposal Works Construction Permit No.......................................... dated------------------------------------------------ THE ISSU N OF THIS CERTIFICATE SHALL NOT BE CONSTRII AS A GUARANTEE THAT THE SYSTEM Vltll�X NCTION SATISFACTORY.DATE....� ----------------------------•---•-----..._....--••--- Inspector-• ---• ----------..-........--------------------•---. •----..._......----..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '/r'Z f• �J(/ ...................................................... No......................... � FEE.....----............•-- . PermissionIs hereby grant d ..................;=--•--.. ..................................... •••...--•--•-••--••-••--••••--.......•••..............•-•--••.._._.. to Construct ( i}r Rep i ndivi'r3 alp ge-ID.isposal System a at No............. f. ¢-r'... �7�.d, Street as shown on the appli on for Disposal Works Construction Permit No---- •_____________ Dated.......................................... sl ...................................................... 1 DATE........------------•--- •-•----•............................................ Board of'Health ; FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS