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Home My WebLink About0024 AVALON CIRCLE - Health 24 A'VALON CIRCLE ®sterville A = 145 — 057 rt No. �"�/q Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes am,. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 21ppfication for ]Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. "C� ��,�(��J �p oQ� Owner's Name,Address,and Tel.No. C,,f7(/fV0 Assessor's Map/Parcel 05 M I y_ O S y Instaallller''s Name,Address, gand Tel.No 5rollr 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank I veil 0�i l��N Type of S.A.S. M/�P � � • Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 — Zo _&Z %•il f rdA d'SJIM • Date last inspected: Agreement: The undersigned agrees to ensure the cons ction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env onmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Heal Sign _ Date Application Approved by Date ue/ Application Disapproved by Date for the following reasons . Permit No. Date Issued 1 Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION = 0WN OF BARNSTABLE, MASSACHUSETTS yep application for ]Disposal *p8tE111,(Construction 3pPCUIIt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (� 1(Q,l(gill ��RG Owner's Name,Address,and Tel.No. �.4 //�0 Assessor's Map/Parcel 5�°v y— (l ��/�i� G/ke& s Installer's Name,Address,and Tel.No. ,0-#-0A� )( Designer's Name,Address,and Tel.No. Type of Building: Dwelling No:of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildig No.of Persons Showers( ) Cafeteria( ) Other Fixtures b Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /aap 94114,/y Type of S.A.S. ,4 Description of Soil Nature of Repairs or Alterations(Answer when applicable) �, 4/le-,® 114 W""7q �. Date last inspected: Agreement: s' The undersigned agrees to ensure the cons uction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env onmental Code and not to place the system in operation until a Certificate of r Compliance has been issued by this Board Heal Signed Date A so Application Approved by Date \Tc/ c s Application Disapproved by Date for the following reasons Permit No. Date Issued / - - -- -------------..... THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS r , Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal syste Constructed( ) Repaired(�' Upgraded( ) Abandoned( )by /1��/,�(//�� r4 457W(:_� at aZ 1l /U /•�G has been constructed in accordance / with the provisions of TitllAe��5 and the for Disposal System Construction Permit No:,—�Q9G'--Z-9dated `7 Installer�� //(/'F4� ��y( S']sQ/�2l Designer #bedrooms Approved des'_n flo gpd The issuance of t is petinit shall not be construed as a guarantee that the system wiQl fun ti as desig�ied. Date .: ( )p Inspector i �l ,� PC c7 " --s, - Fee 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS D[8p08aY *pstem Construction j3erlllit Permission is hereby granted to C�/�struct( ) Repair Upgrade Upgrade(t' ) Abandon System located at o/ /'-f1�4t1']i I and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co pleted rithin three years of the date of this pet'mit. ' Date � �� Approved '>_ (c211) Iv LO^eCA- 1°ON SEWAGE PERMIT q0. ", C a (O� VILLAGE 05%Z-,��r�L �INSTA LLER'S NA_AE b ADDRESS �RUIIDEA OR OWNER DATE PERMIT ISSUED DAT E COMP4,1ANCE ISSUED �� _ ,�: �? �1 yyr` 1�'l9 ,, ` `�L � I ,e � � ua �� -- ��'. � - . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH R`U... ..................0 F..�.. � --- ----------""----------------------- , pphratiun for Disposal Murks CIunuIrnrtiun ranfit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal S yM t a": ..............4 L cation ddress ttN , nOwn Add..... . ..... ........•-- . ..... . .. ._._ ......__.rd' .Inst Address d e of Building Size Lot.11C .,..a__ ..Sq. fe t Dwelling—No. of Bedrooms.......:�...............................Expansion Attic ( ) Garbage Grinder YLf '4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures .............. Design Flow..........Y _� ?D.._-_;�,�gallons per person per day. Total daily flow............................................gallons. W �f WSeptic Tank�Liquid capacity/.........gallons Length................ Width................ Diameter__-_--_---_-__ Depth................ x Disposal Trench—No..................... Width. r.............. Total Length........... Total leaching area....................sq. ft. Seepage Pit No......../........... Diameter........ ........ Depth below inlet.....6........... Total leaching area. ._1.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) / Percolation Test Results Performed by.......................................................................... Date------ I f r--------- Test Pit No. 1......�.minutes per inch Depth of Test Pit.................... Depth to ground water... ................_. f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-) aI ... - ................--------- O Description of Soil a- 3• --...... .:..IL: u� .--.. - V --------------------------------------------- •--------- -------------------------- ----- .....----------------------------------------------- ----------------------- ----•--------------- - --------------------------------------------------------------------------------------------------------------------------------•------...............-••------------•------- 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 iIT .;,;. 5 of the State Sanitary Code he unders' ned further agrees not to place the system in operation until a Certificate of Compliance has be e y the d of health. S ned ��Y�$'_.......... •------------------------------- ,� _Date;, Application Approved BY rr1�. ----------•---------------------- �- - r�--------- - ---- Application Disapproved for the following reasons:................................................. ••-•-•.............................•••....Date------...... ....................•-••---••---------•------------------------•------------------------.......---...-•--------------------------------------------------------•---------------------------------------- Date PermitNo......................................................... Issued_....................................................... Date r No FEE........... MM'ONWEALTH~OF MASSACHUSETTS . R BAR® OF HEALTH , y •.>,i. 11 i O iral ,fur �Bi,11n 1 y dark 3 �t r r inn ; rant# 'Application is hereby.made for a Permit to Construct ( or Repair ( . ) `an Individual Sewage Disposal SyM at,. ` caho " tN ff ......� Ow 4 .......... Instal ar Address +� U e of Building / Size fe t - Dwelling—No. of Bedrooms.._. ________________Expansion Attic ( ) Garbage Grinder aOther—Type of Building ._::_:. ,___ No. of persons ____________________ Showers ( ) Cafeteria ( ) Otherfixtures ................................................:..................................................................... .,W Design Flow____ ' . ?_ allons per person per day. Total daily flow............................................gallons..- (� Se tic Tank Liquid capacityr� W P9 e'i`gallons Length___._ Width_ Diameter................ Depth............ x Disposal Trench i;Width_ ___ Total Length .___ Total leaching area....................sq:ft. ' t____ irx Depth;,Ue,ow inlet..: r ,Total leaching area .....sq.ft: Seepage it No ---- Diameter •- Z Other,Distribution•box (• ) Dosing tank Percolation Test Results Performed by `__i....:......... ......... ...__.___ _..._____ Date- _ _ __ Test Pit No. 1___...:__minutes per inch Depth of Test Pit __............... Depth to gr6und�,4Vater__ __________________ Test Pit No. 2................minutes,per inch: Depth of Test Pit___________ ______ Depth to groti,W =water.. r •r Description of Soil d. ........ •. ---"•". �........ .1........ --•---•-•--- V ..:_......._ •-----•--• Wr '.V Nature of Repairs or Alterations—Answer when,:applicable..............................__ ___._.__ l......................_. . Agreement: , .x The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LIT I.,C 5.of the State Sanitary Coder��£-'The unders'gned further agrees not to•pl ce the system in operation until a Certificate of Compliance has be, ss, ec y the id of health g s* SDatte y{" _ f Appliqation Approved By... f= t ----• _ .--• _...._ ...: 7.... r% =:.. ............... Date t , Application Disapproved for the follouiing reasons: :: ;t! ----------------------------------------- -••-_--•- ........ ......• •-•:.... _._.... .. .. .._._ ____-- - --___,•-•-•______ r Date Permit No._•............... Issued-----••--•- .................................. .......................................... Date---•- . ............. THE COMMONWEALTH OFyMASSA:CHUSETTS BOARD OF WEALTH ..............OF. .............................................. %1 rrfgfirtttr:101f Tri*Pfigurr . THI IS TO C TIFY T t'the I ividual Sewage Disposal'System constructed or Repaired (; ) talle � •.I r � has been installed in'accordance.with,the` provisions of T �1 , 5 of The State Sanitary Code as described m the application for Disposal Works Construction Permit No: j_'tr . ........ ` ' : r'' da.ted_... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS'A GUARANTEE THAT THE`t SYSTEM WILL FUNCTION SATISFACTORY v _ � DATE... ------ � ...................... ........ Inspector. �--/t _. . -- ............................ a.THE COMMONWEALTH OF MASSACHUSETTS w, . , BQARD OF H "AITHI ..... FEE... :d it rk uatuatruti f Permission is h relit' granted. - "� ,;< i,a ....... �s __.. to:Construt ,�"or Rep, r ( In idual Sewag isposal Syseri atNo..: = � •. .:..::.......•-.=•• . - ................................ a' Street as shown on the application for:Disposal Works Construction Perm' o !"�_____ Dated.::_ "'s±2-� _.....__. /" �. I r . - ,r� Board of .Health DATE..- .. ... ...................................... FORM 1255. HOBBS & WARREN, INC., PUBLISHERS I v4�LY >r low x t!c:> ti S a 3a0 �� '��•�� 4 5EPf1G TAWV- R � 30 d%50 `% • �5 � ur,E 1000 6Ati.. • 4 Ga r•�a [ G.. T>%S P005AL F?i T V I E loop ,slvewALL AZGA Ise) Sir e3oTroA,A APMMA = 5 C? S f6p F'SZr-vl.A r lC>W SZATL l•t 41 Z ftW oe 40 L)i ° __ s 0 r4,J # i VAXTEFi ~: N, 2 rr4E� 7P3 op F�.iv a bo ' . r: A 1.1ouEs ' E=�,=� M 7�79Z1iTi t oA,vA PL 4•'P.v£ lava tNv " Suety. 4"p;oc D(5r % S6Pt'G T�'4u. • . lcado 9c.•a wV. ' t"ib L• �t G Z. AA VI T m' ala=t'1 WMIAMD C r--IZ T!F I EL> LOT ( t Gr%V.TIFY T"AT ` 'f `VoU�D(�`f'•(oW 51-tcwaJ 1-iE4..6.0�►1 GOMcP�-Y S W t'f't-t TµE ralZJEt_11J�. ,j AWD 45%zl BACK. R�Qu�tz -M'G�►1Tii OF T1-1 W-s`isTQ wet> LAWr-.� .1;beVWp" T41ry PL&tJ 14 140T BA5ED oul• Ate . "4M)mE►,ir, OsTERvI1 1 6 - AAA.SS. SUZ�I TN6 OFFSET; -y"OoLb .Uo-t •8S 04>eJ> aQ(X;:tGAuT