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HomeMy WebLinkAbout0060 POND STREET - Health 60 Pond Street, Osterville A 118-104-001 I a f a i a ....E 4 f s 0 d 111 D TOWN OF BARNSTABLE LOCATi7N 60 /.• SEWAGE# oZOO `of C VILLAGE DS CctC ,L t ASSESSOR'S MAP&PARCEL OO,/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /Z6 �PI� LEACHING FACILITY.(type) S,&O I_ �y ti (size) f3 JC S r7 1 NO.OF BEDROOMS / OWNER PERMIT DATE: b—l B w 1) 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 , O a q 3 c zt:, o- 1 _ ,a., .. ., ,.--� ..-•.-,�...�. - .:�. ..•.w -•'y ...f-�'`.'�"....•"`-•+.+:,`'sue.--^.rt.�,,,,.,..:r._.-. � -.�,� ...-r•+."�.....rr .,s- ... � y.-�.... --w-'^--^.._. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pprication for Miopooal *pg;tern Construction Permit Application for a Permit to Construct O /Repair O f-Upgrade O Abandon O ❑Complete System ❑Individual Components Location Address or Lot No. 6Q POMP! -91 O5let,,A Owner's Name,Address,and Tel.No. /�� Mar/r -f /rdlb�.eeti �r�,1� 60 H6/ Assessor'sMap/Parcel PdPL>ol ®(�_ Q Spd 2 —2oaq Installer's Name,Addre s,and Tel No. Designer's Name,Address d Tel.No. 7 ���� �►941�sly g? �� z A4,14aq Type of Building: Dwelling No.of Bedrooms 3 Lot Size jjqkrf5 sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers(Z) Cafeteria Other Fixtures Design Flow(m/T.required) Z-3-3C:> gpd Design flow provided �� .-C> gpd Plan Date i/LP A—)C— ��, 2CA>:� Number of sheets / Revision Date Title � Size of Septic Tank Of Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 721 6=7 f to 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 C e d not to place the system in operation until a Certificate of Compliance has been issued by this and of H a 3 Signed Daten e. �( oZ 00 Application Approved b Date Application Disapproved by: Date �• for the following reasons Permit No. Date Issued a 0. Za.7g 7`""�"� e, .,w� , , �'.k w " �,` . Fee Entered in computer: r THE COMMONWEALTH OF MASSACHUSETTS p Ye,.� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS i o ZippYication for Mi5pogal by5tem Construction Perm!) Application for a Perniit to Construct( Repair(,,) Upgrade(—) Abandom( �tComp'lete S'ys emj`� 1r►"diuiidiialrC©Fnponents Location Address or Lot No. �Q AgnC � 5lekv,,I /Owner's Name, /A.�ddress, d Tel./No. A'4 -S N Assessor's Map/ParcelP/ Yd!Cf'' �i�, '� / 1t®y rC►'Vl��r/ti`' /`rd l ©g� C7 _ aG Installer's Name,Addre s,an Tel.No. �.�1[ Designer's Name,Address anAl.No. rw�e MSC 71 n g N _ �/il A oc�r �s f���.A y�7, C�eJ t JS/rir"viJIC N� ion ,yip `S�Zy g 03 `91r7•. r� sod-� Type of Building: / Dwelling 'No.of Bedrooms 3 Lot Size _��p /tCl'$ sq.ft. Garb�ge a VQ' d )— Other Type of Building No.of Persons V `yp g Showers(Z ) �taffeteria EOther Fixtures l E Design Flow(min.required) .�L� gpd Design flow provided . gpd W Plan Date V�!� �.3{ Zc�a� Number of sheets Revision Date°' Title,.- I Size of Septic Tank •� 7 Type of S.A.S. "Description of Soil f Nature of Repairs or Alterations(Answer when applicable).. T �� �� lftlZ ;✓ r 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 nd not to place the system in operation until a'Certificate of , Compliance has been issued by this and of a th. �/ Signe G �:G�l Date JZn ,14( �o 0 _ Application Approved b Date �/ --,--,Application Disapproved by: Date ` for he following reasons Permit No. Date Issued 11 THE COMMONWEALTH OF MASSACHUSETTS PP, fro- &Nr� -�o BARNSTABLE, MASSACHUSETTS o,,f r jpr inn is Certificate of (Compliance t THIS IS TO CERTIFY,'that the On'site Sewage Disposal System Constructed (L-7)"epaired ( ) Upgraded ( ) } Abandoned(' )by &J I C OVA Q_ f, �` at ( r-�('' (SA-1 �"t Z 6Q) t Via has been constructed in accordance ` with the provisions of Title 5 and the for Disposal System Construction Permit No. U)—7 2-75 7 dated Installert`tI C C �1 a.c-�l Designer '#bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system wili-fund on asZd "* ned. Date �n t t 3 7/0 Inspector / !/1� )L --- �lJo t �.'1jh'1' ------.------------------ ----No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS aizpogag �&pgtem Construction Permit Permission is hereby granted/ Construct '( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at 0 4��c� �i!— �—�gT✓ �Q '� r, and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the followinge local provisions or special conditions. Provided: Construgtiomust be ted within tree years of tfie date of this permit. Date ,� Approved by � � �\ �� `. 'J'.. I C._.. -�-- ! s4 C ( �` v _� S �� � � . �� © � rU. ��� ,� �� � � u a a � r Regulatory Services Thomas F.Geller,Director Public Health Division + ' Thomas McKean,Director - - 200 Main Street,Hyannis,VIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date:­� � Sewage Permit# of 00 -95r Assessor's MaplParcel/ (9 161 j Designer: /�1 �'J Installer: �J r-uc e- HCA,C a_l s(c� Address: �Al ; ��I�TT Address: rV, (le: tly, 0X(::,SS" on 3-9 7 - 02 �B c-uc c_ "Cticc-, k,s l tr was issued a permit to install a (date) (installer) septic system,at L0 oal StOs i erU ((C based on a design drawn by (address) dated ir- _ (designer) '-1 I Certifythat the septic system referenced above was installed substantially according to F Y the design.which may include minor approved changes such as lateral relocation of the . distribution box andlor septic tank. I certify that the septic system referenced above was installed with major changes (i.e- greater than•107-'lateral,relocation of the SAS or.any vertical relocation of any component of the septic system)-but iir accordance with:State& Local Regulations. Plan revision or certified as-built by designer to follow. LZH OF 414 A EN cyN (installers Signature) 0. 1140 clS7ER�� S . /TAR`i'N (Designer's Siature (_Affix Designe.-7 iWj Here) PLEASE RETURN TO -.BARNSTABLE PUBLIC HEALTH DIVIS16N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUEQ UNUL BOTH—THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU: ' Q:Health/Septic/Desimer Certification Form 3-26 a.doc f r �soo G.nc. .01 SE�OT/G TA•yC DANIEL E, yGN o B, Aid' �Rr�FC3/S T Eat s`�fOMAL TOWN OF BARNSTABLE LOCATION s%1 SEWAGE# VILLAGE S 07'" Lcn" ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.--13. ( SEPTIC TANK CAPACITY LEACHING FACILITY.- ,(type) �e r _Flag^' (size) NO.OF BEDROOMS OWNER l' PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facili Feet ty(If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leachin Feet g Facility(If any wetlands exist within 300 feet of leaching facility) /j FURNISHED BYZy- Feet // 3 .. � -Sys •, 0 i y 3 M ' TOWN OF BARN§TABLE LCw AT:O d D ©���• SEWAGE # VILLAGE 0c5 WIV/n/`e, ASSESSOR'S MAP & LOT&LI 'le/ INSTALLER'S NAME&PHONE NO. �o� d � Ca Ul- 7 SEPTIC TANK CAPACITY 15ba 62 C LEACHING FACILITY: (type) A2 6e L mckiy§ C&isd (size) NO.OF BEDROOMS 3 BUILDER OR O� ��� i PERMIT DA eb COMPLIANCE DATE: !2 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 { t� 00 45 �, 7 � F (� �X all No. ° ++. Fee o— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migaal *potem Construction 3permit Application is hereby made for a Permit to Construct( )or Repair(✓)an On-site Sewage Disposal System at: Location Address or Lot No. /O ®� Owner's Name,Address I Tel.No. Assessor's Map/ParcelVA �� ��/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /- 93 Type of Building: Dwelling No.of Bedrooms Garbage Grinder(14e Other Type of Building dlG No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ila gallons per day. Calculated daily flow J 3,1 gallons. Plan Date Number of sheets Revision Date Title Description of Soil ms/Nature ol Repairs or Alterations(Answer when Applicable) #52�/115'9e. Date last inspected: Agreement: The undersigned agrees to ensure the construction 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 b s B He th. Signed Date Application Approved by o Date / Application Disapproved for the following reaso Permit No. Date Issued ————— — —— --————— ——— ———————————— Fee No. QL THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for 0igpont 6pgtem Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair(✓)an On-site Sewage Disposal System at: Location Address or Lot No. / ®� Jl. Owner's Name,Addre s Tel.No. Assessor'sMap/Parcel "251ellll�le Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder - Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /�D gallons per day. Calculated daily flow 3C5� _ gallons. Plan Date Number of sheets Revision Date Title AA Description of Soil .,Nature o!f Repairs or Alterations(Answer when pplicable) �✓`��'�� `efX z �;D k u i Date last inspected: Agreement: . . The undersigned agrees to ensure the construction ar'e1=13M9=Wof the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of th�"Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue s d� th.He Signed Date Application Approved by t rL ie7 M4/L-&,( Date Application Disapproved for the following reasot�� Permit No. Date Issued 7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance _ THIS IS TO CERTIFY,that the On-site Sewage Dispos�4jSystem installed(, )gg;repaired/replaced(1) n by Installer l���' G at �� hasbeen constru ted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated � "� Date I s-pector f. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE�d TEM WILL FUNCTION SATISFACTORY --� —�------------ ------———_ /0��� No. q1 / Fee / GJ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ]i5pogal Opgtem Congtruction Permit Permission is hereby granted to Aal- to construct( )repair an On-site Sewage System located at No.# D � . street y _ and as described in the above Application for Disposal System Construction Permit. o. f1j Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special eondit' s. All construction ust be*;d within three years of the date below.Date: 9 Approved by 'Q 1 / Board of IkeAd, l . T J s I rp P �o �GM-D pos Fi CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHQU'I' DESIGNED PLANS) ,0or��LO ereby certify that the application,for disposal works D / construction permit signed b me dated ��` �� concerning the p 6 Y property located at 60 ���Gn �� ��/ � meets all of the following criteria: Thcre ire no wcilinds within 3no feet of Ilse r sed is system / p � septic 4. ,crc ire no private wells within 1!o reel of theproposed septic system p •. T c observed ground«•iter Iibie is i A rcc!or greater below the bottom of the leaching facility T1 "-e is no increase in v now and/or chinge in use proposed There are no ariances requested or needed. SIGNED : DATE: G� LICENSED SEPTIC 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 submilledl. 'r G P TM.y'.�'}e_j � J:.i..: -:�_ � � ,}� �4n,j ar•.,?, FlV �> fj} � :.,,. .. _ _ ,r._ ._ ..v - • � .-�- _ .. - .r r--'s yr fin", .. � .' i^ .:.a�.r+`Y �t1rSt 5;;�,,�y. '4"' �'^{' r..;.�.`A'nwf r -;..ti;_ f...••v-, « >.a. .r.. . —TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION ADDRESS: a$t �-� l It F. �T MAP NO. � � � PARCEL 1 ; 0 OWNER NAME: ! b1l iY ' t.� I' VILLAGE: ro INSTALLATION DATE: ",f3 BY: rr 1 ADDRESS: �` = I �" � �i/i � ! � CERT. NO. Q r v/6 0 � t��0-:5 TANK INFORMATION LOCATION OF TANK: L I-, Fr fy .�r CAPACITY ) Iy TYPE t/ AGE ✓ FUEL/CHEMICAL TESTING CERTIFICATION C ] PASS C ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF- CONTRIBUTION C ] 'YES CX] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED . C ] YES C ] NO DATE LUNSERVAiION C CHECK IIF N/A ;17 x DATE BOARD OF HEALTH TAG NO. ]C ]C ]C ]DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD �� z -�� ��d� � ���'�� 7—� i / %Sov 44;,:ST 101, 101, i i �oso. c'g8 EC:=3Z.S n �/000, i I U � � i - gam' 9 Boyd. Pogo OF MASS 5CALE• a DATE.� P �.: DRAWN BY: r `' SP,O,J� r ���' gcyG _.:-/_..-_ z0 cIUNE"/.3ZOo7 ---....GtS�TG�•/ po DANI B m JOB NUMBER: REVISION: SHEET NUMBER: Locv s WELLER ASSOCIATES t� cuss oST �`� I G45 FALMOUTH RD.. SUITE 4C -- P.O. BOX 417 CENTERVIUf, MA 02632 V` 2 WINDY WAY, #232 NANTUCKET, MA 02554 i