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Home My WebLink About0028 RAMBLER ROAD - Health (2) i 28 Rambler Road Osterville I r No. r — Fee��TT �• THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippHLation for Disposal *pstrm. Construrtiun Permit Application for a Permit to Construct( ) Repair()( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. O�? R4"LR_� tz�> Owner's Name,Address,and Tel.No. S`tETSd tJ �-?�*tJG E-b41� Assessor's Map/Parcel ® T� Ala 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(min.required) /2A gpd Design flow provided b l- gpd 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) C4,471� -M—sy 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 Certificate of Compliance has been issued by this Board of Heal . Signe / Date ;L—(*-ox I'l Application Approved by /" Date /2 .3 i Application Disapproved by Date for the following reasons Permit No. oo j-:� Date Issued ...r ..w-r. ^• ... � " -' M..•..4�ts..N^�w.td..;�•�s1.,..iW,�,i..,l„�y�^�^+�.....n(...w..++t..L+.Ti�ir- ..r t w�:-.o. ... - ..-.--� � .,�-,,._ems. - t 4 No. - Fee ��W THE 6bMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �r�.D �h Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 5--r(STSd iJ �"s4�✓� t-b�[.G. v Installer's Name,Address,and Tel!No. SvC2,t4 j- _,S2 Z,oZ Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms lam" Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) AA= gpd Design flow provided AA gpd 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) �A-J�� —sEP-n5:_�0, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in z accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal . .,. Sign e 1 Date Application Approved by � Date Z 1 Application Disapproved by Date for the following reasons Permit No. ) �y Date Issued /qJ 7ifl1 r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance 3C-A - a--fi iC_ T� JK, THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( � Upgraded( ) Abandoned b at , PL�Q (5 S'T" has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoA 1 q4 dated 17 1l N 1001-1 InstallerJ�} ,Q Designer r 1A #bedrooms Nia.. Approved design flow d' gP The issuance of this permit shall not be construed as a guarantee that the system will fund' i'A as d`signed. Date ) '`1 b�l,Z-7 _ Inspector -------------- - - (f------------ ---}----------------�--------------- ---=------------------------ -----=----- -- --------------- No.ZD I - y ! JC L_ v l " P C... 1_��. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction �ermit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at Dl2UC Ll. 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 completed within three years of the date of this permit. Date+2g�j Approved by — ---�-� 6:>V t - .. r_ 1.24 ♦ !r tN _�`� a"s 1a �; "a� 7 �f17't' iw �i f;�s�`�i ♦+ arT,jt, • L �t � a'�ai 8 + 't a j.� j � �A �` 4 � • * •'p'�r � r , E �i a♦ + a. '�ov rat. { � A � } j b k s 1 '� a TOWN F BARNSTABLE ��7°y ` LOCATION el- r� SEWAGE #. rI •�vII,LAGE ®. 74Z-IY/ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. � � � � /' �7l`QW2;- SEPTIC TANK CAPACITY /i 000 6 a LEACHING FACILITY: (type)f yO G4 4 C44y 4v-J (size) /3 X??-, (>,C?, NO.OF BEDROOMS ` BUILDER OR / PERMIT DATE: 2 Z_�� COMPLIANCE DATE: &Z2 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom ofteaching Facility S ¢ 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 �✓� Feet within 300 feet of leaching facility) Furnished by �1 oQ A � � �a -C �� _ _. � � � s r a v � �� rt erg+ � LOCATION EWAGE PERMIT NO. C �- � ,.VILLAGE INSTALLER'S NAME i A DRESS S R OWNER BUILDER 0R 0 ER r�7L'n DATE PERMIT ISSUED DA E COMPLIANCE ISSUED T _ r �' r � •,� s'_ r ,;: - t.� s i �� r �� a��C; c yt-- � \��w ��,.� � �- � � � � � v � t' � ,� - ��. €� .; };,, �; THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH l � . .OF.. ---------------------- Appliratiou for Uiipooal Works Toogtrurtiou ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .....4 a_..RC ._....er.....R--- --------------------------- ------------------------------------------------------------------------------------------------•. --. L ation-Adpd s _ o Lot No. . �.e. 1 1. -�r.. . ----- ...... ............ -)./.. . .. ................... Owner A r s a ........... p....Y.pao;b- ,1� ...............---wl&��i lrQ-------------------------------------.-- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) �+ `4 Other—Type T e of Building No. of persons............................ Showers — Cafeteria c4 YP g P ( ) ( ) a Other fixtures _...----•---------------------------------------- WDesign Flow............................................gallons per person per day. Total daily flow._................:.........................gallons. WSeptic 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 ( ) " Percolation Test Results Performed by............... ---------------------------------------------------------- Date......................................... aTest Pit No. 1................minutes per inch Depth of Test Pit-------_............ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------ --------•q . -- - -------- --- ---.--- ------- - - --- ---- 0 Description of Soil----------------- --•---_.._ .. ..................................................... x x9 .-------•-------•--/---��--------- U Nature of Repairs or Alterations—.Ans e`w en a plicable....._.)__�1_�_0_ _aJ----_ .1. .................. .0 �j ...........PT......w................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T':T— 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issue by h and of he sagas .. --- P --------------------- �). ........ Dat Application Approved By............... -J�.- .. .. . ....................... ....Y/ --------- Date Application Disapproved for the following reasons:.............................................-----------------•--...-----------•--------------....._...._.----- ------------------•-......---------•-•---.....----------------------------------------...............-------------•-•--•--•-----------------------•---------------------------•---------•-----••-------- Date PermitNo......................•--------------.................... IssuecL....................................................... Date ,^/ 1 g+/7-L, THE COMMONWEALTH OF MASSACHUSETTS BOARD,-OF HEALTH t - ...._.....� .��1d .t°....OF.......dt.•t.. .r�J: � _�' . ............................ App irtttion for Disposal Works Tonotrnrtiun Vvrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System_at: _ y ..... .__.�.:: :ot� -- ••-• ...................................... -••-......--•••--•-•--...••-••-....••••---••••••-----.....--•---•-•-•----•---•--•................. ! 3Ldeahon-Address..,_._ "/ or Lot No. Ownez7� r 4/ r �Ad r9ss .�, CiC...a�4F Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ..... No. of persons............................ Showers — Cafeteria aOther fixtures -----•--•--••--------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----- -......-----• -----------•.....•••----•...-......................................................... 0 - < p, I Descriptionof Soil.................-=--- ......... :.....�-----•••••••-..........................U .••-----•-•--------••------••••-••-......-•-•----•-••--•-----------------•-•....---•--------.----•---------------•----•------------•-••----• ......................................................... ---••--•--------•--•-•---•------•-•-•----•--••-----•----•---------------•-------•--. . _. --- ----------•--__-- UNature of Repairs or Alterations—Answer when applicable 3 11' )�` - ! �` I t t Agreement: •t The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT ,s. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu ed.byithe board of health. Signed s : 1 4r ,•. ` �' f `.. �� •�r=- -.... Date Application Approved By.............................. ` .. _/...4 j .................. ----• �_y� a.. Application Disapproved for the following reasons:---•-•....................................................................................................... - •---....••••--------------------•••••--•--•--........--•-•---...--•--=-------•••-•-•-.........................---------•--------------•----•-•-----------------------------•......---•-----•......-•-•-•- Date PermitNo........................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � '!s?. ....<.... OF..... „ �... 1 t. ... .�.e.......: ............. . ..... C�rr�ifirtt� ,af fa�ant�li�nrr . THIS IS TO CERTIFY, That the Individual Sewage Disposal..System constructed ( ) or Repaired (�-4 ` brr r` ) ' r l f s � } a��................ G f d .. ;:o t ---------------------------------- .... -- " Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._....1 .......... dated.__.......____________________________ ___•--.THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIOD SAT SFACTORY. �DATE.............. Inspector_.... � THE COMMONWEALTH OF MASSACHUSETTS �:< • i •BOAR-D -OF HEALTH 1 / , �� No.... -�l..y/ FEE....... -• Disposal Works .Tuntrnrtion �[Umit 1 , ! C �i 7 f 3 F Al Permission is hereby granted..--• �.A -• ...................... 1.. to Construct (- ) or-,Repair ( -; n Individual, Sewage Disposal Syst f , at ---.... --.-_._ = Street a as shown on the application for Disposal Works Construction Permit No..................... Dated......................................... .......... �- o----�•�„1/�.....-•-------------------- DATE--------_--------------•-------_�� a .. .................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS