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Home My WebLink About0213 MISTIC DRIVE - Health L-213 MISTIC DRIVE, MARSTONS MILLS A= 079-055 TOWN OF BARNSTABLE '..00/.''.'ION Z!3 SEWAGE It VILILAGE / ,?/ ��S -/q/;-�15 ASSESSOR'S MAP& INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l,a64 or-4 /L LEACHING FACILITY: (type)( i W eR) 1 (size) y 0 l NO.OF BEDROOMS 3 BUILDER OR OWNER 4?1K! Z5 PERMITDATE: 6-- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Sf 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 r _ _ .`1 f �� 4 � { n �{ � d { S _ �� ' � ' 5�i �` 4� (� O d . ,�Q �,o�a6 No. Fee__1�~(✓ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migozat *pgtem Construction Permit ;I Application is hereby made for a Permit to Construct( )or epair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's N e,A dress nd Tel.�Io. 13 /f/� z l3 Of�l i5//C, X�/-, Ins er's Name,Address, d Tel.No. 7 Designer's Name,Address and Tel.No. r 7/ 9��9 Type of Building: Dwelling No.of Bedrooms J Garbage Grinder(W� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow &/2 gallons per day. Calculated daily flow® gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Rf pairs or Alter Itions(Answer when applicable) e�a/T 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 b s B d e - / Signed _ Date�l� Application Approved by Application Disapproved for the following reasons Permit No. � Date Issued —————————————————---———————————————————— No. ! Fee `+.Gi THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 3pprication for Xigpogal *pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(vo<an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Inst er's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ux Type of Building: Dwelling No.of Bedrooms Garbage Grinder(we Other Type of Building -'No of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3_-3�po gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Rf pairs or Alter tions(Answer when applicable)_ �J��'/� y �/�'/ b ��y'l/�f1 f 1'elle- 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 t is Bo dpf-pea klil ` Signed .x/ Date Application Approved by qC i' Application Disapproved for the following reasons � f Permit No. / ,ft Date Issued e000Ten THE COMMONWEALTH OF MASSACHUSETTS �7 PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance 4 THIS IS TO CE TIFY,that the nrsite Sewage Disposal System installed( )or repaired/replaced( on bye/` r"/�C47041d/l57'/�/G/`fD�ord'> S as has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ° dated �* + Use of this system is conditioned on compliance with the pro 'sio s set forth below: No. 'R Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS 4 Migogal 6pot .em Con/t�ructio-n Permit ,Permission is hereby granted),. 46J L01- 1_6Y ZO&/ to construct( )repair( V an On-site Sewage System located at �j /, 3.r. 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. All construction must be completed within two years of the date below. (� Date: .� Approved b CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION I'Llt5l1"1' (1Vf1'IIOU'I' DESIGNED PLANS) �DI��o� hereby certify that the application for disposal works construction permit signed by me dated 6�/9/�� , concerning the property located at 2/3 �s�`/fG �� o ��'sj`�'� � s all of the following criteria: n within 300 feet of the proposed septic stem /There arc no wctla ds p oW pt sY within ISo feet of theproposed se is stem • TThcre arc no private wells it septic system - The observed ground«•ater tibie is 14 feet or greater below the bottom of the leaching facility :/There re is no increase in flow and/or change in use proposed are no variances requested or needed. 4 SIGNED: DATE: 6 IM LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. 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A.,.�. 3y,�-f, ,.� R a b• t�- s�• v�•.Yi �+s '. r..i �:r..-� t1x�1 ,t > t o Y-m.�• d ~: ¢ •:». cz � J'y..,tiT :qr r ;i'�k'. t 3 -e° .. �l v � - � -"G:'r' r4ya� "xrt• 'ri -R+- { t4 .�4s�� r.c` '` y i� �i.."i�$L.u-.,:tom =�-'�~3`�T� s. a a.� �,7 t•l i afty �s•a�i�.. f t i. ,y � '�,, a a ^a r y q s.I y 4 LOCATION � . SEWAGE PERMIT�ND. V LLAGE I N S T A LLER'S NAME i ADDRESS BUILDER R OWNER DATE PERMIT ISSUED _vj DATE COMPLIANCE ISSUED /�`�� o , , ,, . ,` _ �• � I �1 U �, o ___. 1.. Fim ...... THE COMMONWEALTH.OF MASSACHUSETTS BOAR E HEALT l o I 1--.. ..�..............OF...... .. 4. ....-- ApplirFation for Dispas al Marks Tnnstrurtion thrutit Application is hereby made for a Permit to Construct wl) or Repair ( ) an Individual Sewage Disposal System at: Pr' V c' vk-a-Ks e ..... ..-•••••a-................................ --- ............................ .......................................................-- ........_....---.......-- L io r or Lot No. ..... ..... q: .......: ..................... a r �.............................. -.-----__-- --Owner - 6� Address P ® ... ..................... --•---------------------------•. ..... V.L_�_ ................................... a Installer Address Type of Building Size Lot......V.......... ._____Sq. feet V Dwelling—No. of Bedrooms........ ..............................Expansion Attic ( ) Garbage Grinder (A/(A/4) Other—T e of Building No. of persons____________________________ Showers — Cafeteria � Other fixtures •----•---------------------------------------------------------•----------._...__.............-•-- W Design Flow............. ....................gallons per person per day. Total daily flow...._.......3.-_0...................gallons. WSeptic 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........................................ aTest 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........................ P4 ------------------- -------- • ------ ---•--r------•--------•--•----------------------•--•--••-•-••••••-- O Description of Soil...........--0- y----•-�'•••-------------•• 42(� _ ___-- �� l '........ x - z -•-- ALc r�en..---:.T _�c� rs __ N�_�� .�.............. W ---•-•-•-•-•---------•-----•--•---•-••------•----•-••--•---•--.•..._..-•................................•-------•-------------•------...--------•---------•-----------................................. 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 iITI.E 5 of`the State Sanitary Code—The under •gned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the o d of health. / Date Application Approved By - �. .•--.�-- //% ys ..- rDate Application Disapproved for the following reasons__________________________________________•-__-___-_-___•_--•________._.-___________......-. ____________..._._ ...........................•-----._._.._......._....--------------------------.-_...---•---•---.....--------------------•-------------------•---•-----------------------------------•----------••------- Date PermitNo......................................................... Issued....................................................... Date ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7-aw �.................OF......6..ar. & jble.........------....----- Allp ira Lion for Bhipooal Works Towitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... f.. ..._... .............. - - ------------------ ca ion-Addre s or Lot No. vv - .�1..I..�.�ll�.....� �1��s- r5 .. ......................- ------. O ner d es .:�.----•- . ............................. _ 1 l...Vr..l. ' ---.......-----------------------------....... Installer Address Type of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Ot,he�fixtures -- ------- w Design Flow.• 5.................................gallons per person per day. Total daily flow.Z......0...........................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. 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....................---. O ...................i............. ....................... .... • ................................................................................ Descrj tion of Soil r �. . ....(5 ,�..................................... x ...... ...... -� -- P 1U .[r�eGT�Y�� N 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 TITLE 5 of the State Sanitary Code— The u dersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by t board of health. Signed. . (Date Application Approved By--------• ' /�� i _.'.......... - %=d' --------------- Date Application Disapproved for the following reasons:------------------------------------------------............................................................. ----•-.........-•-••...••------------••••••----•--••-•--•.....................•-----•--------•--••-••---•----•••--•••-•••--••••-•-•-------------•-•--------••----•-••-•-....---•----••••---•-••-------•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .................O F.... .... r.. s - z ........................... (9rdifiratr of TompliFanrr THIS IS TO CF—I2TIFY That the, Individual Sewage Disposal System constructed ( ) or Repaired ( ) ----------- -------------------------------------------------------------------------------------•-----....---------- �I ys�i c rr // `` i�nstaller r at.... 1�1.5.........H-1-•�--1•-J�--......................................................................... has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.(f-),I..1,.Y.................. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ��SATISFACTORY. DATE....... I � ...... Inspector........ ................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. .. <<= FEE ..................... Disposal Works Tonotrnrt#ion rrmit Permission is hereby granted..._ ...t-r-q-6.............................................................................. to Construct ) or a air ( an In ' idu�l Sewage Disp sal S stem at No.�.�-!_ 1.. --- -r� � �14f"s�1 !y:S....... s Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .� /` �� of Health DATE........7,. P ............................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME �jC` 1�2'Dg//L/ 1t'/f�f/f7/w?/1S ADDRESS / W tk �� r-� ^/s VILLAGE V 5 LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL /�PQ 0- a rez e l Doo (Give same information for any,additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. -� 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: //�Al TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS APPROVED Barnstable Conservation Commission Signed to -- I .I-I.--7 1 1 -I-. ----�-1 , - �-,,-�'��-77 7i�l�o'--,- ................... 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