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Home My WebLink About0186 OLD MILL ROAD - Health 186 OLD PALL )MARS70NS PIILLS 1 _ A= 064-018 ✓ J 1 1 TOWN OF BARNSTABLE t'�CATION SEWAGE AGE #�� l�// �� W �_� � VLLACii ✓`!� � �� /�dC�S ASSESSOR'S MAP&LOTZ6 dl g INSTALLER'S NAME- &PHONE NO. SEPTIC TANK CAPACITY 000 Gze C LEACHING FACILITY: (type)1 . 5`00 'a /size) /Y NO.OF BEDROOMS 3 BUILDER O WNE PERMTTDATE: COMPLIANCE DATE: 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 r � ` �rrve A)CA, 3 c 1- 3> 191- W qu4,61 , 177 -- �, � em No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpplication for Digogal *p5tem Cow6truction Permit Application is hereby made for a Permit to Construct( )or Repair(o<)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. /Y(o (3 L.D M i kA- /lA t&U /V4- 7Tj l J Insraller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. aka. . Gt1 � � ,� Cd N S ,,-S lt2� a o 44. -7 U! &\)\A-l�%4 AOD ,its Q/C9Td,.LS A t&A-S /VA4 any T Type of Building: Dwelling No.of Bedrooms Garbage Grinder(—Y-4-0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow q gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) A- .0;51 (, �4_ �- ,�E£P �)lS,NJ �— Sic S '0"kV 6, _ U O1 r� ! y �� Date last inspected: Agreement: The undersigned agrees to ensure the construction ft9 f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental ode and not to place the system in operation until a Certifi- cate of Compliance has been.issued b is oard of e _ Signed Date Application Approved b Z-- Application Disapproved for the following reasons Permit No. 9�'',27 Date Issued �w tr' No. l Fee THE COMMONWEALTHS OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS, Zipplication for Miopool *p!6tem Con!5truction Permit Application is hereby made for a Permit to Construct or Repair( an On-site Sewage Dis 'osa1,S stem at: PP Y ( ) P (°� g P Y Location Address or Lot No. Owner's Name,Address and Tel.No. P� O L.D .vI tom, 4AD,' ✓14 4d n1-F_y IKA-aC z�l.1_S m ( t l-S , A44- � A Fro r 7T,.L M L-tkj Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ;Z_5�6j/bcm uu ,11 Gv J' r3c�/��of n CC)N s� J-.s Pb 3 0+�. 7 U-9— WAij-6B- A.0 Type of Building: !.' ` Dwelling No.of Bedrooms -.7 Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria ) Other Fixtures Design Flow 03 U gallons per day. Calculated daily flow gallons. - Plan Date Number of sheets Revision Date Title r- Description of Soil s Nature;f Repairs or Alterations(Answer when applicable) A,00 A- �- �i 0� ��1 C60 ie?� C, >e- F5�- DEEP �).S�r.J C,- .SpU � Date last inspected: 1 , Agreement: The undersigned agrees to ensure the construction f the afore described on-site sewage disposal system f in accordance with the provisions of Title 5 of the Environn e14al ode and not to place the system in operation until a Certifi- cate of-Compliance has been issued by is oard of a :M .—___. Signed ' Date, /� Application Approved by Application Disapproved for the fol wing reasons ' Permit No. "� Date Issued �,A— ;z b .9 THE COMMONWEALTH OF MASSACHUSETTS o6�1 -D1 S' PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced on by U/t;rlL,6)72 COn1S;RdJ CEW4 /n 0 U4 V19 lt,C /14Az ►N M,U-S ✓A /V"-1401-j c has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Y6 dated Z Use of this system is conditioned on compliance with the provisions set forth be w: ! :. •Jr - 06 No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Digpogal *pgtem Construction Permit Permission is hereby granted to to construct( )repair( D9 an On-site Sewage System located at LZ ✓►'l l u- /c-d,4J J-f s n%r L L�s 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: ��' �� Approve by , :_ I w a n ,n o �Q LAD 0 0 CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, ( 4 a�o 1�J hereby certify that the application for disposal works construction permit signed,by me dated 1-2- concerning the property located at l Z C)iz /&c Jz /VWX,"Jl' meets all of the /14 I U--f following criteria: • There are no wetlands within 300 feet of the proposed septic system • T here are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leadiiing facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: 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 submitted]. - e No....... ..... F�x...l..��................ THEBC®�ORN®ACTH OFHAES^;T TTS i ---...-.-...OF.......... ..... ....�r_y' l ---- ---___4-- -- Appliration for Mopwia1 15orks Tonstrtxrtim tIrrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at Location- ss or Lot No. .. � Owner ...---•--•-----•--•-•...................•--.Address Installer Address Type of Buildine..- ------ Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................ .....................Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ............................ No. of persons.__.___..__....__...._...... Showers Cafeteria 0.4 Other fixt res ..................................................... W Design Flow_. .____ �Ons per person per day. Total daily flow.__�_.� _ ........ gallons. WSeptic Tank-Liquid capacit;r ons Length................ Width................ Diameter................ Depth................ Disposal Trench—lio_ .........___________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_______ ___________ Diameter.................... Depth beloN ic>let_ .__.. ......... Tota leachi a rea..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � '- "7 7 7 V '4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.............__________- r14 Test Pit No. 2..:.............minutes per inch Depth of Test Pit.................... Depth to ground water.......................--- ----••-t-----.-- ----- O Description of Soil---•-•........................Q_._�./'-may... .5 � ( l�I .....W ----------------------------------------------------------------------------------------•-••----•-•-----............._................................................................................. VNature 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed •' ..... ;••---...... .: ._.:.. ate Application Approved B ........ . •-----. C... ° e✓ ----- Date Application Disapproved for the following reasons--------------------------------•----•-•-----------------------•-----•-•--•---•-•------------------------------•- .............................•---•••--------------------•---•--........•----•----•---•-•----•-............•-•---------....------------•---------•------- �,�` - --... Date Permit No....................................................... Issued--- - Date ..---•-- No..... ...... Y Fs$...I.! ................ I THE COMMONWEALTH OF MASSACHUSETTS BARD HEAL H ---_------ ' O F....:..-. ` .ir - 4 Appliratinn for 3topmal lVarks Tomitrnr#ion Prrutit f� Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst a � ...... �� -- _ V, i .............. Location- ess or Lot N o.je Owner- ......................•--..........--•---- Address :e'er . .. u ........_... ..................•_----•_-. ---- Installer Address Type of Build* Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms___t.___...:;____________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _______ No. of ersons____________________________ Showers a g --•----•------------- P ( ) — Cafeteria ( ) dOther. fixtures ..-•---.___.--- - - ----------------------------------------- .........................._____. __.___gallons. WSeptic Tank Liquid capacity __ ___ lons Length---------------- Width______________._ Diameter____.. _________ Depth................ x Disposal Trench— o_____________________ Width.................... Total Length--------------------- Total.leaching area............._......sq. ft. 3 Seepage'Pit No.____�___________ Diameter___________________ Depth Belo inlet_ ___ ma�yy....... Total leachi area..................sq. ft. Z Other Distribution box ( ) Dosing tank a Percolation Test Results Performed bY--------------------------------•-•---------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test - Depth to ground water........................ 44 Test Pit No. 2................minutes per inch -Depth of Test Pit.................... Depth to ground water................ -------------------- O Description of Soil .. .... r �. -!> ' ------------- x W VNature 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is u d by the board of health. Signed ---- .., ---_----- ate Application Approved BY = *. Date Application Disapproved for the following reasons:----........ Date PermitNo......................................................... "t Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS .. BOARD OF EALTH - , OF......:......... . ..... ......... rtif iratr of Tnmpffitnrr T O CE. - -Individual Sewage Disposal System constructed ( ) or Repaired ( ) b �. y � ns ller , �+r has been installed in accordance with the provisions of Article XI' f The State Sanitary Ced'eas"d' oscribed in the application for Disposal Works Construction Permit No________________ .X_____________ - dated_.__ _::_ �_ '_ THE ISSUANCE OF THIS "CERTIPI'C ►TE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... s , THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALT . jr u � r!,1��1!...........OF....._ ��r� - _........... �- f No -.. __ •..... FEE ^--.... ,.,... :.r..w Uiapimal Workii Tonstriuli an Prrntit Permission s 1�reby granted. = ............. •• -•^- to Construct ) or Repair ( ) an r ,, dividua Setw s 1 ySt s...__ ..&i, treet. as shown on the application for Disposal Works Construction Permit No._____________________ Dated_. ! L ...............................a..........-............................................................ .. r Board of Health , DATE.... :........... .................. .. FORM 1255 HOBBS &'WARREN. INC., PUBLOSHERS r BARNl3TABL E COUNTY HEALTH DEPARTMENT BAT.WSTAB19, MASS. 02630 T[L[PHONQB 362-2511 Ext. 331 Date: January 31., 1974 To: Oman Construction 5200 Building West Yarmouth, Mass. 02673 On the basis of a sanitary survey and a laboratory examination on the sample of water taken from a , w located on p ell. ... ... . . . .. the premises of. pm4n Gonatx=tion located at Lot 277 Marstons...N6i II& anus 3].,..],97�. (Place) (Date) this supply is apoved for domestic purposes at the time the examination was made. If you wish further information regarding this supply, please contact us at the County Count House, Barnstable, Massachusetts (Tel: 36.2-2511 Ext. 331)), and we. will be glad to assist you in any way possible. cc Board of Health Signed: - -' Bai"izstab�e �, Public Healt Mass.. 02664 h Sanitarian r -7-7 >� sn