The URL can be used to link to this page

Home My WebLink About1050 OST.-W.BARN. RD - Health 1050 OSTa _ N f� MARSTONS MILLS TM i (1 I TOWN OF BARNSTAAB^LE `✓ L6,cATION � � -. (�• f"`�l rY 7 +�J K( ' SEWAGE# .!�d--7W6 � 'ji.LAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. n 1 m l 1 1 SEPTIC TANK CAPACITY 160 0 LEACkiNG FACILITY:.(ty ) J / (size) NO.OF BEDROOMS BUILDER OR OWNE16 PERMTTDATE: -'7- COMPLIANCE DATE: C9 !5 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 0 A .� m. - TOWN OF BARNSTABLE `G' LO%ATION 10 ..i d Q Af fAl be Q.-I SEWAGE # $ ' 78-o VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f � LEACHING FACILITY: (type) L.6A (`k4*Jw)6(size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: 2 I 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 I� Furnished by ' vim'" � _ jo No....9.0-:.7. Fss.................... ........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Applirativit for Diripwi tl Works Tomitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (V5 an Individual Sewage Disposal System at: fk&Ro'1 44 $�1��,•g - zale oc:ui i-: ddress or Lot omAllk .-r- Owner Ad .-� Installer Address UType of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms-------------------------------------- -----Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ......f40VS-e----- No. of persons._...__._.,�ir............. Showers Cafeteria ( ) 04 Other h xt re ...... d ,/'. W Design Flow........._. - -_---_____ allons per person per day. Total daily flow......... .. . .................gallons. WSeptic Tank—Liquid capacity.. Ions 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........................................ ,.I Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------------------------------•--•------------------------------------•-•-•-•-...........--------.........--•-...---...----...._......_...........---.----- 0 Description of Soil........................................................................................................................................................................ W V .-----------------••---------------------------------------------.._..--••---••-•-.............•------------•---••---------------••--•----------------------------•-------......---..._..........._----•- W --•---...------------------ ............................................................................................................................................................................. VNature of Repairs or Alterations—Answer when applicable-------------- --------------------------._.__................_................................. -•--------------------------------------------------------------------------------------- ---fit 1 ------------� ....................................... Agreement: Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Di sal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersi e further agrees not to place the system in operation until a Certificate of Co plia ce has e issu by the b of health. GG Signed ... ... - = ....... . ............... . ...................... .. ...../077, .79j.:...... Application Approved ByAtC Z..................,-- «'. ." .. �, ---"-......................------------'--...-...................... Dare Application Disapproved for the following reasons: ........................................... ................................................ ........................................ ............ ................. ............................. ........ . ...................... .. r Dare PermitNo. ....... ---------------------------- Issued ..................................................--.. ............ Dace TOWN OF BARNSTABLE `G' LOCATION /0 SO O z W SEWAGE # .VILLAGE M '+ I(n ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY % G�y LEACHING FACII&Y: (type) (size.) NO. OF BEDROOMS BUILDER OR OWNER .nMA-140 3 PERMITDATE: - 9f COMPLIANCE DATE: . , 1 - 9q 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 Werland and Leaching Facility(If any wetlands exist .within 300 feet of leaching facility) Feet Furnished by 1 /7- '0 ri No... ..........._...._.. -- F$$.... __... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Diripaiial �ii orkg Tatuitrnrtiun 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair (v-") an Individual Sewage Disposal System at: j I or Lot No, Location Address .................................r f _..---•-•............•••---......•----- ................................................ _ ... __.....-._. Owner sst 1___. .( t. J �Add�i .•..r,--/-r-_..__��f�a.� ....._. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms................_______________-------------Expansion Attic ( ) Garbage Grinder ( ) p`k Other—Type of Building ------ h ..... No. of persons-----------:3------------- Showers ( f) — Cafeteria ( ) a' Other fixtures w Design Flow........... gallons per person per day. Total daily flow----------?_d _________________gallons. k . . .............. WSeptic Tank—Liquid capacity._!� allons 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 ( ) 04 Percolation Test Results Performed by.......................................................................... Date........................................ .a Test Pit No. 1................minutes per inch Depth off,Test Pit.................... Depth to ground water........................ f� Test Pit No. 2________________minutesper inch Depth of'Test Pit.................... Depth to ground water........................ 0+ --------------------------------------------------------------------------•-...---------• ---••-------------------- •-----•- ........... --------- 0 Description of Soil.................•------••------•••------••-------------------------•--••-•-------•-•-------••----•---------•---•-•----•--••-•••-••••-••--•-•-•......--....---......_.. x U ........•--•-•-----••---•-•-••-•----•-•--•--•••--•------•----------•----------•...........................•-•----•-•--••--•-•-...-•--•-•--••••-•--••-•-•---•---..._....._............_.__............_.. w UNature of Repairs or Alterations—Answer when applicable.......................................... .............................................. .......................i--........................................................................ �,:/,o,- '%/C T' - -I, Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersignedrfurther agrees not to place the system in operation until a Certificate of Compliance has been issued by the b& of health. Signed 4:A��-5- ..... _l..'....................... - f..r....:`......'`f.. /f p Dace Application Approved By_. �'�t'� ...:. �?..?d................ .. . . .. ................... .....f� -,1 . Dare Application Disapproved for the following rea.fons: ............................................................... ............................................................... .............I........................................................................................................... . . ..................................................... ........................................ Dare PermitNo. .......51';7_...7.r�--------------------------- Issued .................................................................... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Q-1-amplianre THIS IS.TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by !........!............:.::....... ............... ._..... ... ......_......... ..........................._........................ ............... ......_..... ... at i�/ ' /' t /x � : "/ t)/ 1� ----Y. f.... � .....L.. ...... F,��... ..................................................... ................................................................. ....... ... . has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ................................................ dated _-_._................._------..._-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. ................................. .........__.............. .... Inspector ...... . ..... ... ..._.................... ......_............. .. -------------------------------------------------- -------------------------- C G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 TOWN OF BARNSTABLE INo... ....................:... FEE........................ Biupuuttl Workii Tonotrurti n "pamit Permissionis hereby granted--------------------------------•------------------------------------- ------------------------- -----------------------••-----••-•---•--•-- to Construct ( ) or Repair ( -) an Individual Sewage Disposal System atNo....-----•---••-••••-•--•----•-••-•--•-••----••-•--•-••-------••--- -••-•-=-•--•---------•--•--------------------------------•-------------------.---...-- -----------•---•-•-••••-........._ Street 1. r'i as shown on the application for Disposal Works Construction Permit No-- ------- G Dated.... ......................................: -------=------------------------------------------------------------------------------•-•---•---•--••-•-- _ , Board of Health DATE...............................=................................................. FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, (,,4X L , hereby certify that the application for disposal works construction permit signed by me dated concerning the property erty located at �Iw. &r' meets all of the following criteria: 61-11-There are no wetlands located within 100 feet of the proposed leaching facility L,*/There are no private wells within 150 feet of the proposed septic system CA,"There is no increase in flow and/or change in use proposed -Where are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) `� Z B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNP DATE: LICESTEM 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]. q:health folder.cert _ rt Ayro � s i i