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Home My WebLink About0047 PENNYCRESS DRIVE - Health i ` j /.� �� ►�G�S S b� � "'1T - �a�. o� J��►rs�;,�s �� .�� X _ a 1 t�.ILLsI�IM S ��/ F � •� � �v aCLQTION 5EW6,C,E PERMIT UO. VILLAGE — — — — — - - - - - - � L If � IWSTNLLER S W&ME ADDRESS BUILDER 5 ' Q &ME ADORE SS DATE PERNAIT ISSUED DATE COKAPLI L1MCE ISSUED : 1.4 =7 C -- r ? f�06/ ) r. .r f l � / I THE COMMONWEALTH OF MASSACHUSETTS - BOARD OV127 HEALTH _._.... . . . .. ........OF........... ..... ::.............................................. Applirattun -fur 43iupuuttl Workii Tunutrurttun Vrrm t Application is hereby made for a Permit to Construct (A �"or Repair ( ) an Indio dual S4=WtA+� System at: - � ....11 T'.... ................pp. ... . . ................ :.�i.. ........................__ Location•Add ss „ or N r ..... Owner Address Installer Address U Type of Build'n Size Lot.. _":__Sq. feet Dwellin —No. of Bedrooms...._....... .................Expansion Attic ( j_y7,_ bage Grinder ( ) per., Other—Type of Building No. of persons--------H............... Showers ( ) Cafeteria ( ) a' Other fixtures ......................... . W Design Flow.....s.��°...........................gallons per person per day. Total ow...........�........_____.............gallons. WSeptic 1`.ulkk�71Liquid capacity_lOIC-gallons Length---ti R........ Width................ Diameter__-.._...-.-_--_ Depth___..--_-.-:_-- x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area--------------.-----sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below X let_.....___•..._._ . Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) ® - C _ "� ✓ �� a Percolation Test Results Performed bY.......................................................................... Date--------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-------..-----.--.------ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-_--_--__.-----___. G4 ...... ......... Description of Soil 2'Q ... - -.../--------=------ tiW-I ---------... l U Nature of Repairs or Alterati/nns—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 s stem in operation until a Certificate of Compliance has been issued by the board of he h. n Sig d--- --- ' -------- ------ -�` . ------------- --------- ---- Date Application Approved B __ Date ' Application Disapproved for the following reasons--------------------••---••---------•---------......((/...................................... a.t.--------------- I •---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ } Date PermitNo......................................................... Issued.. . l ......... Date °11 7 ( i � 7 d� c1✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0F1 HEALTH �.. '?.f .. ---.OF............ ..r.. Appliratinn -fur Dispoiial Worko Totwirurtion Vrrntit :.y Application is hereby made for a Permit to Construct (41"or Repair ( } an Individual Sevfage Disposal System at: jt,f1 ✓�n l� .................P ��5'5 PA ft- 2) Location•Addr ...................... d Owner a • Gf�" �V Address 16l � "'� ..... ..............• •-••--.........-•--••----......------.......................... --•--•------............--------- Installer Address // �P� UType of Build G�-�-- Size Lot......A.2-._(`-___.C____Sq. feet Dwelling—No. of Bedrooms______ _______________ __ -.__--_-__Expansion Attic (Ally drbage Grinder ( ) a yp g �.�'�-_-_--- No. of persons.-_-____'............... Showers ( ) — Cafeteria ( ) Other—T e of Building __.__. .__ Otherfixtures •----- -------------------------------------------------------------------------------------------- --- ------ --------------------------- W Design Flow......._ S..................�.gallons per person per day. Total d�l flow............................................gallons. WSeptic Tank�Liquid capacity--I--_-____-gallons Length.... Width................ Diameter................ Depth...._____------- x Disposal Trench—No- -------------------- Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit uti -._... Dosing -- P V - ;C,�� - � 1•Other Distribution box ( ) Dosing tank ( ) �11-___ Diameter.... . . - e t e et................ Total eac un trea_.____.__.___.._sc tt. Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------.--- -------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...-----._--_.-----.-... (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._.---_---_-----_-_-_- l ... - ........I....... •-•--•.=....-•-•----- ------•------------------------- < pr O Description of Soil )- { ct_...�a�.1_ �t _:_ *� C �^- � ` U .....'__'.__-__._..._ "-'--•-------a`=,.-`-•-- ----•......( i z'r�"=-^ ." .>.F..1�--2 t----- l�_d_/._! ! /___. � ..!....._r_ _,._.....!..... d M _____________________� .. _�-::y.�./!_._._L._/.,.��;� __i�1='![' �:.-.-. -_-__-_-.-__-------____-____--. .-___r_.---_ --_.-_-_-..-.-_.-----__-______--__... 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 Article NI 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 h�eath. c--�- 2,4� e�, Signed_--d'�. .------ =•-•-•........ ------------ n Date Application Approved By-------------/�`� -'��------ t�%..1� 1.- -!i`.� /'� rt`:..` '- -- -` - / Date Application Disapproved for the following reasons:--••-•-•--------•------•------------- .......................................................................... - ----------------------•--•-•-•--•------••-••------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS r--.— -- BOARD OF�HEALTH ?.........OF..... ................................................................................. ��-ter' Qxrtif iratr of QVIOntphatta THIS-IS'T-0 CERTIFY, That the/Individual Sewage Disposal System constructed ( or Repaired ( ) ._....__ ----------------------•-•---.-. J Installer < at. / / Gz/7 has been installed in accordance(/with the provisions of Ade XI/Iof The State Sanitary Code as described in the application for Disposal Works Construction Permit No.............-3i�_�J........._..___ dated'--it- �..~� ......._____.__.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION�SATISFACTORY. DATE......- . -•----•--------4---------- ------------------ Inspector-------- ---------=- .......... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N ......................... FEE...... ................ Binpwi tl Workq inn trltrtinat rrntit Permission is hereby granted--------t/ �' l( .r.r.F---`• ••---1�'?tm-_,.--------------------------------------------•••------••-----•--------•-----. to Construct ( )ror Rep�hr ( ) an Individual Sewage Disposal System at No......ll ��" ��` - --t Street a as shown on the application for Disposal Works Construction Permit No--- '_...e!......_'Dated----- ��_ ',�%':-/.. ....... ---------------------- {� d Board of Health DATE............................................ •-----------------------------•---- €' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i -10 ' ... � `-- �- _`•Mir- • ` �^ � • , 00 Act j f x � 4 6 is,10 OF QWN A� ,; � __ 'civfo.2�y'wy 3� • ,• •_ 7"'i^!L�•�U/LI3/�/G .3�T'�.�C�a2E�Ql✓t,�'EMf�l • dF 7}/ l� t/'N OFF ' L� ,, 71W < r ,�+ ads It✓ � 164 • i .d,. �raa�Ct_s.�. ' :-:1.,.. :.2.-.d.a:Y;..�,�5.,..L.�.za....i.wzs, t..�sLs..__«._..,..��..w.....k >rr:�w .a...�«�...... ✓_._., .. . . .....L�_ .�.___�.... 0,L6PENNYCRESS DRIVE, OSTERVILLE 2-070 r e i a 1 . I l� v `` n TOWN OF BARNSTABLE l� LOCATION (�hoth GG0y 6AU b/- SEWAGE # /�-37V VILLAGE ASSESSOR'S MAP & LOT�0-o 70' INSTALLER'S NAME&PHONE NO._AOW4444' Go J n�e,�o✓ �/ �`t?6 SEPTIC TANK CAPACITY / w GEC LEACHING FACII.TTY: (type) ow C �,-J , (size) /�• -2J" 2/ NO.OF BEDROOMS r/ BUII.DER O OWNER Y� w� G PERMUDA ' J COMPLIANCE DATE: Separation Distance Between the: J f Feet Maximum Adjusted Groundwater Table to:'tlie Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ZV Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 7 f�� .y��s' �0 \ ��` O ` Y + P � I a l t ^� a a .� �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migaal 6pgtem Construction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System "dividual Components Location Address or Lot No. J!S 6 Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Ad ress,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 e��io. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 330 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Do�I'4 �t'�S��9 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Bo f He Signed Date Application Approved by -&� Date Z T Application Disapproved for the following reasons Permit No. Y Date Issued —71 No. s_F, .3 Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for �Digozaf *pgtem Con5tructfon i3ermit Application for a Permit to Construct,,( )Repair(V)Upgrade( )Abandon( ) ❑Complete System P"Individual Components Location Address or Lot No. Owner's}Name,Address and Tel.No. Assessor's Map/Parcet tD' C�p//,�/C1//® ! �Z11t 6 Z - C /J 1, Ci NZ- Installer's Name,Alvress,and Tel.No. ��5� Designer's Name,Address and Tel.No. q�9/�► Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder(leo f Other Type of Building L�A ��No. of Persons Showers( ) Cafeteria( ) �,- Other Fixtures Design Flow &2 gallons per day. Calculated daily flow .330 gallons. Plan Date Number of sheets Revision Date Title / Size of Septic Tank �i7��9 J.l,!5�/hj Type of S.A.S. Description of Soil ZJ�X z Nature of Repairs or Alterations(Answer when applicable) 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 Bo f Heal Signed �� Date Application Approved by Date Z 3 7 Application Disapproved for the following reasons Permit No. q y Date Issued 6 _73- 717 —————————THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE TIFY,th the On-site ewage Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( by 0�DQ��S at L`'e� ( / '�SS /�, has been constructed in accor a e with the provisions of Tide 5 and the for Disposal System Construction Permit No. / / dated Installer Designer T The issuance of this permit shall 7ot)beronstrued as a guarantee that the systpiil function as desLg ed.Date //, Inspector % /� A ,= t ----------------------—� No. �/ —� Z Z_ —(/ 7a Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5po5a[ *p-5tem Construction Permit- Permission is hereby granted o Construct( Repair(1/�Up rade( )Abandon( ) System located at d &4 ( 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. Provided:Construction must be completed within three years of the date of this t. - Z 3 Date: �/ Approved by TOWN OF BARNSTABLE LOCATION SEWAGE # /-375/ VILLAGE ASSESSOR'S MAP& LOT,/.:Z?-a 70 INSTALLER'S NAME&PHONE NO. f III` f ✓ q�$.ggjL SEPTIC TANK CAPACITY / cr) . C7*4 LEACHING FACILITY: (type) 5?JD —I-C Lei. if/.a.��, , (size) NO.OF BEDROOMS BUILDER O OWNER PERM ITDA COMPLIANCE DATE:, Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f 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 �N f4�� 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 PERINM (WITHOUT DESIGNED PLANS) 4 p� // � v. I, ✓gyp' �✓�vvTT//l/"/ , hereby certify that the application for disposal works construction permit signed by me dated 6/W/W ,concerning the property located at pn/?47 y/ee-5 5 4-1/4 -- meets all of the following criteria: It./The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 4 /✓ The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch..: There are no wetlands within 100 feet of the proposed septic system. • There are no private wells within 150 feet of the proposed septic system tr' There is no increase in flow and/or change in use proposed /'There are no variances requested or needed The bottom of the proposed leaching facility will not be located less than five feet above the ma..dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor ethod when applicable] If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the ma-d'mum adjusted y groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) r 57.1 r ' B) G.W. Elevation �+the MAX.High G.W. Adjustment.Z DIFFERENCE BETWEEN A and B z /• SIGNED : % DATE: I [Sketch proposed plan of system on back]. q:health folds:art C S CA �r -t .aA �� • i _ 4p r�Py iF r � is - � a., Y r � � ,t Lk PR\ t. �, •,� �� Ire. '� �0� ��' 'T �p' L� �:.. � 4