HomeMy WebLinkAbout0126 SANTUIT-NEWTOWN ROAD - Health i?-6
---- - - --- - A= 031 005@'7
No. tL) 20 Z?— — 00 ( Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
9(pplicatiou _for Yell Cougtructiou Permit
Application is hereby made for a permit to Construct(01", Alter( ), or Repair( ) an individual well at:
QT—Lk IT-- NFLFOL00 F—D �n.3,�
Location-Address 7 Assessors Map and Parcel
Owner Address
S5-10 62tZ-. k)S
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well II PV L Capacity � �a
Purpose of Well
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a Certificate of ompli as been issued by the Board of Health.
Signed
Date
Application Approved By 7z
D to
Application Disapproved for the following reasons:
!!'' Date
Permit No. L3 710 E?— 00 `f Issued 20
Date
-------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF . BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed(1,?�Altered( ), or Repaired( )
by e Ill N S i��, �,� ;.dI lit-( r-D may-
Installer
at J QLP 29 r`aTLA I j— — 1Jl%40( I.JI`7 JPD .
has been installed in accordance with the provisions of the Town of Barnstable B6ard of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
No. (� �. 2-- (�}(� 1 Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zipprication -for Yell Con.5truction Permit
Application is hereby made for a permit to Construct(V, Alter( ), . or Repair( an individual well at:
\a Cc> 5A PTV 1 T7- N 0-Q r)
Location-Address ` Assessors Map and Parcel
Owner Address
"'�`e�0144.t N S L"O k.U— Tom,"'r.! t �.i n�(�- 20. '50 L 5 . 01 LA L2,5
Installer-Driller 'Address
Type of Building t
Dwelling V
Other-Type of Building No. of Persons
Type of Well 4a 4 N N C/ Capacity
Purpose of Well (2tar, 1 C70
Agreement:
The undersigned agrees to install'tthe afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health.Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a Certificateofof`C.ompliance' as been issuedrby the Board of Health.
ti Sign d
,f Date
Application Approved By ( ?/�
r r J Date
Application Disapproved for the following reasons:
f Date
Permit No. W �� /_ � `J Issued Z7
1 Date
i
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed(�4, Altered( ), or Repaired(
by VJ /J S L,,>C-,Lk I t7-
Installer
at ?4q
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated
I '
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
i
Date Inspector
BOARD OF HEALTH
TOWN OF BARNSTABLE
Very Con6truction Permit
L) Ji
No. (W 2a2?_ -- C)OL( Fee
Permission is hereby granted to 5M Q ikl Imo.)-5 . u-2 E-l-.L 'J ( 1 ,I X=,-
Installer
to Construct Alter( ), or Repair( an individual well at: ,
Street
as shown on the application for a Well Construction Permit No. LJ Z 0-zS- 00 q ated 3 ZUZZ
l �
Date f 7/0/ 2077 Approved B
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'up arc mp,e,id �f�t�:�rep9cemerrt pr repair, as�POWr er
ha tt ark of`Bai ;;` all s ;
fl eck e;bax ° "fit d i i"f , fV,GdDp_for tie f 9lcreeir g t�ements„if, c of
ares in Wink *1 . �i D oil` � str ItY
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m_ mpn`It CYO tire; n s F mm 7drith a yin[ 1` 10s 9pRIra ed.'.by are"'8b4d,va
A m6tai septa t�►k�ill.F�� �i�p�cii i4 It��tMctL4 11.y nit k`krng
�Ce it 411 r5 ondc ng,C e tank i;§less t years 01 l ail2 l�
Tit Official 1n n Form
nr � �- � _eirg lip trry F�€ - lar' l�rr .s � rts.
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>pum ng mpT.,hara "trr7� :V�040 to t rrak�sn
be n plpa are repla ed 7 Y LC- N 0I � latn bel ?r.�a
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y �v.1ii faaiatta;s �� at1 efiltb. ��nfa�� 1raix�iea}r',ifrtp
datirrriiin th t the iyst6 i n I fubcdoAih ih-a manna t ttrat t "136bildbi4ithi
an ea'va��ni�ant
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pp Y_ '
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i l fa tfl: rt,�rt .i dic sat a t a a � t�f aanr vn� aiitg gets n i rasa r ki0-den as.fqq aj
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turtia
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spaot;or its*,Oily�a? r% 1 qf. : ublic walk
0 L MyportI6n.-6f.a cesspool mr,p a as��; in-50r-fit 6f a�priv %er a;sup lL.
rt�+to rtia sf pa pri4 Is Ins ;' �r� 1,00 10et Out greate.,Ih §�Few
td +lfi p�iu tart si I�'' f a}i r € b � t Q"tiki��RIs This
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it's i r if' tl
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a� onoa rot�r�g�afa an si n be. �#! ,�p el f tb e� ffi prm;
pr a lded Rbia a�ai a l er, �Q er tt a(v .
tt y yst frr[s.a a s pools ring a ifit *M sign fly+.-C.200 pd-
` 1Q b.0fl0pd,
U4 s � �,9 haiw<clot road gaat crr,�IKIrr e o f th : e fa4l�ar :
eraf l2 exist as 6bed:in 31t1, ll(R 15 3 3 ttt f+re the WS eni RII9, h .
sys9rra cfwiri ;shul�cxat� t tt7i ii me, tl
care t e;fa 6 ,
ii Lame� s ia~rrts be cpr� ied pry U # Ylity wth .
iiesig�rlar
Tor ddftia-0418
i' the s� t rra iS w�r�ttu`ir �tlQ}€ at s� drin r c+ ter sup
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thi : �t anx ac ted ��►g nr ra s6rz�i&i ar�� 6I 16'ti e he �tpc
` I tF� artslpp d tm �,;puhfic water-suppl Yielt
ifpy, EF, he swOW,,i t1ereA Anitibb4hr ter"t
yr" nvei b "I tlanm�thee :spa hk fl fie €�nmr Orrtar rave.
st�arrrsi+li �srfiart ;tt �r��t ut�L#rrBCI�1�1=K9P f�rie tt3�shll Yp9reKe
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b �I a isystern M-epi d vr�n F:llvta 'irt'.th6 Rr r 9' :t c Gir l
H -,tare tiralurrtr� s, f ulf tan 9n� :c�ed tQ t17et recQi�tl or as,parf cif:
Q itsspee;ttd "+
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� tt 6npedT'sigt�s
tem cmrtptsne t irt�l'Qd9rt�#h $-I ql Al `
-twk,mnanholes d gpanet and.tht±ir�t rtor v the t nl�
Irspt fP ter' f W �l�rttt,
die e t p;dep�a+ f ttqu �d pthe fsi d and. topth n7 4.
® 4d 'thi'liit�t +grrie ,ac. u �nt�tFriifFe� nf<ty over prutded wt ;
i lt'O"at i of the•p,'rI n n t +c vF s su fie' timr i!tpg
L � Oiti� 1P�o iibll hD S GI`A- si p, y��t �� �': rrtn .sNtq he' s
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0 h tiea�ar�fd�tna�vt�s Fir evarrrp ,:a
C� teimt�td in the fitCd ft€ ��rya tf1 tlit �r rltti Pitts
t: appromatiQr� if° it .ircib,1 .�[ 1 [�1R. = : t3 ( �,
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a .
€Owner
rnr ak7ra;r I!n,Off
;1Ye? i g � t frog ern Nbtfor Voidntiai ne 3
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t yiTo4v3 _ 1 '�cdeld `,abate-d intpediian
P46fin6+6r:0f oiaTr±'h,t fes dA 61;Oe
D Fesid�n ,a rap grara�e ❑, -yes No
i� ra ry,ora ara ,se y t rn' �I I Us1d J yra rr�inspa t a i 'Y O..fV
J6,f�er'rra�iar h fh b �it��rt:Y
soul-%e ? L7 ,Yes
VJater,enet r
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:
l Est d .oE oo uQ
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h
ign.
drease trjap f nt?. N
gitvdte tgl �r► prer{
! on s r h�ds a"d td l e'TFle $ s�etx�' ' �' 0. NQ
"c titer r Gee 6�gs,Jf'ailbbi :
tH?k�fx .v±ib jrdo•5 C is'L easscry F r?�e 5 uam,`[ �agree SSs6etro Pie Y.i2i
.Inormq.l"is, ub urfa.�ce aWa o imh�posa s sw n Forra, Not VolumWyAs sman a
rca Ir►d foT a}eery
126 Ni amaGa'ickd,.
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6]ev��r'sc�ame
RY 'a. ate o Itgp e>irn
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ral la���r�aa�l€►
-P����n�an�I
t iime of;inf6rmatlo _
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tt+� d t 1ii y O n } �Nf r��,Ott r s Kr s c r it
Ir rE et[ t �ti t chits gy b r gar bft1te uri ont Ppr norlind
r
�ndirat ipr price oont�4pt(to b�s inn. fa�om st n fur �d � ( c f:f st
n .fit th; lki4 styr prat dl t
T! t.tank-Attocfi[:copy Of
�a�R Oppr�+
P{H liYQ., TGr`4�•`4}5a3i1� 94,¢ ;R43 i9�!iS�5t�'9�r+tasrx•.c$w,P.Id$ ][tA �S+g4"$�"�.a 4•.
Tide� �.
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in i rrna vre aabs rfa ag � p 9 Sir,%t$�i Form INCL fvr Voludery,�,As� i�n�r�t�
rAwiied for +r l :f
PO$, '126,Remown Rd--.
dote;Pik.
r5tiiZ:S IVlall ':___ f3 ;^___ �1R7,M
'Di*of InVeoprL
in a 'v ail cxi Pa 11-ts oim't ied tit k it } o ys a i o 6f rr n
+d41 r s v t r ,det t d u� 6,41(_i1a9 t Site? 'yeas v
E�%iB�t���e�cr�r gate�n�it� aaa}
I lii`t wow gads, 2
t�et
Material of:oo'Astt tion
cl!cae irsira N- P Daher(eMpl irij: _ .
i5 Pl fr�rrr�priy€rt€stater"Su pFly We 9r sum Im-C� t
er tore ndih€n'bf}�otr�ts,`Veho r evid'encq� es e,
Toy .� o��► i i1-
CIeiStM be!ci4nr grade: -—
NA
M'ta i3f o tru tiara
kf# k iA a to list
in P� cc of cord bY��:
Sludgy depth:
ilstpc}gr,sn Tics S O�r��.• raaass F�rriG.` +at+�� eaud��a�a® Pam gut 17'�
s Form;
Iin�libi2 es611oU $` Q *i �Qll � Ir �} �lr
rna for .
bital skins � Is:�- __ _ h4 itt7
CtlyTcra�i,'ti �i�,� Zr¢fitsr� 13 `:Gil��p? i'�zi ..
41
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um thickness,
af1Ql3 rt l tip of r 6 t auk[ t t6e:6r b0fflr?a'`. '-
Dastanaem bolt�. �n t -6atq�i of at�tltf . ,. ._-
kv�r� �r�inrpa�si�kfir�r> dg�.j#d9� �
Ca€x M." On pumping.rewmt imer llon,r I I t rc�.au i$oo rtba#to condition-, strui raI Wtag0y,
�gUid v�ls r laibid to ol*i!
u6k�704, k Pam t +4 �Q Br i i�l rr i��tl #tie Rn p�lai ,: ##utti�`.ol.
cn Oct 6flc: t1Gtv_r l[ rlt ,af 6ink jS'4wLt, 'qfuo v� ap'ope
rispro €rf vt�# t ant IQrI� .af lei ira# If talk:
t; ap 0a aai
�}epth�elaur gra�li :, s€ `
a pol ekhi�leta�: C� rSk�2���xp�i�i�}•:
y
inn f �a aE sc tc�t of anti t Y, l '
I a' i cxfi► t te;+ar baFfii
<. .
t7�ie olrlatgt pul�iplrc� p� .;
Til I � fit.% Forts.-,
iirpl� 3�na tu �' tavipl tr Frig [ c ;f�r' i�nry � tint
requffea louver
�Pet�r:;�tr€ k
t �k s i itil A-
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,UCATION /� /V�,t Al � SEWAGE # 9 (- 32 5
- VILLAGE MESA& o ,/�s ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. A-49 7 75 -Z S-CU
SEPTIC TANK CAPACITY laory
LEACHING FACILITY: (type).1"5ZM6AI Lew k N". (size)
NO. OF BEDROOMS_
BUILDER OR OWNER
PERMTTDATE: t!D "a • 99 COMPLIANCE DATE: ?— ' 9 9
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) 'N- Feet
Edge of Wetland and Leaching Facility(If any wetlands exist }
within 300 feet of leaching facility) Feet
Furnished by e
•IR�a s
E-- .
No. s J Z f— Fee S�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS
i
1ppriration for Dioogal *pztem Comaruction Vermit
Application fora Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components
Location Address or Lot No./a(p e(.J 1 dk)) Owner's Name,Address and Ty.No.
Assessor's Map/Parcel 631
_ DOS .00 7
Installer's Name,AddrAs&$TedkC,co Designer's Name,Address and Tel.No.
350 Main Street 2)//4
W.Yarmouth MA 02673
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 '230 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /006 0a6's�i r<q Type of S.A.S. T-oo 9,4(, eli~6ers
Description of Soil 4vaV
Nature of Repairs or Alterations(Answer when applicable) 1 Y)-f4 A l( o,V a
Date last inspected:
Agreement:
The undersigned agrees to ensure thf 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 this Board o e�t t.
Signed ` Date
Application Approved by t Date 16'7_
Application Disapproved for the following reasons
Permit No. Date Issued Z—
No. 3,"7
-r—. * i s Fee
x
THE COMMONWEALTH-OF-MASSACHUSETTS Entered in'comput.V
Yes
PUBLIC HEALTH DIVISION- TOWN'OF BARNSTABLE, MASSACHUSETTS
ZIpprication for Digpozar *p.5tem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Loch tion Address or Lot No. (? e w Foci n Owner's Name,Address and T 1.No.
r-,
M, vt✓t I l y {e I- S l Pc
Assessor's Map/Parcel
! Zq A,
Installer's Name,Address T N Designer's Name,Address and Tel.No.
J4 dANCO
350 Main Street ,
4y
x' I
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1o60 CA- Type of S.A.S. d ` S yo 2,4/, c11,,,,,/;e
- Description of Soil J A V1 Y
Nature of Repairs or/Alterations(Answer when applicable) 1 oj4,a .2( o)1 v cl�
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 bythis Board o e�lth.
Signed � ( Date 3
Application Approved by Date G ?_q
Application Disapproved for the following reasons 01
p—
Permit No. J 2- Date Issued
THE COMMONWEALTH OF MASSACHUSETTS \
BARNSTABLE,.MASSACHUSETTS
certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( )
Abandoned( )by C'��('\D
at /o.) (o C 0 looj Cl J S�b M W ( l has-been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No "7 2r dated t1
Installer Designer 9
The issuance of this�p / 't �alll not be construed as a guarantee that the sy, te'm will function as desi d.
Date �I Inspector A� /1/) _ At J° V `/1v!&
•4�N1. ®---Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mi5po$al *psStem Conotruction Permit
Permission is hereby granted to CV11
ct( )Repair( )U grade(✓j Abandon( )
System located at �� ti J_� (✓A ,f� /�1GlJ�o„
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 thi e t.
Date: 6 r 2` / Approved b
rK _
1/6/99
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 DESIGNED PLANS)
IA-n d-r. hereby certify that the application for disposal works
construction permit signed by me dated (D - 3 - S'S concerning the
property located at loZ ( meets all of the
following criteria:
The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• 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
V111. 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
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
method 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(ld)feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation Sol• V +the MAX. High G.W. Adjustment.�1%/ _ `S 7• S
DIFFERENCE BETWEEN A and B
SIGNED : J DATE:
[Sketch proposed plan of system on back].
q:health folder:cen
G VL t
Cot
�-
n
t r
TOWN OF BARNSTABLE
Qq �
LOCATION Zo / IAJt7l►-rit/ SEWAGE # -_ J (- 3a
YII,LAGE_ I,4l�S�,u.S � rl� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 7 72'Z
SEPTIC TANK CAPACITYC-
LEACHING FACILITY: (type). 'S Gas1 Lew1, Chr ML, (size)
NO. OF BEDROOMS �J
BUILDER OR OWNER
PERMIT DATE: 6 "a 9 9 COMPLIANCE DATE: 7— 6 -.9 9
Separation Distance Between the:
i
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 206 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
i
`f
fw
I O'C AT ION -� WAGE PERMIT NO.
VILLAGE
INSTALLS N E i ADDR
d UILDE R OR 6,WNElt
DATE PERMIT ISSUED
OAT E COMPLIANCE ISSUED
Y
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