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Home My WebLink About0086 TUPELO ROAD - Health 86 Tupelo Road Marstons-Mills / A='051=16�`� C TOWN OF BARNSTABLE LI LOCATION --- -2-4, '%�a4,? LO �1 a SEWAGE # VILLAGE �° �lY,�'_��Y7i�� OR'S MAP & LOT cSZ-6 7 LOsj INSTALLER'S NAME&PHONE NO. E# .d S �- C� � ^ SEPTIC TANK CAPACITY f c�0, LEACHING FACILITY: (type) f it lML f y l:T (size) !!i X 423 1 NO. OF BEDAOOMS -3 BUILDER OR OWNER IV/ e PERMIT DATE: 10 5 COMPLIANCE DATE: >_ 6 1 9t Separation Distance Between the: -Maximum Adjusted Groundwater Table and Bottom of Leaching Facility t Feet f .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 t —TrE d . a� �. z b' a' —— J No. �— / 01 _, Fee THE COMMONWEALTH+OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Migponl *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System .Individual Components Location Address or Lot No. �(�\V Q G Ovxwq Owner's Name,Address and Tel.No. ` CC�V�..r- Assessor's Map/Parcel 6'5 7—/,0� 1 A —CA,5o I Installers AName,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms S7. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow a-3,-c--, gallons per day. Calculated daily flow '7K'--k c7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. c�c Description of Soii -emu �1t9 v�� Nature of Repairs or Alterations(Answer when applicable) =cc�-�� n �l 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 Signed Date ` (. Application Approved by _ s Date d 5 Application Disapproved for the following reason Permit No. — 701 Date Issued ' 7 7 TOWN OF BARNSTABLE LOCATION : SEWAGE # - o r VILLAGE ASSESSOR'S MAP & LOT16S 7- 1.D_ INSTALLER'S NAME&PHONE NO. ^'i t) c,e b SEPTIC TANK CAPACITY Z� <J r LEACHING FACIILITY: (type) —<<,�r�r lrf�/f %o;�.$` (size) -/-/_// NO. OF BEDROOMS BUILDER OR OWNER PERIMIT DATE: J D -24 —%l COMPLIANCE DATE:_ 10 - _ 9 q Separation Distance Between the: j 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 77-1 ;r -!p No. �'" 01 Fee�— THE COMMONWEALTI#`OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS 2pprication for Digpogal bpztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System .Individual Components Location Address or Lot No. F(Q k j P C\OV,Vk Q Owner's Name,Address and Tel.No. Assessor's Map/Parcel jJ S 7- JO Y' ►` Installer''ss gName,Address,and Tel.No. Designer's Name,Add r ss and Tel.No. 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 -C�, gallons per day. Calculated daily flow If'�'i gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank r St y'`OOC Type of S.A.S. ,C41 ` G�-kS Description of Soil 541A f d Nature of Repairs or Alterations(Answer when applicable)737,w%�i ja < G 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 is Signed Date 16—ca Application Approved by Date — S= Application Disapproved for the following reason c�; q Permit No. /�— 701 Date Issued/4— Z1= / 7 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the -site Sewage Disposal System Constructed Rep�a( ) ed( )Upgraded Abandoned( )by r at F has bcWh onsiructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?7—7 O dated` Id— 7 I= 9 9 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date I h __ 1 `f Inspector -----------------------------------=--- No. 99- 0 / Fee '' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS MiOpo5al *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(L,,Y<bandon( ) System located atU_, 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 permit. Date: O ' �` Approved by2Z_64,�Zf " Y 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) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 0A o ICE(A C6-CUi`) 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. t/• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. i y 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 y 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 me od 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 maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation f<<0 +the MAX. High G.W. Adjustment3J _ F' L DIFFERENCE BETWEEN A and B J' 7 SIGNED : DATE: O c3s S [Sketch proposed plan of system on back]. q:health folder.cent -- . s. G d or THE COMMONWEALTH OF MASSACHUSETTS HEALTH ..._11�1 .�-----------------OF.............. ..�i �Gn ............................. Appliration for Biiprrs al Works Tonstrurtinn rentit Application is, b made for a Permit to Construct �r Repair ( ) an Individual Sewage Disposal System at: \ T . .............. S.? .. ---.... ......... catio;A., 4 dress, ��_ o ... o�j Lo N -.. ........... Addr s GG ............ N .._.......µ....... .......•........... .................... .4...._............N Installer Address U Type of Building Size Lot.-_. . . Dwelling gNo. of Bedrooms............. Sq. feet ........................Expansion Attic ( ) Ga age Grinder ( ) Other—Type e of Building p� yp g ............................'No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtur ----------------------------------------- ------------ ••------------ W Design Flow......._... .....................gallons per person er day. Total daily flow.._....... ,>................gall`s. WSeptic Tank—Liquid capacity/./CM.gallons Length. ....._. Width .A... Diameter................ Depth. �... . x Disposal Trench—No. .................... Wi ..........Total Length........//.............Total leaching area.................... ft. Seepage Pit No..................... Diameter.._....... ..... Depth below inlet....6.......... Total leaching area....''- �- ..sq. ft. Z Other Distribution box DDsiu&tank '-' Percolation Test Results Performed by.... _..x�¢�s...�.... -.`t.-.�._`.-.� _._=. Date....___-.__ .-�� ,a Test Pit No. 1................minutes per inch Depth of Test At.................... Depth to ground water.._.._........._.._____. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ....._._ ................... .... ... ....A.- -------------- ------ Description of Soil---- .:�XQ -- ------------------------------------------- 4---�•-.-�-'-1-�..... ••-_.. W ----•--------- ..................................... �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 iI ipUj 5 of the Stat Sanitary 6e e— The undersigned further agrees not to place the system in - operation until a Certificate of Compliance has en iss ed by the o r o lth. Signed ---------------•--- •---------- ---.---••- ------- Date Application Approved By � .z-----� -•------------------------•••• ` �� Dace Application Disapproved for the following reasons:................................................................................................................. ---------------------•-........--•••-•.....-•------...---------•••--------••-••-•------••••••------••-•--._...--------------------•-------------------------------------------------------------••------. Date PermitNo......................................................... Issued........................................................ Date No.... 41-.3---- FEE.............................. THE COMMONWEALTH OF MASSACHUSETTS F> HEALTH OW/V..................OF........... ....1�..1.� !�. ............................. Appliration for Disposal Works Tonstrnrtinn "profit Application is-hereby made for a Permit to Construct *-1-or Repair ( ) an Individual Sewage Disposal SSA---. atio ..Ad ai es t N 1F O er Add e s W F Installer a "( Address Q Type of Building Sizp Lot•-•. .. . _.. .S . feet �'25 q Dwelling—No. of Bedrooms............ Expansion Attic ( ) fa , a age Grinder ( ) '14 Other—T e of 'Buildin No. of persons............................ Showers — Cafeteria a' Othe . . . ------------------------ -••--------••....t................... ..............------•• W Design Flow............................................gallons per person p;r day. Total daily flow....... fs.........gallons. WSeptic Tank—Liquid capacit�Q�•.gallons Lengthh$'4 ._.':,Widtl'f�_/ ..... Diameter _.`i� Depth�.__.e. Disposal Trench—: ::' «, W' •••rr ; Total Len'th....... ... ... . Total leaching rea__._._..�". ...sq. ft. Seepage Pit No..................... Dl �., r1ep h below inlet.. ....... Total leaching`larea, w sq. ft. Z Other Distribution box ( ) i .re �kaihiN�„�,�+ "y�� 3 _ ' Percolation Test Results Performed by t'� > • • . 4 /" t . ... Date----...... r aTest Pit No. 1................minutes per inch Depth of Nest it.................... Depth to ground wa er..../!�. -- Test Pit No. 2................minutes per inch Depth of"TestMPit j.............. Depth to ground water--------g.._....__.____ O Description of So>l._. _- V ...-.61 ?.)._...... .............. - .................................� W..-- C _ ---------- - ---- --- . � . w � �� r � , -------------------- ----------------------------- ... -- U Nature of Repairs or Alterations—Answer when applicable k P J ........................................................................................ ......... d _._. ......... -.Q .._ Agreement: {. wx�a YA_ 4�.,. The undersigned agrees to install th"o eeddescribed Individual, r wage Disposal System in accordance with { the provisions of TITLE 5 of the State Sanitary �b`c e—The u si furor'agre' S n t;�t lace'the sy em in ' operation until a Certificate of Compliance has ed by the b and o alth: �r Si ned......-- k=f Application Approved BY �..r '...:. +€ -- - -- ` ............. 1 ........... -- 7 4 - Date Application Disapproved for the following reasons: �, •---•----••---•--------•---------------=•---------------------•------- •••--------------••.._....••---•------........-••-••--•........_.....•--.....................--------••-•----------••--•-•-----_._...--•-•-------•---••---••--•-------••---•••-•.........-•••----......_ Date PermitNo......................................................... Issued....................................................... Date 4+- ; THE COMMONWEALTH OF MASSACHUSETTS O R HEAL H ( z .................................O ..................................................................................... (Inrtiflrate of Tnnmpltanrr THIS IS TO CERTIFY, Indi` dill e `<'Disposal System constructed ) or RepairedbY---------------•---------.--------------- J�tje .......... .. ......... ..... ......... Instal �� J►1 -� [af--- at �_ r -- ---••- has been installed in accordance with the provisions of TI � S,*The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... date ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHAh,NOT BE CONSTRUE® AS A-GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. y� DATE........................S_... - ..�.....------•-•-----•-•---• .._.. Inspector--•----/ A.Z:......................................................... THE COMMONWEALTH O -"MASSACHUSETTS BOARD. OF HEALTH -3 4RNsr4Sctf OF /¢tit hJ ..... . 35 No....sa^.y1.'.�.+r". FEE........................ Disposal Works TanstriWiott Prrmit Permissionis hereby granted -------•----------•----•--------•----•-••----•------•••-•---••--•-•••----•--•-••-••-••-•-•--••-•..............................•••• _ to Constructor Rair Individpal Sewa s osal System j at No.. p ------•.../..W....(. __/......1_ GAG ! �.p 7"� --••.............._ Street as shown on the application for Disposal Works Construction Remlit�No.__......_ at .......................................... Z /— oard of Health DATE..........................-----�-------------�-----.......................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS St t.,.Lr--- >`AM%u4 - 3 ISIODtOoM Tv P E LO ►IO GA=MAGE GPI . EM:P . �tt_� t=LAw : Itb +� 3 • �3o G•Pv J uy �,�� ; Sr�T'tc TA&4v- L 330,E 150 % R 4�15 6.r'•O. ��'_�„ S>; use- t ooc, 6AL. g _. l 1 tUGWA-L AVF-A = t5o S-; •-�3 C? 'Z.S * TOTAL -V ES16W =425 Tt>To u .vA►t_�f FLcw z .330 6.PD. � i � -' - ` � • . PMC-DLpTIOQ 6ZAT6 : J°Iw 2-mlIJ• 02 Lam. tl1 - teal. .f,'• -. ; =��; , , - - - � �\ , �sz (r. oft IN, i4rlR-G< �S BICHA ALI A. io nr 'D2QIIJ BAXTEH 'S+ , O C A S eN 6+.IT' �No.24149� lD T�sT 792 ! !S=J`lo•S TOTir� o t�j'1: �. ol lop - Ravi .St�85a+L p,P,& �,-r; IUJ. 4- 2 -BBoy, S� sEQnc r c 4 tuv C Ta�K GAL.- 54.2 54 LEACH A ifleD p,T WAS►ICO MEA S STOWE- o CEQTIT=IED PLCT', PL.atr.t rL_ ' PTZOT=-t L.f a L oCATI 01-4 hWiTO44 Mu.LS 97 /2 _r,„I p s�e.�.� �cntw t= /"• moo' p-ATM S/O/S L D K,1aTP.< �aopd��V pLAtJ RtFEtLE�1GE LGRTIF-{ 'Tr`lAT THE OV'5$ t•1TJZ tobla co&,,PLVs WIT" THE 51 vrr-_Lt►-1� LOT l g A.1.tD seTt3Acv- vC4utceAAE7-"T4 of 'r"r- TO W U 0; 3 Ac A4-rAA3; Ljl: VA.T6s RcGlsrc-.cZ>`v U�t�o 5uev�Yoes THIS PL,& -J IS UoT T3ASco OWA'" OSTF V-V%L Lr= a MASS. iw5rcuAAF- 4 Tt{L- UFO i�T'�i 51�GWLD APPI.-t Ga."'r '1`y �•bT- To DMTceMtNC LOT LlWiB fr..c�Sts�T�i K-t�u re FLavt/ z %to V. 3 • Sso C.•Pv S�T'tG TAi,4v- O %. K 491 uS+-- t Ooo 6AL.. �ISPOSAi. PtT - uSE loco GAL.. r� rXP d ' ISO SF' � 2.S • 3-15 G.P.Q. � — r� N � ,�� •+ $ormIrA .AOEA e END G TOTAL '�pE.SIGtJ t 42S G.P.D. TaTo� va►t_� Fc..t�w = 3306.P.v. � i � — — � � ' .. `O% of • — . Z t�t RICHARO A. r' IoIN BAXTER t" . N 0 Nj C A S 5iN 6rJ't" �No.2:044- o O /�' 4 efg•�t!' ► �/Ors I.CN�\a/ ►h �S•Op V ' ko stltt *. O - -res7r 792 f4_$G•$ Tor .. SNf150VL 4� IW. GAL. 8 t�v T-Aw w- GAL. Sq•2 644 PIT wAs�+ev M EA S 35 ,'• OV, sTo..r� qg.o C aZTtFIED PL C)r Pt.A..W Py-oT=-tL-EE L.ocATIO" 1AtZ DID, MILS 4 �� 11 97 rz ./'� moo# 't>,4-+rr=- 3 8 82 o Y147U< CGRTtFY "THAT T14a 40056 SlaortllJ PL-AIJ RLl'�RELLGE NE:Q G>��J Go�N1PL�lS W 1 TI••t TWc 51 D E..t_I Nir LoT •�� •.;. . '. ALID SETt3AGK 1~C-4UICEMcWTS OF TMC- 1'ow►.J Olr 3AQ-►�1�i�'A 1..� d`�STEP- Gova vAYG2L �..*:'t B a xTc>t u�E Inc. RCGIS t ,cat> luF-Y, f0 TI-AIS FLAW 1S �lOT >3ASCO OW A&j QSTEmv%t Lr- a MA54 lW,9reUAAF-%J T ��/C�{ TNL- UF�S�T'�i 51-IGWLD AIaPt_1 GA.tiaT j n_• - 1"e t••br er.. U,�,Cn Tc, Oe:TCeti(INc Ln'C LlW . SESSOR'S MAP NO—. '�� PARCEE !� �rc A T IONt " `,6S'EW4`C- PER IT NO. 4 o''T - VaKE FE-1-0 Flo" VILLAGE I N S T A LLER'S NAME i ADDRESS � IUILDER OR OWNER DATE PERMIT ISSUED �� DATE COMPLIANCE ISSUED�1��a r <�1 i ti f , l G� J a i 4 i ' No.. .q3� Fes$ ........ THE COMMONWEALTH OF MASSACHUSETTS ` x ~ -- BOARD OF HEALTH Ou_)o ...---......_........... ..... OF. Appliration for Dispaii ai Works Tnnitrartinn Famit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at:Lor _ 6Z6.7••Loca•on-A ss FjkZ' or I.ot ...---. Owner Address W Installer Address U Type Building Size Lot.._. x ..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder a Other—Type of Building ....::::..... p ( ) — Cafeteria ( ) ............... No. of ersons,.__...._._._.._._._._...... Showers Otherfixtur ----------------------............................-•--•-•-•--------••--•---•--•---- ............................................................. _ W Design Flow................... 5�--._.._.....gallons per persor�er Jay. Total d�ily �ow.._........_-3 Z..�.._..._......._ lons,,, WSeptic Tank—Liquid capacity. .gallons Length_'4f`- ,.... Width-�'1"-0... Diameter--------........ Depth. _ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....___._.k---------- Diameter...........g_... Depth below inlet.......!..... Total leaching area..,p'?.60_sq. ft. Z Other Distribution box ( Dosin a aPercolation Test Resul s Performed by..........................................� ........•......_.. Date_._. ._'. � __...__.... 1 Test Pit No. 1.../�.--.. 7-_minutes per inch Depth of Test Pit....k.a.®...... Depth to ground water..�'�:�..._..Q`Z 0i4 Test Pit No. 2................minutes per inch Depth of Test Pit..... k........ Depth to ground water--__._�k.......Lt.. O Description of Soil....1-0✓ z `Su/�� .---- ...............� �� •------------------------••-----..........---••- V --------------.--- '- •-------- .................. ---......................................................... Z.W V Nature Repairs or Alter do s—Answer when applicable- ....__ _ �c4¢ '.._�`f �................ ----- ------------ — �^ ' . u Agree nt: � `�^ "L' ACC. �t� (�/ 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 undersigned further agrees not to place the system in operation nt a Certificat Co pliance has been issued by the board of health. *if ed.-•.....................•--...... ... ----.........--•-•...------........--- ------------..............•••••. Application Approved B .....---• --.....--- -......................•--•------..........--------------•--- ........... ....... Date Application Disapproved for the following reasons:................................................................................................................. ----------------•-....------------...--------•---•---•--•.........-•--••------•---------...-••---------•--_-••-- Date Permit No................. - ------ Issued....................................................... Date No------------------------ Fz s�?��......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..........A................--•--..........._..............-----------..................... Alp iration for Disposal Workii Cfoustrndion ramit Application is hereby made for a Permit to Construct Q or Repair ( ) an Individual Sewage Disposal System at: ....... ......... ...... f......-----................. ... ....... Loca ion-Acid' ss .� P .. t or Lot ? �ry ;s A , f.1 •9 e_g ...°a 6 " ?-. .... ............................ ............................................. ................................................................................... Owner Address W Ub.... ... _._........ --- — Installer Address --� Q Type of Building Size Lot.... _Sq. feet Dwelling—No. of Bedrooms______________4:'............._..........Expansion Attic ( ) Garbage Grinder ( } Other—T e of Building No. of persons............................ Showers — Cafeteria QI Other fixtures W Design Flow..................... ".:=±.._._._._.___..gallons per person'_ger flay. Total daily gow.._.......... .-..��:__ ::___._.._.._.. lons,, Septic Tank—Liquid capacity__Lv_o.gallons Length. —G.... Width�_:-!�?.._ Diameter-_._- :_.. Depth..__._: .. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area_._.........._._____sq. ft. Seepage Pit No...._.._.............,Diameter.._.......'..... Depth below inlet........ '----- Total leaching area... :L-.0..sq. ft. z Other Distribution box ( `; Dosing tank ( ) t.-s 1.4 Percolation Test Results Performed by.. :. v................•-•-----•--. Date...- ... --- ='== ......__. 4 f� Test Pit No. 1.�*c_..__ .!-minutes per inch Depth of Test Pit.... � ...___.__ Depth to ground water..!:.Y-- f.,°' Test Pit No. 2................minutes per inch Depth of Test Pit---_--0........... Depth to ground water__........I........ x :.... ----------------------•-- 1 0 Description of Soil 1.r _ �F 9�r, r x f =`� _ IF��` `r f ..................................l.6 .^ V ----vr••.....-•------•--- W -•-•-•--•-•-----------------••----•--•---•-•••--•••••----•----•-•-•••••••-•-•••••---•••.......---•------•----•-----••-----••-•---•----•-•-•••••-•••---•--•-----••----•--•----------•-. --••- r,p_ _ dtv U Nature of Repairs or Alter do s—Answer when ap llcable _ �.___ l.!lP,�•X""."._.- _________________ Agreer ell nt: �1:�- h 1 n ��=:,G 4' 'C t CC C "r- 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 undersigned further agrees not to place the system in operationjint a Certifi it Co plia�nce has been issued by the board of health. igned--.............................. •----.....•.... i r�, ......�•,._ -.e.-,.7...� ................................ Application Approved B ..... :.:-- Date Application Disapproved for the following reasons---------------••----•--•-----------------------------------•-----------------------------------•----------..._.. ---------------•------------------------------------------------------------------------- ---------- •-•-------------------------•---------------••-------------------•------••-Date-------------- 4 PermitNo.............. ='~ ..................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD'"OF HEM..? . .....................0F...........t>.��Z h. . ...................... (In ifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) . . ---•••...by.............. .....:...... . ._.._..... .........._. Installer ...._.at. ""S�!= f Q._..."— -------------------------- "_ . 5�. ..?. -..A......S...---------------•--------------. has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----- --"---•�-�-3...... dated---.�1._:�710jc---.-------_---••- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................................................................vy"r: *.. Inspector.................................................................................... THE COMMONWEALTH OF`MASSACHUSETTS �L '�r� CA,)/*jt5e� BOARD F HEALTH 11ispaiial Workii 1011ontr ion Prim .i,, Permissionis hereby granted.............................................................................................................�.��4 to Const uct ( or Repair ( ) a dividual Sewage o Systemd n .. jj I at No.._k` ..:. .... ,f�. , /sC?... •-•-••• ----.............tr ----- `r Street as shown on t e app cation for Disposal Works Construction ' 11 �:.. Dated.._ Board of Health` "--- DATE--- ' 1 V. . •---------•--.................. FORM 1255 HOSE & WARREN. INC.. PUBLISHERS - SIt.J,GL'� FAMIL`•( - 3 81=D1ZI�ON� � 4/ •d3� Flo GAtzaA--F--- Gr2I,,tc�sZ tadt U%4 FLAw Ito -4-3 -- 330 G•Pt? , SE>?'t'tc TA"tC 15G % .— U ,�ISPoSAI PIT uSk- loco GAL... �CLE.WAl1. AQE A = lSD S F. 15o SF : 2.S = 3 15 G.R . .c $tJ iTo�t/l A2EA- rzpD ST-. v s►�. 1 .o SO .f?�. - ToTA L 'C;>ESIGk.I = 42SKY P=C-DL.QTlOLJ t?&TE : l tt.! 2.MI IJ' OIZ LESS. 1 N Y D•13ax _ i o�� 9cy � • tvUo Glut-- � _ Pc TER c � � S. 'i`•A-+..III✓ S� � 76 SULLIVAN y per' WILLIAM ��;;, No. 29733 'P �- �lo NYE No. 19334 ST SU +r?i=S.T• [J_6qj Tor F'uo _ � �• l aoo Iu� 4'paw •ate .a Iw. GL. z , 'box G�, Seprtc tNV C T'A�iK Io 1000 641 ` kNK •., tNV A �jJ�,t d1 dot GAL. �� 2 444 C ."W _. LEACO I y : FIT V./ r � r r WASHED --7� STow�t= S C� 5 C-EiZT17-la-7. pLdT' - -12 No �N��tc�l- � • 3 � i G G tZ T l 1-=�{ 'C t�A T T 1-�C-. ��• �!�i� S t-lory lJ 4�L�.l�l R�.F lZ�t.i C.E. t-IF:Q'C::t�t�1 Gc�rtilPt-�l5 W t�'t-t T1-a�: SIDC.Lt►-•1E: AWt> SETU,hc:lC I~r-QU IIZEMEWTS of -ri-te �--•c, 'T" -To vvL cr= t5A-F- Js I�r-3L—'• PA.'TC U' GL) t2EGl5'[-c-: Gt> "l-1D 5U2vEY�c�S Tt-tls nl_AI-I l%, t-1oT LA�7CO U+--� Ad:! OSTE2V1l.LC o /IrCAS-i, JSt'�:JI,r�C:t.l i ��tJk:\/t=mot' '(t�L" UFt'SC•�, Sk�GEi1l3� A.PPL..l 'T ,1- T' BC U�,.UO Ti:) i)r_-_Tc-VMi►4C- Lj::i ' U W=15- iG r � R BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers g y 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WILLIAM C.NYE,R.L.S.-President I RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering August 20, 1986 Town of Barnstable Board of Health P.O. Box 534 Hyannis, MA 02601 RE: Lot 5 Tupelo Road Applicant :' First Atlantic Development Co. Installer: Aqua Jet - Joe DiMaggio Dear Board: Based upon a visual inspection, the installed system is in accordance with the approved plan except Ifor location. The location of the system is represented of the attached plan. I trust that this meets your present needs. Very truly yolurs, Peter Sullivan, P.E. Baxt e Inc , LTt1 OF PS/bc Enclosure PETER < , SULLIVAN No,29733 " 0 P000�GISTEaf` �sStONAL MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS �. 2-0-7- 2-2 a, -76 i •. � 5,�nub LOCATION SCALE - U DATE '�� PLAN REFERENCE • Lam- BAXTER ?~ NYE, INC. THIS PLAN IS NOT BASED ON ANC REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES, APPLICANT