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HomeMy WebLinkAbout0061 WREN LANE - Health Ow 61 WREN LANE, MARSTONS MILLS - A=029-015 J No.-- --d0--------0(3 —ORFee---- --------------- BOARD OF HEALTH TOWN OF BARNSTABLE Zippiicat ion-for Vell Cootruction Permit Application is hereby made for a permit to Construct (0, Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel /to bye ► i �'� C�✓env_ —�,t&!Crv.,s Owner Address Installer — Driller — Address Type of Building Dwelling --- --- ——-- - Other - Type of Building-- —_____ No. of Persons— Type of Well Y — Capacity----------------- Purpose of Well{-_-,, Agreement: The undersigned agrees to install the aforedescribed 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 Certific I a of Compliance has been issued by the Board of Health. Signed -- ` date �k�A� Application Approved By - - S ---- -- date Application Disapproved for the following rea -------- -- -- - - -- ------- date — Permit No. � — Issued --------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f (tompriance THIS IS TO CERTIFY, That the Individual Well Constructed ("), Altered ( ), or Repaired ( ) by _ AA-&", l/ Installer at-- G I i'o t00 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--- --- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector----- --- -- I . J 0 3 No.- ------------D Fee---!-------------- BOARD OF HEALTH TOWN OF BARNSTABLE Appfccat ion-for V ell Construct ion Permit Application its he eby made fora ermit to Construct ( - ), Alter ( ), or Repair ( )an individual Well at: _ Location — Address Assessors Map and Parcel T ,�P - �• w �uvIC(0.If Mrl/f-- Owner Address A SC_c# ary Ply ��� �� t l/, �� ,��,� �6� ,4,,t�1- ,KR &J.� Yy Installer — Driller Address Type of Building Dwelling --- -------- Other - Type of Building-=---- -------- No. of r� Type of Well y - ---- Capacity- ---------- Purpose of Well Agreement: The undersigned agrees to install the aforedescribed 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 Certific to .of Compliance has been issued by the Board of Health. mac. � ' Signed ��%� �kV�j , �� ��'"1�` date fv � Application Approved By r� ,/� ��� date Application Disapproved for the following rea s: ---- —---- —_ __ r� IV -- ----_---------_b4 �------ date------- Permit No. Issued , ate BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ("), Altered ( ), or Repaired ( ) by Installer at l . Gv 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---- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- -- Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Vefi Con!9tructionVermit ./ No. Fee ---------- Permission is hereby granted A to Construct (✓S, Alter ( ), or Repair ( ) an Individual Well at: No. — - -------— ---------------------------------- street as sho o th application for W I Construction Permit No.--� .o. _—__—_ Dated- - 1 --- ---- --------------------- -- - ---------------------------- /?. Board�-�-r of Health DATE. 112111412 • - TOWN OF BARNSTABLE Ki7 LOCATION ���� ` SEWAGE # ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. %����/ �� �d5 7 7 SEPTIC TANK CAPACITY MCC GOA LEACHING FACILrn: (type) a"N a a �(size) /0 NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: �� �� COMPLIANCE DATE: IO l LI 97 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welf 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 i within 300.feet of leaching facility) Feet i Furnished by r► Q 1 '� !454 1 f r 33 a x> No. Fee - THE COMMONWEALTH OF MASSACHUSETTS �zCy el/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS l 01pplication for )igpool bpgtem Cow5tructiun 3dermtt Application is hereby made for a Permit to Construct( )or Repair(X)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. M AU`7UP,0 p44 I"-S /Y4 G (,—I— W(t—&,,1 c.4N C v►,Js /M LL3 AAA,- d�A Y 7- Installer's Name Address,and Tel No. Designer's Name,Address and Tel.No. l o►.�s�t.u.s MA-.�U�-Gti c Type of Building: Dwelling No.of Bedrooms 1 Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow —7,3 Q gallons per day..Calculated daily flow -73 a gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer w�-3 en applicable) f Z 7 �S Ertl E �A144-(__F A-4 f i w 1`, a)=- Yoh,4 f t 4 -on D i E 7D 'i L cS E47r(,.C_ Date last inspected: Agreement: The undersigned agrees to ensure the construction 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 B d f Health 4 Signed )� Date �� Application Approved b O ✓ � Application Disapproved for the following reasons Permit No. Date Issued /.top W, ` r _ �lf No. .��,.- r ` ,i - � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Mizpogat *pgtem Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair(X)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 64- W(� C/t-N£ ( C,C! f2.,^—' Wp ftAAU TvF►4S M 1 L,.J /Yb4 cJ(CAN t £ Installer's U ame Address,and Tel.No. Designer's Name,Address and Tel.No. okra L_V o Fl Got.3s I /4j Vr'ttlr l `7G'S'—" l..t/1►L£L q /Z4. �L� Type of Building: I 'r Dwelling No. of Bedrooms 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 Descriptidn of Soil 1 4 Nature of Repairs or Alterations(Answer w en applicable) o %_b4 L "LE•S&U E / d� Date last inspected: }I Agreement: _,A The undersigned agrees to ensure the construction i�e 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 B hard Health Signed Date ��/�� Application Approved b i Application Disapproved for the following reasons 1 Permit No. Date Issued *' t 3 " ------------------------------_________- ----------- THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of (Compliance - t THIS IS TO RTIFY,that the On-site Sewage Disposal System insta11 d( )or repaired/replaced(�on by Q/C.,—zTc tr w GD i�y t.'—T 1a*1 for (usr, ' TA:4 0 aI �� C�J�'J ��- A-/LSD"0-LS �Y1i has been constru ted in acco'rdan�c s with the provisions of Title 5 and the for Disposal System Construction Permit No. � dated �"''�s Use of this system is conditioned on compliance with the provisions set forth be ow: I t 4 77 N J No. �G� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpont *pgtem Construction Permit Permission is hereby granted to �a/C'i G W 7 7 c o ,Jg-—s/LJ o--co,f to construct( )repair(�an On-site Sewage System located at w__)_ WILCI-i LAVili t 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: �'�'� �"'y� Approve Lei�1�2( i i f _ 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 CAI-Nj( {z, 1s /Yl t t tS meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There 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 leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTE 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]. z 77 _ •C ,� '* x "�Y+c t� •^fi a fir`.a r ,.' '•.�+.r�:;�r .,y,4.'.'- �- ^Ci�/ fi' ,� ,�.:¢'X ;'Y r,:2;. .J• ;a yv _ ,t s*q��'�1"t''iY'` r�-,�� �.e z ��M•',k�a �_�'�� ,��" '@c+" ,ffi: �*- �x .�..:. . ti, .,S ..- - i �. .�„�,- �x'.'= w+a��':" 7� �'�' - 5••ei-na =k:y�" +,ti ,' :r't :. ",;_'• ?yam.. ♦' '- Y�1 fy ',y"1:.�lj y' .�"�#•,r% - 'A+:t �C. Sc.,. kS.( 'IMF_ '�i�a `g q'��.yp��.�Nr3• +iew.u+ •*J.✓�iw' �!;,� �� I {I{�•.���_.�.//tl���� . Yr- ^' j J'- e..V:C•tY. .L. �•�i:�" "�„ •J�.h» •'�.. YR-+ >�- � aj.�'rynw a d.Y K '.' _ ;,`.p"h ...'.io�` <, "T�i,i.• ` -`` , a-.�s•'•" s: Y,. • ,+..�tq:_ i '7:,� '_,ra:. - °` 'O�" tip'' ':`-""�ey[{.'o" u: �: J'p_ .:..."-s'•.. '� :„j �}< y� .$a�"•a7'`i. i+i' '5.� + • ,-x. - •� ^¢.. t^S:>.t q�' F t y � � .. `� �+ d " �•/ aa�i.i, � -, <.� '% P'm'-s'•'.+t';{ f�.` � f�7 t� Y t `�-r.v� ��,f���'/ �/� Q. �I'-�'� - P$ ��#-����� ' ,�� ��•'t F� t Ai'..3 ' g . y. - k _I .7� f r.otr„ ^ V r.Y ,,�.t`x i• �y��; a �-.�_.,g'a a' t A 6�. g-L6 ,t-�� - ..:.�,;- '.. • ��-, :: _... - • . .. �S•96 L16. ' 'o ZL6 •off 196 6-1 a , . � -��. �► 6'L6 L_ s '�O©� 'GOOF✓ �. TOWN OF BA$NSTA.BLE LOCATION. e�e !� SEWAGE# 4;.6 - VILLAGfi.Wlor,-5 ASSESSOR'S MAP&LOT DZ INSTALLER'S NAME&PHONE NO. oo / C�hS 7 7� ! SEPTIC TANK CAPACITY 16co GO LFACHING FACILITY: (type) (,W—L (size) /a NO.OF BEDROOMS BUILDER..OR OWNER PERMIT DATE: �� ---COMPLIANCE.DATE: I D ' �'1 47 7 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 30.0 feet of leaching facility) Feet Furnished.by - i gam . LOCA N SEWAGE PERMIT NO. i4 ui/CAE—H 7'�-- 5, VILLAGE I N S T A LLER'S NAME B ADDRESS or BUILDER OR OWNER 7 i ' DA T E P ERMIT I S S U E D �, 7f--- DAT E COMPLIANCE ISSUED � z ,, 26 _—�� s• l :1 i� 02 o � I o 2 a No.. ---- - •. , _ Fmc.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD jHEALTH ............. 1n'.........OF......... Applira#ion for Disposal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( , ) an Individual Sewage Disposal Snn, m at: ------------- .... .... _. ,� :.::...�.0(..co.o. ... ...-ram. LD: �-13.E-. �T..• -. Lo Lion-Address _ or. Lot,1o� Owner ` n-n Address - ,-a --•-- �...... -------------------- Installers Address Type of Building/ Size LOt.].A_..� _--.-Sq. feet U Dwelling-No. of Bedroo L .....Expansion Attic ( ) Garbage Grinder (V)D Uf#s� .'No. of persons............................ Showers ( ) — Cafeteria P4 Other—Type of Building% ( ) Q' Other fixtures ................................. W Design Flow.................... _....._..__._gallons per person per day. Total daily flow...._..-� ..._....................gallons. W Septic Tank Liquid'capacity,/gallons Length._.......... Width...... Diameter�01... Depth................ x Disposal Trench—No- -------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below • et_.. ...... __.___. Total leaching area..................sq. ft. Z Other Distribution box (\4 Dosing nk W Percolation Test Resul Performed by.../ G j(' /a ..................•........ Date.. ..:1s. ........ Test Pit No. 1. t��-....minutes per inch Depth of Te it.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O .......- --------- -- ...._........ ..... r ............... --••-- Descri tion f Soil... .__(1..'...!``" r ..9E _ .... . _ rl _....... W 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'L l'= 5 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. Signe ........... ...................................................................... Date Application Approved By----•-- --.16d. ----•----------- 1= . Date Application Disapproved for the following reasons: ----------------•--------------------•------------•---------------------•--•..._...... .......----•--•-•-•-----------------------------------------••------•---•----...------------.......--•----•--•------•--------------------------------------------------------------•• Date Permit No..................... Issued_...... :....`.__ Date C n ¢ -- • .14 THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH OF......... .1. ...................................................... JN�,pVliratioit for Disposal Works Tonstrnr#iun Uprrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at: Lo"ion Address '� -•- ...... �'' �......7..- :1- '...................................... `1 ` Ce+M � +�..... _ r. tin+ ►' �i,�4.Jr be: oy Ownerddress 1:10 .............................. Installer Address a UType of Build + Size Lot1A::.�.�__•'"'_"....Sq. feet. a Dwelling No. of Bedroo . __.__..___ .3.........................Expansion Attic ( ) Garbage Grinder ( / aOther—Type. of Building m'i a No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures . -------•-•---------------------------------------------------•----------------------. .. ..._.. ------......._... w Design Flow... ...._____._ alIons er erson r da Total daily flow......... gal ................ .. g P P y ? Ions. WSeptic Tank Liquid capacity/ .gallons Length.....-••....... Width...... ........ Diameter ./... Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below • et._•.._ .. ....... Total leaching area..................sq. ft. Z Other Distribution box X Dosing nk (,!) U *+ /0'— 704 '-' Percolation Test Res Performed by.- t1% r ':. ......... ....... Date._e..:/`..: :'....... a Test Pit No. 1 - -..-minutes per inch Depth of Te it.................... Depth to ground water........................ LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground Water.--..................... a . ..� .. .. Description f Soil "j' :^ V --------------- ........ . .. ....... --- ....,:.... /...44 ......................... UNature of Repairs or Alterations—Answer when applicable.:-----_........:.........................:..................................................... -----•------------------------------------------------•----------------...-•---------•--.....................-----------------------------...----------•-----------------------------••••-•-............ Agreement The undersigned agrees;to install the aforedesciibed 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 until a Certificate of Compliance has been issued by the board,of health. Signe .... ..... ... .................. .......................... Date Application Approved By........... L% �%� x..... -_7 ' Date Application Disapproved for the following reasons: --------------•-•-----•-------•-------------------------------•----------•---••---••••-...._-•-_.. ..........................................................----------•-••--•-----•------•----.....-----••'---------------•--•----•---------------•-----------------------------------------------•---••-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS k BOARD O HEALTH =' F......... 4�++i ......: .............•.•.................... Trtifirtt#.e of TomptiFanrr � p THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Z<Or Repaired ( ) by..-... .... .... -••--....... .....--•-•• ...- ........... Installed -• -_ •- �. at has been installed in accorrdance with the provisions of TI`?Z�" 5 of The State San ary•Code as described in the t application for Disposal Works Construction Permit No....................................•... dated_`Y/ f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL .FUNCTION SATISFACTORY. DATE................•-..........._..._...........--•----.__-_.___...---._........... Inspector'.-•••---••_.___...••---........--•--•••••---...................................... THE COMMONWEALTH F MASSACHUSETTS e � BOARD ` HEALTH Y .. : ...... OF .... f. ...................�No : ............. ...... FEE..._!'t4 lea •... .......... i ra lr nrk Tun#.rttr#ion"permit Permissionis hereby" anted ...."-•.---------------------------•----•••--.---.........--------:----------••--•--....... ................................ to Constr' t or air ( ) an n ual Seaga a isposal -S tem at w- 5�r S reet . . 1. ,1� as shown on the application for Disposal,Works Construction Permit No---------------- Dated.........:F............................ z o.w Board of Health w DATE.............--------........---------••---•---•-•-•-......................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS j. Z L/v b' Q��C7�'ddb� ,�,•. �, a'© X3 A n S' CL c /-/_L_ C`� /� O Q 3' d O g 31 b'Q >% !��' - r y/ .- .. �y lJ !'. :Z% .11 Co . v ____ — — -- z s wr •Mni ;;i /n C73 a' �' b' _L_3 S �/v/ Q J 71 /� 3_L d¢ 3da3✓ f l�c�o�N O 0 S G�/ .L / 1 �H 1 ¢ _. 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