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Home My WebLink About0882 OAK STREET (CENT./W.BARN) - Health 882 OAK ST., W. BARNSTABLE j. Cummaquid No. 4210 1/3 BLU e ESSELTE 10% o 0 o 0 --°------a- � � Fee----��----- BOARD OF HEALTH TOWN OF BARNSTABLE z.pplicationjorIvell uCootruction3permit Applica 'on is hereby made fora ermit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location Address Assessors Map and Parcel®ick Owner AddresAda r Installer — Driller Address Type of Building Dwelling Other - Type of Building - No. of Persons-- ------. -------- U Type of Well----- � 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 Certificate.of Compliance has been issued by the Board of Health. / Siged,- aul— y— dat ff Application Approved — __ _______—___— 731_� date Application Disapproved for the following reasons:— ------------------------------------------—--- ---- _—_--------------------- J1 date Permit No. Issued-----�- ` 1 date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individ al yll Constructed ( ), Altered ( ), or Repaired ( ) f'Y! '��„J ------------- --- Installer at— "l� -------------------------------- -- ------------------------- 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.k&�' —Laa 34Dated-1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -- — Inspector —_---____-- 21) No.------------------ Fee----- ----------- w BOARD OF HEALTH TOWN OF BARNSTABLE Zipp[itat ion fforWell Con0ruct ion Permit Applica ion is hereby made fora mit to Construct ( ), Alter ( ), or pair ( )an individual Well at: g _6A k 3f _ .er f3AAuS - --- - -- Location — Address Assessors Map and Parcel Owner -__—Address Installer — Driller Address , Type of Building Dwelling ----- Other - Type of Building --- No.�` of,Persons--- _.--__-.. --_ —_-__-- Type of Well Capacity---------------.--__--___—__—_ Purpose of Well------ -0-j 6Z-- — 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 Certificate .of Compliance has been issued by the Board of Health. ' Sig ed �__� '_�/��!' '----- - x", dal Application / A A PP roved — ---------- � - -- date Application Disapproved for the following reasons:--, Permit No. date " "— __� �` "-C - Issued----- - date ----- date - ------- -__._ y BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY,-That the Individ al Well Constructed ( ), Altered { ), or Repaired ( ) Installer 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.� 'i- -C 36Dated� _�THE ISSUANCE 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 Well Con!gtruct ion Permit No. i��1 C7 Fee- . a ( s. } Permission is hereby granted? G Lo ' + ____�_____ to Construct ), Alter ( ), or Repair & an Individual Well at: _— __ _ _ ---- -- ---- --------------------------------- Street as shown on the application for a Well Construction Permit No.- -- — D --------------------------- ated- -_ -- ---- -- - - -` DATE i T�WN OF BA.RNSTABLE LOCATION VILLAGE ``�. - SEWAGE # INSTALLER'S ASSESSOR'S MAP& LOT .! -• fit``; NAME&PHONE NO. ; {' SEPTIC TANK CAPACITY LEACHING FACILITY: ----------- NO.OF BEDROOMS �) res'`Esize) �_.% X (C BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: I Separation Distance Between the: i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility L-A— onPri"te Water SuPPIY Well and Leaching Facility `� Feet site or within 200 feet of leaching facility any wells exist / Edge of Wetland and Leaching Facilityl within 300 feet of leaching facility (�any wetlands exist Feet jFurnished by Feet I 0 03- V ( �T WN OF BARNSTABLE (, P *� V LOCATION SEWAGE # dG� VILLAGE _ a ASSESSOR'S MAP& LOT (d 00 INSTALLER'S NAME&PHONE NO. SEPTIC TANK'CAPACITY f, LEACHING FACILITY: (type g. / size) 90 X 0 NO.OF BEDROOMS 5 BUILDER OR OWNER (0 , ON xa I PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: A h (A- Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility V Feet Private Water Supply Well and Leaching Facility (If any wells exist 4' 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) A Feet Furnished by �_ � (07 � . i A- 2 'I li \r -7 2.S- e Fee J -0 o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS } ZippYication for �Digool *pttem Cow6truction Permit Application for a Permit to Construct( )Repair( i4 pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Q Owner's e,Addres and No. Assessor's Map/Parcel � 1 ti �er's NmA,Address,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 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Old 3 kk iL w 3 g7MN39_ 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 o e 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu b t Board ealth. Signed Date Application Approved by Date l r Application Disapproved for the following reasons Permit No. Date Issued AZZZ27 F 0. �9 — Z S— Ch s4m`�° I Fee 6 w THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes f PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSEtft Z[ppriration for Mt!5p !6a1 *pgtem Con6trurtion Permit Application for a Permit to Construct( )Repair( ✓jUpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (�,��. Q Owner's Name,K dres s and Tzl�N\oR`e Assessor's Map/Parcel `C1U IJ( T=ttC \1 Installer's�Lme,Address,and Tel.No. Designer's Name,Address and Tel.No. RAV__ cmnPvtO 30 U Type of Building: Dwelling No.of Bedrooms _ LoY'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 a Size of Septic Tank Type of S.A.S. Description of Soil Y Nature f Repairs or Alterations(Answer when applicable) W -S(Zk, !q Date last inspected: _vr. Agreement: The undersigned agrees to ensure the construction andpaintenance of the afore described on-site sewage 'sposal system in accordance with the provisions of e 5 of the Environmental Code and not to place the system in opera or u til a Certifi- cate of Compliance has been issue b t Board ealth. „r Signed D to _-- Application Approved by ZY D to Z/12 Application Disapproved for the following reasons 101 4 f Permit No. cl — 7 Z Date Issued 11 2 �{ If THE COMMONWEALTH OF MASSACHUSETTS a�tp'C� BARNSTABLE, MASSACHUSET.TS G �ertif irate of Compharire THIS IS TO TIFY, 1 -site Sewage Dis osal System �Constructed( ) aired( '�)Upgraded( ) Abandoned( )by r at ; t has beecoiructed in acc rd ce with the provisions of Title 5 and the for Disposal System Construction Permit No. dated — Installer Designer The issuance of thi emut sh „not be construed as a guarantee that the to w' l functioTil" /d�' ire/d�. �/r ! Date Inspector A / I YI {l � 'V / ° \' ( No. — Z d: Fee . --f THE COMMONWEALTH OF MASSACHUSETTS 'PUBLIC HEALTH DIVISION -,BARNSTABLE., MASSACHUSETTS i ogar �p�t mn„,-Conwtrurtion Permit Permission is hereby granted to Co ct ) �p ` ( a'Upgrade( Abandon( ) System located at C- `'' ' 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 witthin three years of th6.Aate of this Date: .1 Approved by - h 1/6i99 Ilk 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) ��hreby certify that the application for disposal works construction permit signed by me dated ( concerning the property located at � -I,�gl�e is 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 • 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.dmurn 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(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) nn �] B) G.W. Elevation 3n +the MAX. High G.W. Adjustment .a's _ 37. 3 DIFFERENCE BETWEEN A and B t SIGNED : DATE: �` A19 [Sketch proposed plan of system on back]. q:health folder.cent I � { .. ---------- i