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Home My WebLink About0032 DORCAS DRIVE - Health 32 Dorcus Drive, Barnstable A= 298-103 Lot # 14 TOWN OF BARNSTABLE UX�►TION-�� C C�;��) �� SEWAGE # p> V;.,,AGE ASSESSOR'SMAP & LOT ;1 ??- 10.3 C INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY e •. R. tt 6 f _0/6/ t"i t LEACHING FACILITY: (type) Ne U k L P 1.",' (size) i coo NO.OF BEDROOMS _ BUILDER OR OWNER / PERMIT DATE: , _COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ,4M 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 eCla—nds exist within 300 feet of leachin f cility) G Feet Furnished by 1, A 4o -sn 60 �'Or 70 sk 163 3 � ��a ' No. � , Fee THE COMMONWEALTH OF MASSA USETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Apprtcatton for Migonl *pztem Construction 30ermtt Application for a Permit to Construct( )Repair( V�Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 3a ®o<-cvS Qer�.`u—Sav e,� 3a Q rr-c: f Assessor's Map arcel b� Installer's Name,Address,and Tel.TI& Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(Na) 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 L10b . Type of S.A.S. Des 'ption of Soil 1AA r 'K (A=. I'f 4s /a-1= 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 th ro ode and not to place the system in operation until a Certifi- cate of Compliance has been is d by thi oar f e lth. j Signed Date / Application Approved by Date Application Disapproved for the following reasons wq' Permit No. Date Issued TOWN OF BBARNSTABLE "� LOCATION �S �,� C_L�; •) p)� SEWAGE # — VILLAGE 'PIr,r-\S t V c tASSESSOR'S MAP & LOT ;I INSTALLER'S NAME&PHONE NO. S SEPTIC TANK CAPACITY k'S IN L 16 06 f C) I" ! a LEACHING FACILITY: (type) ACC L k L PI'} (size) J I We NO.OF BEDROOMS_ BUILDER OR OWNER ` PERMITDATE: COMPLIANCE DATE. Separation Distance Between the: fa Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 04 A4 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 an-wetlands exist t within 300 fee of leachin f Aity) �t Feet Furnished by orY,6�3 � . a . - ��" , ...�„tr' ... ,.,,1,�. '4.!y * .,�.� �r � .3YF,. 4,r .. r 1;,,,:::.f<w✓h -.rt d .f:...�/. wtF' `+..;pn ro-..w iE.-,; 1�3 No. e 2 G Fee 5�"4Z THE COMMONWEALTH OF MASSA HUSETTS.-f Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS f Application for Zigpogal *pgtem Cow6truction Permit Application for a Pernut to Construct( )Repair( Apgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot Not. Owner's Name,Address and Tel.No. Assessor'sMap/Parcel 3a Doccu's71 Qel�`GF SG• �'� 30� `�./:Csf G � Installer's Name,Address,and Tel. `o. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(AJ 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 Wl10b . T e of S.A.S. P YP i Description'of Soil � ��_� � (�� a 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 'vironm al-Code and nor to place the system in operation until:a Certifi- cate of Compliance has been is Red by thi oar f lth. Signed Date Application Approved by4Z Date 0 Application Disapproved for the following reasons i Permit No. 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 A v at %C? S+g�1 p h�has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.a dated ^'". Installer Sc cj� M G c-r..n 1iC:" M O),55 CG jX_ Designer The issuance of this permit shall not be construed as a^ guarantee that the system will function as designed. lr Date Inspector No. Fee-45� a- THE COMMONWEALTH OF.MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE., MASSACHUSETTS ig oaY *p$tem Cottgtruction Permit f Permission is hereby granted to Construct( )Repair( /Upgrade(. )Abandon( ) System located at -Z ncs y S 5 Oc LG.c-nS 176 -,1i& \_ \kc !4k 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 withinthree years of the date of thi e it. Date: Approved v �` 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 lag�//GI 7 , concerning the property located at Sa 'D(-c'j&S �)C' 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 SYSTEM 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]. N j:cert � � -- 03 s L or 13 z , 1 r G ( i S 14 Z -76't V .\� r p.c• � r �l � Lor 1 1 S ZONE-72b-3 •�-', 1 s�rt�cKs i t. CE > I , 7: ' PEAS 27 SILL bLE✓ FEAT-400✓E Z>oAD PL r oL A IV �..� _ s SCALE _/ " = 1 G L)A7 �� _ -Z6— .14 /1CC. ; S,/-,/OWA/ /A/ Pi—AAl r7c'A_ -90 ♦ �worM �r� 'y GFURG �' 1c �- r NE.�E0y C6Qr/FYTNATTHE EX13r- LOW. 1P. I � I /N6 FOUAIDQ T/ON LOCAT/ON /S GVZZ s 0, (r) .45 6WOWN AAID-L?��,�___COAlrOPM Wir'N SUp+JE� Tf/E 8U/LD{NG 56T(3AC-ele4f_lPUiAP6"bV7. OF T/✓E OWN OF ,� ;�f, _'1_�c`'1�� ----- . ' lolt' - .- >'oe CVol wfI-e. TAYLOAZ O)e-)' 6 Gt//GGON/ST iQ�/O u7�/ybQT i'!q. it LO.C&TIOtj SEWD,C,E PERMIT 1.10. lW5TI4LLER'5 W&& AF- ADDRESS BUILDER 5 Q L MF- ADDRE55 5M i rif DLNTE PERMIT ISSUED _ - L�-7�_ D ATE COKAPLI WA CE ISSUED : _ - - 06 ro It o o c i No.......................... Fps..r�• THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEA T 4, (�... .-------OF.......... .............. .... Appliration -fur Uhipuiitt1 Works Tnnitrurtion Vrruid Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: v' ............ cam---._...._--•- ................ ----------------------------------------------•--•----...--------------------.-•----.......---... Locatio .Address t LA /�/ or Lot n� 4-( Ow.....__..... r ---------------------- --------------------'x - ---------- Installer Address Q Type of Build n Size Lot.... ___ :...Sq. feet U Dwellin —No. of Bedrooms............................................Expansion A tic (�PS,I Garbage Grinder (IJj aOther—Type of Building ............................ No. of persons.............._._______.____ Showers ( ) — Cafeteria ( ) p'' Other fixtures ------------------------------------------------------ W Design Flow-___ __: gallons per person per day. Total dail flow_...._...------------------gallons. t� Septic Tank— iquid capacity_ _gallons Length...__-..j..... Width.-__-. .. Diameter-..------ ...... Depth..-----.__.----- W Disposal Trench—No--------------------- Width_------------------ Total Length........ Total leaching area.............-------sq. ft. , x Seepage Pit No--------------------- Diameter-------------------- Depth below •nlet-------- __.._.._.. Total leaching area - ft. z Other Distribution box ( ) Dosing tank ( ) J_ O V' oe/A® 6d /G Percolation Test Results Performed by........................................................................... Date----.---------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit....---------------- Depth to ground water.._-.-_-..-_.--.._..__-- (4 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........._.-._.__-.-.__. W _--___--_ J _____________?.........__._..____: ei....... O Description of Soil--- ...�� .! ! ` .. xX--..-.--.f 2.. �° �� b44.-Z ate..- -44- -�--- --------------------------------------------- W UNature 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 health. Signed- . .............. .....•---- ----- ................. Date Application Approved By........ - Date Application Disapproved for the following reasons:......... ....................................................................................................... Date Permit No.----- ....... Issued........................................................ Date No......................... FEa... .. �• THE COMMONWEALTH OF MASSACHUSETTS BOARD O� HEA TH Z�j Applfratfon -fur Bhipouttl Norks Totwlrurtfon Vrrnift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -- ++ Location-Address /y or Lot No w V 1 ownef �U ' Addr�s—- l f� .l.i `... -----S--------------------• --------.................................°' � � .......{ '`" ----------------- ----------------- Installer Address Type of Build�n Size Lot_... :-.AC-`--�:.---Sq. feet U Dwelling/L No. of Bedrooms------------ _________________________Expansion Attic ( Garbage Grinder Other—Type of Building ---------------------------- No. of persons..__-_____-__�_--o).__ Showers ( ) — Cafeteria ( ) Q' Other,�fixtures ---------------- -------------- - - w Design Flow----- .0.........................gallons per person per day. Total dailyflow.......... �.................gallons. WSeptic Tank�"L'"i�quid capacity-- Length......... ..... Width_.-.__ ...... Diameter___.-_..__.__-_ Depth.....__.__.._.. x Disposal Trench—No. .................... Width.................... Total Length------------------_ Total leaching area--------------------sq. ft. Seepage Pit No--_----------------- Diameter.................... Depth below inlet----- Total leachin a ea.--_-----_____-sq. ft. Z Other Distribution box ( ) Dosing tank a .Percolation Test Results Performed by-----------------_--- -------------------------------------------------- Date..............------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit..-_____.__----..__- Depth to ground water_..______..___.-_._-_._. �14 Test Pit No. 2------,----------minutes per inch Depth of Test Pit____________________ Depth to ground water__._---..-____.______--- x ; �-=----•----------------•-•-•--•--- -•--•-'--•-: - -- _''_'_ - ----'_.._ : . O Description of Soil..__ •-- -- --- -- - ---- ---- --r - Ur.�------- 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 Article XI 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. r LSignLd._�.- ---- --L••..................---�----••-•------------------------ -------------••------...-------- Date Application Approved BY 1� ------------------- ---- -- = yF ;-------- Date Application Disapproved for the following reasons___________________________ ---•---------------•-•---•---.----•-•--------_---_---.---------- ._------------ .,...-•----••----._....--•---•-------•-•---•------------------•-•--------•--•--------•-------•---••-•-•••'------------. _---__-_---.--------•---•---•--------------•------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f..r.J T � p.......OF...........�1 - -' 't.............................................. �rrtff irate of 1011,11utpliaurr THIS,TO CERTZFY, That the Individual Sewage Disposal System constructed ( <r Repairedbi ( ) - -------- ---------- - ------ I t ller --•-----•---•-----•-•------- has been installed in accordance with the provisions of Ar •cle XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-- 7G._..._,.�'0_ 3--------- dated__.7'_!__41."_'.74.................. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------_-- - j �-- --------------- Inspector...-- -- �__ -----•------•---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD Oy HEALTH .........2....... oF.................. .................. ...................... No.--- .............. = FEE----/V.......... � �trnrtfu$t �rrntft Permission is hereby granted... . F_ ,�t�E �;;, -- ... to Construc �_ror Refiair ( ) an Individual Sewage Disposaly�te Street 7`/ as shown on the application for Disposal Works Construction Pe.mi No.. ..._ __. Dated__.__-._.._____------------------------ ---------------------------- Board of Health/ DATE. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS L.or /,3 164. 9-s ! j ! 1 ir LOT / `�. , `` If c LOT- r m e � 241vE.--Z2:>-3 4ry S/L L ELE✓.. '` Ff..�T 480✓E �O.d1.7 '� li, ,� tWOfM ►1 j 4T _ L GEORGE e• o pow, J I Al42E8Y C6Vr/FY7-1-IA7, T-"` /NG 1-1-04/NDAT/ON GOCAT/ON IS .8 .lQ AS SCOW V AAID-L?oE,t*___CONFO� ,may wiry . TNL SZ%/LD/NG 3ETE3AC'C�'.L�E�'l�iP�M�V7� OF 7i41E ✓ Yoh 9 Gt//GGOb1157 YAIZA40 U771POQT,A054.. tell r r