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Home My WebLink About0116 GOVERNOR'S WAY - Health 116 GOVERNOR'S WAY;'BARNSTABL'E 1 = 258 038 001 , • i s r y. �r , • A'a .. - , - .. _ j,. �- :, '9 �_ ,. ,�.: f.v '6. ... :, .. •atf' '_ a ,. - a k,n , + f 0 , •.. :: _ v u t. , t, w i r 0 4 " v P tY aR Q TOWN OF BARNSTABLE LOCATION -'VC IA3,45!f SEWAGE # Zae)j ZX3 L VILLAGE 8,0 eel ,/��=ASSESSOR'S MAP & LOTZr Y b3?`fib1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /So® asp ahI ,J LEACHING FACILITY: (type) LmkL Vii<< d�-tgr (size) 7-o',X /b'x NO. OF BEDROOMS BUILDER OR O NNER Rc,,j SGI al cI PERMITDATE: COMPLIANCE DATE: 5-)LI-0/ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet y. 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 i Z2-3 Z, �1 A vsr jr l f No. / 2_6 - .. Fee — , Cc THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ✓� 01ppitcatton for �Digozar braem Conotructton Vermtt Application is hereby made for a Permit to Construct( )or Repair( A an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address 2,� -03 d Tel.No. l6 G ooE4ttk,4s- vjA koW SC�t Assessor's Map/Parcel ?— �® Y� A sT�9d� 6 dy, A,4 w j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling . No.of Bedrooms _3 Garbage Grinder WO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /a gallons per day. Calculated daily flow .3 3 0 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) i gvZ .3' 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 by this Board of He th. Signed - Date Application Approved by Date S O / Application Disapproved for the following reasons Permit No. 74V Date Issued ——————————————————————————————————————— '--•v r i} •C�' »s ka 7. � EY..* -�' , # `4 7 ^T i �"k .t 'Tx` s 'rrt d ,.,.� s� a. _ ....._... ... ...,..-. .. -. ...,.' a •,..' ' T0�WN OF BARNSTA$LE � - LOCATION Gas).-;c�W o A s _L�.� U AV � SEWAGE # ZcyL zC 3 VILLAGE 64 PU�5r4 6 ASSESSOR'S MAP & LOTZS L LE I INSTALLER'S NAME&PHONE NO. 1f2i�� ^� �1��►� SEPTIC TANK CAPACITY. 1AF—&J LEACHING FACILITY'. (type). 3 (size) z o' i by x NO. OF BEDROOMS; BUII;D8R OR OWNER' 12;, LL LSg.;6 ci d PERMIT'DATE: S= a COMPLIANCE DATE: �— L/-0 I Separation Distance Between the: . . . Mazmum.Adjusted;:Groundwater Table and Bottom of Leaching Facility . Feet I Private Water Supply.Well and Leaching Facility, (If any wells east on site or within 200 feet of leaching facility) Feet Edge of.Wetland.and Leaching Facility(If any wetlands exist Feet, within 300.feet of leaching facility) Furnished by s tD i l \ ' �C4 ..C), .. a i 9 •G� - £ r' w h-hF--.u z f. " —s.� .�_..=ors-�--•�. :-�"'s�,t`#�''�'�•` �_.,�Y , / No. 2.6i, }, Fee $�J' THE COMMONWEALTH OF MASSACHUSETTS4 / - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01poYication for Zigdoal *pgtent Congtruction permit Application is hereby made for a Permit to Construct( )or Repair(A an On-site Sewage Disposal System at: t Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel ttl�/Q�Oil:s`�ur4y ��.t�✓5��1�1I� ' teditr SC�PE( :. �1Y �A rv- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -� a Y,/y Type of Building: Dwelling No.of Bedrooms .3 Garbage Grinder A)O) # Other .. Type of Building D.J. No. of Persons Showers( ) Cafeteria( ) t Other Fixtures t Design Flow ., gallons per day. Calculated daily flow 3= gallons. Plan Date Number of sheets Revision Date Title Description of Soil s .r_ Nature of Repairs or Alierations(Answer when applicable)-P= {jr €� � ,L r.;?' r£ A ci 11 1 r A Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of fhe 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 of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Zew l Z.G 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(X )on by l?,1A�, Installer � r V at jig .- A 4 A j 9 has been constructed in accordance with the provisions o Title and the or isposal System Construe 'o Pe it No -2k A dated r-j"- Date .!r /4/ h / Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. ——————————————————————————————————————— No. 2.f/GI— 26 Fee S-00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 0igo0ar *potem Construction Permit Permission is hereby granted to to construct( )repair( �/)an On-site Sewage System located at No.# //� GavLinorS G✓C� 9 X Street and as described in the above Application for Disposal System Construction Permit. 74--'01 -76 3 No. Date 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 three years of the date below. Date: AAv o Approved by Board of Ith 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AIND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERItiIIT (WITHOUT DESIGNED PLAINS) !C c LAJ G , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at /t c Go uy;�A,,,,k,4 S LAJ,+�j N' L5 meets all of the following criteria: • This 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 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(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 +the MAX. High G.W. Adjustment . _ DIFFERENCE BETWEEN A and B SIGNED : DATE: [Please Sketch proposed plan ofys stem on bacl . ivOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert �- ;i,— . . �� 1��6 - �,(�� y �" —�� is — — — -—-—�` � —_-- — - -�--_. , f--- —— — — �`— n� w� iso�fr �S� �-- - �� 1 r �_ ,__`\ TOWN OF BARNSTABLE LOCAf16N 1/&&1 bies-y SEWAGE # ``'VILLAGE s,' A� ASSESSOR'S MAP&LOT 3 INSTALLER'S NAME&PHONE N0.. 1A-40TV y v v SEPTIC TANK CAPACITY LEACHING FACILITY: (type) b (size) NO.OF BEDROOMS_ 3 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: ®® 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300feet of leaching facility) Feet Furnished by ' � �� "" .rr � .� -4 . b J � ..� C" A a i S' Fee No. ✓ ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS p7� rfcation for Mfg ogal otem Construction Permit Application for a Permit to Construct/ )Repair( )Upgrade b on( ) ❑Complete System ❑Individual Components Location Address or L t g9. /1p t9d-veAr x9.�01- 6w er,'sly ame,Addr ss and Tel.No. / Assessor's Map/Parcel e!q_ ®5 —9 aller r st 's e,dress,an Tel.No. 77 Designerf's,(N/e�,Addr_e�s and I�o. �C ��F !OLO7JS rl1G Ids+ ..Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(1 " Other Type of Building meads No.of Persons Showers( ) Cafeteria( ) Other Fixtures C,� Design Flow �Sy 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) 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 he E vironmen Code and not to place the system in operation until a Certifi- cate of Compliance has bee ssued b h. i Signe Date Application Approved by Date Application Disapproved or the following reasons Permit No. AMC Date Issued ----�_---__.�;-.----------- TOWN OF BARNSTABLE /� �'�> { .°r�. SEWAGE # LOCATION f _ VILLAGE— 'S ASSESSOR'S MAP & LOT ��- s r � INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY %ice LEACHING FACILITY: (type) ,', ,= (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: ®® 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) Feet Edge of Wetland and Leaching Facility(1f any wetlands exist Feet within 300 feet of leaching facility) Furnished by t T _ No. Fee THE COMMONWEALTH OF MASSACHUSETTS _ Entered in computer: ! . Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,. MASSACHUSETTS ` � p 2pplication for 10igpogal *pgtem Con!6truction Permit Application for a Permit to Construct( )Repair( )Upgrade an/on( ) El Complete System Elindividual Components // Location Address or 0L gg- /�j (�o v e r w 6/• Ow er's Name,Adds and Tel.No l ' �ArNSria�lr r s �tl�'f f � Assessor's Map/Parcel Installer's e, dress,ant Tel.No. r / Designer's Name,Addrer s and�je No. ` k° � C_aNSrC/1,. fd C_ � 7�lDntS` �uG k.. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. - Garbage 0,inder Other Type of Building KeS /food( No.of Persons Showers Cafeteria Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Num er 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) 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 e E vironmen Code and not to place the system in o erx4,onMuntil,a,Certifi- cate of Compliance has beesue f h. Signe� o Date __ 41) Application Approved by t r� Date Application Disapproved for the`following reasons ` i Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTSi BARNSTABLE, MASSACHUSETTS : ,-' Certificate of Compliance v , Tl4 IS IS TO CE hat n-,he O ite Sewage Disposal System Constructed -)Repaired(:1 )Upgraded( ) Ab,0.andoned( )by f oN S rr vc 0/i Tiy� ... . _ at ha!j'boen constructed in accordance =' with the ppoa+is s tTi 5 and'tlie fodr DisposaSstem Construction Permit No dated. Installer `f O i�S T uG'7l,g�c! `.^1 C Designer`' A P The issuance of this permit'shl opf}beacon&,trued as a guarantee that the�ys�t\e'Zii',will.functions ldesi Date { €iL �hr/ Irispect`o - :..: Jv 10 �1�i'11 JL, U! 4,) 06 No. �"oZ� Fee THE COMMONWEALTH OF MASSACHUSETTS 32.Z4UBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS 30f 5pozai bpgtem Con!5truction Permit Permission is hereby granted to Constrr�u�^ct( )Repair( X)Upgrade( )Abandon( ) if System located a )14 t 9a 1/E?r-&s o r �A` ;a r�u s`l a k f 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:Cons c ion must be completed within three years of the date of this p 17 it. Date: O Approved by , 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) D , I, AO ArA�0 ► s hereby certify that the application for disposal works PP P construction permit signed by me dated ? ' DO , concerning the property located at /l �vetjol_ O�� 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 • 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(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 +the MAX.High G.W. Adjustment. _ D=REN TWEEN an r SIGNE DATE: [Sketch proposed plan of system on back]. q:health folder:cert