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1506 HYANNIS-BARNSTABLE ROAD - Health
1506 HYANNIS/BARNSTABLE RD. BARNSTABLE �I A =298 023 002 _.- _„ ._.mow� _-�-���._ _ w � » .ter• s' , r .. -. ., - � r, ... a ' - .. .. a •._ ... h. - r. .- S - : , i 5 r' , + t a 4 .. a . l y r ' n if , ' -�' , � N' - � "'. n rp ,n, H� � _•���' a ,4 r.�,, ,xe �.'. � .. � s' TOWN OF BARNSTABLE C® LOCATION la C G /-�� IVVIS&Y-Z• SEWAGE # G� V)ti':AG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. r1 /� SEPTIC TANK CAPACITY �Qo q U o�3 4 0 - A 1 LEACHING FACILITY: (type) 5w. l n ��,�. (size) NO.OF BEDROOMS (9s BUILDER OR OWNER �A I ��� ���c� t PERMITDATE: 6 GJQ0 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 300 feet of l acility) Feet Furnished by - A = AO Y � SCE ��i'• ��� �z.�v�'1�� , No. �✓�� t/ l� Fee-.25 f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migooal 6pgtem Cow5truction Permit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. � Owner's Name,Address Tel.,No. Assessor's Map/Parcel Inst ler' N e,Addres ,and Tel.No. Designer's Name, ddress 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 epairs or Alterations(Answer when applicable)Box ` l } t Date last inspected: i��la-7 140 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 EnvironrrWgtal Code and not to place the system in operation until a Certifi- cate of Compliance has bee Sig Date Application Approved Date �-v Application Disapproved for the following reasons Permit No. Date Issued -----------— ---i=-- —T---------- — — — — — — -. _... TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ICoo •� t� LEACHING FACIL ITY: (tyPe),�?�c��..� .��..1�. (sine) NO. OF BEDROOMS BUILDER OR OWNER �'I � , 14— PERMITDATE: CC� i COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any.wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of 1 �fac�ility) Feet Furnished by r � IJ i 13 = 3, InA c i o? Sty ,��1• ��-.�� �_�+Ics .: 3 1 No. 'V Fee p X" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y¢s 7 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migpogal *pgtem Construction J)ermit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owne 's Name,,AAd�dd,ress Tel.,No Assessor's Map/Parce /r� I tpfler s N e,Addres ,an0 Tel.No. Designer's N ame Addre and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other .Type of Building No.of Persons 5 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 ep i or Alterations(Answer when pplicable) a Q�"E'e./ leGAG //i j zle.Ile o Date last inspected: J to?�Ob AgreeTheundersigned 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 Environn tal Code and not to place the system in operation until a Certifi- cate of Compliance has b�en'' t is Bo a . Signe Date b c� DU Application Approved ' �: ! Date " Application Disapproved for the following reasons Permit No, �� "�' Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS .'r. Certificate of Compliance THIS IS TO CTIFY, that the On=s'te $ew ge Disposal System Constructed(A Repaired ( )Upgraded( ) Abandoned at /,5-06 /` ha structed in accordance with the pr igaf T' S acid for Disposal System Construction Permit N . 'l dated �/ Install ed/iy / GL Designer The issuance of thi pe 't al t b construed as a guarantee that the sy tunc 'o as�e igne�. Date 5 0 Inspector L/z t p ((( No. � P � -----------=-----------Fee '�' a � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS mtgool 6pgtem Construction Vermit Permission is hereb an ed to C nstruct Uupg�a ( )Abaytdon Y ( — System located at A 17/� �S J 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�o,�f t-hisst. � s Date: Approved :_. °"�'2 PP Y �r /f Y y' 1/6i99 ~ NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH ACID APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLAYS) I, p � hereby certify that the application for disposal works construction permit sinned by me dated -2> ® concerning the property located at /S®,6 meets all of the following criteria: Ir 1/ The failed system is tonne-ed to a residential dwelling only. There are no commercial or business uses associated with the dwelling. j/• The soil is classined as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. �T here are no wetlands within 100 feet of the proposed septic system T"acre are no private wells within 1do feet of'the proposed septic srstem v There is no increase in flow and/gr 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..mmum adjusted—oundwaEC.table e!evation. (Adjust the groundwater table using the i=rimptor Method when applicable] L,�Lf the S.A.S. will be located with 250 ieet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than f ouneen (14) feet above the mx imum adjusted groundwater table elevation, Please complete the following: v A) Too of Ground Surface S'.evation(using GIS information) B) G.IN. Elevation_the Mx�'(. High G.W. Adjustment D IF'c ERENCE BETWEEN A and B 11 Fir SIGNS DAT—E: (Sketch proposed plan of ze n n bat. q:health folder. :-t b _E' LOTCA,T N � SE �1AGE PERMIT N0 63 V I L L A C I w4 1 IfS A LLER' NACRE a ADDRESS GUILDER 00 WHO s 2414:� DATE PERMIT ISSUED DAT E C 0 M P L I A N C E ISSUED rm-kc dF O Ate , l� yi �_.... ../.... FFE O THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH u, ✓.................oF.... ✓`! J.. ..................................... Appliratiun for Disposal,Work,i Toutitrurtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal j System at: . /L .. G Ce /J. _ ..>.. ---....... �Y.�!L.^ .......... .._.. Locatio - ess n or Lot No. •z . ' G�Z r f zr r.l� ../ . Ow ._---------��..�i .�t .._. . .. Address c....... erInstal Address dype of Building Si e Lot............................Sq. feet Dwelling—No. of Bedrooms.........z..............................Expansion ttic ( Garbage Grinder aOther—Type of Building .. / ............ No. of persons_.. ............. Showers (� — Cafeteria k o) Otherfixtures --------------------•-..._..---•----......------------....-------------- ---------------.....-------------------•---------....-•-------•-............ Design Flow.....�..p....:...........................gallons per person er day. Total daily flow..........'.v. ...___._..... .._.gallons(? . W ^' G: Septic Tank—Liquid capacity/ gallons ngth.. ... ._._ Width__`l�.:�... Diameter. , :. Dep hh... ..:_. .. - Disposal Trench—No. "�! ..._..... Width... :..... Total;Length.../V _. _.____ T�otal'c ing areal�' .........q. ft. Seepage Pit No_______ ___________ Diameter......1!>_...... Depth below ihlet..._._ .....<Total leaching area.�'?Z.�q. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY......................................................................... Date........................................ Test Pit No. I...Ze:J .._..minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L� -----------------. ............................. -------- O Description of Soil......... ------- !��?--._ .GIMP C ...._..__cs' - �?Q�� __ ll -• ; U Ile ._"...C�-...._ ... rkr-i. -�•=.••yam---- J� 4� ie 1... .4 ---- --------- --------------- P...- . �Z.._. 11 ._i>...--- �� "...... _/��_.��1 UNature of Re irs or Alterations—Answer when applicable_.. / C ...a ^ �_.__.�*�!�' e�� �_ --------------------------------------------------•-----------------------••--•-•--....._----_-•-•-••'--•-•-....••••••---•----------•-•---••--•-•••-•--•---------------•--•--•-•-•--•--••--•-------..._. Agreement: . •. undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with th pro isions of LITILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in er h u a e i'ca f Compliance has been issued by the board of health. i ed ate A roved B C .............. �. P Ic Approved Y = E f • . Date Ap ication Disapprove r following reasons:......................................................•-------•---------...-•--------------------........---•-- .........--•----•-•••••-•-••--•-•-•-•-•--••••-••-•..............••-•-•••--..._••--•-•-----......_............---......:.............------•...••---••--•--••--•-••--•-....---•••-----•--•------...._.__. Date PermitNo........................................................ Issued....................................................... Date -- - - - --- — - y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................._.. ...._.............OF................................_...... Alip iration for Uiipuiittl Works C rimtrnrtinn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...----•---•-•-----------•--••------••-•...................................•--••••-••--••--.-••-.. .....••----.....---.....-----•----•••---••----•....._.......•-••-••--•--•...............•-•---.... Location.Address or Lot No. ......................_.......................................................................... ---......--•---•-•-•--••-•-•--•...............................-•--•-............................_. W Owner Address a -•-••--•--•--•-••---•••-••---•-•-••----•••-••............................•---•-...•--.......••. •..........•-------...-•••-•--•-•.......•-•---••---•-•......--•-•-•.................-•--•...-•---- Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.............:......_._....._ Showers ( ) — Cafeteria ( ) d Other fixtures .................................................. .-•----•-••---------------------------------- ------------------------ -.---------------- ... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--_-._---_--•-----sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W -------------••-••-•--•-•-••---•--•-•••••--•-------•••----••--.....--•-.........----•-......--.....•................................................:....•... 0 Description of Soil........................................................................................................................................................................ x V ...•-------------•-•-----•-----••••----.._...........-•••-•••---........--•-•-•----•••-------•-----•-•••-••--•••---•-•........••---------...--••-••-•------••••...--•••...--•---••-•••--••-••---------•-• W x --- ------------.............................................-.......................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------------------•--•--••--•-••••---•-••----••-••-•-----•-•-•----••--.....••--•...........•--••••----••-•••---•-••-------•-•••--•---••••------•-•-•----•-•----•-•......._•-••••--•--• Agreement: undersigned agrees to install the aforedescribed Individual Sewage'Disposal System in accordance with th pro isious of TITLE 5 of the State Sanitary Code—The undersigned farther agrees not to place the system in er h u Da a e the f Compliance has been issued by the board of health. I S• ed..... •......--••••-••-•-•••---------•••-•----.....-•-•---•-•-------•-•••----------..�..... _... --......_.... ....� �s to �Ap i Approved By f--- .... .'- - Date Ap ication Disapproved or t e following reasons:--•----••-------•-•---•----••-•--•-••••-••--•-•-------••---------••-•--•-----•......•... •-•..............._ ------------------•--•-•-------•-••-•......_...--------•---•--•••-•-----•----•••--••-------••--------...•-- •-••-•--.....•••- Date PermitNo......................................................... Issued-......................... Date THE COMMONWEALTH bF MASSACHUSETTS- BOARD OF HEALTH ..........................................OF............................................. Trrtif iratr of Toutplutnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (vYor Repaired ( ) by... -•-=•............................................ -•-- -----•-•-----• ................................ --...----.... .--•--•----...------ ---•-----•- Installer has e n installed in accordance with the provisions of TIT:LF 5 of The State Sanitary Code s d ribed in the �p ication for Disposal Works Construction Permit No.-k.......... dated__ ._Z.r'..��.................... THE ISSUANC OF HIS CERTIFICATE SHALL NOT BE C AS A GUARANTEE THAT THE SYSTEM WILL P, NC "N' SATISFACTORY. DATE..... /l••.......................••--•------•-----•---- Inspector .---- ........................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF WALTH ........... ..OF.................. ....................... No......................... FEE.. ................. Disposal Marks Tvnitrnrtuan ramit Permission is hereby granted.... Lei... •------------------• •........•-•--• . .----...-----._...... ......._.._................. to Constru ( ✓f or Rep. ( man, dI I al!J5e ge Dispos y ¢ . . at No.-•-- !` .. ..�,......% Street ----------------- as shop w on the application for Disposal Works Construction Permit NOD. . ....... ated.-��--.-__�....�:�................. .............................. ....... .............................................................. I Board of Health DATE------------l ` l` -. ...................................... FORM 1255 A. M. 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