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Home My WebLink About2772 MAIN ST./RTE 6A(BARN.) - Health 2 F72 MAIN ST, RTF 6A BARNSTABLE r A = 258 065 : .. rr , l• J- M r - y .. • , r: dk =k.^', —ter r • .: � • .. 1 a � u , • I s i _. ,.._ ..l n^ ..,:P ri �_.. s...'-.. ir° •�. 1 r• .-" SIi 4 ... -. TOWN OF BARNSTABLE LOCATION 2, 7 Z >>/S//rk yI Jr SEWAGE # = Z VILLAGE �O/�!/"S C11� ASSESSOR'S MAP & LOT ZS8'DErS` INSTALLER'S NAME&PHONE NO. Mlo1,"`/ SEPTIC TANK CAPACITY S DD LEACHING FACILITY: (type) (size) 94 X.� NO.OF BEDROOMS BUILDER OR OWNER Crig Il/ PERMITDATE: f /31eo COMPLIANCE DATE: !/—00 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 leaching facility) Feet Furnished by e( � a W V A p� Q C i No. 6_0 C/� Fee' /� 3 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 iJ. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pphratton for Miopogal *pgtent Congtruction i3erntit Application for a Permit to Construct( )Repair( 1/)Upgrade( )Abandon( ) L�Complete System O Individual Components Location Address or Lot No. N Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. !� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms .5, Lot Size sq.ft. Garbage Grinder Other Type of Building e0ele No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow &Z2 gallons per day. Calculated daily flow �✓�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /457)10 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /�/t1il2l"�lf 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 bee ' ed by this Board Health. / Signe _ Date 9/iZ1�� Application Approved by Date Application Disapproved for j he following reason Permit N :- Date Issued Fee {i THE COMMONWEAtTHwOF MASSACHUSETTS Entered in computer: 1 l Yes Er PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Mi5po!6ar bp! tem Con5truchou Permit Application.for a Permit to Construct( )Repair(,` /)Upgrade( )Abandon( ) L�Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.. -? - Type of Building: Dwelling No.of Bedrooms c5 Lot Size sq.ft. Garbage Grinder( G Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 12�1�7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic;Tank l jt Foe Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) y`11/r° 'vr =.s 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 bee 's'sued by this Board of Health. � Signe w 1 � 9 Date 1/L./egp Application Approved by Date Application Disapproved for the following reason y Permit No. Date Issued tr ----_------ THE COMMONWEALTH OF MASSACHUSETTS /V✓ BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( ✓}Upgraded( ) Abandoned( )by Ae 1l01l�N/ 101 `& /-. at y L O has b p constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No, - ated Installer Designer , The issuance of this permit sha no be construed as a guarantee that the stem-will function a�,dl sign`yd� Date Inspector V / r�� _tJ 1 / �fV? t7 — No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mizpo$ar *p,5tem ConsStrurtton Permit Permission is hereby granted to Construct( )Repair( LUpgrade( )Abandon( ) System located at Z-7 7 Z 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 truc 'on mu t be completed within three years of the date of perms/ Date: A roved b / /' PP Y , TOWN OF BAFNSTABLE LOCATION ,�/iJ_7 7Z. ISn//7 /}?JET SEWAGE;# 2G' SqZ VILLAGE 1 /'�S �lG� ASSESSOR'S MAP & LOT 2S�QE:S INSTALLER'S NAME&PHONE NO. &O )rOlO2f i SEPTIC TANK CAPACITY 1 S 00 LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER GrQ'/f f/ PERMITDATE: 13Io4 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 leaching facility) Feet Furnished by .i" FT -- C. a �Cn 014 W 4� O Oo� � 41, �t < p'R�• W yi- �� 64 `\ •p VVV V h �a o ` W JQ � jjb � • � Q �'� •� W M J 0 J V 61 0 pb Q It tA �. � % ow a Q ..pp. v e+ r! i' p, in �s . w •;• 1 1\ . M • ^ 1 fie° � � v ` � N N4� + � • � � aQ �Q a e � 2ok v. Cl 14 t• ti e« � .. ` Abe � � w � pb 2 � 7 '�. v wit, � a.o �•o •spy rti ^ NOTICE: This Form Is To Be'Used For the.Repair Of Failed. Se -tic Systems. Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS), I, goier)�_ LT hem hereby certify that the application for disposal works construction permit signed by me dated ��/Z/,ey concerning the property located,at 7 7 7 Z ,� 7L 6i� l7dr�5 �/� meets all of the following criteria: /The failed system.is connected to a residential dwellingonly. There are no commercial or business ustness c uses.assoated with the dwelling. y i fie soil is classified as CLASS I and the pe:coiation rate is less than or - uai :o � minutes per nch. / There are-no wetlands within 100 feet of the proposed:smuc.s;stem Y :here are no private we?ls within 1-40 feet of the proposed semic s STeM +' i here is no increase in flow and/or chanap in use proposea / 5- v There are no variances.requested or needed. Y The bottom of the proposed leaching facility will not be located less than five feet above the ma--durum adjusted groundwater table elevation. [Adjust the groundwater table using the' tzmptor /method when applicable). ✓ If.the S.A.S. will be located with 250 feet of arry vegetated wetlands. the bottom of the proposed roposed leaching facility will not be located less than fourteen(14)feet above the ma.-dmum 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.S 3 = z.v r DIFFERENCE BETWEEN A and BQ SIGNED : DATE: - [Sketch.proposed plan of syuem on back]. 4;helm UdQ:cut i 4` ' TOWN OF BARNSTABLE LOCATION oZ 1-10? At I/9 SEWAGE # VILLAGEG+Y �1 S : ASSESSOR'S MAP 6i LOT Ir INSTALLER'S NAME & PHONE NO. /1® SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) 10X y NO. OF BEDROOMS PRIVATE WELL O PUBLIC ATER BUILDER OR OWNER DATE PERMIT ISSUED: y � DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No \� �r a j � r � - Y Y J No...74.).3 . Fss.., 2.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH , TOWN OF BARNSTABLE Appliration for Uhiposal Workii Tom5trurtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ' eocation-Address � ti � �1or Io o. ... ��H� ..... .. - � ..........- 7 Owng /� f 5 7 Address ¢ /i/ //f a ................................... b�''._..w t_._.. ... •-•--•---------------- C�`�- --`' .......... .. 'fw ii ►.`.--•-•-• ..............•.... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bed .................................Expansion Attic ( . ) Garbage Grinder ( ) �-t Pk Other—Type of Building .Xei...."_....... No. of persons............................ Showers ( ) — Cafeteria ( ) 04 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.----.-.--.-••.-_._----- Test Pit No. 2................minutes per inch Depth of Test Pit............---..... Depth to ground water........................ 04 -------------------------------------------------------•---•---•-••-----............----------------......................................................... 0 Description of Soil..................................................................................---------.-------•--•------••-•--•-•••••••••-•--•--•••..................................... x W - ----------------------------------------------- - UNature of Repairs or Alterations—Answer when applicable_��_"._ '�t'._�eS ��rL �, i�5 ��-+� --------------------------- �9Qa-•-s ............................................. `�,�g--s..z:� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia has en issued by the boar of health. Signed .. / ..........- .................�--- ........... ...................5./` .--.......,...................- Date Application Approved By ..---------- �y/[ . -- ..� ----- ------/y�-/!m-.Z.7'9�..... /;e�__ /1- L "Date Application Disapproved for the`f/ollowinng reasons- ...................................................---------------------------------------------------------------------------------- ----------------------------------------------------------------------------------.....:...-----------------........----------....---------------------------------------------------------------------- ---------------------------------------- Permit No. -------- J-` 1 -------------------- Issued ----------.......----ate..--------------...------.mate b No..- --/,-.. ,�,0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNS;TABLE Appliration for Dispusttl Oaks Tonstxnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 77 2 / 6� �rn sf!/� TjT,"ovation-Address ......................•�Af� Ci/'IVH! ....... .......l�.... ./ �7 .LAr7f / •YbS.......................................................... Own r / f Address .................................... .................................................... ........................_ .........----------..........._..... Installer Address Q feet Type of Building Size Lot............................S q. U Dwelling—No. of Bedrooms....... .................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building -RES A No. of persons............................ Showe'rs — Cafeteria Q' 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........................................ aTest Pit No. 1................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........................ P4 ----•-•••-••--------•••-••--•••--•----------•-••--••-•----•--•-•...................•--...._.._..----......................................................... 0 Description of Soil...............................................................................-------------------------------•----------------•-•-•----------------------------------- - ------- ------ -----------.................------------------ --------•-----•------ UNature of Repairs or Alterations—Answer when applicable_'"_ hod s I`• T`'-k nB _ �1 �... _....5.i,., O . Agreement:- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli?hn as en isssuue'd by the boar of health. Signed ----. . -----------�--- --------------------------------- Dare Application Approved By ............. ---------------------------------- - Application Disapproved for the following reasons: ........... e ..................................................................................................................................................................................................Dare . .................._ ................... // ... - Date PermitNo. ..... -- ! s... ...................' Issued ........................................................---------- I r t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifiratr of Q-1toutylianre THIS To cT RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired .... ..x ��2 " - ----------------------------------------------------------------------------------------------------------------------------------------------------------------- by • Installer at -------------- ---..... Z " at...----- � . . ......------..........------------------........-------------------- ..........-----................ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... ./.-.. .-)--------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE,.................------------ ------------r P..-------.'../---.......-------------- Inspector ----.....----------------�.. ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...1�............ ...V r FEE.� .......... Disposal urko Tunstnu ion ami# Permission is hereby granted.............. ----------2.......L-0_&&...-•-------.......--•-•---•--•----...................----•-................. .._. to Construct or Repair (X) an In ividual Sewage Disposal System at No. ......_../_..... . .. � ... �-�, .e e... ........................•--•----•--•-••...........•---.......----•- . .. ... street as shown on the application for Disposal Works Construction Permit No-71__110. Dated.......................................... ............................... ............................. � .. ................................................. DATE. 1 72...................... Board of Health r FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS