HomeMy WebLinkAbout0210 OLD JAIL LANE - Health 210 Otd. -Jail Lane
II ' Barnstable,
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No. �J'' lt r. f Fee /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rpphration for ;[gpogaf *pgtemc Congtruction Permit
Application for a Permit to Construct X Repair( ) Upgrade( ) Abandon( ) `Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.N .
2/t) 0L.'0 7411- 44/1/h f4/CA_ S� Z/ZO
Assessor's Map/parcel In. 2,7$ Me, 4)- 4+ 37 Zl ,e00r,-:f . "",9
Installer's Name,A ress,and Tel.No. Designer's Name,Address and Tel.No.
17,9 C4o Z-ciz�-L-A VV 15.,4WZ1�W y
Type of Building: Z-D 8 4-c4ir-
Dwelling No.of Bedrooms Lot Size 9�, 9�G sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) j'.S--D gpd Design flow provided S gpd
Plan Date /O 2-4--0 Number of sheets / Revision Date_
Title.S'17 5-' A �'� P44V rIZ- A/C",1--',4
Size of Septic Tank 115-do Type of S.A.S. C�i9/?9� /L SySTyTJ
Description of Soil 4 —/O LOi9/YI'/ S'.9 A)''—<36 7/!JE�b Ss�vA
sk<
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afo described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code d t to e system in operation until a Certificate of
Compliance has been issued by thi • rd of He
Signed Date
Application Approved by DateI IF
/
Application Disapproved by: Date
for the following reasons
Permit No. 2065 Eql Date Issued I D
Fee
1 THE COMMONWEALTH OF MASSACHUSETTS' Entered in computer:'Yes
�. PUBLIC HEALTH,DIVISION' TOWN OF BARNSTABLE MASSACHUSETTS
ZlppYication for Mi5po5ar 6pgten� Construction Permit
A lication for a Permitto Construct ] Repair rade Abandon pp .� p O� pg ( ) (; ) Complete System OIndividual Components
Location Address or Lot No. Owner's Name;Address,and Tel.N
3z01A
Assessor's Map/Parcel /n, Z 7 9re,4 AAA
U!'E G� �9/1�tlST•9BG E
Installer's Name,-Address;aiid Tel:Nd" - gner's Name,Address and Tel.No. .S�d�-
_S oa s 61 /7a c 15,2„ h/�9
Type of Building: Z-0 8 4c4F r
Dwelling No.of Bedrooms +5� Lot Size 94° 99 G sq.ft. Garbage Grinder
u Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) Sso gpd Design flow provided S 6 gpd
Plan Date /O— Z:;�DJ' Number of sheets / Revision Date
' Title X/TF i9MJ .S' G11�6� /OL IVX- Xkh/ i�/2,d S��CJ`/T/VfAl
Size of Septic Tank ffdQ Type of S.A.S. C11i91)&6 e 5ZS75/71
Y f"
Description of Soil O��`/D°1 LDi9/)7y Sq /6°1_3�'�� S,¢N4 3C�"JZO`�/rl f� Sff�•�
r/
4.�
Nature ofAoe hirs or Alterations(Answer when applicable)
Date last inspected: ;
Agreement:
a.w The undersigned agrees to ensure the construction and maintenance of the afor,�described on-site sewage disposal system in
accordance'"with the provisions of Title 5of the Environmental Code and of to l system in operation until a Certificate of
Compliance has been issued by this B'ard of He `—''�
140.2
o Z
Signed Date
t Application Approved by / ✓f 4 Date /Q 2
1 Application Disapproved by: rr, } psi/ n Date
! for the following reasons ! {t l Y z
Permit No. �200 J 'S141 _ Date Issued f ��2,510—S
----------------J--"l, r------------ ---
1/ �, r
THE C�M' MV WEAL� NTH OF MASSACHUSETTS
BARNSTABLE, MAS- =ITUSETTS
C.ert f cage"of/tC, riance
THIS IS TO CERTIFY that the On--site Sewage 'iisposA System Constructed (�) Repaired ( ) Upgraded ( )
Abandoned( t')`by'
at �� i `�c-, Lon e has been constructed in accordance
with the provisio�ns_o(f�Tjit`le Sind the for Disposal System Construction Permit No. I dated oh 5
Installer ,-- - Q)A'' Designer
#bedrooms Approved design flow gpd "
The issuance of this permit sM
e construed as a guarantee that the system will ' oUTC- a'.gne .
Date 61 Inspector
------------I--------------- -------
) ;Sin C)
THE COMMONWEALTH OF MASSACHUSETTS .
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
'=i!6po!5at i§pgtem Construction Permit
Permission is hereby granted to Construct ( �epair ( ) Upgrade ( ) Abandon ( )
System located at I U ry-?- "
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 of this permit. -
Date (O latrApproved b -��
opt „ Town of Barnstable
Regulatory Services
IJI MSPABM
v g Thomas F. Geiler,Director
�p i639
TEo Ma�A Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644
Fax: 508-790-6304
Designer Certification Form'
3
Dater
Designer; ,/,�dYGZ 14FU'061W 7 I�s
Address• /�G. CLot/E / .D W4 y
11,47 cI-1 y11- �, J ,4, O Z 53�
On X-6 QN/,5-1 was issued a permit to install a
(date) (installer)
septic system at 2 AD j!5fl-b (,�/4 L d l based on a design I drew;
(address)
dated A) Z
I certify that the septic s stem referenced above was installed sub
stantially
y
according to the design.
I certify that the septic system referenced above was installed with changes but in
accordance with State & Local Regulations. Revision or certified as-built by
designer to follow.
o JOHN
o P.
c, IYOYLE,II1 H
'52 . N0.89DBg
(Desi Signature)
S R
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.
CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS
FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE
PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Desiper Certification Form
Town of Barnstable PH
Department of Health,Safety,and Environmental Services
Public Health Division Date I 2
367,Main Street,Hyannis MA 02601
r6y�. .� Time /(� r� n., Fee Pd.. - v-(J
Date Scheduled r 0
Soil Suitability Assessment for Sewage Disposal
d7�Tfo y Witnessed By: h✓r
Performed By: t
...:.:...................:•:.:•: ::.;...........
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'ocaion+Address 2t� Old �.e Owner's Name ,Vow,wr�? ovLl,A�j y
r Address
atil'nsy'^�f- .
Assessor's Map/Parcel: L7 8 a 9•0 a Engineer's Name srarar30 A-1
04RAC. 46er PC. 4-1 hone N
NEW CONSTRUCTION ✓ REPAIR Telephone
Land Use l "S���r/TI/32 Slopcs(%) SurfaceSlones ✓ Je.y� '
Distances from: Open Water Body NA R Possible Wet Arco NA R Drinking Water Well n
Drainage Way /� It Property Line le, Z/ n Other - fl
SKETCH:(Street name.dimensions of lot,exact locations of lost holes&pere tests,locate wetlands In proximity to holes)
/%ut\ Vl.. — •.
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�9k � tl i
to
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Depth to Bedrock \
Parent material(geologic) �1T
• -
Depth to Groundwater. Standing Water In Hole: Weeping from Pit Saco ,
Estimated Seasonal High.Groundwater < ° RIM
>s";.ry ?:a�.y ;.ff1��'r rrt x. t' hsF•`. A Y�`;ikcr :ai�r
O<.r...p,.✓; � �/,:� �4lA�2. ?y,�•�}h� � � i�sa�o:.{¢•.,. ::t%h:� A. >' .
t�' 5;:•f:%:;�•'�.�.:�•:'nka.:>�fi:•..{<>,eG.•! �• .� 3,'?f:••:.':s:as•nr.f:'4i..1...Rx.2i.c::,ura'.;�•:.2ti:e:.
Method Used: In. Depth to Soil mottles: In.
Depth Observed slanding In obt.hole: in Groundwater Adjustment IL
Depth to weeping from side of obs.hole: Adj.factor.Adj.Groundwater Level_,.
.-Index Well N •Rnading Dale: ff
Index Well level __
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Observation Time at 9"
HoleN ----'—
Time at 6"
Depth of Pere ,
Time(9"-6") --
Start Pre-soak Time Q /
End Pre-soak
Rate MinJinch
Site Failed: Additional Testing Needed(YIN)
-Site Suitability Assessment:.Site Passed _ —
„ ;„_to- tit.r,,,,,vIi„„ Observation I,Ole Data To Be Completed on Back-�
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