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Home My WebLink About0070 VANDUZER ROAD - Health 70 Van Duzeig Road,. Barnstable A=352-010 t I � 1 ASSESSORS MAP N0 No. 91 PARCELIdO: �`� Fee,�� C� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppYtcatton for Migooal 6potem CowNtructtou Permit Application is hereby made for a Permit to Construct( )or Repair( man On-site Sewage Disposal System at: Location Address or Lot No. 4�/lG�r'jr� Owner's Name,Address and Tel.No. 362— 6!5-1 �i'?70 N �t��CY 1?,4> ` 5> t� w 4 br v.� C iW&-,p T f� Assessor's Map/Parcel /C) 2.4 / �� o y yy Installer's Name,Address,and Tel.No. Designer s'Name,Address and Tel.No. l � 9% Type of Building: Dwelling No.of Bedrooms Garbage Grinder WO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33® gallons. Plan Date Number of sheets Revision Date Title Description,.of Soil Nature of Repairs or Alterations(Answer when applicable) R a"'ey-J C:� rr xt sf.J a i® W rs 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 byrthis Board of He P Signed Date Application Approved by Date J? Application Disapproved for the following reasons Permit No.!!� `✓�` �� Date Issued � � �� 4. No. iF�ed�1 Fee :!`r —=—fir.. THE COMMONWEALTH OF MASSACHUSETTS l PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ;- 2ppricattan for Mtgpogal *potem Construction Permit Apljlication is hereby made for a Permit to Construct( )or Repair( �,an On-site Sewage Disposal System at: f `�'4 F Location Address or Lot No. r .9 Owner's Name,Address and Tel.No. 74 �Y 7a =.4,Y ?f Q !11, Assessor's ap arcel f (AJ 4 t-ro-J G 19A)n"T to,lo Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t A t ssl,.)G e J r t /1 7r Type of Building: Dwelling No.of Bedrooms Garbage Grinder(mod Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures " Design Flow /t„ gallons per day. Calculated daily flow ?3 0 .i. gallons. Plan Date Number of sheets Revision Date Title Description of Soil ` Nature of Repairs or Alterations Answer when applicable) C- r f ♦ P � ( PP ) l�-e.-�€��—�,�T��.-ems r+ 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 Health. Signed ✓ Date o J.* Application Approved by Date A* .-o= ,I— AS I/' Application Disapproved for the following reasons Permit No. 9z" �� ' Date Issued r ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( Von 49-947" = by Installer at has been constructed in accordance with the pro 'sions o itle 5 and the for isposal ystem Constructio rmit No. dated . Date Inspector 11 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT HE SYS- TEM WILL FUNCTION SATISFACTORY. No. ��-- �l� --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwiopogal *pgtem Construction Permit Permission is hereby granted to to construct �( )repair( On-site Sewage Systemii;located at No.# e /7 A 4a4 4 �i_ �F` �>��%+� Street and as described in the above Application for Disposal System Construction Permit. No net /�, 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: .. c:� _,� Approved by / goard—of Health 1 ,SSESSOPS MAP NO: ' 'lv� No __--Z �3 — Fmc.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q � -----� ----.......OF.....�.. ............ ---------------------------------------------- liratiou for Di" niitt1 Works Tomtrurtion rrrmd r Application is hereby made for a Permit to Construct ( ) or Repair (L4"an Individual. Sewage Disposal System at, 1 Locatio ddress �� or Lot No. ..••-•............ ... .r_._...... '1 �.h.- -"^ ' ... - r caner y dre s a `V---=--�'''�`-7 r"-�- � S S°'� 1 4�-L- � ?. --1 ----------------------------------- ---.•-•• --•---•---•. •••---- Installer Address d Type of Building Size Lot............................Sq. feet V D .elling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) aOtfi Type of`Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) xtures .. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. G; Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter----------•..... Depth................ 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. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---___-____---_-----_--. Ix -•-•-•----•----•---------•--•--•--•-••---••--------•----•-•....................•-•-...----•---_........................................................... 0 Description of Soil ---------•--------------- U ----------- --•-••----------------------------•------•---•----------------•---------------•-----------•----------------------••-•••------- W - ---------------------------------------------------------------------------- -- - -- - --.................... UNature of Repairs or Alte ations—Answer en applicable_. .. _ ___ __ ________ ____ __ - --- - Agree �ent: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 4 the provisions of iT T E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issue y the board of health Signed .... ................-••- --- -.V ' .......................... ... ---•--. -•----------- Application Approved By................... ... Date A lication Disapproved for the following reasons:......... .............................. ...mow-' .............!i Z Date .fir•,. r" PermitNo-_ .._•---- •-------- 'Issued....................................................... z0 Date No............... FizB..............�7.._�` THE COMMONWEALTH OF MASSACHUSETTS E®ARD��F HEALTH ;,, �-. 0 .... -............................................... Alipfiration for Dbipusa1 10orks Tontitrnrtiun Punfit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at .........--•-.... ...................................... .---------....... / Locatiosr•:Address /f �' or Lot No. 1/►/� f .7`-<� ---"-vl c.'> /•(t =�---.....�.-� .............................................................. - ......... . Owre: ddr ss a . .. . ............... --- -------------------------------------- InstaLer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) al 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—NTo. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter--______------_---_ Depth below inlet.................... Total leaching area..................sq. ft. I 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......................... rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_____-___----_---. P4 --------------------------------•---•------••-•-•--------------................•----.....•-•--.............................................................. 0 Description of Soil - ---------------------- •------------------------------- •-----------------------------------------..._.._... x i�. ^� ------- --------------------------------------------- ----------- •------ U Nature of Repairs or Alterations—Answer en applicable. ...__. -------- 15 Agree ent: � ~ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T-ITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h4bD issue +y the board of healtSigne -------------------•---------------. ---------- --------- •-------Application Approved By_____________ _�� Y `rl. ._`"� ------------------- Date Application Disapproved for the following reasons................................................................................................................. -•-------•------•---•------...---•--•----------------•-•-•--•----------•--•----......-----------•---...---------•---------------------------------------•••----•-•----------------" ----------•--- Date Permit No. -�='� �� ! �-' ...... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...'.` :' �..............OF../... .f - f""` ..................................._...._.... Trrfif irtttr aaf Tomplianrr THI IS T GERTI-FY, That the Indkvidual Sewage Disposal System constructed ( ) or Repaired ( ) 1---�'� �,r�. c at _--------•--• -------- --------------------------- has been installed in accordance with therrovisions of T_Ir T LE VD_oi The State Sanitary Coe as describred in the application for Disposal Works Construction Permit No.-----_ h........ ' �.. dated J`S-(0.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FyfACTION SATISFACTORY. �- 1. ,... DATE................. ............. L Inspector....................... . _ THE COMMONWEALTH OF MASSACHUSETTS 130AF3 F HEALTH ,OF..... ......�'v..'k' _r,...k ..................... v� FEE.... .'..... r` �in��rn�1 ,rk� ,�.nnn#rnnr#uan, rrnti� - Permission is hereby granted ------------------------•--•-�...1:_v t._.:-...-•------------•--........-•---------------•--.......------................--•----- to Construct ( ) or Repa'r�( an Individual Sewage lXsgesal System r^ GI i�'O.__ i .� .'�.`!1_. .!� [7 ✓ / . ��L/� U 2"1 ................' ✓ / t,inn-�"'ILI! y _......_. .......................... ......-------_ :%._. .._.._._. _ _..... ..l Sr:eet� � as shown on the application for Disposal Works Construction Permi . -)_t=. .....'.'.;Dated--______. .__ _tn DATE` -•--•- 5-Z)/s' 4'---------•------------------- Board of Health FORM 1255 HO S & WARREN, INC., PUBLISHERS LOCATION � SEWAGE PE T NO. VILLAGE I N S T A LLER'S NAME i ADDRESS I CRMG MEDEIR405 qS®� vie �g OWNER ttycann% mom 775-MIS is?'I gf 7 GATE PERMIT . iSSYE0 ��•-�. dz DAT E COMPLIANCE ISSUED x'0/6110 ls � i � 5�� .x_ /! TOWN OF BARNSTABLE LOCATION '7 o UrAA)[ts j?.E9 _ILA SEWAGE # 9'6 — VILLAGE ASSESSOR'S MAP& LOTLS�� t " INSTALLER'S NAME&PHONE NO. �,1 G• c s��c� . °1''7aF'--® vi�� SEPTIC TANK CAPACITY / ®o ,6Z S r ' i6I5Ys q �"C.�.1 LEACHING FACILITY: (type) L_ Ae 1.¢..j, :2="t-' (size) NO.OF BEDROOMS 3 BUILDER OR OWNER W AL7'o,&) cA y rO!4 i*Z PERMTTDATE:� --COMPLIANCE DATE: `' ` Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 A%- i7-7 2Ilk - i2 s 26� \7/, A �a V fi Al d 0 2.E- �y4