HomeMy WebLinkAbout0061 ANSEL HOWLAND ROAD - Health 61 ANSEL HOWLAND DR.
CENTERVILLE
A = 172 220
OC 12534
J��GYCIBp�
No. 2�-1� 5�
HASTINGS. UN
No.� e�-ca 'off Fee-�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pplitation for &9;po.5al 6pgtem Cortgtructiou permit
Application for a Permit to Construct( )Repair(t-/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 61 AA(5&964 1g,+0 Owner's Name,Address and Tel.No. 669W_
Assessor's Map/Parcel �a `� /1) LOT
T 17 / 1
Installer's Name,Address,and Tel.No. �(� �V�� Designer's Name,Address and Tel.No. `T
,qo -rA�C-TOP �42
/ io- �e
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 3 30 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
6 �_
Nature of Repairs or Alterations(Answer when applicable) 2 �O 9 C"G4� G_ 4 S 2� `� 4--
.t/ �— Qox
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 ron a tal Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued is o He �r
Date c 7���D Signed
Application Approved by Date�6_f _DPI
Application Disapproved for the foll ing reasons
Permit No. Arm — Date Issued
TOWN OF BARNSTABLE
LOCATION �� AIMS<i i,�i ,�,a ,Q� SEWAGE #
VILLAGE //;; ASSESSOR'S MAP & LOT `
INSTALLER'S NAME&PHONE NO. 1.5)C 1/w, 1990' _776 �Qe - j'yam
t. SEPTIC TANK CAPACITY /oaa
LEACHING FACILITY: (type) �0 afA'1 6iQ5 (size) I 3 �:��f,�,�� �7c
NO.OF BEDROOMS-3
t
BUILDER OR OWNE
PERMITDATE: COMPLIANCE DATE:
_5&�
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
9
T7
f�
x0ro V-)0
'
4c I
•
_4N
No.� ?0 ZA: RS ->� lFee ol
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS
01pplication for Miopozal *p.5tem Construction Permit
Application for a Permit to Construct( )Repair(L/)Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. �� /� CC�G Owner's Name,Address and Tel.No. 66O 66 ftl OkCNZ1
L
Assessor's Map/Parcel n a u/7 {LOT 17
/ 1 o(f_1^ //,
Installer's Name,Address,and Tel.No. 88/14 't AyOTT& Designer's Name,Address and Tel.No. 'T 6 `f
aO TA&-.Top G11Z
20-
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.3-7(> gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank F-44 I EQ Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Z C-9 t0_4na
O X
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 iron e tal Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued Z
o He
11' Signed 'Date S "00
rj Application Approved by Date 67 tg _ nc
Application Disapproved for Re folfAing reasons
Permit No. A&n:2 Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CE}TIFY,that the On-site Sewage Disposal System Constructed( )Repaired (!/)Upgraded( )
Abandoned( )by i99CTTC/=
at NSEL liGC�j 1,///j &, has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No-Jnca-_-)_ .213'.S dated
Installer Designer
The issuance of this permit shall not a co Itrued as a guarantee that the sy t m .11 f nction s d-Q ne !,
Date �� Inspector P 7
N . J
--�t-, ------------------------------------
No._ ✓ 1� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS
1Xh6 pozal *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair((/)Upgrade( )Abandon( )
System located at_61 4�6- L 1&1. Z dW /!.dr
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: �,-` - — �d Approved by
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. -
CERTIFICATIQN OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, 8M# !1� � , hereby certify that the application for disposal works
construction permit signed by me dated ' ^-mod , concerning the
property located at 61 4K&-1Yo&m10 A0, meets all of the
following criteria:
9• 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.
DIFFERENCE BETWEEN A and B
SIGNED : > DATE: � �O
(Sketch proposed plan of system on back].
q:health folder.cert
d /Doo T,
a,
Ll
TOWN OF BARNSTABLE C o 1
LOCATION 61 &u j oL/-Ij yD R/J. SEWAGE # o
VILLAGE ��� LJT%� •ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
IVI
SEPTIC TANK CAPACITY /002
LEACHING FACILITY: (type)1 5-00 C A19M&R5 (size) I3 X��L�' 5 �
NO.OF BEDROOMS
BUILDER OR OWNE
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the: r
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
� 6G
t� B
T,!
DSOK
6y
III Q' bo Col-eel c/ H GOCRS �5 �.
FEs...... 1:..........
THE COMMONWEALTH OF MASSACHUSETTS ,
BOARD OF HEALTH
................. .............OF..........................................--------------------------.._..........----•-...
Appliraiiun for Uiupuuatl Works Totes ur#iort antic
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................_........-...................................................................... ..........--••-----------.................................--------•---------------•---......•-----
Location-Address or Lot No.
......................_.......................................................................... -----.....-•------...----•---•------•-•--------.....---.........-----.............................
Owner Address
Installer Address
dType of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Pa 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 ( )
1-4 Percolation Test Results Performed by...........................=.............................................. Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
---------•-----------------------------------------•-----............_................---...---•--••........................................................
0 Description of Soil........................................................................................................................................................................
x
w ------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------------------------•--------------•---------------------------------...............-•-------------------------------------------------------------------------------------•--•--••••.---•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT:.:, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signd--------------------------------•-•-•----------•--•-----•--------------------......-- ................................
w �) ,�, Date
Application Approved By..........-• -� ,� �=, ---------------
Date
Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------•-•-----•-....
--------------------------•--•-----•-----....----------•-----•---....---------------------------------------••-•---•-••---•---•-•-•--•••-••-----••-------------•----••--•-----••----••----••-••--••..---
Date
PermitNo......................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
CIrrfifiratr of ToanIttiFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (. ) or Repaired ( )
by............. ......... ---------•---------------•------•--------------------------..........-------•----......------------.......:-----------•-----------.•.•....
nstaller
L. f
z'
has been installed in accordance with the provisions of TIT LIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...... ""._ .......... dated_._............................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED/AS CONSTRUED/AS A GU RANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
�r
DATE.................. a.. :- 1-�--•-------------.............. Inspector................
f = -....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No..: I_'r FEE--- .a.:...........•---
�iu�uuarl ���u �unuirttr#iun rruti#
Permission •s hereby granted---------- -= =......z_.C.!f4-------------------------•------------•----------.._.......------................---••----
to Construct or Repair ( ) an In ividual Sewage Di osal S stem
i
at No......... ---------�n.............. : � :��:_
Street
as shown on the application for Disposal Works Construction-Permit ..................... Dated..........................................----------- �
oard of Health
DATE................................ Gf
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •.
V �
'S1NGL.E FAM�L�( - � BEDROOM A
WO GAI:mAGE �jiZJND6R. • 3"
DA4% ..--( FLOW a {10X•3 = 3306.Po
SEPTIC, TANK = 33ox150% --A95G.P. o
use- %000 GAL.
015POSAL Prr u5E I000 GAL.
150 S.F x .2.5 t 375 G.Pq °- (r
BOTTOM ASZF-Az ,.
So s.F x 1. 0 5 GrIT
-ToTA>-. cESIGN = . Z2
-Te>TAL pA 11-Y Ft-o�,� 33o G,Po, r�►N�r... _ - - - St.
PE2cOLATION RATES 1"Iti
.+ , +rN.
13_ Fovvcw r/04
- 5$ I
��Q {N OF,M� Ir Gam- O O
� - � � �► lob 22
<Sr RJ()1-IAP4) ALA Py
�j A. W• i
,I BAXTER H JOt�(E {�`b II
No. z:ate n,. z5 �►JSEL 1- cw LA
o
I,
TOP FWD=Sg
Fl= 51 i� F Nv. S[.•o
�� + � � loou ►NV. ;
SV95oll, 0 ST. . CAL., �$.$
SEPTIC.
e°'` lN�
56•L TANk
I �000 ANY•
I &aAVbL LEAGIl
j PIT ANY. INV.
! WIT14 552 SS'`l
r
:i -1 I�3��•i�L •�g •
670N6
Mom. 9 "
�. GE2T11=IG0 PLOT PLAN
i, PR-O F I LG
1.oC4z1oN ce; Tb-zvlt-LE
12 No
Ila VJ4r
�- P L-P,P.I REP 6{Z.EN GTc
CERTIFY THAT TH'E rOV�1DATIO0 5Koww —
Htr•R Eo 1J GOMPL-`(5
i A u P 6 6T QAGK R-6.Q o 12 E ME NT> o F'Y 1a E CEIJTEIzV I�.�-t's t E�i-1 t�iJ DS T� '}-TOWN OF �AR1.ISTA$tG AND le.-. I•IoT
LOCp.TED WITNIIJ N'S G ooD LAIN I_�• $IL• d� QCo t�� i
DAT E.g-I"
6AXTEct.e NYE INC.
REG I try>r--er-V►AN o S u MY E�(o>� ►
TulS PL0•K1 1 fi NOT gnSEp o►d AN OSTER-VILLE MAC`s•
SuevG-Y �-TNE Or—r tiET5 SuoUL t
' NOT DC- V�C.hTO pGTC-�'-,MI►-IC l..c�T L.INGr� QPPLIGANT
pl-
V
LOCATI0 SEWAGE PERMIT NO.
-Co¢ /7 141-S6-/ Z �,Oz�6a��
VILLAGE .
I N S T A LLER'S NAME & ADDRESS
AOBERT B. OUR CO., INC.
GREAT WESTERN ROAD
NPAR HAR NCH MASS 02645
S U_1LWE R OR OWNER
�4/�i� f dS�a.�O/ 1�✓�.
DATE PERMIT ISSUED
DAT E C70-M,PLI-A-N-CE IS-SUED
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