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HomeMy WebLinkAbout0149 INDIAN TRAIL - Health 149 INDIAN TRAILL r CENTERVILLE A = 211 001 081 f' No. r Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes Zipplicatiou for &&;Pool *pgtem congtruction Permit Application for a Permit to Construct( )Repair( Vd Upgrade( )Abandon( ) @'Complete System ❑Individual Components Location Address or Lot No. �/ T h �`a� ,"fell Owner's Name,Address and Tel.No. Assessor's Map/Parcel Cep e/� i Qwe-S Installer's Name,Address,and Tel.No. �A — Designer's Name,Address and Tel.No. 7 7) Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow J 3el-) gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank Type of S.A.S. Z::_ 1kn. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: l 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 this d of lth. _ Signed Date Application Approved by 14 Date V 9- Application Disapproved for the following reason Permit No. Date Issued Fee THE COMMONWEALTH OF MASSACHUSETTS Egtered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application for Mi5paaf *pgtem Construction Permit Application for a Permit to Construct( )Repair( (/ Upgrade( )Abandon( ) L complete System ❑Individual Components Location Address or Lot No. / /1 T �'a� 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. t3D�7�7l Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building Kio3l elc_e- To. of Persons —Showers( ) Cafeteria( ) Other Fixtures > Design Flow gallons per day. Calculated daily flow J -3a gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank / S as Type of S.A.S. Z—sae' Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 this d of the Signed Date D/ Application Approved by U / Date Application Disapproved for the following reason rrr' t. Permit No. "`Y w Date+IssuedA t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERPFY, that the On-site Sewage Disposal System Constructed( )Repaired(4-/)Upgraded( ) Abandoned by VVr,_,"aLa.111,411 CO10"J` at a,l ce!7 v/I e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7"1—Z.L?6 dated/y G Installer Designer The issuance of this per i hall ot be construed as a guarantee that the syst ill fun o design�l Date Lv/d I Inspector r � ----�- ��j- ---- -- Gfl'—d���al N Fee o. w( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5po5al *p5tem �cCongtrurtion Permit Permission is hereby granted to Construct/ )Repair(✓)Up rade( )Abandon( ) � System located at /G/9 - d!A/ll�I T/-G�/ G�e,�/Vtr //� 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:Constructio st�be�jo plete within three years of the date of t 's pe Date: ''/ D Approved by L �.� . . �. v.,, � i ��` 1 `� ``l 3 �\ N i �� 4 ` QI _( � ©' � � \ ` �� � � � o '' � � � NOTICE: This Form Is To Be'Used For the Repair Of Failed Se itic Sy§terns.Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUMON PERMI (V I=QUT DESIGNED PLA.NS) � r o� - 0 II`/n..eOy certify that the application for disposal works corssuction permit signed by me dated���Q�_ concerning ffie property located:at 49w2ie pllelmeets all of the roUowinz criteria:. , /71ac;ailed system is canneced to a resideadal dweilin;only.. There ;, no comme:c:al or ht�-in P-Sas rescca � +ted with the d-wencr 4'a—e soil is c:2s, ' CLASS -tnea as A���T I and e --roaiadan ate is :ems chars or egt:ai :o. nunutes per Mc.L 4,1e=are no wedands within 100 of tpe proposed-z=dc system :ne.e are IIO „vale wP. 'tS wi*.nin.1:0 :of tie proposed=zdc s�,,eM. he:z is no increase in flow and/or change in ase proposed �/-Tlc =- a no v-aranc:=s a;use or nmdy±bottaz;t.ot the proposed lea-c sing faclity will not be lxated less than five toot above tine :taxim=adjust,,oundwatc able--?oration. (Adjust the ---oundwater.table.ising the rrimmor cthod when apolicablej. if-the S.A.S. will be I=Md with_50 fee:of arty veQtated wetlands, the boron of the proposed leaching facility will not bee located less than fourteen(14)fey;above the ma..-drn=adiused oundwater table elevation, Please complete the following A) Top of Ground Surface EIevation(tying GIS information) b�� B) G.W.Elevation _the MAX.raga G.W. Adjusttnent. D117ERc'NCZ- BE WH.z A and B Z S Z SICKED : DATE: ✓�//I�/�� [Sketch PrOPOSCd PL=OfVSZCM on WCkj. TOWN OF BARNSTA.BLE. . G LOCATION SEWAGE # ZL%6�1-2` VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �' �� =,j�/� >Z '�f� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) �3 NO. OF BEDROOMS_ 3 BUILDER O Old WNER�/r / PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S Feet Private Water Supply Well and Leaching Facility .(If any,wells exist, on site or within 200 feet of leaching facility) iG/Ily Feet Edge of Wetland and Leaching Facility(If any wetlands exist �/ within 300 feet of leaching facility) /Z%`� Feet . Furnished by i5c t i L -- --..._... --- -"- TOWN OF6BARNSTABLE LOCATION :nJ14t1 ��'/�/ SEWAGE # 2 97� VILLAGES ASSESSOR'S MAP & LOT- INSTALLER'S NAME&PHONE NO.� �✓ � f� S ��- 3y� SEPTIC TANK CAPACITY I'ao'gewe— LEACHING FACILITY: (type) t'g,0G4C r&oAn (size) /7.3' Xm2T NO. OF BEDROOMS— BUILDER O OWNER PERMITDATE: 5-- /4/ y I COMPLIANCE DATE: r`/f C / Separation Distance Between the: _ Maxim Adjusted Groundwater Table and Bottom of Leaching Facility S 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 6Ct Of s� �2r ems, - — r No.fd.:3k.. F�s..�J -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispas l Workii Cnnnitriirtiun jinmit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: nn Location-Address or Lot No. " ...................++1 �/us. S ----��1 P 1�... ........................................................ a -- � _S .`... r... �tr. ..•--.........•. ............... 9—v— •.u�Dress... �. ...... ..0 ` ........... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms._..._..._____. _Ex ansion Attic.-.t g— __ ___________________ p ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------------------------------------................................ ------------- ............................................................. Design Flow........ __J..........................gallons per person per day. Total daily flow-_ .......................................... WSeptic Tank—Liquid'capacity__......_...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—Not .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.-__./-------------- Diameter..-.1.0._..._. Depth below inlet---�_............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................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........................ a ...-......................................................................................................................................................... 0 Description of Soil........................................................................................................................................................................ W x -----•------------ -----------------------•------------------------------------------••-•-..... -----------------------...------. ------------•----------••-•---•••-•------...--•-------••--•---..... U Nature of Repairs or Alterations—Answer when applicable-� ` ....._1QZ�...L- ..jP?`_:1:................. - --------------•--- - S • f5...._� ..... s ............................................................................... 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 Compliance has bee i the bo d of health. Signed ---- -----------------------------------... ..................... ------ `...s Date Application Approved By ---------- --...... -tee•.=.. ......5----J� .._.�2- ----- ----------------------------------'--------..-...........-..-'--------- Date Application Disapproved for the ollowing reasons- ...................................-------------------- -- -- --------------------- ------------------------------------- -- -----------------------_--- ---------..............-------------------------------...--------------------------------------- ...-- --...........----------------- -- -- ....................................... Date PermitNo. ........�; ...--.. .- -...lo--..................... Issued ......................------ . .. ------------------ ....... Date TOWN OF BARNSTABLE LOCATION VAR R t�i;c ,u `'c �c�a\... SEWAGE # q� "7J9 VILLAGE G ASSESSOR'S MAP & LOT d 0 INSTALLER'S NAME & PHONE NO. SeMf SEPTIC TANK CAPACITY SyS-� vq LEACHING FACIL'ITY:(type) Vp-e— (size) NO. OF BEDROOMS PRIVATE WELL OR BLIC WAT RCS BUILDER OR OWNER `17P M-f-S q DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No • k �/ �° aiy( f \ � i f' �. V w'w „t .- .1�`" Q No.fa 00 THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tousuvdion frrmit Application is hereby made for a Permit to Construct or Repair (--)-a/n Individual Sewage Disposal System at: =P& k.CA_ Location-Address or Lot No. F-71"Pal—------------ Owner Address ------------———z e- 11_"V,4-----1Sp I e__ —------ Installer Address Type of Building Size Lot--------—Sq. feet Dwelling—No. of Bedrooms___----7---------------------------------Expansion Attic Garbage Grinder Other—Type of Building ---------------o------------ No. of persons---------------------------- Showers Cafeteria Other fixtures Design Flow--------5_��----------------------gallons per person per day. Total daily flow-- -----------------gallons- 1:4 Septic Tank—Liquid'capacity------------gallons Length---------------- Width---------------- Diameter---_-----------Depth_--------------_ x Disposal Trench—No--------------------- Width--------------------Total Length---------_-__----__ Total leaching area-------------------sq. Seepage Pit No­j-------------- Diameter-----I_Z9....... Depth below inlet__- ------------ Total leaching area-----------------sq. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by------------------------------------------------------------------------ Date---------------------------------- Test Pit No. I----------------minutesperinch Depth of Test Pit-------------------- Depth to ground water------------------------ P4 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ C4 ------------------------------------------------------------------------------------ —--- --- 0 Description of Soil-----------------.._____________-----_ ------------------------------------ W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ U Nature of Repairs or Alterations—Answer when applicable___--73;_� -------� ----- ------------ ------------ L__2j41( -------- n r-----------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 Compliance has beery issued h, th bo I d f health. Signed ---------- ---------------- T ---------------------- ---------;�------------------------ ApplicationApproved By --------------- -- - ---- ------------------------------------------------------------------------ ------tea--------]�------ Dam Application Disapproved for the following reasons-- --------------------------------------------------------------------------------------------------------------------------------------- ; Date PermitNo- --------- ------1_7...4?--------------------- Issued ------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Crrtffirate of Qlampit-unre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( by-----------------------------------------------� _ — Z-`-�`-✓J----- �_1- — ( ------------------------------------------------------------------------------------------------------------------ at ------------------------------------------------ - - ----------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The Sta 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. �t DATE----------------------------9--, -�>-,� 1, -------------7------------------------------------------------- Inspector ------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Disposal Works Tonstrudiou firmit Permission is hereby granted---------- ....:S �_0_S._--------------------------------------------------------- to Construct ( ) or Repair ()_ n Individual Sewage Disposal System atNo-----------------------------4__SA_fk--------- 4 C-, `_ --,C- -k,: -- -O�rf-o----------------------- -------------------------- . Street as shown on the application for Disposal Works Construction Permit No.&�;3&--- Dated--------------------------------------- -------------------- ------------------- Board of Health DATE--------------------53-- FORM 36508 HOWIS&WARREN.INC-PUBLISHERS