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HomeMy WebLinkAbout0308 OLD STAGE ROAD - Health 308 OLD STAGE RD., CENTERVILLE A=189136.001 UPC 12534 No.2-153LOR `� HASTINGS, MN Town of Barnstable Health Inspector FtHe tp�, Office Hours o Regulatory Services 8:00—9:30 Thomas F.Geiler,Director 1:00—2:00 BMWSTwat.E, Only '""9. 039. Public Health Division ♦0 Argo �a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: n Address: Map Par Name: T�11 ; J ) �t� c gN1 Phone: :7 5 2a. How many bedrooms exist at your property now? 2b. How many bedrooms total are proposed at this property(including the amnesty unit)? 2c. Please include a copy of the floor plans for the entire propert�� e sf�µ �^ 6-,J(c 3. Is the dwelling connected to public sewer? YES or CNO�) If the dwelling is connected to public sewer, skip questions 4-9 below. 4. Location of dwelling is INSIDE " or OUTSID a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? =YES or NO 6a.If yes, how many bedrooms were approved according this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic syste n inspected by a DEP certified inspector within the last two years? YES or U-O) FOR OFFICE USE ONLY TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY The Public Health Division h s no objection to_ bedrooms at this property. Signed: Date: o3 Inspector(Print): Mc Q;1health/wpfiles/amnestyapp vlz �loNO fz-�� III 4 i ,J ro 0 m (6 ; t, �- l2o L1v►NG � rp oM . �2s7 tzv�2 °ate No.. Fee �`� 50. 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Mtgoml *pgtem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) IlComplete System ❑Individual Components Location Address or Lot No. 308 Old Stage Road Owner's Name,Address and Tel.No. 7 7 5—3 8 4 2. Centerville ,Mass . 02632 Murray G. Bain 308 Old Stage Road Assessor's Map/Parcel Centerville ,Mass. 02632 X_elF /t3 (9; a a Installer's Name,Address,and Tel.No. 7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.-Macomber & Son Inc . J.P.Macomber & Son INc . Box 66 Centerville ,Mass. 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling X X No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 461 gallons per day. Calculated daily flow 4 x 110=4 4 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 gallons Type ofS.A.S5—High Capacity Infiltrat Description of Soil Loamy sand to medium fine sand . Nature of Repairs or Alterations(Answer when applicable) Omitting cesspools . Installing 1-1500 gallon tank. 1—Distribution box. 5 High capacity infiltraors packed in ot stone with of,_ stone underneath . 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 Cod and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this of 91th. Signed % o Date 3/10/9 9 Application Approved b Date —, Application Disapproved or the following reasons NJ Permit No. Date Issued `;Y7` <�7> Fee$ 50• UO w THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: If Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS R#plication' for Moon[ *pgtem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) XXComplete System ❑Individual Components Location Address or Lot No. 308 01 O d S t age Road Owner's Name,Address and Tel.No. 7 7 5—3 8 4 2 ,, Centerville ,Mass. 02632 Murray G. Bain 308 Old Stage Road Assessor's Map/Parcelle Centerville ,Mass. 02632 Installer's Name,Address,and Tel.No. 7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son INc . Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 ♦ �Yr Type of Building: Dwelling XX No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 440 gallons per day. Calculated daily flow. 4x 1 1 Om440 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 gallons Type of S.A.S5—High Capacity Inf iltant Description of Soil Loamy sand to medium fine sand . Nature of Repairs or Alterations(Answer when applicable) Om it t in g cesspools. Installing 1-1500 gallon tank. 4—Distribution box. 5 High capacity infiltraors packed n 41 ot stone with of stone underneath. Date last inspected: Agpeement: 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 CLodap and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this of H lth. Signed , Date 3/10/9 9 'Application Approved b Q 1 Date ��o Application Disapproved or the following reasons Permit No. "" .. Date Issued ----------------------------- - --------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the°Off-'site Sewage Disposal System Constructed(�,X X)Repaired ( ) Upgraded( ) Abandoned( )by HJ.P.Macomber & Son Inc . at 308 O 1 d Stage Road Centerville ,Mass. has been constructed inn accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. %+f > dated 5-'°"'/ e9 Installer J.P.Macomber & Son Inc . Designer J.P,.Macomber & Son Inc. The issuance of this permit shall not be c6strued as a guarantee that the system jwill function as d�esi,^' d.�� Date 0 , k G UI ��� Inspector l'"�I I/� I --------------------------------------- No. Fee$ 50. 00 .. w THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigogal *pgtem Congmruction Vermit Permission is hereby granted to Construct(X X)Repair( )Upgrade( )Abandon( ) Systemlocatedat 308 Old Stage Road CEnterville ,Mass . 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: ems°'" r5f" Approved K., 1� / 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I,J o s e p h P.Macomber J r . , hereby certify that the application for disposal works construction permit signed by me dated 3/10/9 9 concerning the property located at 308 Old Stage Raod Centerville ,Mass meets all ofthe following criteria: 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. QThere 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 OThere 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] QIf 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 ma dmum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 6— 9 y B) G.W. Elevation 3 J— +the MAX. High G.W. Adjustment. 7, DIFFERENCE BETWEEN A and B rI j SIGNED : J DATE: 3/10/9 9 [Sketc posed plan of system on back]. q:health folder:cent i i �'� � --. TOWN OF BARNSTABLE LOCATION 3 a S 'A R SEWAGE # VILLAGE G e N re R i/I/%e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. _ .Nl X C O Af I3eR 1-so-41 SEPTIC TANK CAPACTIY 0 0 LEACHING FACILITY: (type) IX A rOR(size) NO. OF BEDROOMS BUILDER OR OWNER /9 A bV PERMTTDATE: 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 4 w i �,Y Y0 O J � j i TOWN OF BARNSTABLE LOCATION &V .SO 6 e 912 SEWAGE # 7?-143 VILLAGE G e y Te P, V//1 e ASSESSOR'S MAP& LOT 6 INSTALLER'S NAME a PHONE NO. io, Al 4 C o /79 ReR t..Seal!/ SEPTIC TANK CAPACITY �D LEACHING FACILITY: (type) .r"`/l i�L fA0% A r©9(size) NO.OF BEDROOMS BUILDER OR OWNER 19 A IAI PERMTTDATE: 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 l � a LOCUTION ' SE\" f. E PERMIT MO. 1WSTNLLER'5 W&& AE ��AD RESS BUILDER'S Q U1.AE ADDRESS DATE PERMIT DATE COMPLI &KicE ISSUE]: c t _ eP