Loading...
HomeMy WebLinkAbout0554 OLD STAGE ROAD - Health L 54 O/d.Stage Road' . ' enterville oaf llll Y11 P(7dY;, A _s fit, 5 r z UPC 12543 4o. 53L©R HASTINGS. INN ? ' TOWN OF BARNSTABLE LOCATION S sy 04 r7' ST'4t�f AeJ SEWAGE # ,20o VA-LAG C��t/t-•P/�t/rr���� /ICJ _ASSESSOR'S MAP& LOTa— `X/ DiSTALLER'S Nfi.ME&PHONE NO. J06-+% Qovu 4-5 -so 6r-7 -al-Y 7 SEP'ITC TANK CAPACITY LEAC.rIJNG FACILITY: (type) C4117-ec S ?3O tf try (size) 5-1 Y- to•3 Y -2— _ NO. OF BEDROOMS S^ BUILDER OR OWNER v E D V vvA A-5 JI. _ P.ERMITDATE: ^02°l a oa I COMPLIANCE DATE: _ Separation Distance Between the: Maximum Adjusted Groundwater Tale to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist or,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) Fe 4,t Furnished by _ __ } ��i� � ' . �p� Z� . , GF � � .. 3 � 1 � .. _ �� s' �� _ 1 �; � s� .. , . � ,� . � .. t L.:No.;?00 /-12 1'g Fee d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z[pprication for ]Dig ogar bpotem Con!6truction Permit In ivi m n Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete Complete System O di d Co po e nts Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel C Installer's�NWe ddre� ss,and Tel.No. Designer's Name,Address and Tel.No. Type of Building:Dwelling No.of Bedrooms Lot Size sq.ft. Garbage GrinderKhla Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 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 Natu R�ppf,Repairs or Alterati ns(Answer when applicable) ��lyrC.. 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 issue y this Bo d of / Signed Date Application Approved b Date 6 �l Application Disapproved for the following reasons Permit No. -4O�C/-7 Date Issued - S�Z F O/ i No.+s► ©�"�Z./ ! V Fee �? THE COMMONWEALTH OF MASSACHUSETTS >. Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 0.pplicatiou for 30w ool *potent Conotructton Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. J�. G 1 Je r5�_el,jx (Z J Jv� Assessor's Map/ParcelJ � U —UU Installer's Name_Address,and Tel.No. Designer's Name,Address and Tel.No. S U^V e; Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft., Garbage Grinderd(�1 " a Other Type of Building No.of Persons r Showers( ) Cafeteria( ) Other Fixtures t Design Flow 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 Nature pf Repairs'or Alterations(Answer when applicable) 1A c- " r o d t C 3�o S w C/Pt 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 issuedrby this Bo rd of a df._ Signed eT Date C Application Approved b f Date j5 Zf- Application Disapproved for the following reasons F' Permit No. Date Issued — 4T THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( ) Abandoned( )by s M U i at e/ n oe i;k-k�x 2 d has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit dated AIC-- w2 9F 43j Installer Designer The issuance of this pe t s all no �je contrued as a guarantee that the -stye wiyhfunctio as'desigi edlr v +.Date / Inspector t� I �� � �!1 / � r/5 No. �7 i� Fee 453, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Ii!6pogal *ps�tem Construction Permit Permission is hereby granted to Construct S )Repair( �')U grad ( ) bandon,,,System located at ll��s%�CO 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 oft a rmt. Date: 'j-' �r � Approved r, R I 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. r CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I , hereby certify that the application for disposal works construction permit signed by me dated 16, (0 , concerning the property located at J� e ��({ meets all of the following criteria: j� This 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 4/ There are no variances requested or needed. +f 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) C B) G.W. Elevation �._,3 +the MAX. High G.W.Adjustment.}1`� _ J DJFFERENCE BETWEEN A and B $ SIGNED r: DATE: ok'�7 [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert r ' TOWN OF BARNSTABLE LOCATION �!� S SEWAGE # 02®0/ —15'1-1— VILLAGE ^��PI��I '� —ASSESSOR'S MAP & LOT INSTALLER'S'NAME&PHONE NO. A 6Y SEPTIC TANK CAPACITY` l SG fffD LEACHING FACILITY: (type) �jl7�e (size) S! ►� X-2— NO.OF BEDROOMS 5 BUILDER OR OWNER E OM*- PERMITDATE: CP ^02� 'oZ da I COMPLIANCE DATE: _ Separation Distance Between the: . , Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility j + 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. w't}in 300 feet of leaching facility) ___- __-_. Feet Furni — I 1 i I i �4, it fq1-ao LOCATION ,r SEWAGE PERMIT NO. VILLAGE INSTALLER'S AM i ADDRESS , �4 I� OR. OWNER 7 DATE PERMIT ISSUED 0 DATE COMPLIANCE ISSUED - ,( 1� .- - �i �, .� ,. � •� ��, � / ,. `.. �� y� �. :�,. - �±� I r� �. .� '�' ,� s �f s "1-11-12 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............. ....................OF.........................................................-----------..._................ App ira#ion for Dispoii al Works Tungtrnr#ion Famit Application is hereby made for a Permit to. Construct (:,'�) or Repair ( ) an Individual Sewage Disposal System at: L ------ .�.............. /.. L- ......... -........ ---.�............................................ ca on-Addre or Lot No. iCff ----• ----�5/..=� �!...... ........................................... .............................................. ...................... / Own ---------------....._...........Address - Installer Address r Type of Building Size Lot..lY.Al,..._....Sq. feet Dwelling—No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building --_-____-___•-_--_-______- No. of persons........ ................. Showers (.2-) — Cafeteria ( ' ) a' Other fixtures .................................. W Design Flowl..........................................gallons per person per day. Total daily flow........ ...__..............._...gallons. WSeptic Tank—Liquid capacityl5-)S_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 ( l ) Dosing tank ( ) ~' Percolation Test Results Performed by.................................................... .. ............... Date........................................ a Test Pit No. 1 �a..rninutes per inch Depth of Test Pit----- Z..._.:_ Depth to ground water_______________________. (� Test Pit No. 2................minutes'••per inch Depth of Test Pit.................... Depth to ground water........................ Ra' ................--y` ---------•-•••-------------•-------•.............--•---•----....._---•----------....---•---••-•••••••------•-•--.........•-•--...... O Description of Soil...r .....__..._ ✓^ - U -------------------••------•--•--------------------------- 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 T I Ti LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu5,bWr,�of health. 1 igned••...0._!. -- G_.......... -••----•-----•----•-•-- Application Approved By....... ---- . Date Application Disapproved for the following reasons:-------•-----------------------•---------------------------------------------------- -----•--------------•---- -----------•--•---••--'•----••••---•---------••-----•••.......-----•--•-•------•---•••----••-------••-•----•----------••--•------•--------•-------•-•••-•••........................................... Date PermitNo. ............................l . Issued....................................................... Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ----.------- .................OF.......................................-.................................................. Appliration for Disposal Works Toat.stratrtion Frrutit Application is hereby made for a Permit to Construct (��or Repair ( ) an Individual Sewage Disposal System at: ,K ............. . t�.._.t2Z4� �:. .......... ...............................................1� ............................................ ocation!Addr or Lot No. . / ner Address a ....--••-------•--------------•.................. -••••--••-••••-•---•••....._.........................•... ....... Installer � Address UType of Building Size ........Sq. feet �-, Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building -_-_____----•-----_----•___ No. of persons........_:"r.................. Showers (e2„) — Cafeteria ( ` ) Otherfixtures -`-•---•-•---- ............................................................. W Design Flow...........•................................gallons per person per day. Total daily flow-------3-.__._..........................gallons. Septic Tank—Liquid capacity,'3__�.1.gallons Length................ Width................ Diameter................ Depth..........._.... W 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 ( ) aPercolation Test Results .. .. Performed by.=................................................. -------- -- ---- Date........................................ Test Pit No. 1 ".:Z4t�ninutes per inch Depth of Test Pit.... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1Yi _ O Description of Soil....____._---__ uC.`.___ _ U ••...............••----........••-••--•••--•••-•---•---•-•-•-••....._-••-••-••--•_...., W VNature 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 TITLE: 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 b the,boa of health. Signed_.__1' /�_.:. � �f __... __ e�eAl� / r rt• Application Approved By._:`= ''` Jam'-1-` `'-4 :......................................................r -Z �Da f ate -Date Application Disapproved for the following reasons--------------------------------•--•-•---------------------------••-•---------------------•-----•••......•-•-•-•- ----------------•---......•-•---•---_•---`•.....:-..`......--........._..__...--•-----.._.....----•---•..--•-------------------------------•---•----------------•--•-•-----•-----•---------•---.._..... 1, Date 172- 1 Permit No........... -� •--•----------------------------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS; F BOARD OF HEALTH ..........................................OF................................................................ (9rdifiratr of Toutpfiattrr j THIS I$, TO.,CERTIFY, That the In ual Se Dis sa ste onstructed ( ) or Repaired ( ) by• .. •. - _. � 1....... --------------------------••-•--. ......•-•-•••. •-•--••-••.............••- has been installed in accordance with the ,p'rM/Iisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ - .......... dated------------------ .. THE ISSUANCE OF TH!S.,CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION'SAT,ISFACTORY. DATE....................�J � �5•---.... Inspector........ ........ .•••............. I THE COMMONWEALTH OF MASSACHUSETTS BOARD O ��iALT�'� 2 ............. OF........ *.........J.............................._...._................................. No. .............. FEE,.... ........... Permission is hereby granted.......;%: "�" u x.. ... to Construct 1 j or Repair ( ) an Individual Se rage Disposal System r.,,t �J-.�,,.-• --•--- -- ------------------•-- ----•-..__............ Street as shown on the application for Disposal Works Con tructiop, Eeranit.Nof ��=r t 7 2 1 .......................................... /D 70? � P Boar f Health FORM 1255 A. M. SULKIN, INC., BOSTON t yAPPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS a CATION 5.:6;'49 dL 7P S74 /Zy r`. ..c`� NO.P Z _ TLLAGE Centerville _ DATE_ PPLICANT R�A >l FEE_ 30 DDRESS 551,. Old Sta.-e Rd, TELEPHONE NO. 775-3698 (Non-refundable ) ; 1 `�GINEER r-rank nnnAryr TELEPHONE NO. 775-6764 } ATE SCHEDULED n, 14/84 _ (Applicant' s signature) . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SOIL LOG IJB-DIVISION NAME Ra mond Dumas DATE 11/14/84 TIME 2 PM �PANSION AREA: YES - NO n ENGINEER Frank Conery ._ )WN WATER /PRIVATE WELL Ron Gifford BOARD OF HEALTH Al Fuller EXCAVATOR � ' ':ETCH: (Street name, etc. ,dimensions of lot, exact location of--test holes and percolation tests, locate wetlands in proximity to test holes ) GT NOTES : Oaf ®e l Loa 3 `ll -------------- /SS.oa I "RCOLATION RATE: Les than 2 min. per 1"' _ . '`;ST HOLE NO: `1 ELEVATION: 0. TEST HOLE NO: _ ELEVATION: - 1 2 ---- Top 2 --- lourse 4 ---- 6 - Soney 6 - --- 7 7 -- 8 _ 8 - 10 Medium 10 — 11 Sand 11 12 --- 12 13 13 14 - 14 15 --- 15 16 16 / `TITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD - LEA HING PITS t� LEACHING TRENCHES ?SUITABLE FOR SUB-SURFACE SEWAGE . REASONS : )TE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION '.IGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH pY: R-ETAINED BY APPLICANT 3Z.c► 1111LCFILE NO SCI;LE d a 00 i 1500 G.S.T. 1-6 ko + I J 3C d -1/2 13tone , r I o lop Lot2 -4 Lot 1 O c� 1 29, W-48 C rs. 3d. " G �b lU ;� 1-6tx6t Pit '� • ;r'/2t Storie26 -� FLAN SCALE 549 GPD401 1500 j Date 12/4/14 " 1 ! Lot .3 3a3► Zo 18 All Cape ungi neerin P 3 7-1 49 Harbor Roiid Hyannis, Pia.ss.' 02001 �a9..� � `roo ed I_i � 129. . .2a• i ! i ss.oo Zu.3 _. . . _.B.KETCH;V�N_ UI Y. '_�'D IN CENTERVILLE,T=irl. .I for I -Michael A. Dumas ! ' Beim ©t , 3 as shown on rla.n done for Rayr:i-,nd 4 F. �uin�sby All Gape sn-•-ineering and datcc-1 0ct. 12th f. 1984. 1 i Flevat cans shown are on ^.n assumed datum. r----- -r----------sr---r---- r-r---- --��� -� I Date Agent : Barnstable of Ham.alth ..f. . TL,^T YIT` ',1T;-3830 14,ade..11/14/84 ! I _ flit.--Rem- Gifford.. _.{ ._.. _ i N'o: water. encounter ' Less :th.an� 2' min. p'e 1" b Top 3 •3 28•3 .._ .. nurse �:_I boney ; {t ki or FRANK 21.3 i FRANK CONERY y CONERY y ,p No. 6232 0 edium ,o ,A�NO. 6573 Q� s sand. �o� �rsr��`� 4 c� TE Ry�p o- � �� SURE 1` ONAI