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Home My WebLink About0176 SHEAFFER ROAD - Health 176 SHEAFFER RD. , CNTRVILLE A = 171 057 MMiiN�.11N t TOWN OF BARNSTABLE -` ► LOCATION i��n'�ae'� t C� SEWAGE # 06 6- ' VILLAGE C e1,_A- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. sc8 SEPTIC TANK CAPACITY E� LEACHING FACILITY: (type) .(size) NO. OF BEDROOMS y BUILDER OR OWNER 1 PERMITDATE: I 6 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) wT J Feet Edge of Wetland and Leaching Facility(If any wetlands exist,: within 300 feet of leaching facility) -- Feet Furnished by A S' V. TOWN OF BARINSTABLE LOCATION 1 (0 `S IM4P R A SEWAGE #.-�00 6— Q,�7 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 6 SEPTIC TANK CAPACITY X LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 1 y �•�^�' BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: J 7 ��r✓ 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 A/ within 300 feet of leaching facility) . ��[ Feet Furnished by . o j Q d1 No. !� � Fee G� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Mkgpogal 6petem Construction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `'�bb _5, _0 c&7P-6f e�Owner's Name,Address and Tel.No. Assessor's Map/Parcel `\'V Installer's aml ddress,an Tel.No. Designer's Name,Address and Tel.No. cS C.-v�' rTJ"�� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder MY 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 U Type of S.A.S. Description of Soil Nat re of Pepairs or Alterations(Answer when applicable) Add U 1.;N-PC,I V l c ko rt" &i f 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 i sued by this Boaz Signed Date -J I 'o o Application Approved by Date/ 7,r, 1 Application Disapproved for the following reasons Permit No. Date I ued Z-s 1 No. Fv f _!/ J�✓ / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: \,7"' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS 0 01ppftcation, for �Dkgpaar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 1-7(p S g G--y- 2 J Owner's Name,Address and Tel.No. µ, Assessor's Map/Parcel UA-4 r '_ \\ �("`S 1 `'S 2U ci c-_r, -- oS 7 � 1 1�i 11 rt,5 �J t,.�-c � r'► i� Installer's Nam ddress,and Tel.No. Designer's Name,Address and Tel.No. S C.C? �—cr�✓, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder O ✓ 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 0 U U `Type of S.A.S. Description of Soil Nature of Pepairs or Alterations(Answer when applicable)-A j U LI 1. t r t-Ar)r-S L4 L j � 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 Boar th. 4, Signed f Date , Application Approved by. %: i, Date Application Disapproved for the following reasons Permit No. Date Issued g✓� .r '� 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 C v,r (,�, C_r t S at CZ 7 c�r. has been constructed in accordance with the proXisionstof-Title 5 and the for Disposal System Construction P 0!rJ�G3 dated,f�- , � A �' Installer J C,O �! ��--r ,V� Designer The issuance of this p sh e t a 1- o bejelonst s g y ed as a guarantee that the s e wiI-'-ffunction as designed Date ��1 / �l Inspector p4fr�`��A' --------------------------------------- No. A 00�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS 'tgpogal *pgtem Congtructton Permit Permission is hereby granted to Construct( )Repair( %el Upgrade(t�)Abandon( ) System located at \ S t�C ��`C1' (Z t� (.C�T��l 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. Wfe:7/- 4-,0W Approved be_ 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(,y � �� W`�' , hereby certify that the application for disposal works construction permit signed by me dated i I IOU , concerning the property located at Y'-'kg;CY- (�,-(� meets all of the following criteria: .This failed system is connected to a residential dwelling only. There are no commercial or business IuTbees associated with the dwelling. • 7soil 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 c SIGNED : DATE: J13/ / o y [Please Sketch proposed plan of system on NOTICE Based upon the above information,a repair permit will be issued for 3 bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert �, 0 � �k��S��"� ' Q � L� ,. No...... .......... Fxx ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Bisposal Works Tomitrnrtion Punfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Jlocation-Addressp-T or Lot No. ----•-... ••./— -•------------•-•-.....•--_..__...--•-•--•----- Address r}t Gmels -••-•... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms____-•3____________________ _ Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ________________________•-• No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other fixtures ...................................................... W Design Flow.......J-Q......................... .gallons per person per day. Total daily flow....... RA...........................gallons. WSeptic 'Tank—Liquid capacity gallons Length................ Width................ Diameter---------------- Depth___--.-_-_--__-_ x Disposal Trench—No.................... N.idt ....____....__ ..... Total Length.................... Total leaching area---------------------sq. ft. Seepage Pit No../QQO _ Obiame ----------- 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____________-_______._.. (s, Test Pit No. 2................minutes per inch Depth of Test Pit-_________.__•__---• Depth to ground water-______________-____.__- -------••------------------------------•-----........--•------------•••......••-•-•....._••------•--......................................................... 0 Description of Soil-------------------------.�� `' :---------................-----...---------•------------------....---...----------------------------------------•------------ x G"l -------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------- ....................... 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of CC s been issued by the board of health. , 9 ,1 . e G Signed _,�. ;•-s'f t_-.7 _.' Date ApplicationApproved BY--.. --------------------------••----------------------------........ -------•-•-------- ------------- Date Application Disapproved for the followi g reasons_________________________________________________________ ---------•........................ -••••••••----- •------------------------------------- ..................................................=...................................................................................... ....................... Date PermitNo. __/_.------'------•-•----•----------- ------ Issued........................................................ Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA 4 No....... -�-•--------- FEx..... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 14s�------- ,�•��Iar��a� fir �i��,��1 urk� Cnu�t��r�r��lor� �gr�t�� Application is hereby made for a Permit to Co->struct ( ) or Repair ( ) an Individual Sewage Disposal System at: ;t 3 �-, r a t fx: k '......................._C p....... ......... Location-7 Address or Lot No. } ..____...... :. "d �' ............. ...... ...... Ofvner7 -----•------ .t ." a ------------�'`'------r--^-�=--=-----------='=!-''.-_. = `-�'---- °� � Address •----------•----•--•-•--------•-------- Installer Address Q Type of Building r Size Lot............................Sq. feet Dwelling—No. of Bedrooms....... ..................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures --------•----•-•---------------------------------------------------------------------------------•---------------•--------------••------------------- W Design Flow_______,M _ ____ ______________________gallons per person per day. Total daily flow--------- ..........................---gallons. WSeptic Tank—Liquid'capacity�`}�_C2galIons Length................ Width-----------..... Diameter---------------- Depth---------------- Disposal Trench—No._.__ ........ Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No.7' f�,!_-'::��wbiamett r._ -...... Depth below inlet....................Total leaching area Seepage ft. z. Z Other Distribution box ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------- Date--------•--------------------------- --- a � Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water._--___.___.__________-. (sI Test Pit No. 2................minutes per inch Depth of Test Pit-________-_-_____- Depth to ground water._._•_______________.-.- D Description of Soil---•------•---------_---z t_n ./• ..............-•-•---------•-•----•-•- a -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------- 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 Article XI 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 'xr Signed _ ". r si' ` � s w� Date Application Approved By--==" r .,�`�� " "�ti ` 'r l ------------------- --------------- ........................................ Date Application Disapproved for the following reasons:�.........:: -------------------------•------------•----....-----------------------------------------------------------------------•- Date PermitNo.---f ---------------....._....-•--------....--- Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. "ta.�.44" ........OF.... }r' r.-. Trrftf iratr :of f wn;i1iattre THIS.IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) byA - _ ---------------------------------------------------------------------------------------------------------- r Installer has been installed in accordance with the provisions of Article XI f The State Sanitary Code as described in the application for Disposal Works Construction Permit No____________________ 2 ------------------- dated---------=Z--...... '�------�. ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ DATE_..... - 1--a-sl- 7Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH ............. .... ..OF ,(�) v_ No.:....... ........•--- ------•�....... .. .. FEE ....... Ugn:Vv gal Workri %T11mi#rurtion rrmit y Permission is hereby granted.......... `; '= - "" ` to Construct O or Repair ( ) an Individual Sewage Disposal System at No. -------- ,.: --------.._------ '` -- ------------------------------- -•------- Street as shown on the application for Disposal Works Construction Permit No..__..`_ .` ^___-- Dated___ _ ......... .- . . ..................... --•---- "'""» Board of Health DATE............................................................... ; FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -