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HomeMy WebLinkAbout0195 SHEAFFER ROAD - Health 195 SHEAFFER RD. CENTERVILLE A = 171 064 UPC 12534 11�p.2153LtaA NAYT180i.YN, i TOWN OF BA�R�NSTABLE " LOCATION Z 15- 5 l/ SEWAGE # VILLAGE GeW�r`y///e-" ASSESSOR'S MAP & LOT »—�d INSTALLER'S NAME&PHONE NO. 9,01'&496' CW,1 L, 7 7/'2e3T SEPTIC TANK CAPACITY _1000 �C. LEACHING FACILITY: (type) S�Q 41 1QCd (size p� NO.OF BEDROOMS BUILDER OR<5� �J✓`�� PERMITDATE: T//ll®D 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(lf any wetlands exist within 300 feet of leaching facility) Feet Furnished by 38 y 32'� " _�, y-7 , s No. - Fee THE dbMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Miopaal bpotem Congtruction Permit Application for a Permit to Construct( )Repair(lo)Upgrade( )Abandon( ) O Complete System 2 Individual Components Location Address or Lot No. Owner's Name Address and Tel.No. � Assessor's Map/Parcel sT cel �®� ,,c,o�vj��f� Installer's Name,Address,and Tel.No. / v Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(141b Other Type of Building Rio.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /Z 611 gallons per day. Calculated daily flow �J' �� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Z--J��OWC ka r el/s Description of Soil I Z •��` Z�X Z / 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 B d o ealth. .............. Signed Date emo Application Approved by Date / -e Application Disapproved for the.following reasons Permit No. �� Date Issued No. 'G�J� yaT Fee F 1 _ THE IIGiAONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Misspo0al *potent Construction Permit / Application for a Permit to Construct( )Repair(1/)Upgrade( )Abandon( ) ElComplete System R Individual Components Location Address or Lot No.a/)- 5d��a Owner's INme Address and Tel.No. �( ��e19 C�°ST Assessor's Map/Parcel Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. Geo Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/6© Other Type of Building �eowrAo.of Persons Showers( ) Cafeteria( ) Other Fixtures_ Design Flow f` gallons per day. Calculated daily flow -3Q gallons. Plan Date Number of sheets Revision Date Title ` Size of Septic Tank /©©� 94/ 4i )_5 ...-Type Type of S.A.S. Z —✓ 94/� l�`i l''%S Description of Soil 7 X Z X E Nature of Repairs or Alterations(Answer when applicable) p 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 issueeddyb this B d o ealth. � Signed ` / Date Application Approved by Date 17 f I Z:4 +O Application Disapproved for the following reasons Permit No. / Date Issued ._ THE COMMONWEALTH OF MASSACHUSETTS -7 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE IFY, that he O -site Sewage Disposal System Constructed( )Repaired(l/�Upgraded( ) Abandoned( )byD/ at 9J z`'�? �'/, ���9l�v/ E' has been constructed ' accordance with the provisions of Title 5 and the for Disposal System Construction Permit No774&V —e-/l� dated FYI 71 4vP Installer , Designer ri n� The issuance of this permits al n t be cons ed as a guarantee that the s 1 e vv .11Jfunction s �signe :� Date Inspector pl­ No. Z.O7/y _ ------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogai 6potem Construction Permit Permission is hereby granted to Construct( )%jepair( �Upyade( )Abandon( ) System located at / J S�I Ci�`�`�'!" /''lam'• C ed/l_tle/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:Construc •on must be completed within three years of the date of this it. Date: �/ ' 7 �� Ap proved // �. 1499 ' NOTICE: This. Form Is To'Be'Used For the Repair Of Failed Sep-tic Systems Only: - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) L RDlR r r Ael Y`61t , hereby certify that the application for disposal works construction permit signed by me dated d'11,10O concernine the property located at Gel?�G'�i��meets all of the followinsz 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 classiiied.as CLASS I and the percolation rate is less than or equal :o : minutes per inci +' I here are no wetlands within 100 feat of the proposed septic system There are no private wells within 1-40 feet of the proposed septic systeht P P . There is no increase in flow and/or change in use proposed There are no variances requested or needed. I. The bottom of the proposed leaching facility will not be located less than five feet above the ma.,dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptcr method when applicable) V1If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the ro sed P Fo 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) l c B) G.W.Elevation +the MAX High G.W.Adjustment. _ DIFFERENCE BETWEEN A and B I �, SIGNED: DATE: (Sketch proposed plan of system on back). ^`roo 9 J�erg o 0 L Goa le 0 v / TOWN OF BA,R�NSTABLE LOCATION SEWAGE # orJ VILLAGE Ge--tZ /�rJI�/�. ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. IY01,71�14911-Z C-eues2, ]7/,9ZeX SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L� (sizes v NO. OF BEDROO�MS BUILDER OR <^' !R! l 6/ems PERMITDATE: //? LSD COMPLIANCE DATE: iSeparation 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 s-45Y S I/-r (3 -7 - 3 a TOWN OF BARNSTABLE L(,,bATION '�,� S�PC Tf-r- SEWAGE # — 7 VILLAGE ��'1T�C/'yi/�� ASSESSOR'S MAP Sk LOT_jj� Y► INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY i LEACHING FACILITY:(type) oda (sue) NO. OF BEDROOMSPRIVATE WELL O UBLIC W TER BUILDER OR OWNER �� �e- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ��• /�` /� VARIANCE GRANTED: Yes No `� c� � 1 ................... THE COMMONWEALTH OF MASSACHUSETTS +� BOAR® OF HEALTH Barnstable �OVEI TOWN OF BARNSTABLE rv�>rjon�� Appliratiuu for Diipuuttl Workii Tomitrurti +� Application is hereby made for a Permit to Construct ( ) or Repair .(&--'J'an Individual Sewage Disposal System at: .......................................................... Location-Address or Lot No. �.................................. ................................................................................................. -------- ---- Owner Address ,a Installer Addres < Type of Building g Size Lot----------------------------Sq. feet .-1 Dwelling—No. of Bedrooms.,3--------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a 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 ( ) 1­4 Percolation Test Results Performed by.......................................................................... Date........................................ 0.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4 Test Pit No. 2................minutes per inch Depth of Test Pit...:................ Depth to ground water.................. -••-------•----•----------•--•................••-•-•---------......-•----••-•--------....-------•---......................................................... 0 Description of Soil........................................................................................................................................................................ V ..............•-•••--•-----•-•••••••-••------••-...•-••--•-•-•••-•-••••••-•---•---•••••-••-••••••------•-•-•••-------•••--•-•--------•---•---••-••--•-••••----•--•-•••-•--•--•••.....----••---•-.._..••-- W -------------------------------------------------------------------------------------------------------= U Nat e of Repa)rs or Alterations—Answer when applicable______ _____________ L� 1.� ?C�__._ t ----------------•-----.....•.............--•---•-•--..............................•... 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 Co has been iss d by the board of health. Signed ..... .. -------------- ................................ ....- te _ Application Approved-BY .. ... ..... . . .: . .�=:......... .. : . . Application Disapproved for the following reasonf- ---------------------------------------------------------------------------------------------------------------------------------------- .............. ..... Permit No. .r'.� Issued -------------( a ({.r ���le a FEB..-.': -O.................. THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH TOWN OF BARNSTABLE �V' � �zA �liration for � ��n��� �rk� �����r�r�ton [ermtt � Application is hereby made for a Permit to Construct ( ) or Repair (v)"an Individual Sewage Disposal System at: ..- .n� ...............�:......----•-.... C.�P-T f2 V( t...c... " .--•--------•---.....--•----•------•---•...............................................•-... Location-Address or Lot No. .................E+. -•--- .................................. ..........--...................................................................................... 19 Owner Address a -!L.B....... /`V.CCU............................................ ...cr G 9 U . \I p. .`�`r•U.v.. rl 1, Installer Addresd UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.-,,3.....................................Expansion Attic ( ) Garbage Grinder ( ) 1-.4 Other—T e of Building a —Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 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 ( ) Percolation 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........................ P4 .---•-------------------------------------------------•-------......----.....------......-•--•...........-•---•-•---•-----...----...----•------•......•-•---. Descriptionof Soil j ...........................................................................................•-------------•----•-•---•---• ^ - ..................................... .................. lope. °'� ¢* , �Natul e of Repa trs or Alterations—Answer when applicable.................... . -------- -31Agreement: The and signed 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 been issued by the board of health. J 'te Application Approved B � .��. �l-t. ...,1��//L- --, Date Application Disapproved for the following reasons- ------------- -------------------------------------------- ----------- ------------------ --- --------------- ------------ ---------------------_..........---'------................../...�----- --..................----------..--...---....--............------------.................-/_ .... ............................ R / /Dare Permit No. q-- Issued ............... '"? ///// � (/� �------------J-... ;.......I.................... C / i- ---------- r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE f Certificate of Compliance THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ✓�' g p y ( ) or Repaired byI^1 ........<'-f -N- --------------------------------------------- ..............------------........................................... --- ----------------------------------- Installer at ........1.- ..--.SN- -p.rr.le..Z T-->_.. - '�T. has been installed in accordance with the provisions of TITLE 5 of The State tpyironmental CodeY�. described in the application for Disposal Works Construction Permit No. -.-_..l� ...J5 7 dated --....� .._ /"t/---.-.--.- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEEITHAT THE SYSTEM WILL FUNCTION SATISFACTORY.' DATE............................... ry 1 �' �C Inspector 1 � ........................ Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , TOWN OF BARNSTABLE No.........r...... ... FEE..... 0....�....... Bisposal Permission is hereby granted......P- �� fA-h7 C,C I to Construct ( ) or Repair an Individual Sewage Disposal System at No......... 5- ': ' I_ '. ..1 l .......... .. •----- _E a?--�5I�.V/4_4 / r . ..-- Street Y as shown on the application for Disposal Works Construction Permit.No..gl"'.�._!_.�Dat ,;.-. !. rn' .. . �. . oar�f Healh ��._ ... � -� DATE �� r ;--------;----------------•-------------------- FORM 36508 HOBBS h WARREN.INC.,PUBLISHERS '