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HomeMy WebLinkAbout0299 SKUNKNET ROAD - Health 299 SKUNKNET RD., CENTERVILLE A = f I TOW�N�OF BARNSTABLE s '� rLOGATIO- LAGE �f V P!�►'��e� f�� SEWAGE # �Y— to®Y C na4rr ui))-e— ASSESSOR'S MAP & LOT 17D. aSy INSTALLER'S NAME&PHONE NO. /1�-c .S-1d iC 77S' ('►6Rc� SEPTIC TANK CAPACITY 1060 aaI S. LEACHING FACILITY: (type) y" Ni Can -'AWNS (size) IYX,2� NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE:�"/�L�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 - O -- G O No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZtppYication for Miopaal *pgtem Congtru>rtion Permit Application for a Permit to Construct( )Repair( )Upgrade(")Abandon El Complete System >t4ttdividual Components Location Address or Lot No. 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. Type of Building: Dwelling No.of Bedrooms `� Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �3 W gallons per day. Calculated daily flow - 1-1 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. t glow—i L.t Description of Soil 16-5- 5a.4.417 Nature of Repairs or Alterations(Answer when applicable r u Ye . ` 1 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 b ealth. Sign Daten1 - Application Approved by Date Application Disapproved for We following reasons Permit No. Date Issued rtN - 7 No. O +-I Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0.ppfication for Migpoml bpgtem Con.5truction Vermit x Application fora Permit to Construct( )Repair( )Upgrade( )Abandon( ) D Complete System individual Components Location Address or Lot No.Q Q 0V4c"keff- Owner's Name,Address and Tel.No. � C6K,./ Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r lJ—Gt4 pt Sr(�' /4YlgV% vt�l Type of Building: Dwelling No.of Bedrooms_ Lot Size sq,;•ft. ;+,Garbage_rrinder( ) Y Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 7�t'13�0 gallons per day. Calculated daily flow gallons.-" Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 S v- Type of S.A.S. r Description of Soil_Q'l=r,� -I b�0 Nature of Repairs or Alterations(Answer when Applicable) ST S / /n ,�I,a�-'�`ems.-( Date last inspected:; L 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 t ' ea 1 Sign Date of Application Approved by Date Application Disapproved for We fol.Rving reasons s" Permit No. Date Issued 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 i —C n -- - at C Ali C—t�tZ" 6LJ + has been constructed in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No. f dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date y Q�0 Inspector � 4, r --------------------------------------- No. — , Fee " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mioc!6ar *pztem Construction Vernmit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at :Z2 ri!2l t::�, Vyti .T— / vIIA.. _V y,., 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: cl=!T _ �9 ' Approved by 1 tii 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 PERM (WITHOUT DESIGNED PLANS) I, �1 hereby certify that the application for disposal works construction permit signed by me dated �� IS-—�9 concerning the property located at r �Ck �[����,� ,. QL ' meets all of the following criteria: V• The failed system is connected to a residential dwelling only. There are no commercial or business es associated with the dwelling. �/There e soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. 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 u zere are no variances requested or needed. 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 Frimptor applicable] /e'hodwhen the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed than leaching facility will not be located less an fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: �. J . A) Top of Ground Surface Elevation(using GIS information) ^� B) G.W. Elevation , 01 V+the MAX High G.W. Adjustment DIFFERENCE BETWEEN A and Ba�- SIGNED : DATE: [Sketch proposed Ian of system on back]. q:health folder:cert G - � � l TOWN OF BARNSTABLE E �— LOCATION SEWAGE n VIA # �- j�ta e VILLAGE ASSESSOR'S MAP& LOT I INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 01LO a&Jr. LEACHING FACILITY: (type) 'yi C�n 'ri}/raf (size) �� k NO. OF BEDROOMS BUILDER OR OWNER �,i I 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 -... 1 o � I i . i i i I t i No.... ............ THE COMMONWEALTH OF MASSACHUSETTS ? BOARD OF HE A TH ...........OF......... .. . ..._.-...:...: .� ppliration for Bigpasal Works Cnowitrixr#ion Frrmi# Application is hereby made for a Permit to Construct r Repair ( ) an Individual Sewage Disposal System at: . . � .1 :�_ Q ............ ...... __ .L. zQ ocation-A es or Lot No. ............. _. .:....... ...---........................._...._....... Owner /press a � • = .............. ...........---- 6 , ......... -Installer Addresso.0��qq.ffqq Type of Building Size Lot...� ...._.......Sq. feet V 73 Dwelling—No. of Bedrooms......................... ..........Expansion Attic ( ) Garbage Grinder QWWpa' Other——Type of Building ----•....:............•----• No of persons............................ Showers Cafeteria.. Other xt es ............................... Y ow.._.........Design Flow...... gallon r ------------------------- �s P � WTo Liquid ca acit .U. b�IonsL th.. h Diameter:___. _._._.Se tic Tank ...(.o .).. �p x Disposal Trench—No. .................... Width_ _. ....._...... Total Length............. Total leaching area.__..,,.�._n_.......sq. ft. 3 Seepage Pit No. ..... Diameter_.......... Depth below inlet..... Total leaching area....l..l✓� ...sq. ft. ------ Z Other Distribution box Dosin .'"' Percolation Test Rest Performed by.--g t.'t_^. -- —....... Date...�.5:2. .A. ..4&S Test Pit No. 1..._...... inutes per inch Depth of Test Pit... .�. p...... Depth to ground wa er. .�.I . 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.... ................. O,`" Description of Soil.... ..... �7 ��.... ��` {` �' C.�...... .............. . .... . .............. . w ------------------------------------------------ V 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 LITL: 5 of the State Sanitary Cod The un ersi ed further agrees not to place the s stem in operation until a Certificate of Compliance has been issu th o lth. Signed.--- •.... .................................. �.. . ............ t .. Application ` proved By..................... .................. 1_.�._. ... . ... . Application Disapproved for the f ollo ing reasons:........:....:.................................................................................................. .................................•-----...................._... ............................•............_.....................................................•............... ............ Date _ PermitNo......................................................... Issued........................................................ Date IC) No.......................» 5 Fizz.......................... THE COMMONWEALTH OF MASSACHUSETTS (BOARD OFj�{HEALTH � ....._.t.. 1X�. .,..4...........OF...... ! "�l�-.!):, [ .�%�.L_ .... Applirtttion for Disposal Works Tonstrurtion Permit Application is hereby made for\ Permit to Construct( ),or Repair ( ) an Individual Sewage Disposal System at ..... :2 .....�- r _.....•..... O'A...t __ � •Location.Addre` 1 C J�— .» C� or Lot No. .. ••.•••..•.... W ............ � / _.o�C Y. :_ Owner..........— — ...... .... ` / Address •• .............».......»..... ". ".. ......•-•••-.....,.. ... .... r.a ... ..... ........... Installer ress � � Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder 014) e of Building persons............................ Showers — a Other—T yp ng ..:.............' No..... ( ) ( ) a .......................` .�. �of p Cafeteria Other fixtures � --•...............'..............---................ W Design Flow............. . .. ...... -. gallons per person-per day. Total daily .flow.......... , .' )............gallons^ WSeptic Tank—Liquid capacity 'rGgallons Length.?_)� i. Width: ( y. Diameter:............... Depth �(,�..� x Disposal Trench—No..................... Width ........... Total Length..... . ..... Total leaching area.._... �....sq. ft. 3 Seepage Pit No................:.... Diameter .... Depth below inlet......e........ Total leaching area..ZQ.(.sq, ft. !. Z Other Distribution box (",O Dosing tank ( `" Percolation Test Results Performed by......�''r ...' ���L--- ... Date...�. a:.� . � a ...................... - Test Pit No. l.............. minutes per inch Depth of Test Depth to ground water ., `. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....n................. xA _ --........�.-�: -----f l ) ................•--.-.-...-.---..--.........---.-.-................. . Uw -------------------------- -------•--.------------------------------------------------------..` `c. f .... .......... 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:I i I.: 5 of the State Sanitary Code=�The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue the,,boar`d`ofjiealth. Signed. •---•• .. . — � .....�.. ...,, �:..�. .............. ..... .Date Application A proved By...................... � .. .. Cal(1 '................. ..�...... 'M .���... Datl � Application Disapproved for the f ollowtng reasons:........................................................................................ ............. ............................................Date.............. PermitNo......................................................... Issued............... ..........-••-._......___......... . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' '� f 1 OF...............I..................................................................... Tertifirttte of Tomplittnre THIS IS TO CERTIFY, That-the Individual Sewage Disposal System constructed (—)-or Repaired ( ) by........ ,�!'... ` ....... ...... rtl f I..... .............. - � ...- ...................... ..... ..._ has been installed in accordance with the provisions of TII'IE 5 of The State Sanitary 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. .-� DATE......... /�-•-7��---��----._....-- Inspector..... .. ... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD10F HEALTH r cis - hC�3j�.......................................... / 1`/��7W- /<::>- FE � - Disposal Works Tontttrurtion. Permit , / = Permission Is hereby granted......... I...............; .............. .......................may... .................. to Construct ( L) of/Repair ( ) an Individual Sewage Disposal System at No........................./__P1 / t �—�I !//'1 /�/��� ........... Street as shown on the application for Disposal Works Construction Permit No......A............. /Dated.......................................... .. 1 ISU2fd Of��{Ca�«1 DATE...............I...... ..-z ........................................... "ASSESSOR'S MAP NO.Sc -4ASt& PARCEL 2a) 10 35 LtNCATION p��� SEWAGE PERMIT NO. dILLAGE INSTA LLER'S NAME a ADDRESS ti 0 � 8UILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � c d v�� �� � ,� � � �� i �` -mL�" �� y�` 6,. � � .�.. I xI • t,t iz ION S T EW . - . . ,. . EC AGE; - •� • :v 77 i 41 • _._._SEP_TI_CTANK. . - D. ..BOX _ ., ., ..LEACH: ZrV -TOP OF FDN' .. Vim•>y�}�. 1 WASHEO STONE. IN• OUT• +S IN _ Q II�eflO_G- OUT• IN• r SEPTIC x� •rE, TANK C ELEV. ELEV. ELEV. ELEV. G - 'i ELEV. -''ELEV. 1 LUT 1.. z a.� a -•J :�. OFV."-IV." � Gd ]- 4 9 E WASHED STONE 4-4 TEST HOLE LOG TEST BY,lei f::Amh rl �� h • �• ��x{ � - ' Iy of /�S P TEST DATE WITNESS 3 BEDROOM HOUSE DESIGN _ T.H.- w 1 T.H. + 2 __A[ ELEV.��Jrr(. ELEV. NO K PERC RATE 2 MIN/IN. DISPOSER DISPOSER FLOW RATE �.tGAL./nAY 3c� a . SEPTIC TANK 3BO 0)= REO'D SEPTIC TANK SIZE p - — GI� Y LEACH FACILITY y� g SIDE WALL (2'C) .3 .¢J G/D. Off' lh� BOTTOM .�, I,O) _ ' G/D < . b TOTAL' Z71 /pAl Sp, USE: LEACHING. !?" ^ram WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) ' ' L �+ RC, ZoN 1NG 0? 1.DATUM(MSL1 LTAKEN FROM'J,&�Qr-*-�,w QUADRANGLE MAP a - 2.`MUNICIPAL WATER _I�_ oVA1LABLE i F�0 P4 d 2-Q'. 3.PIPE PITCH:% PER FOOT I`�. �( p�!', 1 I. 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO• ,r �,� -44 �� ` ©F ��Srr 5 U)E7 S.MIN..GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT.6.PIPE JOINTS SHALL BE MADE WATERTIGHT c ARNE H. ��, REA R_ - F 0 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. O' ILA SITE Ft e N STATE ENVIRONMENTAL CODE TITLES !'�_ # / SITE ate..• �L:^ 8. T w.� ��s. 1 F=ot Y��^x� w,arX o�,�-r �.� b•-�o���-p 'o 03:)9 %P`�H OF �Asf7 LOCUS: y T- a 1 S K u AiNNE ti CFI/T�F)p VI MASS - __..._ REG. 'Si NGINEER o R .. � ov •- :<'+ idol; (''�°'+GE - ,i �i�e gineerin� ARE saLLow REF: d®w17 . c en 4'� �'`��` " -• PREP D FOR: S _ CIVIL.ENGINEERS t' LAND SURVEYORS BOARD OF HEALTH REG.LAN URVEYOR.' . ;I ��eAs:tn.sIh CONTOURS (EXISTING)--- �1�57f'-� MA . SCALE C-_ (PROPOSED) APPROVED APPROVED DATE . _. DATE � �