Loading...
HomeMy WebLinkAbout0621 SKUNKNET ROAD - Health 621 SKUNKET RD. , CENTERVILLE A = 169 011 i rirr UPC 12534 No. 2� HASTINGS. HN R j 4 1 Y l 0/4 0`f No. �° Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfppltcattou. for 30t�pogal *proem �tCom5truction er nit 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. Assessor's Map/Parcel 6 $Z1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7? 9 �e lf5l-' 77�- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building �Ievl _e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow '70 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Ze Description of Soil /01K WIr 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 b this B and og Health. /�� Signed Date Application Approved by Date Application Disapproved for the following reaso Permit No. e— Date Issued LQ' f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF B.ARNSTABLES MASSACHUSETTS Rpprication for &.5pozar *pztem Construction Permit Application for a Permit to Construct( )Repair(, Upgrade( )Abandon( ) O Complete System Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor'sMap/Parcel V Ge,�Ie v/ /Ie LZ 5 a, *e/4 '// Installer's Name,Address,and Tel.No. fl Designer's Name,Address and Tel.No. �Dl7`0X6�1`/COvlS�` 77/ 93�9 Type of Building: Dwelling No.of Bedrooms—� Lot Size sq.ft. Garbage Grinder Other Type of Building 3 Iee9_ ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow A29 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date ."Title Size of Septic Tank 4.X15 /��/>/� Type of S.A.S. ,,-.Description.,of Soil /0/wlO l Z_ Nature of Repairs or Alterations(Answer when applicable)_T)7-le z; !./,f,yz�e 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 this B and of Health. ,f Signed I")— Date 1 /1�16V Application Approved by - �`1 1 , �'' ,/ Date W i Application Disapproved for the following reaso Permit No _42sq-11Date Issued ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,th t the On-site Sewage Disposal System Constructed( )Repaired(V )Upgraded( ) Abandoned( )by at r� Z/ ��/.r`Il�! Y C�!7 j4'i'y/'/�G has b constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �~ dated Installer Designer / i The issuance of 's/p/ermit hall not e c n d as a guarantee that the syste it functiio,�n;`as designed. Date ! r `� = Inspector /.r;/ /17 ----- No. �— — ----------.-- / — ^ ©�1 FeeI L/ ! / J ✓'""' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Migpogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(l/)jJpgra,e( )Abandon( ) System located at Z I 51K4,W e)j e % 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:Con ction e/c'o�mpleted within three years of the date of t 's pet. Date: ! V �✓ Approved b j r � PP Y s 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) h hr/bP6,Aereby certify that the application for disposal works construction permit signed by me dated ��/�'/�� concerning the property located at � . '1/r/,�f� y� (!':R&'>�P//le-meets all of the following criteria: v/The failed system is connected to a residential dwelling only. There are no commercial or busine ss /es associated with the dwelling, e 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 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 Iif ethod when applicable] the S.A.S. will be located with 250 fees 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) 3, B) G.W.Elevation Z D +the MAX. High G.W. Adjustment. 7•b = Z Z DIFFERENCE BETWEEN A and B D 6 SIGNED : ��j!''�I DATE: [Sketch proposed plan of system on back]. q:health folder.cat co X �D XI/ 0 4v6 0 r TOWN OF BAR�NSTABLE LOCATION �i Z-1 J��ll!?.�</s��"/fit' SEWAGE # VILLAGE G���Ci�!/I/�� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. r��� � SEPTIC TANK CAPACITY ©DU LEACHING FACILITY: (type) `-2r;#/ / /"A0/2; (size) Z1ditr 2— i NO. OF BEDROOMS --� ,r`�►'G�IGi BUII.DER OR OWNER ' PERMTTDATE: ��LYl 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 •19 j jpilft 1 ^ TOWN OF BAARRNSTABLE •�� LOCkS ON Gi Z l ✓�C�t%�i��� '� ` SEWAGE # ,VILLAGE ASSESSOR'S MAP & LOT�6Lell-®V f INSTALLER'S NAME&PHONE NO. &/"A_Gr 2�eI 4e5 '4;P'- ?,2' SEPTIC TANK CAPACITY LEACHING FACILn Y: (type) G( `�� /�����' � (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: L//LY COMPLIANCE DATE: 410K - 4WPO 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 LT--7 Al 61 - 3q Az- gf � r Z - Z3 A 0 C 4 T 1044 S EiMA� E HERMIT NO. VILLAGE .. P INSTA LLER'S NAME & ADDRESS BUILDER OR OWNER et ��,� i .DATE PERMIT ISSUED OAT E COMPLIANCE ISSUED j � � � t � r( � - � _. _ � 'I .. � � _ 1\l �o l � � � ��1 ��� � -- ,`'�.. �_ �y ��. -: THEAO !EALTH F MASSACHUSETTS BOAR® OF' HEALTH -.............._.....:..._..:....OF............ A11.0rFa#ion for Disposal Works Cnonstrurtinai rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ............. _..�............................................................. ------------------------------------------- ---------._......------------.._......._. „. �Looc/ation-Address or Lot No. _._.._.... ..®.��✓1(.. :....{::1.pq_vn _a-..................................... .................................................................................................. caner Address --• L' -•-••-•--•------------------------------- Installer Address d Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms_________________________ __________Expansion Attic Garbage Grinder ( ) Pk Other—Type of Building Ubcd_______________ No. of persons_______` ------........... Showers Cafeteria Q' Other fixtures ......................... -----------------------------------------------------------------------•---_------�---------•-----•--------------------- W Design Flow_____________5.5.....................gallons per person per day. Total daily flow_______Z____2-0_____.._______._____gallons. WSeptic Tank—Liquid capacity_IO.V._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 ( ) aPercolation Test Results Performed by.......................................................................... Date......................... ........... Test-Pit No. I________________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......................... 9 ---------------------------------------- ___---•---•----------•--••----•-----_-__-___------------------------------------------------------------ ------------ 0 Description of-Soi1-----------------------•-----•------..._....----------------.......----------•...-------------------------------------•---------------------------------.....--•-------- W V --•-•-•---•--••---••--•••-•--------•-------•--••-••------•-----------------••-•-•---------••-•--••-••••----•---•--••-•-•--••--•----••----•----•-•••...........................••...................... W UNature of Repairs or Alterations—Answer when applicable....................................................................__.......................... ...-------•-•------••-----------------------------------•---•----•-•-•-•-----..•••-•-•-•------------••--•--•-•_•--- Agreement: The undersigned agrees to install the aforedescribed Individual Se ge Disposal System in accordance with the provisions of III!L-� "5 of the State Sanitary Code—T s• ed further agrees not to place the system in operation until a Certificate of Compliance has been issue rd of health. gne ------------- ... .............................................................. ----- c� Application Approved By..-? -•-••.•--�-L-.... -----••---------------------------•-•----•----•--.................. �� Date Application Disapprove e following reasons--------------------------------------------------------------------------------•---------------------.....-•---- ----------------•-•---••------------•••--••--•-••-•------••-•-•----------.....---•------.....----------...------------•--••--------------------------•-------••----•--•-•----------•--•-••-------•••••--- Date PermitNo...................................------••••------------ Issued....................................................... Date Oita THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .................... ..•-.--.•---...-.OF......-..-.....-.............-........-.-.----------...-=--------------..:.........._.._. ApptirFatiun for UWpos al Workii Tow3trurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............L��._...........0...---••J................ ................................` L . ......... LLoccation-Addre's orNo w r - Address ►W-a �U �' ..................................... .. ••------•........................•---... Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........______.............................Expansion Attic Garbage Grinder ( ) p•, Other—Type of Building _ _______________ No. of persons_______ ________________` Showers Cafeteria ( ) 04 . • Other fixtures _...._•••--•--- ----------•-•-------•-••-•••••------••---•••-•--••---•---•-•---.._....:-••-•••••••••-•••-••f•••-•.._..--•----..._•---•---•-----•--- W Design Flow.............r gallons per person per day. Total daily flow___.._._s _..= .... 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........................................ W a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --••-------•--------------•--••••-••••••....•••••-------•••.....--------•-•.........•-------.....••.......................................................... 0 Description of Soil........................................................................................................................................................................ W UNature 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— T s- ed further agrees not to place the system in operation until a Certificate of Compliance has been issue rd of health. r r ate Application Approved B .__: :__ f � a..-' PP PP Y -- -•- • --------------------------------------------------------------------- ----- Date Application Disapprove or t e following reasons------------------------------------•----._..__...------•---------------------------------------------...--_----- -----------------•-•----••------------••......__...-----------•--•---------------------------................................•-•---•---•••-•------•------•----•-----------••-••---------•--•--••---•--- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOA OF EALTH JJ A Tntifiratr of ToutpliFanrr T Sly°S C,FORTIF That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................--_: _..._..... _ ----•------------- --------- ----- --•-- ----------------------------------------------.......... . ................................. - Mall at.........f?._f-_........................ --------------•----------------•-------•---------------------•- -------------•---------------- has been installed in accordance with the provisions of TI T LP ` of The State Sanitary Cod a described in the application for Disposal Works Construction Permit No. _""r� __ _________________ dated�l._7 ._:�.`_____________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU A GU RANTEE THAT THE SYSTEM Vl/ L/f UNCTION SATISFACTORY. DATE... .......................................................... Inspector- ----- --------------------•------•-•-----..._.........._......--•---..._._...--- THE COMMONWEALTH OF MASSACHUSETTS ~� BOA OF H .......................0 ... i�t .:....... N.._�-= •--..._..__. FEE..?Y� �iuun u n� rutit Permission is hereby granted ....-•- '----•-�-•-•--- t .................................................. to Construc (�•�-or Reg tr ( ) andi a r e a osal System atNo.......X_! ------ �Q-------- �' . .--•'" •••-••--•------•-•••---••••-•--••- ---•-•-------------- f Street �y as shown on the application for Disposal Works Construction Permit No......... . r°Da d' . .... ._......................... ............................... •••••. ----------- -•- --------••--•---•-•-••••--••••---•---•-- Board f Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS E 19� 7"' j2 510ecs ARC map.Q iSex LFvGx_. t 1 0 S C �2- Y ffr-W'AU_ U W Et-, A MIA41ML)ltj op NO fS E UI,4 LEbS CTW�C — ALA- PIPF-5 Ow ICL_- 7 12.0" 4,:*-- -5r�laouL ME7 CAS AO 'P>\./.0 ALL. S C PTIC 'MilA IC5 lEsox, A"D 2..o v 0 C, 5,5 -5,o, -n-i (OD o#J J5 MA-1 _Z%4t__ e�F_OEA k QS op A&.)C> eAr _%L _L_ \.,j tT" C L.A., _1!5 41 0 F Le-AC_ _T X PT A�"I_ 0 _ 0 '0 (o I I WF- S4-5;rlE" k-> N CA %3 A— =r Sl �f4 X_ (r .... ...... 1 e-t4 m," AL c> 7e4 q=occ4e�r> Sep-r-Ic -r?--�v- wy Am ce c*.,i przc_,-,sr SC4& -cw -rd AISF V. oTr,:Ace- r j C "C Pr_P745 F LAOZ D Cl�� _i�_e_ -rew c Y�l r La r 'a 0 ol: �p 0 o DIS 0 CD C) 0 0 0 0 9 (D _0 0 0 F_% v r -rC XW_ LJW V_L_ STAS,L Le _rYP I CA L * rr Wor TC)SA=.a,.L CS 7, 000 p 4 to LL OCA pp-o po 5 IED VJF_ I KIG Oe:5 law Cel, eel-4 44 WA, so 0 PO 6 V-0 S M CF_ DI-SP40- �,.All�'A,4"J*eAe IO.P I YI 0 dr > 'e� JA(3 'o /W - . rrrr PAYMOND -1 4o -04e A4 y r AIC Aofl t Li it�. ..�Ppopo5mo LMACHINco P1 0 EX PA NI S A tA fft -For 3 7 OAT. 'SHEET 77 SCAUE rA 0 AW14 By APft -IMY: CHico ey� t