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HomeMy WebLinkAbout0020 STANLEY WAY - Health 20 STANLEY WAY,CENTERVILLE A 228 108 III � �UU iy� ad/�"'c"at", = m UPC 12534 No.2� 153LOR 11ASTINGS. UN i it I ,� i //TOWN OF BARNSTABLE EoCm LOCATION �7�l�'�'!L°Y �Q'� SEWAGE # VILLAGE G�61 °I"�>��e ASSESSOR'S_.MAP & LOT ZZ$ INSTALLER'S NAME&PHONE NO. _!�®� � ���✓iST 7l`�• � SEPTIC TANK CAPACITY /5"0o6-44 LEACHING FACILITY: (type) Z 41" ��� (size) //x 37 �0 � t✓ NO. OF BEDROOMS BUILDER OR(OWNE w3 PERMIT'DATE: /'I—Z✓'? COMPLIANCE DATE: ®- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching-Facility S 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 �C� 4IN DQou"• Li EI :SO6` Pot " 3 7' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS "- - Tipphratton for Miquaf *pgtem Congtruction 'Permit . Application for a Permit to Construct( )Repair(/)Upgrade( )Abandon( ) El Complete System L5Individual Components Location Address or Lot No. �y�� J awy Owner's Name,yAddress and Tel.No Assessor's Map/Parcel /�� / �,4,4) w/ Ci l/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Q�r j372-j C Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(� Other Type of Building C GG�No. of Persons Showers( ) Cafeteria( ) Other Fixtures l j� Design Flow l/10 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ®® 441S/`Al2 Type of S.A.S. f f i Description of Soil 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 by is o f alth. _. � Signed Date /�/oe9 Application Approved by Date Application Disapproved for the following reasons Permit No. '-Z4VO 1-T 3 Date Issued i l/TOWN OF BARNSTABLE LOCATION 7i0 ✓7`ak SEWAGE # �OU-ZS3 VILLAGE— e-&14 ASSESSOR'S. MAP & LOT ZZS' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Iraq 64L LEACHING FACILFTY: (type) (size)' NO. OF BEDROOMS y BUILDER ORCW"N3E .vs I PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S^� Feet Private Water Supply Well and LeachingFacility ty (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 , Qf ,L£ a sew pLL .�LC `(' j I ,<oe400 0�� . � Z Zk_eY No. L :a .+ Fee_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Miquar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) El Complete System L individual Components Location Address or Lot No. �Q Owner's Name,Address and Tel.No. y 7_1�9 S r.� O y Geri ,��-�,'ii s Assessor's Map/Parcel Cho�1 �,Q�/J �- 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(--to Other Type of Building of Persons Showers( ) Cafeteria( ) _ Other Fixtures l Design Flow l o gallons per day. Calculated daily flow `7 1/62 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /37410 42K/lS 2'14 > Type of S.A.S. 1D i� i'oJD/S Description of Soil r 7- Nature of Repairs or Alterations(Answer when applicable) / ll"Llt©� 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 is o of alth. ___. Signed / ��'� Date �Z�/®l� Application Approved by Date Z I-- 7-ae'D Application Disapproved for the following reasons Permit No. -ZA VO- Z 5 Date Issued y" Z S Z-O -0 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Z /D BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (✓)Upgraded( ) Abandoned( )by O Z9 at 710 "v I e er41 ,'--' has been constructed in accordance with the provisions of Title 5 an the for Disp sal System Construction Permit No. 7, 71&-21 3 dated Installer Designer The issuance of this per%ta�] �,q be o trued as a guarantee that the .e '11 f nc ion s die'gne Date Inspector ) ae / ——————^———————————————————--———————————— No. Ze'z 7-J 13 2 Z_1­1�1 15 Fee 3-0 r THE COMMONWEALTH OF MASSACHUSETTS , PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogai *p! tem Congtruction Permit Permission is hereby granted to Construct( )Repair( 14'Upgrade( )Abandon( ) System located at �4 i 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 Date: Approved by Q� 14" 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) L 7-,. 4elf te6,o�6l hereby certify that the application for disposal works construction permit signed by me dated y! ��� concerning the property located at 5�CadI dip l !mow y (1eo meets all of the following criteria: 1� The failed system is tonne-ed to a residential dwelling only. There are no commercial or business ' /uses associated with the dwelling. Y 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 1-40 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 tna�dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Athe S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located Iess 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 SIGNED : I - DATE: / (Sketch proposed plan of system on back]. q:health folder:art / d /� k�.,� ,� s ,I L �, ,►. TOWN OF BARNSTABLE LOCATION �Pd /'�� SEWAGE # VILLAGE l- �✓ ���1� ASSESSOR'S MAP & LOT2� ,;INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY �aa� i LEACHING FACILITY:(type) & �Lle)l-r (size) NO. OF BEDROOMS .-- PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERJ'fGl DATE PERMIT ISSUED: p- /19 4-17 DATE COMPLIANCE ISSUED: 7 VARIANCE GRANTED: Yes No .. , ,+ �,�� � ;i �� � yq aG � . �I° J :� No....11..:1..:. o F�s...,a4:..... ....._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF1 HEALTH .75'wV!1...............0F....!J4rnsLb L ....................................................................... Z ppliration for Disposal Works Tonstrndiun thrmit Application is hereby made for a Permit to Construct ( ) or Repair (4) an Individual Sewage Disposal System at Opp. J: >�I ........ .t.. ' � � II ................... .................................................................................................. L ton-Address _/ o Lot o. ......ANur_►_r„�f.... ?A�.. t ........................... .. ...... a..Q... 4mley _.�A.rLtrtV►�1. ............................ Owner Q Address ari�o---------------------------------------------------------------- rct. taw u.....---.....--- Installer Address y Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms......4.................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers a —Type g --------•---•-------•------- P ( ) — 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 ( ) 0-' Percolation Test Results Performed by--•----••••--•--•--•.........................•----------------••--.•---• Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.......----............. fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .•••-••----•-••-••-•••••--•••••••••••••--------•............................•----.........------------......------••--.......•-----•-------------...------•. O Description of Soil........................................................................................................................................................................ w U Nature of Rena*rs or Alterations—Answer when applicable JY10 -.[SQSy. 2Q.-Sep._lss..... la....�...-------D--i--- s.04...... 11— Agreement: li The undersigffed 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 by the board of health. Signed: lazw1aw./c................•------ ���Q - ......... q Date Application Approved By............. ..... -.. -----......1_� 7- Date Application Disapproved for the following reasons------------------------•---•---•----.......-----•-•----•------------------------•------------------------------- ........-•----------•................••-•-•----•----••••-------•--•-•-•---•---•••------------------•-•-•---•-•••••----•---------------••-•-----•-•---••-•••--••-----•......••-•••=•••---•••---....------ Date _ Permit No......................-•----------------------........... Issued....................................................... N., Date o ? No.......... 3 Fizs............._............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F...-.'-...--.......:........._........--------------..__......._.:_..._..._......_.._...-- Appliration for Disposal Works Tonstrnr#ion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (-;-) an Individual Sewage Disposal System at: ............... ...... .............................. - -------•--• - .... - ......... Location-Address or Lot No. 11 I f 1. ......................».......................................................................... •-••••-•---•----•--•-••=••••••••••=•-.........•••—•.........--•••••••._..._..............-••••- Owner Address W Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No, of ersons____________________________ Showers a YP g ---------------------------• P ( )--- Cafeteria ( ) dOther 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to.ground water........................ 9 -------------------------------------------------- -..... •••----------- •.... •... -•-----• -------•-•----•---•---------_----. -•........ •-••••••----------- •-- ODescription of Soil.......................................................................................................----------._...------------------------------...._•-•-------•----- x V .._..--•----------------••-•------••-•'-------------.._..-------•-•.....-•••----------••--•-••••---------....._•-------------------•-------•-•'---------..._...-------._.......-----••------•-•--•----•'- W U Nature of Repairs or Alterations—Answer when applicable._1____________________...................................................................... ----•-•-•----•-••-----------------'-----•--•'-----------.-•..'•'--'-'-----------------------••••••••........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 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 by the board of health. I , - Signed---------i-•---:...--•------•-----...-•........................................................... q Date Application Approved By....... --•----•---- Date Application Disapproved for the following reasons;----•-------•-•-'---------------------------------------------•---------•---•--------------•----...._..._....... -••----•---------------------•--------•---•--------------._.:..--•--------------•----....._..__._.....-----•------......---------•-•-------•----...--'------------------.•------------------•-------•--- Date PermitNo......................................................... Issued-...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ T ..........................................OF.........................................:........................................... Trrtifirab of Tontplittnrr THIS IS TO C RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY-------------•...... ... ........................... ' C Inst (1 l at--••---------�..................................... • ----------- has been installed in accordance w i the pros of TI�j 5 of e State Sanitary Code as described in the application for Disposal Works Construction Permit No----U-'--^___5_. .. ..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILh FUNCTION SATISFACTORY. DATE............... .'. ...:. ----------------------------------------- Inspector...............W---------------------•-----•-•----------•----------•-•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..........................:.................................._....................... , _ No.- FEE.........--•--.......... Disposal Works Tonotr iott rrnti# Permission is hereby granted........A...... ?..---- �L� � -----------------------------------------------------------------•--........-----•-•- Ay'V to Construct ( ) or Repair ) an Individual Sewage Disposal System atNo-----------------•-------------..__._...---•--------...........----.-....-•---------......_..__._...-----'--------•---............................................. ---------- Street ?� as shown on the application for Disposal Works Construction Permit o _______ _ Dated._____!: .�____._____.....__.._........ ................ ------- ---- ..... ........ C/ / _ Board of FIealt DATE------------ % o....f........................................ FORM 1255 HOBBS & WARREN- INC.. PUBLISHERS