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HomeMy WebLinkAbout0213 STONEY CLIFF ROAD - Health 213 STONEY CLIFF RD. now CENTERVILLE A = 190 153 No. 42101/3 ORA e-2 V 1000 0 @ I 0 © C O i TOWN OF BARNSTABLE LOCP�t'_ON 2,i 3 �,^ SEWAGE VILLAGE ASSESSOR'S MAP & LOT-LID" 6S . f i INSTALLER'S NAME&PHONE NO. ��t/ / 14MO5 vW SEPTIC TANK CAPACITY _ AM LEACHING FACILITY: (type) --330 P.FY c (size) ff.2-0 NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: G- Or COMPLIANCE DATE: I (7) 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 /� � �� �'� a��� 1 a7 � � �� �� .? ,Y� � �? ' o i No. Y�✓ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: res PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for �Bigpogal *pgtem Comaruction 3permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Lo anon A ss or L o. Owner's Name,Address-and Tel.No. Assessor's Map/Parcel % 1+13 Y 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(A)p 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 X 1 d�� Type of S.A.S. Description of Soil MdNature of Repairs or Alterations(Answer when applicable) �� _l(\Qc,kg,,A)r,� 1-4 C12,k OP 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 ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B of Signed Date �tG�la S Application Approved b Date sS'-��=� Application Disapproved for the following reasons Permit No. �1?�� C� Date Issued _ �' 4, No. 'f/�F/ � / Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in comp��ter: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIppYication for 0i.5pool bpotem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lo No. Owner's Name,Address'and Tel.No. - ,�fr�v a s #- y 'It c� //�`M N C, Assessor's Map/Parcel 1 I L 'S 3 / Installer's N ame , Address,and Tel.No. Designer's Name,Address and Tel.No. 7 �Vim..� �G..�J`���f'y��"�• (�� Type of Building: r, Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(M) Other Type of Building No.ofiPersons-,k- r- h Showers( ) Cafeteria( ) Other Fixtures7r f� ' Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �yU Type of S.A.S. Description of Soil k)d ,� Nature of Repairs or Alterations(Answer when applicable) ( t(1 kCTAfs 14 G-C.fZA Q - SkT;� 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 B of eZ)f _. w Signed - s, Date L 1,t'e Application Approved b �. -z.w �� Date .s�! -e Application Disapproved for the following reasons E V Permit No. dl'0/i ! Date Issued " C5 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that tke On:site Sewage Disposal System Constructed( )Repaired( V Upgraded( ) Abandoned( )by 1vtr\ at S R,, /Vk�\_1_ has been constructed in accordance with the provisions of Title 5 and the for Dis osal System Construction Permit 0/ rr Sr dated ,C" —0 /. Installer _U Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date c7` Inspectors No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpooal *pgtetn Construction Permit Permission is hereby granited o Construct( )Repair(" Upgrade( )AbandopO System located at rJ�CS/� Y C�-C t �V ou-"iv-i 11 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 thi ermit. Date: Approved + 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) (\-N�r-^"I k hereby certify that the application for disposal works construction permit signed by me dated & /)-4- 16 , concerning the property located atS�^2� C.� �(� meets all of the following criteria: This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 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 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 i 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. + = V`� J DIFFERENCE BETWEEN A and B SIGNED : DATE: CL -7 [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert c% B 4 xas., s �. � '�° :::;,y 't+,�'�7. - '� � •� �i h#t ' �" � -.>;: f ti "•.:"� !1 �'^'c .,y '� �?-��"+A �''r �r• � .,� r ' r �' �,-1�1 d i! - .P �, � tidy`r �� tizX? sjd,� .�^t.0� £ r�"� z g • TOWN OF RAW NSTABLE �- LOCATION ,2/3 SEIWAGE.#a2oo/=5'ir3 s .VILLAGE,. ASSESSORS MAP & LOT �J 3 INSTALLER'S N,A&M- a PHONE NO dj V �ryr - SEPTIC TANK CAPACITY�6Dd LEACHINC� FACII,IT'I .. . ice"•��-o'' NO. OF BEDR00h%I5. KaDER OR 0,W1i Est PERMITDAT.- .G�—.2 0::" ®�. COMPLIANCE DATE. Separation Distance Betdveen the. Ma QmurnAdjusted Groundwater Table to the Bottorn of Leaching Facility Feet Prtvate.Water,Supply bberL and LeachingFacility ty (If any wells exist on site or within Wo feet of leactung facility) Fee t.• Edge _ g Wetland and Leaching Facility(If any wetlands exist wi thin'300 fee:t.of leachin g facility) ,:Feet Furnished by I 0 1' o E tr e ' TOWN OF BARNSTABLE LOCA'_'ION � 1� _57 d.,ajr cfZ /9; SEWAGE # Z3— )93. VILLAGE C2G /'aJ;%/ ASSESSOR'S MAP & LOT�1�Zllly--1-113 INSTALLER'S NAME & PHONE NO. y�nv �,�Ijrl�y�s�5 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) /f.-1 cJ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER TG�L'Y BUILDER OR OWNER e� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No l r � -r ��� � � ', �` s �� '� /� , 1 C1 0 THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOAR® OF HEALTH a` OmervationDepertmenrrOWN OF BARNSTABLE 6 — / .3 --l�itof ;-Di ipagal Work.5 C onfitrurtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: t ........ ocatinn or Lot No. ...................... ... ......./ T................................. -••-------------•-------•-------------...._----•-•----••...-•----...................•............. avn er a Address •........ ........ .. �............................ --------••--......------..................- .......------------•-•................---- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms...........V�--------------------------.-Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons--.:-----------.----------_ Showers ( ) — Cafeteria ( ) dOther fixtures -------_-- •--•-•------------•------------------------------------------------------- ----------------------••-----•----•------------•------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacit ,/ ''r2-.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........--............................. 0-� 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........................ Descriptionof Soil-------------- . •.......... ` ------------------------...--•---•-----------•---------------................ V 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of•Comp 'an has been ips dN the board of health. Signed .. .. . .... .. .. .................. f' '--- ............ .......... ..................:...... Date Application Approved By ........�e:,� . . ..-_�- ........ ................................. Application Disapproved for the following reasons: ..................................................................................... .................... ............ ................................................................................................................. .... . .... ..................... ........................ .. ....................................... qq Dare Permit No. ....../93... -.... ...��... Issued - ..✓ I. ........... .................. Uate w...L'.i..a`.+-..;�„-r`'r-- �-,.�1�..'-�.tee..... v -v' ...7.:.� ._..y�aa:... -.- ..�..�.-. _Pt'.. ..,G,�.r. ..-t.. e.-.��i..y-r" '�-+i;i.,•:✓�....wv-...`....-.-.-.� Ci o 16-3 No... Z6 - g.-1-- Fss..... >.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH - 1 TOWN OF BARNSTABLE liration for Dio:poaal Mork!i Towitrnrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ------_-----•---------- •-•----------•----------•-----•-------•••----•--------...-•---------------•-•----•----••-------•-- oruintd rss or Lot No. .........`!:^':Sh _ ...... .y rrl. .. ................................. .................................................................................................. \crier Address W .............. ... . .txL �s�'�'.�r°K' ....... YM-1 Installer Address UType of Building Size Lot............................Sq. feet I-, Dwelling— No. of Bedrooms.__--_.-._�.3----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -------------------- ---- No. of persons---------------------------- Showers ( )�.Cafeteria (� ) Other fixtures ....... -- -------------•----------------------. .............------... W Design Flow-------------------------------------.......gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/0UQ--gallons Length---------------- Width---_--.-__-__- Diameter.---_--_.--_.__ Depth................ x Disposal Trench-- No. .................... Width.................... Total Length.................... Total leaching area........._..........sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area...t.............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........................ Lr4 Test Pit No. 2................minutes per inch Depthof Test Pit.................... Depth to ground water........................ Description of Soil �� 1 .._. � I ....... ......•-- ._..--......--------..---------•---•--••-•------------- x . w ----------------------------•----......----------------------•------------------------------ ------------------------ --------------------------------------------------------------•--------......... 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 TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of CompkaT has been iss ed y the board of health. Signed .....- - v�� .�l� ... ......�...-.a.....-`...�� ..... ......................... Dace Application Approved By ....... � —. ....-`1 •4.�-- �r «�, - ... Date"" 9�?� Application Disapproved for the following reasons: .... ............ .................................................... .............................. ................................................................................................................ .... ........ ... ......................................................... ........................................ Date Permit No. ....._9... - '`7...9... ............... Issued .................. _ �- �--........ Lr.............y- �............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE %T.ertifiratjE of TIImplialarr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ...N v... c. � j......................................................... ----__..... ..... ..._........... ........_......_............................... at ........ _�.. ............ ..1..ClY.................�� -.....- .......--...... r?_ s ._' .� _� n.- -- - has been installed in accord with Xbcdtovisions of TITLE 5 The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._._.� ......;._.�.' -.._. dated ..........6 ' ._.�...Y.�.�3 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... ...� ..L�- L- .-._........ ..... .....__ ....._ ...._ Inspector .... ...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q TOWN OF BARNSTABLE No... FEE.'.: . �...... Eliquisal Word ion trudion Vern it Permission is hereby granted---------l l,'Q.'1t�ii---- l s cacc cr� --------------------------------------------- --------------•-----------••-------•--- to Construct ( ) or Repair ) an Indio-tual Sewage Disposal System ........------------------------------------------------------- -- Street as shown on the application for Disposa Works Construction Permit No.��_-��/�__ Dated-.---___.�..._�.�."'.�� Board of Health DATE---------- ---------------------------............. FORM 36508 HOBBS✓!t WARREN,INC.,PUBLISHERS - '