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HomeMy WebLinkAbout0010 SAIL-A-WAY - Health I 10 Sailaway, CENTERVILLE ! A=230, 094.002 No. 42101/3 ORA L-21a 0 ` ESSELTE 10% ® o 0 0 F i TOWN OF BARNSTABLE LOCATION /V SEWAGE # PILLAGE Cl?nfc4�� <- ASSESSOR'S MAP &LOT OTT AO;. INSTALLER'S NAME&PHONE NO. �� CQ �- aSt 'OfoB4 SEPTIC TANK CAPACFFY C O© LEACHING FACILFFY: (type) A l/?C-xAZ.S (size) AY x NO.OF BEDROOMS BUILDER OR OWNER PERMFFDATE: _1 C- �G COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 `% >4 t� within 300 feet of leaching facility) Feet Furnished by 140Lse- � r 1 Q _ o� :1 l fl 3 9321 A ti 'M �, No. / dac.v r • Feed / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Mtgpogaf 6pgtem Cougtruction Permit Application is hereby made for a Permit to Construct( )or Repair( L_Ian On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) 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 Description of Soil AAA -k S WIT�!) Nature of Repairs or Alterations(Answer when applicable) e 0 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 issu --- // /� Signed Date (ra'`1"gY� Application Approved40 Application Disapproved for the following reasons It Permit No. �•� Date Issued Gam"`L G,--. Ab r No. ham' Fee f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pprication_for Migpogar *pgtem Cofigtruction 3permit Application is hereby made for a Permit to Construct( )or Repair( k_J On-site Sewage Disposal System at: j Location Address or Lot No. Owner's Name,Addressa nd Tel.No. 5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. by Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures I Design Flow S 'J gallons per day. Calculated daily flow 0 gallons. Plan Date Number of sheets Revision Date Title nn Description of Soil .. Nature of Repairs or Alterations(Answer when applicable) 'T'#kJ T0L( —VWf 0 —S V-C 36 9 {-(� i Date last inspected: Agreement: p 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 issu Signed Date Application Approved Application Disapproved for the following reasons Permit No. iv 17 , Date Issuedr"° L �� 4 ------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Certificate of Compliance THIS IS TO CE Y, t the - e age_Dlisposal System installed( )or repaired/replaced�n �O C� by Ia r ..���ita_� v;- for CtNc o`a L �i e c (� as L— Y C e� .,v,� has been construct d in acc9rdanc e/ with the provisions of Title 5 and the for Disposal System Construction Permit N 0dated " Use of this system is conditioned on compliance with the provisions set forth below: Li No.71 ^"'�.F Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpont *pttem Conttruction permit Permission is Hereby gra v a-W! \G_ \)D� �S to construct( )repair( )an On-site Sewage System located at n S 14 A_ Ate-Yk_)r L�PcvT-' 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. All construction must be completed within two years of the date below. Date: �`��!'' 7 Approved n CERTIFICATION OF SKETCH AND APPLICAILUNRM , . WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLAN 1 .. t 44, 41 {x �:;, r '+..' f•,G F _t Ir F ♦" }i`�Igs-iv � �i�i�• \'�Si.S 6r_.T',+t Y hereby certify that the applictot�fbt a construction permit signed by me dated ` property located at /l� S k� r�— '"4" C�� `; bf&�' P ' 2 following criteria: r C 4 ti, 9iRF � A • There are no wetlands within 300 feet of the proposed septic ttyettrtt • There are no private wells within 150 feet of the proposed septic"etit • The observed groundwater table is 14 feet or greater below the bot ton of the leachii4fl6citlty • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. R. i < i'ijt#3' ire ipary � I� c F# �� D ._ � (g F,� �A tr uq a� ��A�d•[t� t [�F 1. 1 SIGNED: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARN LP.NU1Nbl�lt Y x\�J b� ir'�r 'B`a tp±;.•f'" iw'rry a 1 1 7 4. Ae R r !a• f<k.,i 4 j�'8�y� ? �'in� t�tf t.���q }x F t„„"q •at���,A'�'! a�"F�. [Attach a sketch plan of the proposed system. Also if the licensed installef p i ' this plan should be submitted]. t EX r � i'•.y�' k �s��,�`.. + �. ''F -a�+hyw�S5F..� l4��1�gr r�" +. �?ur *'x'r'4r'i�g.,�t�}aW��,i-�ia r�1"� az�a� '✓�f 91 All jr Wf sntnn 4ti a�t(ki'rZ ���x(qqc^ si. k=a a T � �� h .�� 1 , v� ® ® � � � �/ � �' � 1 �` � i 1 ��/ " DAj-t-Gr'%S U ec.4L coo Q �CTC.r R2+ ,1 agow� LEVEL. Fr KL T S elyl;I EXiSYi[vG Q �`�- C,f::r(ot I r E1 qc P n ' D H�.D / 4 —_ yTOWN OF BARNSTABLE_ ZTGE:—Cefr7 O SEWAGE# <�'est�S� fGt✓t��{r ASSESSOR'S MAP&LOT O a, INSTALLER'S NAME&PHONE NO. /714d Noo —1CxIZC. SEPTIC TANK CAPACITY C 00 O LEACHING FACIIJW: (hype)—�. �e es (size) :ka x Ca,00, NO.OF BEDROOMS -3 t I BUILDER OR OWNER i PERMITDATE: '/l- 91, COMPLIANCE DATE:_ � ' la I Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Fat Private Water Supply Well and Leaching Facility on site or within 200 fat of leaching facility) any wells exist Edge of Wetland and LeachingFacility at ty(R any wetlands exist within 300 feet of leaching facility) Furnished by Fa93 A � a O. AT 0 3EWA E" Pf R T 'NO. ,� I wa; 1NSTA LLfI'S NAME j �.ypORESS B U 1'L t R 4R OWNER 4 G DATE PfRM'1T I1S0'E0 -OATE COMPLIANCE 1S Sul D Z.'4 x•.sr�e. al t6�.'ffi� a ' 1 a � 3 t0' CATIO SEWAG PERMIT NO. VILLAGE INSTALLER'S NAME i ! ADDRESS BUILDER OR OWNER Q Z DATE PERMIT ISSUED 7- DATE COMPLIANCE ISSUED is tt it t C �f } �•SE 4GXX3 G-�AL =.t ��l�t. . r7N. 1s4 PG. Go t-i,tp. le , i�.TZ ( lu I fiitlt,l o� 4 `} e3 v, i Rgi �tA ; Ll 1 r 1 ee i3 q t 1;:r1Ul4IVAM SLI d�fvG 4 ! lt�N. .._ - � i vir Y/tip ✓ d`+ .,'. '#.r w• .� SYt7�.la i-,i..t' jzof sllwi�irM.� �7 WAIM OF rahs�as rs►tu�' A• , No...._... % ... Fzg.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® H EA TI—I G oF........ . . .................. App iration for B44paaal Works Towitrurtiun rqmit A plication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst 4. f W --------- ----------------- _. ----- --------(.............. ........................................................ ...... r Lot No. �/`�=�'---- - .'."�e"..................... .... ......................--- ....o�.......... •-----------•---.....----------- owner Address W ° .' ................................................ ............................................................ - 'Installer Address d TypeifBuild��, Size Lot............................Sq. feet Dwelling . of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers, ( ) — Cafeteria ( ) w ..... � Other fixtures --------------- ------- ------ -------- -------------------- ------ ----------------- .............................. Flow._........_�5............. ........gallons per person per day. Total daily flow �?_ __ ....._ gallons W -., �iquid ca ity_�...' ....gallons Length ......-.._Width.__ " __ Diameter ______________ Depth W gj4d.4d : t........ Width...../,I--___-- Total Length........ ._ Total leaching area..___Z sq. ft. . x Seepage Pit No-_----------------- Diameter.................... Depth below iplet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosin tank 7' -J' !!-- '-' Percolation Test Results Performed b ._ ds......... Date___ -_ '. d` �, Y 9 ,� Test Pit No. 1.... , "__minutes per inch Dep h of Test Pit____________________ Depth to ground water--_-_-__:-.�.., /..0 (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------ .......... --------------------•. y ® Description of Soil 'a- . -' 9'... ............ . , V .....-•--------••------------------------------------------••---------------...............--------•-•----•••--•-•------------------•-----•-----------------------••-----------------------------•.--•- 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 i1'1 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. Signe CC, Date APPlication Approved BY _- .: - ..._.._...._ 1__-'_........ ---7�.... a Date Application Disapproved for the following reasons-----------------------........................................................................................ --------------------------------------------------------------------••---••----••-----....••-••---•-•-....-----••---•-•---------- ----------•- ---------------------------------------------------------- Date P PermitNo...................................-----........••-r•-•-. . Issued --'? ---� ._....................... I' Date No :�. ��'- .��, .� Fps � � .... j' . THE COMMONWEALTH OF MASSACHUSETTS BOARDg HEA TH r Appliration for Difivolial ivorhi Tiamitrurtion J10 tit. A plication is her made.for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systat. -••- ........................ .............••---••----•-- ......... ` ...__........ ......: ......... L Ad ' ss or Lot No ............ •-_ --- .......................................... --- Owner -Address W = ` ... ________--•-----------• -- Installer Address dType(f Building Size Lot............................Sq. feet aDwelling To. of Bedrooms......_....__________________________Expansion Attic ( ) Garbage Grinder (' p•, Other—Type of Building ............................ No. of persons...------------------ Showers ( ) — Cafeteria ( ) p' Other fixtures ..... ,._-...----.--- allons er erson er da Total dail flow_____ --- --- -- ------- _ ----------------- - W Desi n Flow._........_ ` �...............................gallons. W S �cTapiquid ca city l .gallons Length................ Width_ . Diameter ____ Depth .__�.._..__. x 1 a .+ - ........ Width cc:__ .et►...... Total Length......... Total leaching area .....:sq. ft. Seepage Pit No..................... Diameter..................... Depth below • let..._....._.....___.. Total leaching area.... ............sq. ft. Z Other Distribution box ( ) Dosing tank 7- r '-' Percolation Test Results` Performed by. ''...... d`yr�r*,-� ......... D.ate._� `.7, ....... Test Pit No. 1..../.___..___minutes per inch Depth of Test Pit __________________ Depth to ground water +.y f � rf Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......!-. .......... `t a' -- -- p„_. Description of Soil `" --- �� � r ✓ U ............ . --------•-•---------------- -. ----------....... .-----------...........---•----------•-----•-----------------------------------• .............................................. W ---•- --------------• ...•--•---•---------------------------•-----------------•----•----------•-------------•------------. •----------- VNature of Repairs or Alteratioris—Answer when applicable.....________________________________•-_--_--1 ..............__................................ ...................... •---------•- ---- -- .p .......................................' ------ ............................................................ Agreement , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 1'A iE `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 bythe`board of health. Signe , ..4 -------------------•-•--•-_---- ................................ Application Approved By------ Application Disapproved for the following reasons_................. _____. .. .............___.:.____.________..______.___.Date ................•------------•-•---•----•-•-•--------------------•-------.........-..........-----------=------•-------------= ---------------------------------------------......................... Date Permit No......................................................... jssued................................................... -•=--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALT Trrtifirati� of Toniplianrr IS TO C TIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( " ) by ...... . .. --------••--•-------------•-•----------- _---- --------- Installer •---•----••--••-••--••-•---•----- * ----------------�-----•-------•--.... has been installed in accordance wi -I the provisions of TI" r' S o The State Sanitary Code as described in the application for Disposal Works Construction Permit No..". s.... rB . "" -- ------------ dated--- --- A-'-'"l---_-Z - --------- THE ISSUANCE OF-THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. j . DATE................................... --•-••---...............---•-----••-••--•_.. Inspector:.........................................................= F : .........:.............. ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH .. ....OF.. ����' ' .!............................................... G7 ), r. No..:....l.A. .... FEE.. ................... Ri In or � n� �trtimrn rrntit Permission is hereby granted_.to Constru t ) RepairXZ�Otl. Individual ewa sposal System, at No.-"� ` ".. ... -- -- --- r."S e,t .. as shown on the application for Disposal Works Construction Per o ated.__ *................ " ` j -Board of Health ................ ..... DATE-------=----------•---••-•------••----•------- . FORM .1255 HOBBS & WARREN, INC.. PUBLISHERS