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Home My WebLink About0013 MARC AVENUE - Health Y H annis A 252 -:062 No. 43501/3 RE® ESSELTEf �M q o a o S f No. ! ?' / Fee $5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Migpozal bpeum Construction 3dermit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components ocation Address or Lot No.. G'�t^t Owner's Name,Address and Tel.No. 'i Marc . Ave . , ., e , MA Frank Metell Assessor's Map/Parcel r 7 7 8-6 0 9 5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service 9 B@ �089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. 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 Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) New Title-5 septic system 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 Environment Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this ar of Health. Signed Date Application Approved by Date —2�— Application Disapproved for the following reasons Permit No. — ?4 Date Issued r z TOWN OF BARNSTABLE LOCATION a.z A. SEWAGE�,--__ GE # VILLAGE ��/(/T�'VIMF SSESSOR'S MAP & LOT �h' ✓Jn INSTALLER'S NAME&PHONE NO.-j SEPTIC TANK CAPACITY IS6 lo LEACHING FACILITY: (type) �-_ �'7 C. (size) NO.OF BEDROOMS BUILDER OR OWNER��%�AV�- PERMITDATE: �/-�'�' T j' COMPLIANCE DATE: -I/- 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 �C r w G No. / Fee 5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes "PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS s 0(pprication for Oiopooal 6pgtem Construction Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 13 Marc . Ave . , Centerville, MA Frank Metell , Assessor's Map/Parcel -7 S Z 0/ 7 7 8-60 9 S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service 40 V89, Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers(' ) Cafeteria( ) Other Fixtures �S Design Flow gallons per day. Calculated daily flow y gallons. Plan Date Number of sheets Revision Date Title ° Size of Septic Tank Type of S.A.S. Description of Soil Sand � J'r Nature of Repairs or Alterations(Answer when applicable) New Title 5 septic system I( ' G-' 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 Environment Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by th�arealth. Signed` Date A lication A roved b :. r - Date pp .P_P. y Application Disapproved`fo the following reasons Permit No. fib( Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 3 Metell -` Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( ) Abandoned Wm. E. Robinson Septic Service at 3 Marc )Ave. , Centervii.Le, l�a, Peen constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. %' dated Installer Wm. E. Robinson Sr. Designer 4' The issuance of this p shal of be construed as a guarantee that the syst ill function as d / ned. DateAq qq Inspectord !; a ---C---/-------------------------------[-- No. r r t Fee $J U s- Z 0 G T_ THE COMMONWEALTH OF MASSACHUSETTS Metell PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopooai *pgtem Con.5truction Permit Permission is hereby raWed to Construct( )Re air( X rade_( )Abandon( ) System located at l�larc t�ve . , C en 'erV 1 , lvlH 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 �` _ - f NOTICE: -'I't°&-Form-Is-To—He-Used--For The Repair Of Failed Septic Systems-Only. CERTIFICATION OF SKETCH AND APPLICATION FOR Az DISPOSAL WORKS CONSTRUCTION_PERMIT(`?VITH.OUT ENGINEERED-PLANS)- - I, William E. Robinson, Sr ,hereby certify that the application for disposal works construction permit signed by me dated S concerning the property located at 13 Marc Ave.,Centerville, MA meets all of the following,criteria' * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * There is no increase inflow and/or change in use proposed. * There are no variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S. map) 7 B)Observed Groundwater Table Evaluation(according to Health Division well map) 3.3 12 _SIGNED. DATE I LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). r d j i y 0. ti t r ` TOWN OF BARNSTABLE LOCATION SEWAGE # ` VILLAGE-- ' r—QU-6 V1 cSSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. j e)��+-,srr '2 F 7 C SEPTIC TANK CAPACITY' /•�� 9 w 'o'� LEACHING FACII.TTY: (type) a-- G (size) BZF:g2 N0.OF BEDROOMS BUILDER OR OWNER �t0i PERMTI'DATE:. . 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 Fin-fished by S 4 _ r E ' n ®p 't r LOCATION SEWN-706 E PERMIT NO. l2cTnhkc I�lj�uE /`/ VILLAGE 6�, �� ff)(A INSTALLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT 'ISSUED � DATE COMPLIANCE ISSUED J � 2� $ o � p f i � F N �- 3 N }i 3 t Fmc' No.2.(--L............ .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................0 .................................................................................... Appliration for %Vosal Works Tomitrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .......V4TV................................................ .................T................................................................................ nn^ vs LoM n-Adkess or Lot No. ecx-....��ro 5, .5$c _P ..................................................... . .................................... .......................... .. Iq ::F.. .............................................. 0 ... wn Address .. ..... ....................... ...... .............. ........ Type of Building Installer . Address .....4..... mr.... Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......4�.............................Expansion Attic Garbage Grinder ( 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( A4 Other fixtures ..................................................................................... <11 ............*---------*-------------- ------ W Design Flow._...____ ................gallons per person per day. Total daily flow..........�_73t..0.................gallons. 1:4 Septic Tank—Liquid capacity.LO.W.gallons Length________________ Width._.___._.______. Diameter_-_______.___._. Depth__.______.___._. Disposal Trench—No..................... Width_____.._._._...___._ Total Length.....................Total leaching area....................sq. f t. Seepage Pit No....k....VC-tDO. Diameter____________________ Depth below inlet___._______..___.._. Total leaching area..................sq. f t. Other Distribution box 14( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutesperinch Depth of Test Pit._._______________._ Depth to ground water_.__..__.__._____.._.__. Test Pit No. 2................minutes per inch Depth of Test Pit._.__._____________: Depth to ground water..._______.._.____.___. ............................................................................................................................................................. 0 Description of Soil...............................................................................................I......................................................................... ---------------- ......... .......I-------------------------*----------------------*------------------------- ------------------------ -------------------------------*--------------- .................................................................................................................................................................................................---- U Nature of Repairs or AlteratiQns—Answer when ------- ............... ...................W.00.....t-:4:10U.:..........PA.......(.A.-I.. J-0................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLIIHL4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h4AJ).een issued by of 14alth. Signed....)F::?,=; ...�.. ........................ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................. ....................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date i No........... .............. THE COMMONWEALTH OF MASSACHUSETTS - SOAR® OF 'HEALTH ...........................................OF........................................... App ration for UiupuFal Works Tonotrnrtiun lirrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................................... ...................------I.QA._......._ ...----------------------.._..-•-....----- Loca on-A ess or Lot No. � .... k W ...YY�! : .....V.1. ....J-f Q.5------------•............. ...................... ....--•--•---......................................... W Address b �� /VL�t : u-... ---•----........ �� P.art. ................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........;;l—..........................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building No. of ersons____________________________ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures ------------•-•---------------------•--••-------------------•----------•-----•--------•----•-------------•------------._..._---------............__.. W Design Flow...._.......iS_r___________________gallons per person per day. Total daily flow...... LZ..C].....................gallons. WSeptic Tank—Liquid capacit}L000gallon's Length------_------- Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date............._.......................... a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f-T4 Test Pit No. 2_...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 .................................... ---------------•--..............................................•........................................................ 0 Description of Soil............-..................................................................-----------------------------------------------------------..._---------==-----._...--- V ---------------------•-----------------•--•--------------------------------•--•-••--------------------- ° • _..--•-----•-----------------------------•----_...----•------•-•-•------•------------•----•-----••-------•--•--------------'.•---•----•-----------------------------._._.._..---------------•-_...-_ Nature of Repairs or Alterations—Answer when a licablAfewage ___..( ... _O. __..._..._.. Agreement: The undersigned agrees to install the aforedescribed Disposal System in accordance with the provisions of TITIIL 5 of the State Sanitary Code—The udersigned further agrees not to place the system in � operation until a Certificate of Compliance ha ued by e boar ]th- Date ApplicationApproved By.............................. -...----------------------.....__......._....................... Date Application Disapproved for the following reasons:................................................................................................................. ........................................_.............................................................................................. Date PermitNo......................................................... Isg&&.................... ......................... Date THE COMM TH OF MASSACHUSETTS �OAR OF HEALTH �pV ...................................... ...................... ........... inttr of Ton Viftanrr THIS S T CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by '� .. -••- : .r . ..._..... -•--- ^•---•------------------• ----------...•---------- Installer at-•----•�--•----•----- -= `�``�..................................•---•---=----•----••---=-----------------•-------•-- has been installed in accordance with the provisions of TI1 4�5 of The Sanitary Code as described in the application for Disposal Works Construction Permit 'o..__.�_/__.__.*"'_______________....... dated......................................._........ THE ISSUANC • OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM VblI F NCTION SATISFACTORY. DATE....�1... -•-............................................................ Inspector.... ..- --------------•---------------------------•----•----.........--- 6 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 76V) ...........................................OF...................... ..__......._........._..._._.__.._..... _..._...__-.._......... No......................... FEE._./................. Maps Cnontrndion pamit Permission is hereb granted___fl_..__' .............................._ ----------------------------•----...---•-------------•---••---------...._•------........_..-- to Construct or, �epai ( � dividual Sewage Disposal System jr at No f ,• .._. sr_g2 •----......!fir Street ,f as shown on the application for Disposal Works Construction Permit N,o�'��_........... Dated.......................................... ------------------------------------•---•----•-----------•------------- Board of Health ' DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '