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HomeMy WebLinkAbout0037 WAGON LANE - Health 37 .WAGONyLN. ,HYANNIS 191 A = 270' UO C A T ION SEWAGE PERMIT NO. s �9,Z 3 / �14 VILLAGE I N S T A LLER'S NAME & ADDRESS ® U L D E PR OWNER DATE PERMIT ISSUED -7 0 DATE COMPLIANCE ISSUED � � ,: mot' v� I �" Y .' \ � ,. .. '� No. FRs.... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF..............................-..............----......................................... ,� lirtttiun for Uiuvusttl Workii Ton,itrnrtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal 1 System at: , '- ' .......... ....................Cd.�c:�.,�-.. --.......................................... b� 6 ` - Loca io rese or t No. ..................... -•-• .... ..............---- `:::.-•----.... ........... _.. .......................... Owner . ddress W •-----•--•----••••••. ........................................ .............(�.. ... :y. .:....... Insta Address Type of B )ng Size Lot._.___`Q.c_ _°..'..Sq. feet U Dwelling—No. of Bedrooms............a..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ............................ W Design Flow............ 7 ....................gallons per person per day. Total daily flow......3.2 0.......................gallons. WSeptic Tank—Liquid capacityJjov-?.gallons Length............ Width....:G��. Diameter................ Depth..,57fK'.... xDisposal Trench—No.Iz—,............... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........-- -. Diameter......(a--.--..... Depth below inlet__._...........__ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch 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........................................................................................................................................................................ ",� 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 iITLL 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. 4 _ Signed ----•-••..................................................•--•--------------------•- --••--• ---•--- --._...-----•- ApplicationApproved By.... ••. ----- .--• •---•--•--•-----•--••.............•---.....----•-••............-•--- ... "� %........ Application Disapproved or e f ollowing reasons---------------••----------------........----------------...---------------•................................... •-••-•--•-•--•--•-•---••...----•-------•--••-•--......---•.............•--........-•--•------•-•--....-----.................--------•---••-••--•--•••-•----•-----•----•• •---••--••.........----- Date PermitNo......................................................... Issued........................................................ ---- - - -- - -- Date�`u+-au-----------� l .n4y � ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF..........................................................------------.................... Applirtt#ion for Dhip stt1 Workii Tonitrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................. , _ .. . ....................Lam.... . . .... --••--•------•-- Loca ko ress or t No. ................. =-----...... ........... Owner ddre s w --------------------- :. .......................... ...... ....-----1( Address d Type of B i ng Size Lot...... °_'._Sq. feet U Dwelling—No. of Bedrooms------------C3..........................Expansion Attic ( ) Garbage Grinder { ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ..._..-----•--- ----• . d W Design Flow............s�t�.--�........... gallons per person per day. Total daily flow......+�c?4.......................gallons. q p jos,x.gallons Length_... ...... Width._.. '! .!"... Diameter................ Depth.. .. W Scptic Tank—Liquid ca acitvl . ,.. x Disposal Trench—No.�:.`_'� Width...I................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------- ` !.. Diameter.......4---------- Depth below inlet.....4............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date._._.__..........._..... -------•-- aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........_.............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pG ._...---•-••..................•----.............-•--•-•--------••-------.............-•-•--•----•...•....................:..------------------ --------------- 0 Description of Soil......................................................................................................................................................................... x 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—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 f..............•------•-•---.............:..........._..---............---....... .. .. ... .._..... Application Approved By---- --• .--... == ... ..------ .Date Application Disapproved or a following reasons-------------------------------••----•------------------•------•------------.....-----•--._..........._.......... --•-•--•-•-•--••-•-•-----••-•-•-•---.._....--•--....---•-•--••--••-•--•--••----•.................•---••--•---------------------------•------•---•---••-----•-•---------•--••----.... •---...--•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................I................................................................... �rr�ifirtt�.e of faunt�l �tnr�e , T S T ERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by -' % - ----------------------------------------------------- ------------------- at •. ---_.._ .... • . -- nstaller at•--..................... .. _ ---- ---/RTIFICATE f; ``fit" ------...-------••--•---•-----...----••------------.... ....--- has been installed in accordance witovisions of TITLE 5 f T State Sanitary Code s, ibed in the application for Disposal Works Co ` Permit No._, .�"_ K�.. .......... dated... _ ..,/.................... THE ISSUANCE OF THIS SHALL NOT BE CONST U AS A GUARANTEE THAT THE SYSTEId WI UNCTION SATISFACTORY. DATE._..X .... ... Inspector.. •-• ....-•------------------------------•-----•--..__.................---••--- * THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF........... ... NO. .....:.... FEE..p7 ................ - �i��oo�tt� ;��nno�rtgrtion rant# Permission i ereby gi ted.--- ... .: Y. ... ......... :...............................................................•- to Construct ( ) or R it ): Ind' 1,a age Dispos y'stem r •. Street as shown on the plica n for Disposal Works o s ruction Permit No________ _ ___ _ ated ___.........._.. // M L < Board of Health DATE...-=--- ... ..._3-................................................. FORM 1255 A. M. SULKIN,-IN"C..'BOSTON in O fP t ,�.,od 11� 0 p p r AV �� n D to ° d � c n I (P .3 r A a rmo 0 >-z �oL r w$� � y n�m Z IS n r � m 0mrW �� O D D D zGN _ Dx LA co z -1cr p m-C� sl �Q -1 � ➢ 'il � m _ � CO MMo��" Z W Nil c • ZmZ dZ � d SNz D Nn .off p �z `1m Z 11r . 0 cN ) V, o 4d V r p in �o ,, r c n O ZvDO � 0 D v n � � N �m v — .�- L�2 r Z m� __777—__ — — ` %"GLc_ FAAkL`l - 6E0200M IJ� GAQ-i�AGE' 6QjwDE2 DAILY oW :. IIUX 3 = 33oG.Pp 5EPT►G TA► K = 330x15U% = �495G.P. l000 GAL. D►5Po5AL P►T �5E 1000 GAL. S ti DCYdA�L A2CD. = 1 5�o S,F I 233 50TTOM ARF-A= 5O 5.F x I O. .= 5o 'ToTA L DES►GN = ,425 G.P. D. 9f8 97 -W, t O L ;E \ 'TTA DAI►-�( F�ov! = 33oG.Po. — `( coLATJoN RATE r ('�►N ZtAW ot~Lt~55 i P Ex� T• p Q I � �sr•� S.T.ro, O � . .. a (3oac ,,✓.,y�T.y. 98, p Zo' !9 U'r 6w J P��H OF M,(I, A I . �• • � AIAN yN �•3 �) F2ICHARD A. W. I `BAXTER v, JONES u NO.24,048 o. 251c _ 0 �QiST¢R� @' Fir. �,� I -- ///• LU - ^'o Top FNO'-1,00.o NoLV—: Z//8/B3 = 99.o 9-7 Rr i Sr�T laoa INS. �j65a►L. ��� INV S�Pr►c. 97 G �l Z Joao IN , 97 T TANK M EF,) LEacu $Arles PIT � INV. IN WIT" 1r7'o z. I r ' WAsur.a w4p rpIn c ��� CERTIFIGP PLo�' PLAN Sa� P 4Z C�F 1 L.!✓ lL' LocA-r1oN N,�/�� �ls �10 N0. .SCALE SCALE = �AT� 11I83 ��.� ems. ( 13183 , CEP 'f%F`( TNAT TNEi �nut�DA�Io .5NoWN NAr p SOW GOMPL`(5 YJITN T HG; S 1 oEL1t�1 E 1^coT 2 Z � A1.1D 5E'c5AC-K P-GRv►R.eMEN'1"t�' of '(o WN O F:= BAP�JSTABS- AN-D I S Ncn- 1� / L .T D W ITNI IJ T OCp E Glr.00D P 4.I N DATE� Cc BAxTEcz e LYE INC. -I�'SO�j I REG 1 S'T E.Q6U't-A►�D 5 u�v EY�e�S TI115 Pl.at�l 1!:-' NorT otd AN a3TE2.vILLE - ass• I IW51-R.uMENT SvZvey �--r 4e c>1= ETS SuoU4,D �� -rF Noy DE u5Ep,Tco DETE APP EZl^111� LOT LINE�j �.IC A►-JT _ TOWN OF BARNSTABLE ;.OeATION7 L"Ca©& 4. SEWAGE'# VII LAGEi.+i! S ASSESSOR'S MAP & LOT IV , 7_0 INSTALLER'S NAME&PHONE NO:_174 G 414 a SEPTIC TANK CAPACITY /O G J .. c LEACHING FACILITY: (ty ) /il/rz/T2. !d2-_S' (size) L //,�.2S ` NO. OF BEDROOMS ,BUILDER OR OWNE PERMITDATE: COMPLIANCE DATE: Qa3lod 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 Within 300 feet of leaching facility) Feet Furnished by t �. � � �°. � � .. . t�s �, ���I�. - n.� � � .� ;- . _ .. . �Y { ^ 1� � �•. �• '� ,� �. � �.',r- . �/ 7 �Y J IL' • � �r, r., Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSE' Zipprication for Migpooar 6potem Con6truction Permit Application for a Permit to Construct( )Repair( )Upgrade(L/Abandon( ) ❑Complete System 04ndividual Components Location Address or Lot No. -2 Owner's Name,Address and Tel.No. Assessor's Map/Parcel '�'Z�,I *0_1L11 �k � E � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. As `owl sr. 11,4 Type of Building: Dwelling No.of Bedrooms 7— Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flower gallons per day. Calculated daily flow ?J�� gallons. `'Plan Date Number of sheets Revision Date Title Size of Septic Tank f-K ' `r: Type of S.A.S. Cr4 Olt c Description of Soil Nature of Repairs or Alterations(Answer when applicable) rti-St A,-l\ 99tf_ (A` Fg�y1_ 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 and of Signed Date Application Approved by W✓ Date Application Disapproved for the following reasons Permit No. Zero`3 o Date Issued " -2_Z p TOWN OF BARNSTABLE PP11 LOCATION 37 LIM& v,(/ L,41• SEWAGE # V VILLAGE��i�� c ASSESSOR'S MAP & LOT O— INSTALLER'S NAME&PHONE N0. �NAe3 C d 1g e e; Al c SEPTIC TANK CAPACITY /D Q o c LEACHING FAaLITY: (ty ) 141 L-/r"%112�' (size) NO.OF BEDROOMS a - BUILDER OR OWNE G PERMITDATE: d COMPLIANCE DATE: O 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 within 306 feet of leaching.facility) Feet Furnished by . I i s �-,------,--------...___—�.-�_�,._-TOWN OF BARNSTABLE A LOCATION 37 L A6 O (/ 4. Itl- SEWAGE # VII,LAGE ASSESSOR'S MAP &LOT O INSTALLER'S NAME&PHONE NO._ !/p C SEPTIC TANK CAPACITY - o LEACHING FACILITY: (ty ) /4111-ZlIZ lf%Q/2- ' (size) r/r�••2s _ NO.OF BEDROOMS a BUILDER OR OWNER PERMTTDATE: d COMPLIANCE DATE: O 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 within 300 feet of leaching facility) nis Feet i Furhed.by V t Tejo I I • i No. y,/ Fee i / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Di!5pogar 6potem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade(L4Abandon( ) ❑Complete System individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel ` 57 G� 4L) 15 -70- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. :f Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) z Other Fixtures r_ _ Design Flow gallons per day. Calculated daily flow ���.'G gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 9 a -,-,—Type of S.A.S. H k (k (ct a 6 i"t vM A%-g(aC Description of Soil Nature of Repairs or Alterations(Answer when applicable) v�SC"�d\ ��-t�G W lc�.►/L 1A ' L ( u.c_" A- c,•. C_ a� c 2S u l y�-�.,. S ioy 1, rA ;�ete, 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 beerL,i'0edd-by-this­B. d of Signed v� `_ �- ' _ Date Application Approved by Date Application Disapproved for the following reasons P Permit No. Zo 3 0 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIIY,that the On-site Sewage Disposal System Constructed(` )Repaired(�; )Upgraded( / Abandoned( )by I►'1 I p-cfmL S,-0�C 11 at 3-1 c u 1460 LIAtti°> f�-1 cot.GA-u C, has been constructed in ac rdance with the provisions of Title 5 and the for Disposal System Construction Permit No.00 - 3 U q dated Installer Designer U The issuance of this p �e hall not c•. strued as a guarantee that.the -,1�fun�Cttio'n a//sAdes*gne1A,Datei} Inspector No.�v ..�-—————— Fee THE COMMONWEALTHOF MASSACHUSETTS. PUBLIC HEALTH DIVISION - BARNSTABLE 'MASSACHUSETTS li!6poga[ *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(V)Abandon( ) System located t 3-2 IA to C-yu., [,gsk� S' 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:C'o35rtytion must be completed within three years of the date of thi e t. Date: -7 Approved by I q t, r 116199 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) hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at �^2 �J4(_-�OfU meets all of the following criteria: • The 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. d • 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 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) i B) G.W. Elevation ��r +the MAX. High G.W. Adjustment DIFFERENCE BETWEEN A and B 1 SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder.cert �; 1 r .. a "��r I ' �i 4 � 1+ l f E Z 1� J o } 1 t v 30 F . :37 LvCJ 4 ov LFJN .� NyntiN ;�