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HomeMy WebLinkAbout0125 CAP'N SAMADRUS ROAD - Health 125 CAPN SAMADRUS A = 038 053 q I I i _�4 3 TOWN OF PARNSTABLE �1 - r LOCATIQN �LJ� � ��� � - SEWAGE # VILLAGE Go �/� ASSESSOR'S MAP & LOT40r39--053 INSTALLER'S NAME&PHONE NO. Aatroze �Lr117� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) le"tTO X NO. OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: O 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] 10EII&A) Feet Edge of Wetland and Leaching Facility(If any-,wetlands exist within 300 feet of leaching facility) Feet '.b Furnished by $CZ � •E o In �- . � W 0 u No.� -� Z Fee J v • — THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Miquar *pgtem Construction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System L`Z Individual Components Location Address or Lot No. � ^ Owner's Name,/Address and Tel.No. Assessor's Map/Parcel CO /V1•— Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. 6e9&e 7- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building -t6445G�No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3J6; gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank eXL,311rg 149P Type of S.A.S. , sf Description of Soil 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 P. is B of Walth. Signed G Date 4//z//1-ne Application Approved by Date Application Disapproved for the following reasons Permit No. Z�^ Z Date Issued No. —T 2 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for 3Migo.5al bpgtem Construction permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System L'7Individual Components Location Address or Lot No. /` , -- Gq�� �gr�lQ�i'�s Owner's Name,Address and Tel.No. Assessor's Map/Parcel t,0 Installer's Name,Address,and Tel.No. (1� / Designer's Name,Address and Tel.No. 90/_t'd 1!0 Y%C©K5/7- _ '*�Z Type of Building: Dwelling No.r of Bedrooms Lot Size sq.ft. Garbage Grinder(14e) Other Type of Building S POCe No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 114 gallons per day. Calculated daily flow 33t�, gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. V q i /2I`r�J`D/S Description of Soil: 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 B .drof • alth. Signed Date Application Approved by - Date Application Disapproved for the following reasons Permit No. Z T-V-(>' 2 S — Date Issued ---------- ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS 0-3 S�'-d,5_3 BARNSTABLE, MASSACHUSETTS Certificate of Compliance � THIS IS TO CE FY,that/the On-site Sewage Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( )by Or *?;� OGIS at z tw 4 __ *ezZKIZ5 / has been construct d in accordance with the provisions of itle 5 and the for Disposal System Construction Permit No. u� "'2S'Z. dated ?j- Z aW0 Installer Designer r l l/! o111"f U l The issuance of this pe t shall not be construed as a guarantee that the system wil functio as designed. X'r Date l/l z Inspector Yl -J . t ^ r� �� ' --------------------------------------- No. Z J S!-� Fee — _ THE COMMONWEALTH OF MASSACHUSETTS 0 PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwiopoar *potem Construction Vermtt Permission is hereby granted to Construct( )Repair(L, �� pgrade( )Abandon( ) System located at Z J� C'o' y 1, Zel /V 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: Construction must be completed within three years of the date of this permit. /� Q Date: 7 2�— � Approved by.--At,' GG N 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) /- t I, kle r- T "D��z ''ereby certify that the application for disposal works construction permit signed by me dated y/Z/�44 , concerning the property located at L✓—� �• /ll�/�`�ls �� e d7 /Xeets all of the following criteria: VThe failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. V/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. t) ere are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system t/ 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 ethod 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) 652 `/� 2— B) G.W.Elevation 2E/ +the MAX. High G.W. Adjustment. DIFFERENCE BETWEEN A and B J Or, 5— SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder:cert r �r w �A"'s !v G,1 TOWN OF, )7STABLE L LOCATION J� -e 1`S SEWAGE # �� Z VILLAGE 60�`u�'7� ASSESSOR'S MAP & LOTG �'-795733 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /,0o6G4LC ' LEACHING FACILITY: Ial�.. 4 ) (type) - (size) !d'x TO i NO. OF BEDROOMS 3 BUILDER OR OWNER p�G.,3c�✓ PERMITDATE: `ZJ �� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 3 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 her n I - I hA ens s i No...Rsp_:�KLI_ ...... ............. THE COMMONWEALTH OF MASSACHUSETTS arm BOARD QF HEALTH 4-1/ r ........................Ov/1.)............OF....... Appilration for Uhipasal Works Tomitrurtion ramit Application is hereby made for a Permit to Construct ( �or Repair an Individual Sewage Disposal System at: Ir I ......................Api4......5 ................................1br..... ....................... Location-ed dress (;No, 'M i r ................ A. ........ ... ........ Address 0 n r ca.Aos ............ ------------------------------------4=-W......... . . .................................................................................................. Installer Address Type of Building A-7 Size Lot......Z1y._&_0_.Sq. feet U Dwelling—No. of Bedrooms......................................Expansion Attic Garbage Grinder ( '_l P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( 04 Other fixtures .................................................................................................. ---------------Design Flow................15.��.... gallons per person per day. Total daily flow..........'................ gallons. . ------------- 04 Septic Tank—Liquid capacity-AC-----0--gallons Length................. Width_..._........... Diam eter------------ --- Depth_._.._.......__. Disposal Trench—No-.................... Width . .. Total Length..._..__ .. Total leaching area -----_--------sq. ft. I----------- - V--- Seepage Pit No.........I----- iameter--------a------ Depth below inlet_...-... ....... Total leaching are��. ..Z?---sq. f t. Z Other Distribution box Dosing tank ( ) - --------------- Date......1.— ......Percolation Test Results Performed by -- ----1.aj Test Pit No. I-----:In----minutes per inch Depth Test Vit .. Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pita_.........,........ Depth to ground water........._.........._.._ ............................................................................................................................................................. 0 Description of Soil " .............. �4 . ... ................................................ ............................ " ' 7-----------. ......... Lk.........Y.-kLLaw........ .-M-io- --co, -------------------- U W Z ...................................................................................................................................................................................................... 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 TL I TL LE 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.....&&UtUWA_.­a......... - -'elAo ................ ......... Date Application Approved By............------ ppi ... .... . . ............................. .... ............... Date Application Disapproved for the following reasons:.............................................................­_1_11------ ......................................................................................................................................................................................................... Date PermitNo......................................................... IssuedL....................................................... Date r 2 FE$...... . .. .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH OF............. ....................... - ApplirFation for Disposal Works Toustrurtion VvIrmit Application is hereby made for a Permit to Construct ( V or Repair ( ) an Individual Sewage Disposal System at: )44 _.. Loation- ddress r Owner Address W % L �I.1T ,-� .................................... ........ -....... Installer Address /� `/.O Q . Type of Building Size Lot.......Z.(t______________Sq. feet V Dwelling—No. of Bedrooms............. -.---------___---_Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures ................................ . W Design Flow............... .... gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityl.Q gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width....... ........... Total Length................t.. Total leaching area.. ___.........sq. ft. Seepage Pit No.........j-----.__.. iameter........46...... Depth below inlet.......-•_._....... Total leaching area.--- .(?..sq. ft. z Other Distribution box ( Dosi tank (k') / '" Percolation Test Results Performed by. �:K.°__lfo.W ....,___...._�...:.............. Date...... .........../....... Test Pit No. 1..... ....minutes per inch Depth of Test Pit.......f. Z'..... Depth to ground water________________________ Test Pit No. 2................minutes per inch Depth of Test Pit............._...... Depth to ground water____-;__-__-__----..___. 04 -. ---------------------------------------------------------------------------------------------------•.......................................................... 0 Description of Soil••--•- •--6................................................_...- ----- --- ---------- 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. w .. Signed .&IIA".?:^ .:, __ t4.4.Lae!�_,� � •�.......... Date A lication A roved B .................. Date Application Disapproved for the following reasons:...................................... ........................................................................ ------------------------------------•------------------------.....---------------•--------...--------------------------------------------------------------------------- ------------------------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH, OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Tuutplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b .................e.' �hs--........................_..........................................................................................................................._..... Installer �. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal VVorks Construction Permit7__........ d ed________________________________________________ THE ISSUA/UNTION F THIS CERTIFICATE SHALL NOT BE CONSTR AS A GUARANTEE THAT THE SYSTEM WILL / SATISFACTORY. DATE----•---.11 � ----------------------------------------- Inspector........,--•-- ------------------................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.................................................................................... ..... FEE.........:=S......... Disposal Vorks Taanuiruction rrutit Permission is hereby granted.......... 4/ ,.4.............................................--------------------------------------------------------------- to Construct (a ror Repair ( ) an Individual Sewage Disposal System — atNo.......... -. ................ , ------ _11--------------_-_--- --------.------------------------------------------•--------- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... � -.--.--_-_...................•--. i $ Jrdf Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS sl►.IGt_G- FAMII-� _ '�, BCOROoM � 34 a IJ� GaRBL�.6E �j211.IDE2 a _ > , F1.0W s ILO X 3 = 730•G.P.0. 8>. 7 IM 5EPT IG TP►JK = 33ox15c>% =A95P. o G. uSE- l000 GA►.. µ 8 3 •: '.; i oi5Po5A1_ PIT u6E 1000 GAI_. �0[ ZI; 440 ; H 1! ..¢ .4 51 pG WAIL ARGA BOTTOM ASMA: . f•0 4F,-PD I TH, ^ToTA 1- C E51 GN * .4.2 5 G.P o- Ql r,, R HM 'TOTAL- DA 11.Y F1..Ov,! = 330 ?c'• P� r Es; IT­� . . t. 3 G PSZC0I.ATI0W RATE= I"i 2MIN o�►-E55 35 - >,« �.- __:_ . . // PROP ycrr,o 4 Fou•.a •rN+� , , , C ALA v6, a RICHARD g N �� BAXTER JONE r ' No.24M No. 2 J J I! �Q1STf►� l I) 4ap V 0 WAIT • , 1 q `� ' P-,� Z- ► 9 / TOP FWDs1o0•o IT E'�T � ! 9 � F(a Yw i I ►•IOLE i 1000 INV. 9G•5 DUST. - INJ. .. GAL. 96r8o qc.� 5cvT1G So 1000 r-S,7 9aX TANK i 9�,o Gca.. I �,.EA►G1�PITMIITuG,00 I MtD�UM 173/4'(� I 3" To VdA SN L D couRse 6TvN6 _ SAND g1 --7 CEIZ.TII^IGo pl.aT PLAN i; PgZOFIL� I Lo�d�•t1o;N C0TU1T a0 No gI;AL,E $GALE IINsGOFs DAT rc 9�17I�L No'WAVE2. pLp,N REP6QSkcar 1 CERTIFY ?NAT TNE�opFauNtia.T'o+l�SNo1rYN �: H�,R>ra 1.l GOMP1..`(5 Y,l ITN'C NE �S I o�L1 N E I_0 T 35 /AIJD 56T�►GK R.6Ru19-e sN.M. 0r- N� 1, G, 14G'Z.3 $ 'TOWN 4C>FZ3^RN STP.AT ANV 1� KOT LOCp.TED •WIT W 1�6 F ooD LAI . PAT r-. ." .Z' ' gAXTis V N�{Crs INC. R.EG 1'S•T S&V_WD�lAM D S v MV T%AIS PL& J 1�2 W&T Bn5E.p 0►d AN C�ST�citVILLE'r • MASS. Iu5T9,uMEN_ StJ2vG-Y 4-"rNE DFpSE'T5 SuoU To OCTc:.v�INC ��-r' <.IN��� APPLII_F► i NOT DC- v>C.C� � v F:bILCIO L'O C-4.T 10 N S E W A G E PE I t+l I T C30. Sa ,a dY vs VILLAGE INSTA LL "'S HAOf & ADDRESS rc�. !2 d h s U I L D E R OR OWN ER ,. , DATE PERMIT ISSUED DATE C-OMPLIANC,E ISSU-ED ` �.? W � , '' N � � si, � w —` � � e f t� {.! tii: � J