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HomeMy WebLinkAbout0048 CRYSTAL RIDGE ROAD - Health 48 Crystal Ridge Road, Cotuit ;x A=056-002.025 p u ,eTOWN OF ARNST LE LOCATION `� �C ���� SEWAGE # 4 VILLAGE Co / ASSESSOR'S MAP & LOTf��0��" INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /SaO GaC Jbr? LEACHING FACILITY: (type) Som al t(e4di Clao"A'1' (size) /Zf A' &s'` A.2 NO.OF BEDROOMS BUILDER O� PERMTTDATE: P 7/ —�g COMPLIANCE DATE: _;,-7 9 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility s� 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 �ea G ?� s 1 a1� No. " Fee THE COMMON ALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TO N OF BARNSTABLE, MASSACHUSETTS 0[pprication for Miopooar Opotem Coni truction peendit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) El Complete System LJ Individual Components Location Address or Lot No. ��114 P Owner's Name,Address and Tel.No. Assessor's Ma /Parcel , / f-1/WD'l l;"Yzen o. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. B���Co�1Co�zs�= 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building 8 e 4e o.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. / .S`DO 9Q`o/14.t7��� Description of Soil W°'y" jit 56011weo , Nature of Repairs (A or Alterations(Answer when applicable �s � � 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 4 B d Heal Signed Date /17— 7', `gp Application Approved by —' Date/� .Z-�5� .Application Disapproved for the following reasons Permit No. E� Date Issued No. •` Fee V THE COMMON ALTH OF MASSACHUSETTS Entered in computer: °' Yes PUBLIC HEALTH DIVISION -TO N OF BARNSTABLE., MASSACHUSETTS Zfpprication for 30tgozal *pMen Conotruction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( . ) El Complete System U Individual Components Location Address or Lot No. � Owner's Name,Address and Tel.No.zeQ Assessor's Map/Parcel '7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f} 7 7 qVl ' Type of Building: ,J Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder Other ape of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 7Y� gallons per day. Calculateddaily.flow y�7 gallons. 'Plan Date Number of sheets Revision Date Title *, Size of Septic Tank / $r®4 9�''. Type of S.A.S. Description of Soil Nature of Repairs or Alterations(P�-n swer 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 y spr OHea /� ;� Signed Date; 1 Application Approved b _ " Date Application Disapproved for the following reasons Permit No. Z<_fioe Date Issued ''t �1 1P -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired.(r )Upgraded( ) Abandoned )by e9l7h�D L'Gl/?9 at e,,"/ 9 e- a/T has been constructed in ccordance 1 . ir with the provisions of Title 5 and the for Dis osal S stem Construction Permit NO. dated "' Installer p Y Designer The.issuance of this permit shall not bekconstrued as a guarantee that the-system wilLfunction as designed. - Date Inspector THE COMMONWEALTH OF MASSACHUSETTS !�/ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mimnool *v5tem uCon.5truction Permit Permission is hereby granted to Construct( )�RepaiF( ,}�Upgrade,( )Abandon System located at t'/ t/ O� �(/G�yC" Z� 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 rmit. Date: ✓ '� � � � Approved ✓�L%�/�' "�'/ �. to/9/97 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 ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 'Z 247 , concerning the ro erty located at G� J`7L� / Co�`�1T meets all of the rr following criteria: ✓ There are no wetlands located within 100 feet of the proposed leaching facility /-There are no private wells within 1-40 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. If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching faciiity will pQ[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) . B)Observed Groundwater Table Elevation(according to Health Division well map) Z6 SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder.art TOWN OF ARNST LE .;'`LOCATION %g Gr 5�4/ / .SEWAGE # 1 ASSESSOR'S MAP&LOTD 6-GDZG?S' :: :;:<IISTALLER'S NAME&PHONE NO:: $fiP'IIC TANK CAPACITY /SOO Go� �A✓1ll <`>IEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUII,DER O — `PERMITDATE l' 7—7$ COMPLIANCE DATE-1 -7 Separation Distance Between the: ::Maximum Adjusted Groundwater Table and Bottom.of Leaching Facility:: sf Feet <>Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) 'Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by �10 1 ,r/ �4 bJ _ T [ 6 TOWN OF BARNSTABLE LOCATION Uyy ,` � � e cvH4 SEWAGE # I -,0-j _q� VILLAGE ASSESSOR'S MAP & LOT_ h _ INSTALLER'S NAME & PHONE NO. �• �,;�5`�d4� �7!- �!�`� SEPTIC TANK CAPACITY (15-00 gtdlows LEACHING FACILITYAtype) 7_ J<,"Lt, P+4-! (size) GOO '114�k-i NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ��y5 dip ��`,I�%K{ Co, 7`7@ 0�9Y DATE PERMIT ISSUED: lZCS �4 DATE COMPLIANCE ISSUED: p �/ VARIANCE GRANTED: Yes No l r 110 S, Z61 6 ,. /jFizcB THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ' I N....OF...... < Appltration for Uispnuttl Workii Tonstrurtiun Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal system at_. �7ocatioi./ 18 Q ........ V_ .._06-0-40 -- _..... y 'lam Y' .... .C.8. .� ..�r---...-----c -- ._. ........... ......«� C ddless ......... ................................................ or Lot No. ^-..-........................... ..... V - -• • •--••••• ....--••-.. ......-••• Owner j�r1 �/ —Address a ......................•••._..U...... ......- --•-•••-•-•-•-•-•••. .........._ ••-••--••-• ----..._._._.... .._......_......._............................. Installer Address Type of Building Size L'ot_._/.4.66 , ./..Sq. feet Dwelling—No. of Bedrooms__________ .........Expansion Attic ( ) Garbage Grinder ( ) Other—T a of Buildin No. of persons............................ Showers a Type g -•-- p ( ) — Cafeteria ( ) Other fixtures .._..... ... W Design Flow......... ....�_C;d__...v_�_. ..gallons per per day. Total daily flow_._ ...�..�.....___.........._gallons. WSeptic .Tank—Liquid capacity gallons Length................ Width:............... Diameter................ Depth................ x Disposal Trench— o. . ................ Width.................... Total Length.._.___..........__ Total leaching area_._.___._..........��� ft. 3 Seepage Pit No.___. . Diameter...... Depth below inlet���.�.. Total leaching areal_,T.:S,..sq. ft. Z Other Distribution x Dosing tank Percolation Test Results Performed by........ . /V. ............................. Date...... q Test Pit No. 1.._, � r inutes per inch Depth f Test Pit.................... Depth to ground water.�V;,V _.._. (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ''j ..----•---•-------•..............................................•-•-----._............._......_...--••••.............._....... O Description of Soil.... f ( -�6............ ... ........... ........___-_____.....-•....... -___...... •-•-.. V ................................. -----._.....--••••--••••- UW •---•...._..•--------------•---•--.....••-•--•••---•---------••-•...--•-----------••-•----••-•-••••....-•--------...-•---•-•--=••---...._._..--------.....---.......----....._..._...._................. 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:I':L: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been • ued by the board of health. Signed...... .. _....... ... Date APPlication Approved By . : . ..._.__. .4� 1.-- - Date Application Disapproved for the following reasons:............................................................................................................ ---••-•......................................................:..........•---._....._._..........__._.......-•---......---...._.--------_......._....---------..._...._-_....._..._..- -••-•........ Date Permit No......... •. �..":...7--- -5�............. Issued....................................................... 92- — 6 S Data J No..... .��= �" ,• f? FRs..... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .oF....... . k Appliratiun for Uhip uttl Works Towitrurtiun trrntit 1 Application is hereby made for a Permit to Construct � , or Repair ( ) an (Individual Sewage �Disposal System at_.... ..... --.-. c:�..........�.�.� ... , ocation Aydrd�reerss ,q or Lot No. y .. •��� ..................... ;w!... fit ) ! !Z..... ....... ..... .......•............... ......... --.._................................................... n �/��'" '! Address ..V................//�1�.--•--.....--•...............X............... ............--(./..�....`__.......... .............................-.------- Installer Address ,/ Type of Building Size Lot./! /..Sq. feet �-. Dwelling—No. of Bedrooms.......... ------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building _� No. of persons............................ Showers '~ Pr YP g --------•- P ( ) — Cafeteria ( ) a' Other fixtures .......: ...........................4. W Design Flow.......... ._._.�_0 ..............: :..gallons per person per day. Total daily flow.......?..��_.�....._........._gallons. WSeptic Tank—Liquid'capacity gallons Length................ Width..... Diameter................ Depth................ x Disposal Trench—Nio. _....._.__.. Width.................... Total Length.................... Total leaching area................�.sq. ft. 3 Seepage Pit No... _tm.._.. Diameter......1.--Z--.__ Depth below inlet..,...e. ... Total leaching area.__.Y..�, q. ft. z Other Distribution box (>,) Dosing tank ( ) C.I. Percolation Test,Results Performed by,......... r.. )CF"`............................. Date......_ l. :.JP----q..... 1 ,•� Test Pit No.'I...Z... minutes per inch Depth`of Test Pit.................... Depth to ground water. 'nA1 ...__. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 - �-•••.......... .......-•.............•---...--•--..__.......•-------._......-••------•••------•..........--••-' Descriptionof Soil.. ••• . .................•-•--------•-----.........----------------•-----------•-•---...------..................................-••..-••_.. ".� VNature 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 TITLZZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ssued by the board of health. Signed..ti i�-�. SA........._ !� "d/��i, ------• ... ..-- / �� t Date Application Approved By................. g'`^'`-.-- ..?.......,.t'-e...J ,�ram, =D e c�?. Application Disapproved for the following reasons------------------••---••---............------------.....---•------------------....---•-•--......----•....---- ....................•--.......--•--•----•-- .. --.............-----•---•----.......------------.......... ..-•---•---•---•--------------•--••-------•-..................-_.........•. ......---•--. Date 51LPermit N62..... VL: M 7 2- ............. Issued-----....------•--••--- Date t/ J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF. r � - ............................. Trrtif iratr id fauutpliana THI$j, TO CERTIFY, That the Individual Sewage Disposal System constructed '( ) or Repaired ( ) by..............................-`'ram'...zi ..... ?:!x4 .:r., ..................•---•--•---•-------------•------•--•-----.................--....................................... Installer �� y at... ' - '� m =..__._.�,.e �t?�A !_lam. S ._� ...............•-------..... has been installed in accordance with the 9rovisions of TITLE U5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.........�����s_�� ...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION"I SATISFACTORY. B�7 � 0 0 DATE........ %1 -• �L1 Ins ect�d�._5 �� 1/11 .1 1 (��1 /,4�1 _.. .... p • ..... --. ....... .. - ^ •..._......... • .sw+. ..m p►A-.-----..—..w.-.---.. ww. M� ..mow ter. ..w_...r�........we .www wM� w------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH R7I..S' ....ff../<.�ll�!........OF......., err+��:4!o:Q�/5 ...................................No. ..... ...... t F> .. ,.....:.— Diapuuttl Varks Tunutrttrtiun Plermit Permission is hereby granted-------------ti. ....... ' r ........................:........................................................... to Construct (1X) or Repair ( ) an Individual Sewage Disposal System at No..................... n�T Ca !�?Da� �i�a _: �-n. � •----- � �.1 ........---••-•--.....-----........ -n .. � r .... .... I V .. {Street ..'. --E.- as shown on the application for Disposal Works Construction Permit No.1/:!:-/.! 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