HomeMy WebLinkAbout0008 DANIELE STREET - Health 8 DANIELE 5 ;L7
6 0
No. 3.2Fee
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer: �(
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipplication for 33igozal *p$tem Conttruction Permit
Application for a Permit to Construct( )Repair(,,")7 Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. A n 2 Q s Owner's Name,Addre s and Tel.No. .
Assessor's Map/Parcel ��T" Y 7,p 30 x 1?010 La 1.
i
Installer's Name,Address,/and Tel.No. L(a8—Sb�1 Designer's Name,Address and Tel.No.
GO 2Ao
Type of Building:
Dwelling No.of Bedrooms 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
Nature of Repairs or Alterations(Answer when applicable) r� Y v �e �3 D C � c�-J .-
lam/ 2/ T- A .Y _5V Ir(U yrn 11y;ic1/ 3( O' e5iZ,p w� l` STo e
TI
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 issua by thi=ryj
,{�Signed �i / Date /`ozy > 19 c6
Application Approved by Date
Application Disapproved for e fohAving reasons
Permit No. Date Issued
.... ,,. ....,-rr.. "' - ...,fit. .:.-�...r.�.. .-...,.� . .. -a. •:..H�.....-.=e:ry...,...s-._a�� en •.T... ,., ft,
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No. 3 Fee =
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppricationjof Dfi5pogal *pgtem Congtruction Permit
Application for a;Petnit to Constrict( )Repair(Upgrade( j Abandon( ) ❑Complete System ❑Individual Components
j
r Location Address or'Lot No. Owner's Name,Address and Tel.No.
k� e fux,,,S i. �38��a��o
(A C--, ?2r�-r�_.
t Assessor's Map/Parcel,
IN
Installer's NamOAddress,and Tel.NO.) l S b�1 Designer's Name,Address and Tel.No.
O (iu�,>,.
�S 1'cr.
�,C .l ��
Type of Building..
Dwelling t No.of Bedrooms,*� .'" Lot Size sq. ft. Garbage Grinder( )
Other Type of Building. w ,� 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
� / y
Nature of Repairs or Alterations(Answer when applicable) - c D .0` ors %o
_ r
UY r yr Z., f '_� /GGJP 6 e;, 3/4 STorIC�
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordancerwith they provisions f Ti _o Title,5 of the Environmental Code and not to lace the system in
P s operation until a Certifi
P Y P
cate of Compliance has been issue by this BBo,7d of H
Signed ,/�LU/(.r'lZj Date ,9 a> l 9 9
Application Approved by 'L"41Ue. Date
Application Disapproved for We foltAiing reasons
Permit No. Date Issued
---
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired'( k-f Upgraded( )
Abandoned( )by a A.C A-7- �
at A:\)Ac, l 11.e`P S-T. 1 1 has been constructed in accordance
?• with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
` Installer Gn 2 6"^��4 ,An n U s Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date k _ ( , 9 2Inspector
v
No. n Fee to a, ~
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lw gpogar *pgtem' Congtruction Permit �}
Permission is hereby granted to Construct( )Re �Upgrade Abandon air( ( )
System located at C( 7
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.
Date: =1� �' Approved by
TOWN OF BARNSTABLE
�"LOCATION S 0,q/I f,e/.ST. - SEWAGE ;
fig^3a
VILLAGE CoV/ ASSESSOR'S MAP&LOT 6 7. 0 Ga
`INSTALLER'S NAME&PHONE NO.�
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) Cv/TC' 33p `r3V (size)
NO:OF.BEDROOMS 3
BUILDER OR OWNER ka%Vk-RV B= -
PE);tMITDATE: COMPLIANCE DATE:�4'�' . ,
:`Separation is 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
':Fuiiushed by
—_—--
t
A 1,
17• L7
TAn`t
49
3a< <� c.vlbec 018
/ R
;/o 6,0 10/9/97
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 concerning the
property ___e=
located at -' 319f7 fe/S/- meets all of the
-
5
following criteria:
• There are no wetlands located 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 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 facility will n2l 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) $3•_�
B)Observed Groundwater Table Elevation(according to Health Division well map)
SIGNED: DATE: S �'
LICENS 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:cert
r-
0
310
TOWN OF BARNSTABLE rs
LOCATION SEWAGE.#
t�@-30 ,
VILLAGE ASSESSOR'S MAP &"L`OT-Q!7.
INSTALLER'S NAME&PHONE NO.�E U0. .s ler L4 oL8 S-S-DL
SEPTIC TANK CAPACITY./--eO9/ `',C tX(s
LEACHING FACILITY: (type] cv/jC 330� "r3�-= ( ) /0 )C�siie
NO.OF BEDROOMS
BUILDER OR OWNER'keAC
PERMITDATE: aR, i C 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
Furnished by
t
. a .
►�Ae l
�Lf
cvlLec 01B
L0CA'TION , SEWAGE PERMIT NO.
VILLAGE
INSTALLER'S NAME i ADDRESS
B U I L D E R = OR OWNER
�d
DATE PERMIT ISSUED .
DAT E COMPLIANCE ISSUED
29
-22-7
No..2 L Fizz..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HE
.........OF. ...................... ..... . ..... ........................
Applirattlan for Uhipoiial 10orkii T iitrurflon Famit
Application is hereby made for a r Const, or Repair an Ind�vi ual Sewage Disposal
nut to onst
System at: 76-
.................... ..... :!��Y . ............... .....
.r......... ............. ........ .... ................ ....................................
oca Address or Lot No.
............... . . ... .... ...................... ... .................... q------------------------------•-------------
................ . . ............... . ... .................. .....................
r --------
In taller Address
Type of Building Size 11,0 Sq. feet
Dwelling—No. of Bedrooms.._..3................................Expansion Attic Gar age Grinder
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Other fixty.lk§.............................................................................................................
- -------------------*------------
Design Flow................. -gallons per person per day. Total daily flow.........14,u 16.....................gallons.
. a Septic Tank—Liquid capa cit/j.TO gallons Length................ Width.......____.._.. Diameter................ Depth................
Disposal Trench—No..................... Width ................. Total Length......._......_..... Total leaching area......._...._.....sq. ft.
Seepage Pit No........I......... Diameter.....S.7. ......... Depth below inlet....J(�........... Total leaching are .. ......sq. f t.
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.._..........._.........
44 Test Pit No. 2................minutes per inch Depth of Test Pit.._................ Depth to ground water.........__......._____.
...........................I..............................
0 7 > 7.......
Description of Soil 1;--T........ ------
........... ...... -i...................................... ....................
............................. . ........ ... ... ..... ................ . ... .......................
............... -----------19.................. . ....... ..... ....................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
...........I.........................K------d......... .................................- 11 -------------------------------------
s ----------------------------------------------------------------
Agreement:
ewage Disposal System in accordance with
The undersigned agrees to installthe 1ndiv4 al S he
the provisions of TITS!L- 5 of the State Sanitary Code— __signed further agrees not to place the s tem 1
operation until a Certificate of Compliance has bee , is beyboard of health
Signed. ...... .. . ............... ------------------------------ ------- ----- ... ..... ..
D t
...............Application Approved By.......... .......... . ...........Cmeo- 1............................ ......... ..........
..........
Date
ace the em i
-L-L- L-�Y the
has bee Si�gned
e
Application Disapproved for the following reasons:................................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
---------------------------------------------- --- ----
Fl�pit
Noz`!... a... Fps.. .............
THE COMMONWEALTH OF MASSACHUSETTS '
BOARD,,-OF H A T
j.G.'.... ...........OF.......' ....................................................
Appliriation for Disposal orkiiToustrur#ion rrmit
oww".
Application is hereby made for ar ermit to Cons t (P ) or Repair ( ) an Indivj,ual Sewage Disposal
System at:
r Loc Addre 6 � �1� J ..............................................................
or t No.
.. _ r Lot
f.t n ..... .. .................... ------•--•--•--•---•---.............------
rfe� y d�
W •...-- ... -- ......�.--. -------•--- -------•-------
Installer ........................................................
ddress
Type of Building Size Lc ._ ....Sq. feet
�. Dwelling—No. of Bedrooms....43.------....................•__-_-_Expansion Attic ( ) Garbage Grinder
Other—T e of Building -- No. of persons............................ Showers
a Other—Type g -------•----------------- P ( ) — Cafeteria ( )
Other fixt
WDesign Flow................ ........___. gallons per person perrday. Total daily flow...... ......................gallons.
WSeptic Tank—Liquid*capaci > gallons Length.........:...... Width:_.::_:_ ...... Diameter__---_:---_--.__ Depth................
x Disposal Trench—No..................... Widt .................. Total Length_......._:_:__..... Total leaching area--__....___ sq. ft.
Seepage Pit No-------/I:____-__-- Diameter.... ............. Depth below inlet.._►............ Total leaching ar� �_____sq. ft.
Z Other Distribution box'( ) Dosing tank ( )
a Percolation Test Results' Performed by............................................................................
Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0-4
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P•I' T
y�
0 Description of Soil..._.. �'.. - 4 ___._ 'l ...... __
(� _ ----- --------••----- 7
W • .
x ........................... "-lie----��� :. ,�' -`
U Nature of Repairs or Alterations—Answer when applicable._..............j-:____--____--_------_____---------__-__-_____---_-------.----------•--------.
--------•-------------------•----------------------•------••------------------..._...------........•---------------•:----••---••------•---•------------•-•---------------------------•-..._.._..-••••---
Agreement:
.The undersigned agrees to install the aforedescribed Indiv' ual Sewage Disposal System in accordance with
the provisions of TIT1Z 5 of the State Sanitary Code he ersigned further agrees not to place the s stem
operation until a Certificate of Compliance has be is d b t e board of health
Signed.. ---- .-• --------- ------ ------. ..................................
ate
� G• t`M / /
Application Approved By................-......-- (t - ............ - yl.�!_ .. k.
Date
Application Disapproved for the following reasons:--•-------•••---------------•----------...--•---•...------•--•---------•-------•---•-------••----•--...........
....-•----------------•-..._..._..-------••-•-------.......................---•--•---...-----•---••---•-----•-----•---•-----•--------Da......-••-------
te
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD Of HE T
l
Trrfifiratr ilf Qkimpliaaur
THIS IS TO CERTIFY,, T the Inctivid . Sewa Dis, osal System,constrµcted (, or Repaired ( )
by........................ y�; ¢".:"' all
.------•..............� .�;✓-.. e�
---� . --- •• --- via-
at ------•-. -----•--•_...
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..___._.'7i " .._. .......
PP P -- ---- � f dated----------------------------------•------------•
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ,, /. ......... Inspector / .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEAZrHrf
...
� .
No......................... FEE........................
Mops 13 yitr uan rani#
Permission is hereby granted------. ..... t1*4A - ...................... - --------•-••...........................................•
to Construct ( ) or•Repair ( ) an.h iv'd , g posa. KV
�s ,
at No---------------- ��J :: 1
Street
as shown on the application for Disposal Works Construction Permit_ No..................... Dated.._iph_jk5.......................
..................... y4 //`` Jf3 4
DATE. ----_-_ Board of Health
FORM 1255 A. M- SULKIN, INC., BOSTON
Ki
PA j
WO GAQQ�AGE �jQJ/.J�EtG2. f Jr
c N%LY , FA.o w
jEPT%G 'c'ApiK = 33Ox15o'/• ' -49%6.P Q.
o%5Po5A►- P1T �6E IaoO C�a1..
S�DCWAIL AV-SX
375 G.Pq
5 BOTTOM AQF-A
5� S.F x 1• 0 5p b.Pck'
•TCT A I- D 6.51 GN * 42-59y
TOTAL. DA 1�•Y f~�-ow! s 33p(,PO. t
r
PE2coLpTloN RATES 1' IN ZMW op-1-E55
Wit; ur f r � Q
OF S _ 7 ��•3 a
`4 1 off' WILUAM rtrt+ ,
1 ' 1 N Y E
Nu. 19334C-�i�
{ yo ,4C _
i ,�=�_�/`'� .� �p/• � TOP FND•`A-0Z •a
IXY
INV. E,6PT G r }
Z Iaoo INY, Borc ,13:3 T�,►aK '
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PIT INV. INV.
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PRUFILG
I.oCA-t ION Cp��
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Nars�4�� Np' SGALE SCALE / '_� ' �ATPc 9-C/.
P�-AN R6Fr= wCoe-
lit,I' 1 CERTIFY THAT THE Ft'-dP AND• SNovYN
;' Aug 56T1�.GK R.6Qu1R,EMEtJT� orr 'fN� �L�/. .�,�!?BO�: �S
-To w N or- 1 S ND 7-
LOG�aTED WITHIIJ T %:%.0oD P ALN
j� DAT1r `q 8 raAxT6iLe mys INC.
R.EGIS'TEV-rwD IANDSuR Yo>
u15 PLAN 15 NaT 4n5C r� ca AN osTE¢.VILLE • M�►ss•
juSTjzutA SueveY
s Td APPLIC P.r.I'r �EL.,4/✓�