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HomeMy WebLinkAbout0034 DANIELE STREET - Health 34 DANILLE SrKg�' r— A co i TOWN OF BARNSTABLE LOCATION SEWAGE # f VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACEL=: (type). �.�2�'4��f:� (size) NO.OF BEDROOMS ._ BUILDER OR OWNER taus PERMITDATE: Iqq COMPL 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 goo ' r 0 Ar w L O CATION SEW Arc E PERMIT NO. dILLACE 1111.4;. INSTA LLER'S NAME 6 ADD III ES.S_ e U I L D E R ._ rOR OWNER DATE PERMIT ISSUED q DATE COMPLIANCE ISSUED j �� i `a No......, a THE COMMONWEALTH OF MASSACHUSETTS �sry BOAR® F H A TH 7XV41 - .-•-•-.---.- ApplirFation for Uhipaii al Works Tnnitrurtinn rnmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewa a Dis osal g P System at: � .f40 do -Addrex or Lot No. ...--•--•--•------ 1.�. �.►.� ------ - ................................... O ner S Installer Address UType of Building Size Lot.J�.vI!-S _____Sq. fee Dwelling—No. of Bedrooms............ ...........................Expansion Attic ( ) Garbage Grinder '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures -----•-------------------------------------------- -- W Design Flow............ ............... :gallons per person per day. Total daily flow_____--3-3_��_.-..._-..................gallons. WSeptic Tank—Liquid capacity/ gallons Length..... ..... Width....,(. Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......... .......... Diameter.. .............. Depth below inlet....X� .......... Total leaching area.. ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date--------------------------.............. ,_l 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........................ Q+' ll ------ •-••-------- - ---------------------------------------------------------------- Description of Soil-•---- --- -----O�' - -•-------------------------------------- ---- --•-------- ..----•--------------- -•---- . w .�.. ... ......--- ••...............••------------------------------ V Nature of Repairs or Alterations—Answer when applicable.____........................................................................................... ----•--•----••--••--•-------• ...........I_ •-••---•------•-----•--------------------------------------------------------------•-----•••-•-•------------------•- Agreement: • ,c� -1 •' The undersigned agrees to install the afor escribed Individual Sewage Disposal System in accordance with the provisions of iIli L 5 of the State Sanitary ode Th dersigned further agrees not to place the s ste in operation until a Certificate of Compliance has b n is ed e board of health. Signed.. ---- ----------------•-•------- -v -_ !�...� Application Approved By............................ �r-- •-----••-- ------ ...... -----e, ------ to Application Disapproved for the following reasons:------•------•---•--••-• --•-----• -••-------------- -----•............................••-----........._...-----------•------•-•••-•-----.........-------------------•-----••---------•-•--- -------------•-•---------------•--•-----•---•-•-------.....--•-- Date PermitNo......................................................... Issued........................................................ Date fV No.....$5L.e 9-- FRz .......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HIEA T'H ..............OF._... ...... ...... ............I................................................... AV firation for Disposal Works Toustrurtion ramit' Application is hereby made for a Permit to Construct (10<or Repair an Individual Sewage Disposal 4 i/(D A System at: ......................P ........... ...1--------------------------------------------------------------------------------------------- -----------­*-----­----------------- iof�-�dd�re or Lot No. -V14,44 .................. .............7 - ._i --------*------------------------------------- ........../ -----------------­ --- P-------- ne, -"- - ­ ................. ------ f.. .... ---0----------------------------------- -----.-.-.--."--------------- - Installer Address 17 . < Type of Building Size Lot Sq. fe U Dwelling—No. of Bedrooms........... ............................Expansion Attic Garbage Grinder �4 44 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Other fixtures ......I ........................................ ................................................................................................... I I 3C Design Flow_____________"...........;........� gallons per person peL day. Total daily flow------IL..'(-)........................gallons. W Septic Tank—Liquid capaciviz.W' . gallons Length....W--------Width_4......... Diameter................ Depth_____________._. 0.....................:­Wi�th............. 't Disposal Trench—N ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ .......... DiameterJ6.............. Depth below inlet....141........... Total,leaching area42.d.2)...sq. ft. Z Other Distribution box Dosing tank 4- 1­4 V Percolation Test Results Perio`i ne&by......................................................................� 1. "Date.................... ------------------------ Test Pit No. I................minutesperinch Depth of Test Pit____________________ Depth to ground water.._________._____.__.__ 0%4 Test Pit No. 2................minutes per inch Depth of Test Pit_______...__________ Depth to ground water........................ .... .. ............................. ...... ................. .................... ..................................... 0 ..... Z! Description of Soil . .................. ........................................... ... P*,*f-4...... ... ...... ..... ---------------------- ------ ----- -­----­---------- -------- .................................................................................... .................................... .... ...... U Nature of Repairs or Alterations—Answer when applicable______________________________________________________________________________________________ ......................................... ......................... . . . ....................................................................................................................... Agreement: The undersigned agrees to install: the afo' redescribed Individual Sewage Disposal System in accordance 'with the provisions of'11"P12 5 of the State SanitaryCode T ,e place the s sterp in � 0 e� undersigned further agrees not to operation until a Certificate of Compliance has b�' q 4e lj�"the board of health. Signed. 2 24�........................ ---------- -------------------------------------- ------------- D.K ApplicationApproved By............................ ..... ... .... .. ... ....... .. ............. .. . .... D Application Disapproved for the following reasons: ......................... ..... ... ............................................................................. ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued..................................................... Date THE COMMONWEALTH, OF MASSACHUSETTS BOARD,0017 H"LT? .... ......... ...................OF....... ...... ............................................................ TpWrftfiratr-of Tompliatta THIS IS TO CERTIFY That the I d; ' ual w ge Disposal Systeri4 constructed (le-) or Repaired by-- ... ... ..... . ................. ............ ... ........... ............................................................. sfaller at.. ..................... -­-­---------................ ............. ................................................................ has been installed in accordance with the provisions,,;ofTITLF, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._..__ kn_-9-4Z......... dated________________________________________________ THE ISSUANCE OF THIS 'CERTIFICATE SHALL NOT, BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION S AT[S AC DATE. /� ...... V------------ ................................................ Inspector. .-i......12L COMMONWEALTH OF MASSACHUSETTS 130ARI?j0F HEALTH ............................. F­f!� .. ................F No......................... FEE........................ Disposal rks T tr ionVrrmit .....Permission is hereby granted..... .......... ......................................... ................................................... to Construct or,-,Repair an Individi a vc=ag L-Disp"s' y5t atNo............................................. It. ------------f W. - ...........eO .. .... ........................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated_____'._____.____._.__._.___._.._.__._.... ....................................................................................................... Board of Health DATE............................................................................... FORM 1255 A. M. SULKIN, INC., BOSTON DATA �- L Ii�G� FAMILY - :6 IaGU2OoM - — /Sf1.8s uo t*,ActB<*GE- (�¢,ND6cz. �/oil 1 . t I �GT� ,SEPTIC TA%jsc - a3oxlgo��•` = �497 �b.P usE- t000 GAL. D1'SPOSAL PIT VASE Q p S�Dliw/AlL A2Gl► * 15o S.I? .� sC�� ;P•F,aO, ''", ��•/ {50 5.F . X �•5 : 3o75F•P� � � F�✓fit j .fr. io y D SoTTOM AREA • So S.F x 1•0 5.o - G.P o• � � �� -TCTA t- D>:51(-N = 42-5 GP o• im /� ` 'IfoTA1.. DA►LY F%-DV4 = 330G.P� �I pE2Got.ATION RATES I"IN ZMIM ol~LESS � I OF fy�s \ju Of stJ iIVAPI -'; 'o C. E . ) 1`10. 29 Jai ,,fit _/ D TOP F N O s�0•�, . ice -r�'�T �r �G�s� NAL�r -sy /`Y goo. - INV 9y a loco INS. Gnu• / ;•.i -_: •-- .�/��/tom Bu;'• I►Jd. ��P71�. �9. (Ob0 INd �9 T TA►dK 1.6AGu INV. INV. PIT pp w/ITIA y9.1, // Z. ` Ke"' I,/ %L ` •sue WA,u G D 1 W L aµT 6-tvt46 GE2TIFIGO Pt.cT P1_AIJ PR.o P i t_G L o L 4-t 10►J Co T v ?� I! �•8 wo SGAI.E �jGALE�, � ' DATtc 9-/3 8� II . .; rrJ y�. SHo vYN 1p J-p.N lzC-;= N GE { GE RT AT CFY TN ?N� !_l� 4rlama 1.{ GOMPt-`(S 1nlITN'[HE .�,I c�L11J E `- � fi A►J�'SETp�D►G�R.6Qvi2EMENT> of •T1•lE �G �/.1�/l. �U��-�, Z.S TOWN OF-;S3D n(.Srtl, -AND IS �f LOCATED WITH W TN Loop PLA �•1 r #DATC wr gAXTE2e IJYE INC. I`' REG I S't f�26S�'tAN D S u iw Eroe'S 1 Tins PLQN I-j NOT o►d A csTG2vILLE MASS• i I 5T9-uMIrNT SuQvC-Y 1r-rNF nl=s•. ETS wouo pT0 DE'TE`z.Ml►�� t oT t. INE�j APPLICA►.�T T-G��,�✓ TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT�A INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) X �� NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPL 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 i 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 s r� V � . 1 ; Iy , y� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppYication for Di!5poml *pgtem Con!5truction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `]q �Q���S'q— ��r Owner's Name,Address and Tel.No. / Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Av�wW 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) 0,0Y Tk2o 5w 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 this Board of HHeealt�h._ Signed _�c 'F� —Date-3 )-Vj Application Approved by Date 3 - 79, Application Disapproved for the llowing reasons Permit No. 17 9, 13 Date Issued No. / / - / 3 Fee 0 / -THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ) Yet PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application-for Migpozal *p6tem Con.5truction rmit ..,. Application for a Permit to Construct( )Repair( �.Upgrade-(-,-1-A6 don( ) ❑Complete System ' O Iq 'vidual Components Location Address or Lot No. q 1Q��e +� 5��r Owner' ame,Address and Tel.No. Assessor's Map/Parcel On> b Installer's Name,Address,and Tel.No. / ,17signer's NNamme ddress and T_l.No) Type of Building: w Dwelling No.of Bedrooms.__ Lot Size sq. Garbage Grinder/C ) Other Type of Building No. of Pepons e Shbwers(�,`j)fGafeteriaM(b i)Vf Other Fixtures Design Flow gallons per day. Calculated daily flow ti;��gaII-o`ns. 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) a,_�g 'fib 5rz Q4l/or 0 . . 31 STot g- c1( c *w,, l 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 this Board of Health. Signed �1 '�cr- � Date 3 Application Approved by Date Application Disapproved for the F11lowmg reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance 1 s THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( ( Upgraded( ) Abandoned( )by \ \e,4 at 3�l w\ �k<. S Ci®�G��C" has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this B construed as a guarantee that the s S,em s uncti as esigne. o f ja Date Inspector �Ui ---() --—(y(------------------------------------ No. ! f — 9, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS X'i6poOa[ 6p5tem (Construction Permit Permission is hereby granted to Construct( epair Upgrade( )Abandon( ) System located at 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: - 3 - ,9' Approved by �L .T r - - 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) I, l 1�,� Q����g , hereby certify that the application for disposal works construction permit signed by me dated 3\3' �q , concerning the property located at :9\� 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. • 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: I A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W. Adjustment. DIFFERENCE BETWEEN A and B �d SIGNED : � �e DATE: 3 3 4 [Sketch proposed plan of system on back]. q:health folder:cert b rem