HomeMy WebLinkAbout0037 THANKFUL LANE - Health L37 THANKFUL LANE, COTi1IT
A=039-032
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TOWN OF BARNSTABLE fIZI
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LOCATION 37 'NAh k Fyl 1fd-e- SEWAGE # -7 33
VILLAGE ._:C.a r✓i T ASSESSOR'S MAP &LOT 0 3 R'- 0,12
INSTALLER'S NAME&PHONE NO._ 1-/7`7- '0 3 Y9 JvJe,00� l ti l3�wµ✓Of
SEPTIC TANK CAPACITY /00 D
LEACHING FACILITY: (type) Z cr ec TrtiheLi ' (size) X Ll X Z
NO.OF BEDROOMS 3
C
BUILDER OR OWNER Mr A/z d1FJ-
PERMITDATE: l l l 3' C1S COMPLIANCE.DATE: 11 - /3 -9 S'
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 ofWetland and Leaching Facility(If any,wetlands exist w_
within 300 feet of leachin facility Feet
Furnished by a
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No. L' 3-3 t' '' Fee �r '
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes /
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS t/
Zipprication for ;Digozar bpotem Cong;truction Permit
Application for a Permit to Construct( )Repair(l-4-Upgrade( )Abandon( •) El Complete System 11 Individual Components
Location Address or Lot No. 3 7 'IZ")Wh/:�v/ Owner's Name,Address and Tel.No.
Assessor's Map/Parcel Lo; /r 3;7
6d vir
Installer's Name,Address,and Tel.No. LI-'11^O:7 41 Designer's Name,Address and Tel.No.
ja G/bzl 0.-- Z?14n, es
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) �rws;-/o z/ ,lge,4 iyii� /'I✓!u
119X �1X2
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 P Date //-13-7X
Application Approved by r Date ff—fS
Application Disapproved for the following reasons
Permit No. 7 33 Date Issued
3-3
No. Fee r V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes /
,;PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS e/
01ppfication for ;Di.5po5a1 *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(4.4-44pgrade( )Abandon( -) ❑Complete System ❑Individual Components
Location Address or Lot No. 3`� i1e�I��!// L�� Owner's Name,Address and Tel.No.
Coat 37 t1fVA 'Fr// Zs419-e,
Assessor's Map/Parcel d 3� a-'
Co v�T
Installer's Name,Address,and Tel.No. 4d'71-03 41 f Designer's Name,Address and Tel.No.
ja eIO4 49-4. 100*14p5
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers E; ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow t 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) ro SPo
G®X 6/X2
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 zz/ Date //- 13-9X
Application Approved by F 1 Ay Date /f (S'
Application Disapproved for the following reasons
Permit No. - Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS f�
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired(l._.)�.Wpgraded( )
Abandoned( )by 10e,,4 ,d.c Z?,W.-0,0.5'
at /ply k ival zew a Gdrvt r has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. _ 1 3 ) dated /I-1?-!n
Installer Jos:U04 ac ay^"o-5 Designer v S
The issuance o/ .
his ermit shall not be construed as a guarantee that the syst will f too /as deli )a0d. n (}
Date � 3' " Inspector
v
No. ! �'-��� Fee sz, ..�'
THE COMMONWEALTH OF MASSACHUSETTS 03 9 03�
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
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1=i!5Pogar *pgtem con! tructiou Permit
Permission is hereby granted to Construct( )Repair("'Upgrade( )Abandon( )
System located at 37 TLilevavk 6,1 &i"-.,c
CoTvir
.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 ermit. Q
Date: f / Approved by
1
10/987
NOTICE: This Form Is To Be Used For the Repair Of Failed
Styptic Systems Only'-
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORDS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
hereby certify that the application for disposal works
construction peen-,lit signed by me dated concerning the
property located at 37 T,��h k �v �vi'T meets all of the
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 Bow and/or change in use proposed
ere 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 W be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
!
Please complete ithe 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) ` ?
SIGNED: �-� �� DATE:
LICENSED a ARNSTABLE NUMBER
(Attach a sketch plian.of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted).
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/ TOWN OF BARNSTABLE
LOCATION _� T��� i11 Syr SEWAGE # 91- 33
VILLAGE ( .dlf/lT ASSESSOR'S MAP & LOTO 74- 03�
INSTALLER'S NAME&PHONE NO. e-17`7- 0 3 419
SEPTIC TANK CAPACITY �o 0
LEACHING FACILITY: (type) /ct4��
(size)
NO.OF BEDROOMS
BUILDER OR OWNERr
PERMTTDATE: l/- /3' cf� COMPLIANCE DATE:
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 leachin facility) Feet
Furnished by �� cam _
rl
' _ Frvvt
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No.. -•-•-•• ...............•.
THE COMMONWEALTH:OF MASSACHUSETTS
BOARD 017 HEALTH_,
OF...... .
Appltratton -flax Bi_qpuiittl Works Cn astrurtion Vrruift
Application is hereby made for a Permit to onstruct ( or Repair ( ) an Individual Sewage Disposal
System
- c •Addr � or Lo
w Owner Address
ayIL - - ------•------------------ --------------------•-------•-----------------------------------------------------••-- - -
Instal r Address
Q Type of Building e Size Lot-..(_--�------------------Sq. feet
U Dwelling—No. of Bedrooms------------- ---------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons---------------------------- Showers (. ) — Cafeteria ( )
Q' Other fixtures ... .................. ...
w Design Flow__ ___________________ ___.__.... lions per person per day. Total daily flow___---_-J-- -_.--...__gallons.
W Septic Tank-a Liquid capacity/"dons Length...�6"d
Width -..-.------ Diameter---------------- Depth.__-------.----- �
x Disposal Trench—No____________________• Width........ __ _ T Total leaching area_-.--.-.---:_--_-_sq. ft.
Seepage Pit N ..�--_______• Diameter�.1._�_...,�eTpY •- Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed b .
r ....... ................................................ Date----------------------------------------
Test Pit No. 1................minutes per inch Depth of lest Pit.................... Depth to ground water-..---------------------
w/ Test Pit No. 2................minutes per i ch Depth of Test Pit.................... Depth to ground water.......-._.__--__-_-__.
W ........................... ................... ......
. .5 -
0 Description of Soil------- ��------- ----------------------------------------------------------------------------------- ---------------
x
--------------------------
w
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 Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be - ed
tgne ----------- ----- ---------- ----•------------------•--- --•--------•----------------•---
s Date
Application Approved By------ --- ------- ,--------- /0-/fs- 77,5--
DOate
Application Disapproved for the following reasons:------------------- ------------- ----------•---------------------------------•--------•---------------------
------------------------------------------------------ ------------•-------------------------------------•---........--•----------------------------- ----------•----------------------------------
Date
PermitNo.---------S=,, ----•------------.................. Issued........................................................
Date
------------------
No.. dJ --• Fuic.;Z--al---------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD A0F HEAL
OF..... ..... ...------
Appliration -fear Diipniitti luorks nstrnrtinn Pprutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System t
` w e'..i`
Add ss or L
................ ,� -,1 ......•......................
W Owner Address
Type '40 - - .........................
Insta r Address / ` •►
Q yp of Build Size Lot- ...3._ ....._-_-_-Sq. feet
U .
Dwelling No. of Bedrooms-------------. ----------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons __-_-_--__---__-_-__.__--- Showers ( ) — Cafeteria ( )
Other fixtures _.
d .-----------••----•..._..
- -------- - --------------------------- - - - ------ -------------- -----------
W Design Flow_ ___________________' ,,,,__��__,._,,�allons per person per day. Total daily flow_.____-- __-___ ---.-..-.--gallons.
P Septic Tank Liquid capacit v_-gallons ' Length______________"in .----
Width -.._.._----- Di, ------ Depth._..-.--.__...--
' x Disposal Trench—No. .................... Width,_.-._.._. __ Total ___. _ . Total leaching area.____.__....._......sq..ft.
Seepage Pit Nw-'_._ ___________ Diameter e o ____ _____ Total leaching area----...-----------sq. ft.
Z Other Distribution box ( ). Dosing tank ( )
aPercolation Test Results Performed by. •.-----------------------"---------••-•-•---•-••---------•--•••••• Date-------------------------------------
Test Pit No. 1________________minutes'per inch Depth of Test Pit...... Depth to ground water--.---_--- .--_-------
�14 Test Pit No. 2----------------minutes.per ' ch.., Depth of :Test Pit-------------------- Depth to ground water--.-.-.-----_-__-_-._.
•------------------------------------•--•--.........................................................
O ------------------------------------------------------------------------------------
Description of Soil------
x
U -----------•---•-------------------------•------=-•------. -- ----------"---•------•------....._-...---••----•-------•-•-""---•---------------•---•---•-------------------..._.._------------
W
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be e 0
Signe •-•- ...
Application.Approved BY----- �.. •. . •--•= . ••••.. •- , -•-•-
r Application Disapproved for the following reasons............ -•-- ----• - ----------------------------------------------------------------------------
_______________••-•-•-----------------•------------------------•--------___-•-•----------------•-•--•----.._._..-._._..--••---------••---------=--•-------•---•--•-------•-•--••-------•••---.......••••-
Date
PermitNo......................................................... Issued................------- ................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ALTH
... ........O F............... .. ... ........: ......... .........
1,01,041.errUfiratr gf mompiiattre
THIS IS TO CE t A ndividual Sewage Disposal System constructed ( Or Repaired ( )
I,
-- - -------
.yTT. _�'"' Inst r
has been insta led in accordance with the provisi s of ` rticle XI of The State Sanitary C�}'de as describ�d rin+�the
application for Disposal Works Construction Permit No------------ p. ------------- dated._<:L� "`,�l i_.,,rd.____.
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------------------------------------------------------------- ............. Inspector...................................................................................
d_
THE COMIK4' NINEALTH OF MASSACHUSETTS
BOARD OF HEALTH
F � ;'
No d FEE_ •. -•••-•----
Bi_nVo at or nnni#r. fi at Prrmit
Permissio is reby granxed�. ` `
....................................
to,,Constru or Repair ( ) n Indivi 1 ew i sal System
at No.y --- :l�
stree
as shown on the application for Disposal Works Constructio rmit No._ Dated/ � ' -----x,, -----_- `
.....------••---
oard of ealt
DATE- ......... -----
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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