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HomeMy WebLinkAbout0046 GLEN ROAD - Health 46 RD.;HYANNIS' ° ° t i ° a ° � � a May 30 2017 14:16 HP FaxShiretown Glass 15087477864 page 1 j2-L) C9 le- E r � k ' 1 TOWN OF BARNSTABLE i C-- LOCATION TC A IV SEWAGE VILLAGE i/c t.,��i ,s�/_+.:-� ASSESSOR'S MAP & LOT -(1?�% INSTALLER'S NAME&PHONE NO.HIV/-1n e-rl a e �e --►f, r SEPTIC TANK CAPACITY J LEACHING FACILITY: (type) ; li/-4,/TIf NT6 S (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: 1, 1 :L -Oe/ Separation Distance Between the: 1 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 faaity) Feet Edge of Wetland and Leaching Facility(If.any wetlands exist 0 within 300 feet of leaching facility) Feet i Furnished by r �s 1 l vl TOWN OF BARNSTABLE F LOCATION cI E Al P SEWAGE #&-9 26- V LLAGE ASSESSOR'S MAP & LOT .` ff-0,11 INSTALLER'S NAME&PHONE NO. .,'V n c aG 'r SEPTIC TANK CAPACITY LEACHING FACII.TTY: (type) 4 qTO (size) NO.OF BEDROOMS _3 BUELDER OR OWNER Ala AnA � PERMIT DATE: 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 1. .within 300 feet of leaching facility) Feet Fuhtished by t` rp� n } -V lai I�i iL t ` y No.— �]� y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for �Digponl 6p!5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ,'Complete System ❑Individual Components Location Address or Lot No.y� QJ vuwo mac; Owner's Name,Add ss and Tel.No. Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. C- is�OJ-%s S1- ,,YuaS Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures -� C Design Flow O gallons per day. Calculated daily flow 5�) gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank i �;" Sj :O r x,r`t Type of S.A.S. < Description of Soil y Sn Nature of Repairs or Alterations(Answer when applicable) I S c %1,0 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 t to place the system in operation until a Certifi- cate of Compliance has be ealth. (` Signed Date t� 119 7 Application Approved by - Date Application Disapproved for the Yllowi4g reasons Permit No. Date Issued 7—-W N-- '77 - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplication for Miqooal *proem Construction Permit Application for a Permit to Construct Repair Upgrade Abandon `Complete System 0 Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel f o el Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Tide Size 4'Spptic'T'ank t z417 S, o r _ Type S.A.S. 0pr 7Description of Soil: --V7,vQ Z_ Nature of Repairs or Alterations(Answer when applicable) x-, i)_1*?,(--K Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore describedo' n-site sewige disposal system in accordance with the provisions of Tide.5 of the Environmental Code andd�qt to place the.system in operation until a Certifi- cate of Compliance has hSaus Health. Signed Datee- Applicition Approved by Date Application Disapproved for the llowing reasons Permit No. 371', Date Issued ——————————— --———————---—————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired Upgraded Abandoned by A AE' f)-rx C at gW rje—bca' VoiqQ' D has been constructed in accordance with the provisions of Tide 5 and the for Disposal System Construction Permit No. -g742 —dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date I -) r\ -.> iv Inspector 7 11 ----------------------------- -- No. Fee THE COMMONWEALTH OF MASSAC''� SETTS PUBLIC HEALTH DIVISION - BARNSTABLE 2 ASSACHUSETTS 30t!6poal *p!5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgradrt e X Abandon r 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: Approved by 1/6i99 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) hereby cer ffy that the application for disposal works construction permit signed by me dated concerning the property located at I`e to Q (Z� meets all of the following criteria: e&l�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 �/• nere are no private wells within 130 feet of the proposed septic s✓ste n ere is no increase in flow and/or change in use proposed • There are no variances requested or needed. e bottom of the proposed leaching faclity will not be located less than five feet above the maximum adjusted groundwater table elevation. (?adjust the zoundwater table using, the Frimptor method when applicable] If the S.A.S. will be located with'_50 fe`t of anv vegetated wetlands. the bottom of the proposed leaching facility will not be located less than founeea(14) feet above the maximum adjusted groundwater table e!e'iation, I Please complete the following: �( �1 U A) Top of Ground Surface Elevation(using GIS infdrmation) B) G.W. Elevation !2(o _the.Ma`(. Nigh G.W. Adju-nment DEFERENCE BETWEEN A and B SIG)ZED DATE: f(f 9 I (Sketch proposed plan of system on backl. q:hcahh folder:c-i .` ` I c- �� ,. r�`, .-� �. _ � f oC3o £; :f � r ' .6J '-1..�_ �� ��- ,� } /� CM L O CATION , SEWAGE PERMIT N0. VILLAGE r IN ='S NAME i ADDRESS AffAum OR Ow 1 ER DATE PERMIT ISSUED 14 -Z-3 - S-D DATE COMPLIANCE ISSUED �d I, ..��� .. �. �� �'`� 1 �� e ��� `• i ,. �. • _ l ��� ..�. �� At. No........���©:...... Fin$...............��.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH ....l.............OF..... ............................................................. Appliration for Bispaoal Works Tnnitrurtiun rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 0 :....... ............................................ Lo tion_ ddress or Lot No. ..........................-'-••----.... ...._. . .-•....... cam........_.._........... ..___.___.._..._____' -'---•..... -----------•-• •--••-------•........ -• Y. Ow r A ress a .. ... --. •--- ------- ------- -- -- ---------------------------------- L9 ..............•------...�-_� - Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid'capacity__..........gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. w_ Seepage Pit No..................... Diameter.................... Depth below inlet............:....... Total leaching area..................sq. ft. Z' Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by...............................------------------------------------------- aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... f� Test Pit No. 2................minutes per inch Depth of Test Pit:___-___----______-- Depth to ground water........................ C� ....................... ---••---•--•••••---•••---•-•-•----••-•...•---•--•----------------••-•--------......._..----••-•--•----••--••-----•-•----------....-• ODescription of Soil.......-- • --•-•----••-•-•----•--•...........•---•••-----•••-•--------•-----••-•-•-•••-•-•--••-••••••-•-•••••-•••---•----••-•---•-••--••--••----•--- U .. W •-••••----•---------------------------.........................=...................................................... t............. ...._........ UNature of Repairs o, Alte tions Answer when plica le...__._..-___ ____________ _______ ___`_1_U_v v � ............- .�d�t�L .. ........................ ............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions'of LTTU, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been77 is e by th boar of iealth. . !! �� 0 Sign .•--.. ...... ......... z------------------•--•--• K-� ----•:- Date Application Approved By... 6�/11J� 1� -------------------- Date Application Disapproved for the following reasons.:-----............................n--------------......._..---•--------------------------------------......._... ---------------------------------------------------•---•--••---••-...:_.........---...............------••-••--••---•----•-----••------------------------------ Date PermitNo.........................................-............... Issued_._.y:'s :y` ------•--_--.-------•---- Date 1 No....D...trf!?:...... FizB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARDRF- HEALTH...........� � .............OF....... .... ... ....------...----••--••-------------...._.............. Appliration for Diapooal Works Tonntrnrtion I[rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual `Sewage Disposal System at: . .... L� � .................: ..._.. -----------------------------------•... 7� Lo ion- ddress or Lot No. ....................— ........... . ... ••..... ....................•..... ..._......_.....••• •... O , err ress - ............• •• •-•.............................. ........................•••• ........ W !� ..... C�D Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria QI Other fixtures ....................•-••.......•-- --. .. . W Design Flow............................................gallons per person per day. Total daily flow............................................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.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_________-_--__-.--- (rq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil........... - x U Nature of Repairs r Alte tions nswer when lira e........................... ............................................. - -- ----•------------------------------------------------------•----------------------------......•... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T-ITLE, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been igpe by th boar of i lth.Sign. d............. -•--•---•-•-• ................................................ A zD�— Application Approved By ------------• r_t Lam.. i'l/1� !/� ✓-------------------------- 1 Q�.. -•----- -- = ---------- Da-•e---- Application Disapproved for the following reasons:................................................................................................................ •-•-•••••••••-•••••-••-••-•-•----•-•-•••...--•---•••-----•••-•-•--••-••••--•--•---•----•--•••--•----•••-----•--•-••••-••-•••--••••-••--•-•••-•-•••-•---------------------•------•---•-----••---•-------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O401W. F HEALTH L✓h............OF........... .................................................. Trrtifiratr of Tamplittnrr THIS I 0 ER Y r hat the IndiWIwage >sp ys m constructed ( ) or Repaired ( ) by--....... ------. `f :. ....................................... ta ---- --- - - ------------ has been installed in accordance with the provisions of Trq*:Y"1 � 5 of T.. e State Sanitary C2 e � �scrib-A in the application for Disposal Works Construction Permit No. ..__z .. ............. dated...... ...._._....._........._............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....--- .............................................. Inspector-•--- ••. ••... . -------- . .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALTH a�U .............OF......... .. ...C... .................................................. G No...........41......... FEE... ................ •- 1 'k T?1 ion rrntit Permission is hereby grante ..----� • . . ---•--•----•- ------------------------------ to Constr ( br R a' ( an Individual Sevt� geAD' Sat No. -� d2�...`...__...�... - *.... .............................. S�treet as shown on the application for Disposal Works Construction Pe.nat No. ::._. Dated.._.,".2_!3--dC:d ---..------•--- --- �--------------------------••-••-.._ DATE. �,J - ��G-� Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS