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HomeMy WebLinkAbout0137 SCUDDER ROAD - Health 137 SCUDDER RD., OSTERVILLE A = Ila al -3 D n TO' ..'' - S ABLE CO 1; LOCATION 7 SCc>� Pry SEWAGE # VIL1 AGE � 1 ASSESSOR'S MAP & LO.T�© 0f- INSTALLER'S NAME&PHONE NO, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) / (si Ix NO. OF BEDROOMS 5 BUILDER OR O R 6i7 (? 6 FERMTTDATE: �� Yl 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 leaching facility) Feet Furnished by _._ d T c No. FeCV THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYfcation for nigpo�a 6peum Comaruction Veriuft Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / 7 SC d D/` Owner's Name,Addfess and Tel.No. P Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. •S �S u 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 Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations A r whe applicable) /5n2 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 operatiununtil a Certifi- cate of Compliance has been i o e 9h. _ ^�� r Signe Dat Application Approved by s Date Application Disapproved f r the following reaso Permit No. Date Issued 4 _ r5 - No. Fe �'�/• THE,�COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS �,C. Z(ppfication for Migoga &p.5tem Construction Permit v Application'for a Permit to Construct( )Repair( Upgrade Abandon( ) ❑Complete System ❑Individual Coamponents Location Address or Lot No. 1-3 SC d 0,- Owner's Name,Add ss and Tel.No. Assessor's Map/Parcel D 0f aW 141 C Q l Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Gt/w/%'roZ 16ai /�6�C. g ya3 aSfPpv` Rr 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 Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alter tions Aa&wer whep applicable) .�`mot'. , Date last inspected: ` Agreement: x 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 operati unti a Certifn- S cate of Compliance has been i o e Signe Dat '- Application Approved by * Date Application Disapproved f r the following reaso6l I — V Permit No.' Date Issued ------- .................. ----.------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Eertificate of (Compliance THIS IS TO CER the O -si a i� 1 System Constructed( )Repaired (/')Upgraded( ) Abandoned(- )by at ha constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. / dated Installer -i Designer /l /V v i`Ca The issuance of this pe tesh 11 n t be,construed as a guarantee that the 't , -will func ion A ,esigriad. Date Inspegtor1��/� / — ————— ---------------------------- G No. U Fee IV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5po5al 6 em Conotruction Permit Permission is hereby granted to Construct Repay( Up ade( ) don ��` r -- System located at �/ and as described in the above Application for Disposal System Construction Permit. The applicant reco nizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con truyction must be completed within three years of the date s rm)it. is YDat . Approved b le 1 116/99 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) hereb certify that the application for disposal works construction permit signed by me date 1���� concerning the located at ,,/ P �� ///0 property �� C)�'��l� /�"� 05Aets 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 I • 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 ma.,Gmum 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 ma�dmurn adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W. AdjustmenN16 = a 69. DIFFERENCE BETWEElj A and B p SIGNE DATE: ' [Sket proposed plan of system on back]. q:health folder.cen C,/ TO OF B SABLE Q LOCATION �C CJR61 SEWAGE # U VILLAGE ASSESSOR'S MAP &LOT 00 INSTALLER'S NAME&PHONE NOZ �U `2 `Ja C- '� `� •� SEPTIC TANK CAPACITY 00 LEACHING FACII. Y: ) TT NO.OF BEDROOMS - BUILDER OR 0 R (^ (3 104 i PERMTTDATE:v COMPLIANCE DATE: d � Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet j 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 i I JA "f I