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HomeMy WebLinkAbout0009 WOODLAND AVENUE - Health 9 Woodland AveWf3sterville A=140-133 Q f j �I TOWN OF BARNSTABLE Ld:ATION ®� � �� SEWAGE # VILLAGE DS���i�l� ASSESSOR'S MAP& LOT/W-/33 INSTALLER'S NAME&PHONE NO. SEPTIC TANK:CAPACITY /1'00,:6 L LEACHING FACILITY: (type) Ago G, 6m`4 14*41,,< �� (size)/oZ,✓ X �.� JCo?� NO.OF BEDROOMS BUILDER OR OWNER 4 PERMIT DATE: 3_? COMPLIANCE DATE: Separation Distance Between the: Adjusted Groundwater Table and Bottom of Leaching Facility FYI- Maximum 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 Furnished by • D s � 9'� �6 a �� n�- .� �, � O L 4 i �6C - � �.. ,.�' _ 6 �_ - v* TOWN OF B STABLE LOCA?TION SEWAGE # VILLAGE ASSESS09S MAP & LOT c? 219SP61LNAME&PHONE O. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) / (size) NO.OF BEDROOMS BUILDER OWNER PERMITDATE: C 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 fee of leaching facility) Feet Furnished by /3 ✓� r �/ ,� � � � � �� _, �- v R . . � �} 9 �',�� d � i �' ... � �,,,.�....s -+ � .. �c e TOWN OFBARNSTABLE LOCATION 1 G�JO .�i�.d �1C�� SEWAGE # VIILAGE b,5len/Wle � ✓• ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �� 6 Axau . i LEACHING FACILITY: (type) — (size) NO OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet E 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 f leaching ci , ) Feet Furnished by _ `� ® ti o .� � � � � � � — —,� �, � �. ® \ �� _ e � �'� ��-r � �� � © � ,� ti ,� �., � ®, r No. F* aq O "��. Fee�_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for �DigpOgAY *pztem Conttruction Permit Application fora Permit to Construct( )Repair( )Upgrade(/Abandon( ) lJ Complete System ❑Individual Components Location Address or Lot No� �y Owner's Name, Address and Tel.No. yAssessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1— Type of Building: Dwelling No.of Bedrooms < Lot Size sq.ft. Garbage Grinder 0 Other Type of Building 2 elveeNo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ill gallons per day. Calculated daily flow -5—$-0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / ,�0� e of S.A.S. d i Description of Soil Z 7"-e0 Nature of Repairs or Alterations(Answer when applicable) 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 b is B and of H alth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. - Date Issued E ..--,. Fee �57_ THE?COM ONWEALTH OF MASSACHUSETTS Entered in computer: i,. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication forMigpo,5a`Y'&pg"tern (Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(1/)Abandon( ) L/Complete System ❑Individual Components Location Address or Lot No Owner's Name, dress and Tel.No. Gl - Assessor's Map/Parcel Die^�Gw� /gyp Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7/-- 3 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(/�© Other Type of Building des e✓IfeeNo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow / gallons per day. Calculated daily flow S`5-0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank e of S.A.S. d Description of Soil TI'eblGdf�S S' X i Nature of Repairs or Alterations(Answer when applicable) J,tl Date last inspected: Agreement: _sow 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 issue�isand of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. - Date Issued — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE.RXIFY, that the On site ew g Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by at `tIA V`Aff e5 Ir-l-,(xIlle, 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 permit s)11 not be rued as a guarantee that the system will function as designed. Date L4 Inspector No. � 1 7 -------------------- / �fG �33 Fee S`n i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mwi$tJogar *p$tem Construction Permit Permission is hereby granted to Construct( Repair( )Upgrade(�Abando ( ) System located at ,9 w®D� rl �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:- - / Approved by ,� } 10/9197 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) Az . hereby certify that the application for disposal works construction permit signed by.me`dated l �`� concerning the P g property located at A-le "m'z�� Dr** all � meets all of the P Y �l following criteria: /There are no wetlands located within.100 feet of the proposed leaching facility There are no private wells within I:0 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. 11f the proposed leaching faciiity will ce located within=:0 feet of anv wetlands. the bottom of-.he proposed leaching faciiity will a!2 be ocated less than fourteen` i-1) feet above the maximum adiusted groundwater table elevation. Please complete the following: A) To of Ground Elevation(according to the Engineering Division G.I.S. map')~• 'l°' . ) p B)Observed Groundwater Table Elevation(according to Health f Division weil map) o DATE: SIGNED. s . LICENSED 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]. ' ¢bWtb folder.«rt ;a ' L, -------------- J. �\ 1. 6AJ dU Q Lh r .. E. 'Oleo r , 0 00 l j TOWN OF BARNSTABLE G j LOCA G�/DDr9��G�!! SEWAGE # ON VII,LAC�rE O5 /l�/��L� ASSESSOR's MAP& LOT 2W INSTALLER'S NAME&PHONE NO. ` SEPTIC TANK CAPACITY Arco 4.l LEACHING FACILITY: (type) f006,/1~4 I'Aw -,S �9� (size)AZJ X 10 �W 4 NO.0-BEDROOMS s BUII;bER;OR OWNER PERMITDATE: 3 -I� COMPLIANCE DATE: Sepaia�o 'Zistance Between the: { Feet Mauiuna Adjusted Groundwater Table and Bottom of Leaching Facility PrivateW._0er Supply Well and Leaching Facility (If any wells exist oks'to or within 200 feet of leaching facility) Feet Edgebf:Wetland and Leaching Facility(If any wetlands exist witln300 feet of leaching facility) Feet Furni h d by r i 00 ' 6)� dc r S ' \ a " ,- t a � . O rw 4 r r � 3 m H A � A C I O � a a ac ,, ���G �1 _ , � '��' :.�� � ,' � I �, II �� .. .. .. 'r ��/ No&=. ...... ....... Fss... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF......................................................................................... Appliration for Dh4paiittl Works Tnnuarnrt-inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: , ....... ... �..._.. ...... ........................................... ......._.._-••••-•....•-••......--•------- Locatign-Address or Lot No.;.... ..: ............................... ............•••••-• --••--.....................-••-••--•-- ner .�/ ress q/;,;;�j Installer Address U Type of Building Size Lot.f-T PQ......Sq. feet Dwelling"lKo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) G" Other fixtures ......................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid"capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal No.� .... g g •...•--•...._.sq. ft. x Seepage P t 1Nlo-- -�o•-,_._._. Diameter idth::.... Dept Total i let....................Total leaching area....,.............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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........................ -•-.•• ---J ----- .. ..- ODescription of Soil--- .�rf._ Z � ---------------------- ---- ------------------------------------------------ x x •-•...........--..........................................................•----•-----•-•.........-•-••-....-•- -- ------------------------- -------------------------- Q. a U Nature of Repairs or Alterat* ns Answer Wwhenlicable-�............:.....�_y� ..� __.....___._.___.__.___.._.. Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TL I IL LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by thp board of - fE - ._... ...... ....... te Application Approved By••-••... =- •........................:.._ Z3 I........... Date Application Disapproved f o ollowing reasons-------------------------------------------------------------------------------------------=---------------•••••. ....................•--••---..........-••....-•-•-...-•-•-•-•---•-•......•-••-•••-•-....._.............•. Date Permit No.......................................................... Issued =€ ............... Date �- - -- - - -W-4---------------------------------------------- �; rf THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................_...................OF..............................I..........................---------............._ ..... Appliratiun for Uhipaii al Workii Tonstrurtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ......... ... ------.--.---•----------•-•------------------------------•..-.-------..-.-..-----------..-.-------.- Locati9n.Address or Lot No. ............................... ............. ....... OR ner, ress ......................................... .......,....... .... ....... .... Installer Address Q Type of Building Size Lot- --� ©------Sq. feet V Dwelling .___.Expansion Attic ( ) Garbage Grinder ( )No. of Bedrooms. — Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) QOther fixtures --------------------------------------------•------•--............................................................................................... W Design Flow............................................gallons per person per. day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter............_--- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No._._._f .d Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................................................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ...................................................--................................. O Description of Soil._: . x U •----••-•-•------------••----•-------••---••--•-----••-•---•--•---••------•--•-•-•---------------•-..........•-----•--•-•••---••••-•-•-------•--....-------•-••-••-•--•--.....---••-•---••------------. W --------------------------------- ------- ------ ----- UNature of Repairs cr Alte= Answer— when livable-G ee --- ../t). 1 •--- r --------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until . . a o omp>aSi Chas been issued by t board of li 1 -- -•----------•---•-••-- �-'' .��. ......._.� Application Approved By........- ;.: '" ' , -. ........... Date Application Disapproved f o ollowing reasons--------------- ------------ --------------------------.._....-------------------•---•---. ...------...------ -----------•••-------••-------•-•--•-•----••-•------------•••.....-•-----•-----•--.......................•••••••.........•-•---•------•--------------•-•-------•••--•-- -•---••-- -------••---.-•--- Date Permit No......................................................... Issued.-_-=1- •• ... .. . ............... Date THE COMMONWEALTH OF MASSACHUSETTS , BOARD`'OF HEALTH ..........................................OF...................... ...... ...... (Irdif iratr of f� hau TH ISM 0 CERTIFY Tha , e Ind* *dual Sewage Disposal S ten constructed ( ) or Repaired th by......I. . `--• .......--•-- ;-- ---- .-•---- .........-------- Installer at................. z t R ------- -• --- .-.-.-.-.-.-.-.-.-.-.-.-.-.-.- has been installed in accordance `ith the provisions of"TIT r o. The State Sanitary Cod a r; ed in the application for Disposal Works Construction Permit No.- �'"' f' ' ................ dated _ . 1 -- -- ---- ---•-•---•-------•- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST S A GUARANTE THAT THE SYSTEM WI F NCTION SATISFACTORY. a DATE.... ..... ......... ... Inspect --.. ....._._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..................................................................................... No..f—e- v ..._ FEE....................... �t��tu,��Y " r'4•LG� `dY�n�� t�n �G r�t� Permission is hereb grante . . ' .._.............I....................................... to Construct ( or Repair an In vidual Sewage Disp �.. atNo. - ---- ........,- --... _. ..................... . . ......------------------ .....---•--------•-----............--•-- Street � �+' as shown on the appli ion fo isposal Works Construction Permit No '""��4'... Ida`fe .. ...................................... ................................... --- . ................................................ of DATE.... �.:.._ ,A`. and Health FORAM 1255 A. M. SUL 'IN, INC., BOSTON - TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS' I ASSESSORS MAP NO. �Ycl PARCEL NO.' 1 3 3 9 ADDRESS: W ne), ot-+Aj-,) 4vE VILLAGE: oS2-W11/LLc-- 14AME;._..__/� --� r✓LL,S... ---/'E/22 /�1�1 i1/._ ___. CONTACT PERSON .T'f�Y►?� PHONE NUMBER LOCATION OF TANKS.; CAPACITY: ..TYPE OF* FUEL. AGE: TYPE: LEAK OR CHEMICAL, y DETECTION. - SYSTEM o DATE OF PURCHASE OF EACH: 1.. Ti 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASS DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. 1 �� 4 �� --�-