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HomeMy WebLinkAbout0163 ASA MEIGS ROAD - Health -163 ASAV MEIGS�MARSTON:a YIII LS— A=030-073- n o N z Ch TOWN OF BARNSJABLE ✓ LC,CATION l SEWAGE # VILLAGE ` \ ASSESSOR'S MAP& LOT L INSTALLER'S NAME&PHONE NO. ��``�� SEPTIC TANK CAPACITY L o66 LEACHING FACILITY: (type) 62 1+-— (size) NO. OF BEDROOMS v BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: _ Separation Distance Between the: 3 19 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 �oM y AA 11 AB 3 b fA '31 6 O� 1 S TOWN OF BARNSTABLE LOCATION 43 ASA SEWAGE # VILLAGE MAaS l OWS M I LL.S ASSESSOR'S MAP & LOT Q3V v INSTALLER'S NAME & PHONE NO. 1PtM67S dOLt-Qt4201,0290 SEPTIC TANK CAPACITY iS00 CIA WYISTIWO LEACHING FACILITY:(type) 9-00 0 6+AAcw1B6xs (size) 2- NO. OF BEDROOMS P 9e .I O<PUBLIC WATER PUISUC BUILDER OR OWNER 107 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 41 `T ` 9� VARIANCE GRANTED: Yes No r x �f i1 -b AS "® 3 BI otiT 'F3 3fo �t -0 A'S &3- 0 a� If7- 0 re ; ..���No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zfppfication for Miqual *pgtem Cow5truction Permit Application for a Permit to Construct.( )Repair())Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 163 ASA /M 0 CAS Owner's Name,Addres and Tel.No. M��oNS M tLL4- e MA EuiOT V0ELCt TGX_ Assessor's Map/Parcel� ((v 3 04sh M 0&S 030-073 M4gSTpjjs MILL-S MBA Installer's Name,Addres ,and Tel.No. 147.6° 02 8'0 Designer's Name,Address and Tel.No. Ao, Ba ?t' - /M.40-STON5 MILL-- MA P60° BOA 702 /VtACS-r6tv6 MteLs kA 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 Design Flow 33o gallons per day. Calculated daily flow 3`f gallons. Plan Date 3- 30° `1 1 Number of sheets Revision Date IA Title Size of Septic Tank (sa® Type of S.A.S. '29 S o �&A A404 a 01 AAM 6672— Description of Soil Nature of Repairs or Alterations(Answer when applicable) F-ML4GD S A-S Date last inspected: q� 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 issue by this Board of ealth. Signed Date 3 °30, 99 Application Approved by Date Application Disapproved for the following reasons Permit No. aa Date Is 1 No.— y Fee s_ THE COMMONWEALTH OF MASSACHUSETTS Entered rf mputer s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSE7S /0[pplication for Mi5posml *pgtem Con.5truction Permit Application for a Permit to Construct( )Repair(J)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. A3 f}SA M V7,6S Owner's Name,Addre and Tel.No. PAAv_ roNS M M t LLl- , A E T Wi_L10 ORC.&'STFiL Assessor's Map/Parcel 143 ASA M G71 4-S 650-673 m roNs MIus I NA 02-u*+8 Installer's Name,Addre and Tel.No. t47.6, 0 2 b''0 Designer's Name,Address and Tel.No. 'I"ES [COca-e—R _ j"ve'5 I+oU-e-A— A o, gox In- M A"I'WJ S MILLS M A 0, Bax 702- M Ae ro"-5 M t LL-4- M A 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 Design Flow 330 gallons per day. Calculated daily flow 3`-7 gallons. Plan Date 3. so- 91 Number of sheets ( Revision Date NIA Title Size of Septic Tank 1 Soo g Type of S.A.S. 2X SOD C A*m S M6, Description of Soil Nature of Repairs or Alterations(Answer when applicable) QjFP6A4Z- FP,1 LGD S A-S Date last inspected Fib 199`1 y 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 issue by this Board of/Health. Signed Date 3 ' 30. 1 Application Approved bykqP�t�� Date Application Disapproved for the following reasons-6 -' Permit No. Datelssued ——————————————————————————— ——————————— t THE COMMONWEALTH OF MASSACHUSET S\ BARNSTABLE, MASSACHUSETTS Certificate of (compliance THIS IS TO CETFY, that the On-site Sewage/Dis al System Constructed( )Repaired ( )Upgraded( ) Abando ed 1 � at s n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer s? The issuance of this pe . `t shall not be construed as a guarantee that th sy tem will function a° r psi tied. vt Date Inspector v I / t/1 No.— -- ------------------------------- --- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5po5ar *pgtem Construction Permit Permission is hereby grante to Cons ct Re ' ( )Up r de( band ( ) �, System located at / ' V and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/he duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi must b co leted within three years of the date oft this `ermt . Date: V Approved by �l/G�._... 9 °��' TOWN OF BARNSTABLE LOCATION 143 ASA M 67I6S SEWAGE # VILLAGE (���fc5 j Y:n;s MILLS ASSESSOR'S MAP & LOT 030-0� _ INSTALLER'S NAME & PHONE NO. -- AMGS 4OLLCR_ 720,02E-0 SEPTIC TANK CAPACITY is-00 �a (EXis�rlwc,) LEACHING FACILITY:(type) I00 CAAyv 6iFXS (size) Z NO. OF BEDROOMS 3—PR 1 Ta G'r' '-0 UBLIC WATER) PL,I SLIC- BUILDER OR OWNER �L 1-1 pT p�L�cS\\T DATE PERMIT ISSUED: 3 i �3O. 11 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No o a 3 A2 m Bz A 3 -93 3b -6 -o A : &3_ 0 10/97 ------------- NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION W THOUT DISPOSAL WORKS CONSTRUCTION PERT ( ENGINEERED PLANS) l `J Prm E5 46 c -67t- ,hereby certify that the application for disposal works construction permit signed by me dated /V Al2-1' 14 3d, I qn`t concerning the property located at t 3 kSA M Et 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 Flow and/or change in use proposed • There 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 p91 be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: 1 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: 3 . 3 o. g 9 LICENSED TIC 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]. - q:health folder:cent r 2._ Z 13 24►� P ` o � a 0 ZS ��Od 4L EX/Sr,NG o °Tie .?. WK 'r Cat,t%A LPrc,oNa ; 0� 13�xZS� T�1� v$ Usm& SuaaalAIj y WItbF 4' SToMF 3 Z55- I Z 5 iDt wA�Gt SZ t�i 157mp WpmL, `f69 Tt--rAL `*7q Io-o--- 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, , hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at 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: A) Top of Ground Surface Elevation(using GIS information) /G2 1 5 B) G.W.Elevation bJ +the MAX.High G.W. Adjustment. = X- 6 DIFFERENCE BETWEEN A and B % 1 0 4tSIGNED : DATE: [Sketch pr sed plan of system on back]. q:health folder:cert Z, 23 LOCATION SEWAG PERMIT NO. VPLLAGE M I LI- s INSTALLER'S NAME A ADDRESS Y6 7 Tg 06W- T S A,IV A we Cr( Q d U�E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED t a R �l f()6`'. �39 f � ivy�;:. ..... FzB..,rO ............... ` 00 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......OF.......................................................................................... f Appliratinn for Dispoti al Works Cnnntitrnr#inn ramit Application is hereby made for a Permit to Construct ) or Repair ( } an Individual Sewage Disposal System at: o T /oAJ[3cRkY i1IG�- .... --../._�................. --•-------...-••-••---._ ........_....� ... ..................... Location ..... / �lY e e L�C i O ...... A, Address a . ..........................•--.........-- ---...---•----------------..._._.....••------=-'••.......--------•--••----------- .---- I taller Address Type of Building Size Lot... z_Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic•µ(. )` Garbage Grinder ( ) Other—T e of Building No. of persons_.:.-�.. .............. Showers — Cafeteria a' Other fixtures -----------------------------------•-------..----- W Design Flow.. ................gallons per person per day. Total daily flow----.._ 3X.10..._....................gallons. WSeptic Tank—Liquid'capacitylVIW..gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—Nq..................... Width ....... Total Length....................... Total leaching area....................sq. ft. Seepage Pit No.......C------------ Diameter.....�_2.._.._.._. Depth below inlet...... Total leaching area. U ......sq. ft. Z Other Distribution box (✓) Dosing tank ~' Percolation Test Results Performed by.... . .................... Date---fl1-6 ,aa Test Pit No. 1 7 25__minutes per inch Depth of Test Pit---J.Z. ......... Depth to ground water.._A&-Jen......... Test Pit No. 2._11ANminutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------- •..... ...............................................•-----•---------•-••--•-----•-•--••--------.........................••-•--.....----- ODescription of Soil... - /- ?.C(!L.. .SS..------•...............••-----------------------------------------------•----------------•-----------•-•--------------.. ..-- -�' L.A-% ------------------------------- -------------- - ---- ------- ----- - UNature 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 i I L'11 5 of the State Sanitary Code—The undersigned further a rees not to place the system in operation until a Certificate of Compliance has n i­ssu/ed bbythe b and lth. 2Z • ....................... D_.. Y Application Appro d B pthelloUwingreasons: -------------------------•-•----------.................----- / Date Application Disapproved ...........................-............................................................................................................................................................................. Date PermitNo...................................................---- Issued_....................................................... Date FE.B ................ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ...........................................OF....'.:c..... ..:>,.......--............................................................. Appliration for Towitrnrtuan rrntit - 'Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: -:a. ""_..0._1� ....._.'` �vc/.,?Y j?I &•-........................................ Location-Address,.- or Lot No.j �7tc�e_----e�.._.C1.�s.?4�--•----t.r.tr_uT`•_.__ .�12�",�t. ,. .���syG�__..,��:',ca�.��5...�7_:.. ,f-��'�� Own r y Address _W .. re ram. -•------------•--•--•---..•-•-••------•--•..................... ............•••.........._.......••-•---••-•-...------•-•-•---•--•..•-•--•---•.......::.* Installer� Address ,�,.:• Type4 Building Size Lot. _�'..CA..�,..Sq. feet .-I Dwelling—No. of Bedrooms___- ..................................Expansion Attic ( ) Garage Grinder „( ) Other—Type of Building +' No. of persons.........:..:............... Showers � YP g ---------------------------• P ( ) — Cafeteria ( ) Otherfixtures --------- ....................................................................................... --- Flow /O gallons P P Y y v C7 .............................. ... s. W +- __1 ......... ...::.... llons er erson- r da Total dail flow._......_ gallons. W Septic Tank—�.iquid acit;& ..gallons Length__________________Width................ Diameter................ Depth................ -Z .�� x Disposal Trench-�- No..................... Widt ..f.._......__..... Total Length...... _�.__._.__ Total.leaching area.,:,tS 9_...sq. ft. Seepage Pit%No......I-:._--______ Diameter...)l---------- Depth below inlet...................... Total leaching area..................sq. ft. Z� Other Distribution box Dosing tank ( ) Percolation Test Results Performed by.__ 1.� ____ c=tt.11 Date. -3.1__�. _ .�_ 7.. Test Pit No. 1 _5S__-minutes per inch Depth of Test Pit . ....... Depth to ground water..A&eJF=•.......... fs, Test Pit No. 2..Z Al.minutes per inch Depth of Test Pit.................... Depth to ground water......................... P4 --------•---•----------------------------------------------•---......-------•---•----•-------•------......................................................... O i Description of Soil40.w)_ :C_,q.4r ...-.S ss .------•--------------------•------------------------------------ = W .........- ------- ---------------------------------------------------------------------------•--------------------=---....-------•--•--••••----------••- 5tFt ------------------------------------------------------------------ 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, TITLi: 5 of the`State Sanitary Code_Tie undersigned further agrees not to place the system in operation until;` Certificate.of Compliance has ssued:ly the oard ealth. gne 't .......................... PP PP ••••. -•-- -••• - ------......•••----•--•••--••--• •••-•--- •---•••.- ' � Application A rov B ` Date a Application Disapproved f the f owing reasons:..................................... ........--•---------•------------------------------------------•----..._...-•--•--------.....-----•••_•• Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... M'Str#ifiratr of Tautpliaurr THIS I TO CERTIFY; That the Individual Sewage Disposal System constructed ( Or Repaired ( ) by ---- bwthe --_-• •••••--•-••-•••...••-••-----------••---•--•-••--•-•---••--••••-•-••-••-••.................•-••-----••-------_•- ! Installer at_ �Y -------------------------•---------------------------------- -------- has been installed in accorda provi s of TIT 5 State Sanitary bed in the �} °�°�application for Disposal Woruction Permit No.__.___Q-__�j !_J _________. 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 OF HEALTH r 41��` ...........................................OF..........................--•-••----••--•--•-••--•----..........•--....._••.......... No.....��.......1 � FEE........................ ............. nrkii Tonitniilan Vamit Permission is h reby granted ••-•--. i - r ..........:...... to Construct or;Rgpair n Ind' ual S e i posal System at ...... ! - • ................ ................................. -•••--......•---------•• -••--•------••-•-••••-••----•_-•- Street as shown on the application for Disposal Vl rks Cons ction-P--errrri ..................... Dated.......................................... --•--•-- -------•-------•-------••--•••....-•••••-••-------••••-••••-••------•.............•-•---...._ Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON , + Y r I f 43.,54.o S. F 9Lo (r VA CA"-r) !I �( AS5UM�D PR'=5�v U"nm�k.A'R-T ZII f GHAPT732, 6-E "�$QA�JDFATHEr CL�t�1S�' WELL IOCA MM J I°� l0 r I �e \\ � of Al Idl•' a Idt I�z CN JJ k t a q m u d) --4X LP ItA OT OF No sum I � EX It5n Q6 LEI EVAMCW &c,=� 2- PAD PL9=T PLAW LLD ELaVATIc./ e, n=uTcxjP_ R " LOT 1 1 8 HsA M f=.1��5 (,--nA D � o ` AAPRaED; �2D of OEAI_- q s r u s0rr0% b4TE A6ENT 4O DAME: 5 -7. 8 4. CLIEUT: &�(3EM� ccT. r u IEBY c= r,FY TPATTNT PROF EL_LlS s��EvIN6 ram.. J0g Wo 84-4o 25UILbIL16 SNowu orJ -r-IIS PLArJ ' 29 Mus EGET LANE CouFoQMS TO Tl-IE 2c►Jjw6 LAWS C�u1�(2vr�LE, MAss., OF 6A(2WSTAB E, MAsS. CCEVT <-J4. 13Y: S � N AS waTED SHEET I of 2- DATE uD su/b.iEYoR i � 2.G �T, Nti►.1. � / � t�dTE I F ;7-M-•1�R. T.-1 E SE P-r i G -rl-, V- o�L ! r- LEAC N i w b PI-r A•P---- MOR.s 7HA-1_i it" fat=Low IO f-T, MIl..i . _ GQA-�E A 24'bIAor-- Q c'— : aTc c= R t36�o�>6t-4'r 'ro GRA-DE-: ( DQovEwAYS 4" Pic P i Pi= ' Q ter-, ,i Liu cxrRA H EA�n( DuT`/c,45r l Qou covE� / M Ir...d. PITci-t•� l F-L i oi. O /�ca i�2/\. `/g" PEA- FT. ) �I%M1w. C�uCRBT� A / \ G P A b=- E-:R- ��sJ 5rkr.1 D 4,•CAST / -rrrr'-7 I MIiJ. Plrc+-1� COO SAL. o e Gh MNE/ �a WASF4aD ST=�wc' /4 PE:a FT. APT lG TAI-•IIL FIST. l • � � O 1 1 B ° a o e r � • e .b1t '. �rvvE:CT (3EC.o�..! c 1 r. t='FFEL7�1�/1= � e • ° _ ��4•" - ( /���. CLAD l...AV E Q- ° A C:aJ ° e C o e r 1 e e e e r r PQ E.GYOCS'r ����PrcaC t LJ�/1=RT �L_ /ATlO1JS 113, I X . 1.0 = ( 1 3 G /D. ° o r r o r e O r r , Pl-r oP E�cJAL_ e ° I IJ�/�QT T BUILDt"e= q8.3 -L A FT. PsT GAPrL IT"( : 49 0 C= /D �- 3' �.}..4 � FY: D/A M. (t,l LET St-PTIG. -rA"V- `�8.o FT• I F7'. DtAM. C �gt= TABvLATIOI_t oLJT LET SE PTI e- TA+_!K. a 1.8 FT. i u LET D iSfQ i P Jnor 1 god( 9-7.o FT. 1 F G Raul-�D wAT>=R T748L� -T DrSTQ.1 BUr►=*J Lox `i (e.8 FT• I►-►LET . LEAct-} "-!ram PIT 25.5 FT, SSW AGE= D f S PoS r4L SYS`TE:M Prr DESI6i.1 G�IT��IA xAL� : I/a„ a I r o D(�nr= tou A /Z FT. D l MEr 15t ol_1 B A FT. IJUMP Q of D�o:�n5 3 DiMEuSloii C �- FT. GA-RBAI�� Rs�L vutT u�,_ �I L LOG TC7rA L EST7 M ATED Fi &Ay' so I L TEST IJ` t So I L TrMT N d 2 5�I L SST OuM23E7P- ofLEACrliit6 Pn5 3 EL ° DATA oPS,oiL�St- A�„ SiDE L1=A--Hiu6 PER- AiT 15o.8 �. F'r, o-I LoAAA s.s. RE5uLT5 IZ.i=`D I��( Jec @aT7�M I�P�t-11 W,6 Pap—flT I 1 3. I Sq. FT. 7- TOTAL L E-AcH t"6 A-Q- :A. 263.9. '2 �. FT. l 4' GLA.Y CEQcroLA�tou PATE Ai \: PERGOLATO4-+ {2TE RJR 2 "TTfi��l M 1u / 1r.rc+-1 RPSE-kVE 2"3.9 5C;�. f=T- M.eb, t uC 5OsL t=ST P— F P- 3�L98 OF • MeD SNP 4-12 LOT I i 0 / SA M�i65 aoR-D t� �H Of >HgsSf SA11 O CQA>aPLG-( 'f�dGc P-oA D M A �� �iJ .N1 I L I x �`i c 1/ H w R. • .�ML219"5 Q ' 't`i 1 15 �����1F.1� PA�aT �` �'1 TV. EL= e-7.3 4.9 Mu--,k2 EE r LAkj < 1. jrE2vi i MASS s V / Hp SURV � 4nrtaaNa`` o G I2oc�a,D wAT�R>=uccu�rrE�D r.tr• : ""Nwa R�r DAtT� ` ds 2oLju0 wA-rE12a Et_ _ r��aa. C e 5 -1• 94 J J np u�: 84 -40of 2