HomeMy WebLinkAbout0163 ASA MEIGS ROAD - Health -163 ASAV MEIGS�MARSTON:a YIII LS—
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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
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AA 11
AB 3 b
fA '31 6 O�
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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
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
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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
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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]. -
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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
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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
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` 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 ,
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