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HomeMy WebLinkAbout0101 BLACKTHORN ROAD - Health (2) 101 Blackthorn Road,Marstons Mills =31DID-UD Iv 0 l rr TOWN OF BARNSTABLE V LOCATION �Z` I as'Ja id9,.r.� PA SEWAGE # ~ VILLAGE ASSESSOR'S MAP & LOT D y4. ©e,/ INSTALLER'S NAME&PHONE NO. Z SEPTIC TANK CAPACITY 44d!� 1 r»© �i S LEACHING FACILITY: (type) W (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: ) i 177- Q 7 COMPLIANCE DATE: I 1 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 Q2- r No. Fee THE COMMONWEALTH OF MAS ACHUSETTS Entered in computer: S Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Ztppliratfon for Migozar *pMem Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No.�Q �jlt / � Owner's Name,Address and Tel.No.fil ` n Assessor's Map/Parcel 04 � �Lo,\ ` Installer's Name,Address,and Tel.No. p Designer's Name,Address and Tel.No. r4 AP L SL l4 t4 N 1 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building fke of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -7,-30 gallons per day. Calculated daily flow 3"-R gallons. Plan Date E1-1-7-5-7 Number of sheets Revision Date Title-- YtC-i 7 TRy mF i C t-t, Size of Septic Tank Cr,�c t S°t-u� tC700 Type of S.A.S. 1r�o k�Ctr OC['r v-��.�.Tv4TdU Description of Soil I fa Nature of Repairs or Alterations(Answer when applicable) 5 Cc1_ e-ti i ►-,/-iLTn'roPT atGrr; W_K_L T^ t 7 t� `{t 5TO t- lL\ rL; 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 by this Board of He lth. Signe Date Application Approved by Date [ 17 Application Disapproved for the following reasons Permit No. C7 :2 Date Issued 4t � y s } �tl �.o�. No. Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migooal 6pgtem Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ,Individual Components / Location Address or Lot No./Q i� �pc � arn�' Owner's Name,Address and Tel.No. ly1 1If5 Assessor's MapiParcel 0 4� �U� 1 T s Installer's Name,Addres\s_;and Tel.No. --��,g _d6a ( Designer's Name,Address and Tel.No. %N C2 iL� J Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building S' No.of Persons Showers( ) Cafeteria( ) t Other Fixtures Design Flow gallons per day. Calculated daily flow 3 { gallons. Plan Date 11-1-7-5-7 Number of sheets Revision Date Title B aje-- -r 'VRO MF I C L Size of Septic Tank 'q_,n i S`t - LC7?,A 7 Type of S.A.S. Description of Soil l •_Sla wD 1 ; t {Y Nature of Repairs or Alterations(Answer when applicable) '�tn-S'rw-i\ 5; tc la%"�C c�%.6 C r i OA(r _ wKr !�:,j -f tr-__%C7 r.v Lt !9To1-e ov—St Dry -t- ty" Date last inspected: Agreement: The unde_signed 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 by this Board of Health. Sa+ "Sign e Date `/�7` 7 Application Approved by _ Date ! ! �!7 Application Disapproved for the following reasons Permit Ncq a Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS 1 BARNSTABLE, MASSACHUSETTS - ! Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( ) Upgraded Abandoned(,, )by (`n C Ll ff=� SC-e-rf C_ at 10 (. N U v Z Wta R Szi TA M I L L 2 has been constructed in accordance with the provisions of Title 5 and the for Disposal gystem Construction Permit No. 7_1 dated Installer I Designer I The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector -� --i c. 1 2- 9 ------—(,0-------------------------------- No. 7 i� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE., MASSACHUSETTS lwigpogaf *pgtem Cougtrurtton Permit Permission is hereby gra "ted to Construct( ,)'Repair(")Upgrade( )Abandon( ) System located at 01 0�L 0 CK 7 46& p IV) A L S-r o!j L LS 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 Date: �� - Approved byi� / r f , 10/9/97 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) P Z � ,hereby certify that the application for disposal works a E construction permit signed by me dated /`—/2-7-7 ,concerning the i property located at J ) l v meets all of the following criteria: i Z. There are no wetlands located within 100 feet of the proposed leaching facility v. There are no private wells within 150 feet of the proposed septic system e 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 W be located less than fourteen(14)feet above the maximum adjusted ! groundwater table elevation. Please complete the following: 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) 53 J DATE: I L{7 7 SIGNED 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]. q:health folder:cent + � n�^�' IL � O , y TOWN OF BARNSTABLE �` LOCATION PA--i SEWAGE # VILLAG;F__AA ice.a4 M i u h� ASSESSOR'S MAP & LOT D YG_ D&/ INSTALLER'S NAME&PHONE NO. .1 ReQx- SEP'TIG,TANK CAPACITY _ LEACHING FACII.ITY: (type) A (size) NO.OF:BEDROOMS BUMDER:OR OWNEROF PERMTI'DATE: I - 11- I COMPLIANCE DATE: f! -�:6 • q . Separation,Distance Between the: Maxii i ,Adjusted Groundwater Table and Bottom of Leaching Facility Feet Privatp::Water Supply Well and Leaching Facility (If any wells exist on:s te.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 t A�� Q3� • c ..... ... .- 3 • L0,CA N SEW AGE �PERMIT NO. or# , VILL GE INN A LLER'S HAM & ADDRESS C-1u)4i6�2 Bull . ER OR 0 R u ,Pat— DATE PERMIT ISSUED DATE COMPLIANCE ISSUED / � 6 g' poo ,o/r No.. .Sl_.. F��./ ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O. . HEALTH _e_t. ..........OF.............: ..G'! . . . -... - .. -.. , pphratiun far Riipuiitt1 i9orkii Towitrnrtion Prrntit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .� �oz39.............................................. • �-' •-- Location-Address ------.-•••---•••-•-••---•.-•---------••-•or Lot No.MAS. S�£.LU�----•-••--••---...-•..................... Owner ------•..--•-•..............................Address Installer Address Q Type of Building 12, Size Lot.._..1Q._12Q9__--_-Sq. feet U Dwelling�/ No. of Bedrooms---------------------- -- -----Expansion Attic ( ) Garbage Grinder ( )U 04 Other—Type of Building ---- No. of persons--------4---------------- Showers Cafeteria ( ) W Other xtures ------------------------------------------------------ W Design Flow___ -____-.__®........................gallons per person per day. Total daily flow-----2 p©S .......................---gallons. WSeptic Tank Liquid capacity-1- allons Length............ Width....7......... Diameter................ Depth...._----.----- x 'Disposal Trench—No_ _______________---- Width-------------------- Total Length-------------------- Total leaching area--------------......Sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below i et__............ ._Total leaching area----- -------.--sq. ft. Z Other Distribution box ( ) Dosing tank '( ) �— 7 7 l� Percolation Test Results Performed bY------------- ------------------------------------------------------------ Date---•---•-------------------------- Test Pit No. 1................minutes per inch Depth of "Pest Pit----------------._.. Depth to ground water.........---..-.-......- 4q Test Pit No. 2----------_-----minutes per inch Depth of Test Pit-------------------- Depth to ground water--.-.-.-----.--_----.___ lx .................................--- Descri ------------------ Description of Soil---___ . '� c., •--•-••....... .......... - --------------- ••. .. .....•. --------------------------- ----- - --- ------ w d--------------- -- - ------- --------------------------------- -- ---------- ---------------•--. ------ ---- - ------ ..... ' Answer when applicab ... ------------ - -- -G� U Nature of Repairs or Alterations— ....-------------------------------------- -- - ---- ----------------------------- --••--•-----------------------------•---------------------------------------------------•--------•--_-----•--------.-..----.----••-------------•---•---•---•---------------------•--................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI 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 the board of health. Si ed.- ` � GNJ�..�ACj Date Application Approved BY —�-------------------------- .77--------- Date Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------------------........ --...-•-•---•----•--•...............•--................---------•---•-•--•-•-------••••••••-•----•-......•-•••--•-•-------------•-•-----•--•----•----•--•------•----•-•-•---••--------..._-------•---•-- /° Date Permit No......................................................... Issued.--fL� ---- � � ate v r .----•._._._......:/..--- .. ._._ No FED.............................. THE COMMONWEALTH OF MASSACHUSETTS -� ,1 BOARD OF HEALTn - ......_OF. x Appliratiun -for ih,ip itti Workii Tianuitrurtinn Vrrmit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at p Location-Address or Lot No. Y ......................................... •-•----•--•----•-----•-•-•----•--••-••_•- •••_•_•••••----•--••----_. -•---.........••----. s Owner Address 4. Installer Address d Type of Buildin Size Lot_ �a +C�......Sq. feet U Dwelling No. of Bedrooms ____________ ____Expanston Attic ( ) Garbage Grinder ( ) `� Other= Type of Building a yP g t # ' _ _ �To. of persons _:. ................ Showers O — Cafeteria ( ) Other.. xture5'1 ;..-----•------------ ------------------------------------------------------------ •-•-------------------------------- W Design Flow ._ ,....... per person per day. Total daily flow____��'___________________--.-.-gallons. WSeptic Tan Liquid cauacity� gallons Length______..____ Widtlt---� ...._.. Diameter................ Dept h._._._.._ .... . x Disposal Trench—No ______________ Width-------------------- Total Length.................... Total leaching area............ _.__-_sq. ft. Seepage Pit No ________________ Diameter_____.___--__-__.-.- Depth below i let-..__-----.________ Total leaching area..__.:-._.-_--__--sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results, Performed by----------------- ------------•---•--••----•----------------- ............ Date----------•---------•-•---------------- j Lest Pit No. 1----------------minutes per inch Depth of "rest Pit-.._----______,----- Depth to ground water...--.--_---..--.-.---- (_, Test Pit No. 2________________m � inutesper inch Depth of Test Pit------............;_ Depth to ground water-----.---_---_.-_-__-_- t. •--•---•------- - �/l - ---••---•----- Descri tion of Soil ------------------41: �"t!_�4:r � T ' U ........ ................. - s.: ----------- -- ------- •... a ---------------------- UU Nature of Repairs or Alterations; ;Answer when applica --- -------------------------__-__.-.--_-_-.--.-_----------.-...._-..-.-.------ . r Agreement: b The undersigned agrees to install the..aforedescribed Individual Sewage Disposal System in accordance.with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in a ,wl operation until`a Certificate of Cof6pltance has been issued by the of health. Sed. - - ----- ---------------------- Date Application Approved By--- �' i ---• ----- . -- ' 7"r '� 7�� .Date Application Disapproved for the following reasons- --------- ---------- ---------------------------------------------------------- ------------____------ ____________________________•-•••-•-••-••-••••---------••-----------------------•--••---------------•-----------••••--------------•=--==-----------.-------••---------:-----=-------•---••--------------- Date PermitNo. ---------. Issued ............................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ...............O F.. t (9rdif ira . f iaut littnrr TH S IL.10 CER! Y, That the�Indlvtdual Sewage Disposal System constructed,( or'Repatred ( ) .7L /��B, r vv ,��/j ry �! t,► j at ` 7 "-=•`-`'_�'�i�•___ -- K- _- eT -------- -- - �-RrD •. t I of he State Sanitary Code as described m the �;. � ias been Installed in accordance wit t, 4._ -•� Z 1 he rovistotts of Ar P - application for Disposal Works Construction Permit No____ _________i--5:_.: dated. .-'1l THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONS UE® AS A GUARANTEE.THAT;THE - {t SYSTEM WI FUNCTION SATISFACTORY Iw. ,.r DATE--------• r � Inspector----- ------------- --------- -.............................................. r•.. THE COMM ONWEALTWO.F, MASSACHUSETTS BOARD Of HEALTH No. •- FEE-- .................... i� rr tt1FAITLrkfi umtrnrtion rrrmit ; ,,4 Permission is hereby granted '' ..----•_.-----•--•---------------••••. -• t No.___-_. sposal stem to Construct or Repair an -di i al Sew a Di � w P � � r Street as shown on the application for Disposal Works Construction P t No._ __:____ Dated..-+�:.. .y_'_- _�- --1. - t �,�.., - Board of Health - -. DATE.......'.....................` a ---.. . •- -----------­----------- FORMk 1255 HOBBS & WARREN. INC.. PUBLISHERS .. Flo ti F� 12 12 Floor of store e lost +H 3/4" decking iv ;r v O _ L. _O o- _O Ist Floor Main hoe (ex sting) Top of fou dation O Top or slab Scale RIOHT ELEVATION LL ° Scale Cz cn Q CO CO _ 12 0 O 12 Q ° CO ® ® Q ® Floor of storage O loft CO LLU 3/4,decking iv 1 m FM °Y Fp� m 1 LL O c � U 3 -LLU Ist FI or Main hse (existing) O Top ef foundation N � FRONT ELEV � T10N Top of slab � Sheet 1)1AOO (,O in Sloped roof above - I Q Step - -----------------------\- 1r�1 Relocate existing m sliding door I v O Note: I fire _ seperaUon between - A are and Dwelling. LL EXISTING °° IF O 1=AMILY L I io O BARN r y N iv 14'-0" i I'-II" 2'-3" 5'-7 q_ 4' cone Slad Q ir L Br k �0 Fdl r x x LL m a O Uj P0RCH ° e'-o" C D Frame lime v 7 m c � Note: Deck of porch Q extends 6" beyond N m frame line above. U � O o -+ ) C IStL0C Fl_ ,4N - - Scale O A2 O ry c� � Sheet rt 301-01, 1,4'-0" - -------------------------------------—---------------------- Drop top of wall to allow for T' step down from I ------------------------------------------------------- • existing first floor to proposed O.......... Step above ---------------------------------------------------- ----------I------------------------------------------- 11" wide x 8" thk cont. conc. ftg. Provide 32" wide x 24" deep crawl space access. CRAWL SPACE -1 IT-F a EXISTING ocket BARNLM Cut pocket into L 0 existing wall Z2IX2'XI2" thk. LL column ftg 91-1 1/21, ------ ---------------------------------------------- Verifq window -- location prior to c ----------------------------------------I-------onsit ruc t,ion PORCH 3" min 12 -------------------------------------;r-.---- C-0 12 < QQ 9 1 1/2' ------------------------------------ ------ ,q �- H ,Be 'i 2nd Floor i i Droptop of iv wall 5"(verifg on site) i4 C -----------------------------------------------------------------I x Verify clearence Cf) on site O Drop top of wall 12" and run 4" slab rn 15'-B" over. cv < ting Door CC) Cf) 3 '4" snub f1r. 3T" decks i MExipting Floor Lij 0 j Elk j 0� r�F Familg room Floor FOUND ,470N F L 4 N Cf) 0 I 2,x8alf." ., I= 1 0 CO IW'32x - 8 k. ' Garage alaib 3 1/2' lally col Scale co 3'-,1," x9" thk pduredcgric wall 2" thk [,2'x2'xl2" thk on At cont. onc. tgs cover footing Lt conc L-P F: R /4 M P— SECTION Scale 1/4"=1'—O O A3 07 Sheet ' � Jve]i�'Ti ► � y7 Q q3 7'EsEEo v d /U TES T ! 1 o4E Tr 40 JE r, t 1 _ _ s -_ _"~'ate—f� -----�•-{ P,�c,%' ;''f-r /:•.,' ..�,: ,t c n +� �• _ /O• —"�..� ' i G' ��1.l�F'rC..�.r� _�. / , _..1w i L''r'�,7 1...�1a_� ^ l , f+-> ti. • N. OAt M/N — x 3'M!n!. - �`•> '` �,/H"f.R 1 j I ;_— - — Y P/74CEY FLOW Ll,V� rq'/71N. o� —r _irk -f__' _- - Z1 4 FOOT /O M/N. /4., ( �4..�Fo oT .�._ ��_ M/N. I / i/9 .. Fo p 7- c GfI LON �NY�'R-7. �ff'f //VVE RT Co":? Pit C /T Y G "Z U o^-/ID CWf1776'R7-/GN"r) I/VVEEQT /^(VERY /JVVERT _ 0 GAi2BRGE GRI"DEP_ 20'1-oI//V114 vM CERrIFIED O C /-� 7-"/ U!V: /uj A-/2 5 T rA/ C._e/ 5 /CE FE E_ NCE.' BE///G LOT 39 f/S 5f 0IVAI O N /9 ,o L .57;oqBLZ�' COC/NTy ,2EG /5TJ2y OF DEEDS 7r _30 14OF sEPTic TF9Nk To BE /-9. M//V-- //�-/vM of /0' FR OM /cp UNn,9- �✓� `T,!- �`� �L. ��f� 1 T,�'7 •F� GEORGE � . T/ coN AND LEE9CN FP 4 powjR A/ SLO / Co f /1 'Tr4 B E N- A/&/z L,fit A/E I F / d' F R O M PiR O f',--R� . 7-/-/ yA "TICS C.1 7`,Z-1 �t S'..�. �Q sf���4 L / n! ES IQ Al D S EPT/ C 7"f3 A-1 • sttRV 14/L/,D 2 O' a= R U 11.7 F O UAl o A 'T/ Al X CH R 7'"/F>1 TN -'H ry 7- 7 .E N F o u D /19 —r O N -514 o W A/ oN TN /S P aL w N /-5 L O c 49 7-,-- p O/�•/ THE G R O CJ N O >9 S SHOW/�./ �/E R EO/�! .� •------.�..:..•«---��- 4--�°• A AJ D 7-H A 'T / 7- Z)06-,5 C 0 A./FD.E'/"I 0 7-0 -7-A/ R U /.L D //V� -5 aE'7- .3/,?C K RI E Q u//2 TE- ,,�• -- /�I E A/7-5 O F TT/--!� T L�/N O� r-ZA! Z� �9� r! ' �. — •�f/TE� ,B O f /E'�?—O It: X i9 LTr'{ R"E G. L P "D 5 C✓ R y U Fz PP/2 o V/E'D r9 40 G IQ?'