HomeMy WebLinkAbout0164 BRIDLE PATH - Health 164 BRIDLE•-PATH,- MARSTONS MILLS 4
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G' f TOWN OF BARNSTABLE p V
LOCATION / V 6A l �A SEWAGE #q o �r7 Cr
IvYLAGE �" � ASSESSOR'S MAP & LOT Zia. !
INSTALLER'S NAME&PHONE
I SEPTIC TANK CAPACITY,f 6i—
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LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS /�
BUILDER OR OWNER Z &C 1Z�
PERMPTDATE: X:d l COMPLIANCE DATE: a°�
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Ching Facility Feet
Private Water Supply Well and Leaching Facility any wells exist
on site or within 200 feet of leaching facility Feet
Edge of Wetland and Leaching Facility(If wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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-56A
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No. v Fee$50 .00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppfication for ;Df 6pozat 6potem Construction 3dermit
Application for a Permit to Construct( )Repair(xx)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1 6 4 Bridle Path Owner's Name,Address and Tel.No. 4 2 8—8 7 01
Assessor's Map/Parcel Marstons Mills Judy Perchard 164 Bridle Path
Marstons Mills 0264
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Service
PO Box 1089, Centerville 02632
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 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 sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching system consisting
of D—Box, and 2 500 gallon precast -leaching chambers.
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 Env' nm al Code and not to place the system in operation until a Certifi-
cate of Compliance has been i d by th' Boar ea
Sig ne Date
Application Approved by AK 19 j Date
Application Disapproved for the following reas 41
Permit No. Date Issued
i
sl1\ n1
TOWN OF BARNSTABLE
LOCATION /�c` �l c��L7 /O SEWAGE #a
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. n Cr — s• �� 7 �.
SEPTIC TANK CAPACITY✓�.-�
LEACHING FACILITY: (type) ?Aie-t Sl (size)
NO.OF BEDROOMS -
BUILDER OR OWNER / 4&C 1--1A t2C-1
PERMITDATE: COMPLIANCE DATE: t/~ �l
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Ching Facility Feet
Private Water Supply Well and Leaching Facility any wells exist
on site or within 200 feet of leaching facility Feet
Edge of Wetland and Leaching Facility(If wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
Jl4 c-
No.
Fee$50.00'�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: %o
I Yes
PUBLIC/HEALTH DIVISION -TOWN OF BARNSTABLE., MA
SACHUSETTS
I
01pprication for -Migozar *pztem Conotrucfion Permit
t3
P..
Application for a Permit to Construct( )Repair(X)o Upgrade( )Abandon( ) El Complete System 11 Individual Components
Location Address or Lot No. 164 Bridle Path Owner's Name,Address and Tel.No. 4 2 8-87 01
i
Assessor's Map/Parcel Marstons Mills Judy Perchard 164 Bridle Path
Marstonb Mills 02648
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Service
PO Box 1089, Centerviilk 02632
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size_— sq. ft. Garbage Grinder(no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures ,
Design Flow gallons per day. Calculated daily flow. gallons.
Plan Date Number of sheets �,vucil
n Date
Title
Size of Septic Tank Type of S.A.S.
Description of,Soil sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching system consist*ig
of D-Box, and 2 500 gallo iZgca_s_f s.
j�
Date last inspected: f
Agreement:
The undersigned agrees to ensure the construction and maintenance of the of re described on-site sewage disposal system
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in accordance with the provisions o Title 5 of the Envi nm al Code and not to lace the system in operation until a Certifi-
cate of Compliance has been i d by t
Signed Date
Application Approved by Date
Application Disapproved for the following reaso sI W1,
Permit No. 45L Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
Perchard BARNSTABLE, MASSACHUSETTS
(Certificate of (compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(XX)Upgraded( )
Abandoned( )by
at 164 Biddle Path, Marstons Mi S s een constructed in accordance
with the provisions of Title 5 and the for Disposal System Cons-truction Permit No. dated
Installer W E Robinson Septic Service Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date C?' I , a V Inspector -�
No. ----------------------Fee $50.00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Perchard 'Wioogal *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( X4Upgrade( )Abandon( )
System located at 164 Bridle Path
a r s ons s
Installer W E Robinson Septic Service
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 ust b comQVted within three years of the date of this
' p Q
Date: Approved by
r �\
NOTICE: This Form Is T® Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OFSKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
I, William E. Robinson. Sr. ,hereby certify that the~apphcation for disposal works
construction permit signed by me dated , concerning the
property located at 164 Bridle Path, Marstons Mills, meets all of the
following criteria:
* There are no wetlands 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 with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S. map) L3
B)Observed Groundwater Table Evaluation(according to Health Division well map)
SIGNED: DATE
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998
(Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted).
3
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LOC-ATION SEWAGE PERMIT NO.
VILLAGE
1 N.S T A L L E R'S N"A ME a AJ,)jDR EISA BWAI'
Oid Stsge Road
�enrville, mass Ogfi.Ig
BUILDER OR OWNER
5 �cy
DA T E P E R M I T ISSUED
D A T E COMPLIANCE ISSUED
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��A�s��
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No.._......�� .. ""�`• Fps.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. �.W. .i'j..............OF.......1 .. .�`.. ..�410.../v..------................----
Appliration for Diipntial Workfi Tontitrnrtinn ramit.
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
Syst t' :Z...1.-� �. .
..-_... j N ��_�.... .......................................
L c ion•Addr sLot No.
c� fir....� , ------ ---- ............T� �?. - v ...��i r. �.;.... !...ti.
�.. d
�� J" �
•........a
......................... . ...---......
Installer Address
d Type of Building Size Lot.Via/./ .
0 Dwelling—No. of Bedrooms__i__ •-••----.----•--_ -Expansion Attic ( ) Garbage Grinder
Other—T e of Building 1 :�— No. of persons----:If:7................ Showers — Cafeteria
a Other fixtures ............................... ..
W Design Flow.......I- -- --•........................gallons per person per day. Total ily flow-----.Jc 0.0...................gallons.
WSeptic Tank—Liquid capacity.1.0 gallons Length..... ........ Width________________ Diameter................ Deepth.....__.._..._..
x Disposal Trench—No. -------------------- Width.................... Total Length.................... Total leaching area_.•----...........sq. ft.
Seepage Pit No-----_----------- Diameter-------------------- Depth below inle.1-.�Total leaching area._�r^&.......sq. ft.
Other Distribution box ( ) Dosin to ( ) A
Percolation Test Results Performed by -. ........ . ........ _........_. Date........................................
Test Pit No. I......I........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........................
x ..........•-•••.....••••---•.••......................................................... •------•---
O Description pf Soil v= - �`''-... .........
-_f`v. ..�.5?.i t------ ' --------�' 4.j----$N--� s� /�✓�-P
v .................... .......... ......................•� .........6.&' !aj...................................................................
W ---------------------------------------------------------------------------------------•--•---•--•-----•--••--•--•-------------------•-----•---•---------•-•-•••--•-•••-••......---•••-••-•--•......._.
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 iITL L 5 of the State Sanitary Co The undersigned further agrees not to place th system in
operation until a Certificate of Compliance has been ss ed by the board tttrt*.
Signed....... ------• • - ..........•. Date Date
ApplicationApproved By•-•-•......•-•--•-•----•----•-------••••-......•-•---•---•.....................••..........--•-•• ........................................
Date
Application Disapproved for the following reasons:...........................................................................................................------
-•-...••••-•••-•---------------•--...•-•-•-••--•-••••---•-•-•--•-••••-••---••-•••-••----•-••-••••---•••...------•-•-••-••-•••-•--•••----•-•------••----------------------------------------•-Date
a.
Permit No..........................................................
Issued_•••-- f_._�-....
Date
y
No........ ?...� .. '� Fas............._.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Applirtt#iun for Di-sposal Works Towitrnrtiun Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
......... .:� :.:�.. :..Ls............. . �------------------------------ -------------------------------------------------------•--------------------•--........-•---....
....
L c tion-Address -^� --�^Hof Lot No.
W �` 1�Owr#er `),Addrrs �J
t P ( (``
a
Installer Address
Type of Building Size Lot;�_� -----
Dwelling f6et=�"'"�
Dwelling—No. of Bedrooms.._ .:............................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ...� .............:°-................ No. of persons....— ----------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ............................... ..
W Design Flow...... .. ..........................gallons per person per day. Total daily flow------3 O.LO___...._......l8.*Ions.
W Septic Tank—Liquid capacityl- '_:gallons Length....
Width__a ....... Diameter________________ DeptW( ---------
x Disposal Trench—No..................... Width.............._..... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inl t_ --__- : __ Total leaching area...................sq. ft.
Z Other Distribution box ( ) Dosin to k )
z� &
Percolation Test Results Performed by...-•-=-------- Date........................................
Test Pit No. 1.....1.........minutes per inch Depth of Test Pit.................... Depth to ground water........................
(z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x ..........--
-- ----------------
O P: ��, ..SE....�._u.` ) � ' ✓.. ... ,"7 -f....-• .j..................
Description of Soil..__ +/ ...:.__ T `
d
W ----------------------------------------------------------------------------------•--------------------------------------------------------------------------------•------------------------------------
UNature of Repairs or Alterations—Answer when applicable._..............................................................................................
i
Agreement:
The undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance with
the provisions of TIT :;;
p S of the State Sanitary Co The undersigned further agrees not to place t e system in
operation until a Certificate of Compliance has bee iss ed by the board /
Signed........... P._:L_
Date
ApplicationApproved By..........---•------------------------------------•._.......•---------................•---._...__ .......................................
Date
Application Disapproved for the following reasons---------------------------------------------------------------•---------------------------------...............
............................... --•-----------------------....------------------------•---------------...------..... •------------------•-•-•-••------`-----....----------------------------.......
Date
Permit No......................................................... Issued:........�-•--�........��..._`...
Date
I '+
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
yy
......................W i�........OF....3...1 .I.. s I �.1
.... ..................................
�rr#ifirtt#r of �unt��ittnrr
THIS IS TO CERTIFY,r That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by.....__`J--- :.M......�.-T...... f........................................................................................................................
at----....... .....�_S �'... .. .f..:.---•-- . 1�� .... -------- h f
Installer
has been installed in accordance with the provisions of TITLE j of The State Sanitary Cee a� de .in the
application for Disposal Works Construction Permit No----------------------------------------- dated-,..... .._._._.........__.__..___.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS AGYARANTEE THAT THE
SYSTEM WILL FU CTION SATISFA T
DATE..............•••• .......... ................ •--- --...... Inspector... __........ = ..... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-� p,................ ..... V d.
d
No......................... FEE.............--•-•.....
Eltupunttlrk unuriun rrutit
Permission is hereby granted.... _. _ ''.L.. _._.._.._... A- , k
to Construct ( ) or Repair ( ��n Indivvidual Sewage I A al AA f
at No................ ,�---. -4-t-- - C-- 7I# ``11 (1 I •. •------
Street +
as shown on the application for Disposal Works Construction No. _._ _ ._._ _ a ..
.............
i
------.. ----------- '. � :------'.....................-
yam'"
Board of Health""
DATE....................................... ................. ;
FO M 1255 HOBBS & WARREN. NC., PUBLISHERS
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LEGEND
EXISTING SPOT ELEVATION :.'O.O CERTIFIED :, PLOT :'_ PLAN
EXISTING ".CONTO R - — p — — LoT lS Z32ioLG— T��+7 /
FINISHED SPOT VLEVATI ON l0.0
FINISHED CONTOUR- —; ® =—= � .: _ y_ _ _MAr4 '«STOA/S
IN
APPROVED :, BOARD OF., HEALTH: ,� �� ``..ee
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AGENT "'SCALE / _40' DATE : R- Z1 j
E/bGINEER/NG CO., N—'G ;
CLIENT $�2�<C— I .CERTIFY THAT. THE PROPOSED r '
' k EGISTERE REGISTERED JOB NO 7 a 96., BUILDING SHOVdN ON THIS PLAN y"� r LAND CONFORMS, TQ THE ZONING LAWS
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EN-GaMEERS� �lSURVEYORR DR. BY � ff:�'f OF BARNSTABL E , MASS. '
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33 NC' ST MAl'N " 712 MriiN T. CH. BY 1� Ooll
YARtVOtTH MASS. HYANNIS MASS. SHEET_L OF DA E REG. LAND SURVEYOR
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TOTAL 4 _C5rImA7-,-_,D. s=LOw .33 (3 6-4,4'-/0AY ,-SOIL TEST S014 7Z=S7-#,2. 57-
NUA48ER OF 40,4CAllmG ompn,S 0
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