HomeMy WebLinkAbout0165 BRIDLE PATH - Health 165 BRIDLE PATII,MARTONS MILLS
A 125 056
TOWN OF BARNSTABLE t\)J�'J 40�
LOCATION lo#Oe' cjtl •e' / SEWAGE # '? -761
VILLAGE—AW, s ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. /76.4/,,e ar6 w 7 `'I5"f 7
SEPTIC TANK CAPACITY 4 r�.4
LEACHING FACILITY: (type) -S' 'C vl— Z- to (size)/;7-
NO.Of BEDROOMS
a
BUILDER OR OWNER g? e. M g C,1'6p li
,o
PERMTTDATE: 4—/L 7 mil" COMPLIANCE DATE: 11-170—
Separation Distance Between the:
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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No. Fee A 50
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Rpplication for Miopogal 6pgtem Cow5truction Permit
Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
165 Bridle Path, Marstons Mills Jennifer Mc Eneaney
Assessor's Map/Parcel l -4�S— os-
�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P 0 Box 1089, Centerville
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 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 S a n d
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system.
D-box and. 2 leach chambers, with stone all around..
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 j3oa3O of Heal
Signed Date AP0-7
Application Approved by 9�_..._ n,_��_ Date 4 rP
Application Disapproved for the following reasons
Permit No. Date Issued
No. 1 '' Fee $50 ✓
r
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
0(ppYication for Mizpaal *p5tem Construction Permif
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) O Complete System O Individual Components
Loc tion Address or Lot No. Owner's Name,Address and Tel.No.
1�5 Bridle Path,' Marstons Mills Jennifer Mc Eneaney , "
Assessor's Map/Parcel J Z �� L?
Installer's Name,Address,and Tel.No. tQ Designer's Name,Address and Tel.No.
Wm- E. Robinson Septic Service
P 0 Box 1089, Centerville
Type of Building:
h_ Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Othev Type of Building No. of Persons Showers( ) Cafeteria( )
x 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 leach system.
D-box and 2 leach chambers, with stone all around..
Y�
" Date last inspected: �), G f 9 g
Agreement: /
f 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 Boaz of Heal p
Signed /. TTa� �`"^"" Date I AP0- `
Application Approved by �..�.,.. Date-4 . 9- 2
Application Disapproved for thhe follokin g reasons
Permit No. ���- 7E/ Date Issued
----; / ----k --------------------------- . .
LT
THE COMMONWEALTH OF MASSACHUSETTS
McEneaney BARNSTABLE, MASSACHUSETTS
L/ Certificate of Compliance �.
THIS ISM, CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X )Upgraded( )
Abando ed( Wm. E . Robinson ''eptic Service
at 1�5 Bridyl� Path, Marstons Mills has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. I dated
Installer Wm. E . Robinson S r. Designer
The issuance of t ear shall t b onstrued as a guarantee that the s ill function asedisigi��d:
Date U t Inspector P1 f/'u 1 � KD
---------------------------------------
No. Fee $50
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
McEneaneY
igpogal *pgtem Construction Permit
Permission is hereby r n ed to Co truct( Repair( X 11 Upgrade(, 1 Abandon( ��
System located at e Bridle Marst Pat , ons Mills J V
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
,
116/99
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)
T William E . Robinson,S,rhereby certify that the application for disposal works
construction permit signed by me dated �11 6-9 a/ concerning the
property located at 165 Bridle Path, Marstons Mills 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.
• tZ��',`- e//soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
re are no wetlands within 100 feet of the proposed septic system
t/there,are no private wells within 150 feet of the proposed septic system
•, 06ere 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)
B) G.W.Elevation +the MAX. High G.W. Adjustment . = J
DIFFERENCE BETWEEN A and B
SIGNED : G DATE:
[Sketch proposed plan of system on back). _
q:health folder:ern
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TOWN OF BARNSTABLE _
LOCATION c-1 .IL7 d %,/YJ
SEWAGE #
VILLAGE_,�� /!✓o'l s" ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 'i t'6 6
LEACHING FACILM: (type) ,r--S'-e 7 ,l L- ce (size)
NO.OF BEDROOMS^_
BUILDER OR OWNER 4Z /5ti 4; x lam'
PERMTTDATE: 7- 'l' COMPLIANCE DATE:
Separation Distance Between the:
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
' -7F s7/
' LOCATION SEWAGE PERMIT NO.
VI L UAG E
IN.STA LLER'S NAME & ADDRESS.
"•,+ � '��SLg�l��i�_
4le�32 did Stage Rn, ,
B U U D E R OR OWNER
DATE PERMIT ISS D . ------------
i
DAT E COMPLIANCE ISSUED Lvl `-7 ce&z
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s. /����� C iC/1.AwS/ad
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No............ Fps..... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH � /075 -6S6
....... ....1U UQ... ?........OF................ 2 .............._._...�.......................
Appliytion fu q�a1 xk C� �c #r r#iun r uti#
1�dka<*- �> ,,� 2 � C
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Appl>cati<ois hereby ma�e for a Per ' /fo Construct` (`� or Repair ( ) an Individual Sewage Disposal
z t �r�-7 l CS a_�
yst
................�.-• : �...�.. c..... - ----•-. .....---........ - .............
--Locati - ddress / or.�•No. ® 44-
esOwne ddrsa ± :��:�:..... s� �l_W:. oC", raw
Installer rAddress �-�j
dType of Building Size Lot��X ........Sq. feet
U Dwelling—No. of Bedrooms.......... ............................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............... No. of ersons_.........._....___.._..._.. Showers — Cafeteria
a YP g ------------- P ( ) ( )
Other fixtures ......................... ............................
W
Design Flow......I_1_.O............................gallons per person per day. Total daily flow..... __ .._ ......................gallons.
* Septic Tank—Liquid capacity./0I J0.gallons Length..........6... Width_........... Diameter-------------- Depth................
x Disposal Trench—No. ..__._........ g leaching area...J_. ...... ft.
._..__ Width.................... Total Length Total
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.N`.. ..... ft.
Z Other Distribution box ( ) Dosing ,�•� / ,
~' Percolation Test Results Performed by.-
Test Pit No. 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........................
a ......................................................... = ---------------
L"j
0 Descri tion of Soil......0•-3------ L.t Q - -...........
••-••••----•----------------------------------------•---------•••--•----•-----------•---•--•-•----•-----•-••--•--•-----------------••••-••--•••--•••-••-••••--•••••••......................•---------•--
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 of iIT. 5 of the State Sanitary Cod The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been s ed by the bo ie th.
�_i �
Sign -- --- ". .[�°�� --•--�-� •.........................• ---•- - --�•---•-------
(�` /Dvate ��
Application Approved By - I---?...I<.' --•---f f Dat----e--------------
Application Disapproved for the following reasons:................................................................................................................
---------------------------------
-.......................................................................................................................................................................
/ ..-•Date
PermitNo......................................................... Issued....?z.l ------------.
Date
fir/ ^ i
cam,.... ...J
LAG� •,� Fss...... ....s..��....-��
No._..... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
xv W �.:; OF d 4 Z N l
, pplira#ion for U44poii al 10orks Cfnntitrnr#ion ramit
Application is hereby, made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
syst tI L ...�:_.�.c.. '�: ... °......... .... ......
..
Locatic3p-Address or � I� `u
'+ 1 ' }_
.4..... = a "r ----�G_ ',/.1ry : . .�,........����'?�. ....................t �.....1
Ownex ylddress
Installer Address r.
QType of Building _ Size Lot ' .L1.1..........Sq. feet
U Dwelling—No. of Bedrooms............:�'_._-_---.__----_-_____..__Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
P4 Other fixtures ------------------------•--•-•-- .
W Design Flow...... 0...........................gallons per person per day. Total daily flow......
D.3...Q......................gallons.
04 Septic Tank—Liquid capacity:t�Q.gallons Length.............. Width!------------- Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area......_.6..___.sq. ft.
Seepage Pit No--------------------- Diameter._..._.............. Depth below inlet.................... Total leaching area. r?..L......sq. ft.
Z Other Distribution box ( ) Dosing i nk„( G
Percolation Test Results Performed bY....... ..... ...... 3J__ 1............i........................... Date-_-. .......................
Test Pit No. 1...d..........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........................
II --- ...._..�..................
...........................
----------, ........... .. --....-.---..-.-----•--------
VOW Description o)f..Soil..... " - --------- -- ------------.............._..
. --•................................••--•--------------------------------------....r -------------.........
-----------------------------------------------------------.................................-..........................................................................................................
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 IT LE 5 of the State Sanitary Co The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee s ed by the bo tt'
Sign -----•--t x u----•------•---•--••••-••--- . --`� ��..��...
Date
Application Approved BY---- •.... !!f. .. . -.� ------. .. �' .
Date
Application Disapproved for the following reasons:---•---•----•---------------------------------------------------------------•----------------------------••--•--
................................................. `✓ ----r- �.
-
%'
Permit No...............•---..........--------------------._...__. Issued------•---�--....-----------------------•--.-----------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
aQS � I. ...! ............................ dj...� ..........OF �. .. . :... ....
Tnr#ifirate of TomPtiFanrr
THIS IS TO CERTIFY,t That the Individual Sewage Disposal System constructed ( or Repaired ( )
Installer
-----------------------------------------
has been installed in accordance with the provisions of j ..._ 5 of The State Sanitary de as descri ed in the
application for Disposal Works Construction Permit N ._.... .s"- ../._....... dated__�"./-"...7 -------- ---------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION TISEACTORY. j
DATE.....................py..- ----- .................. Inspector........ ..... ...............................
THE COMMONWEALTH OF MASSACHUSETTS
BOA .OF HEALTH
/� .1.... ...drr.........OF..............
� ..- .. .. t 7... ~.................. �'
�! FEE...Zo.n...........
i rn �a nrk �n tr wit pamit
Permission is hereby granted...---__ram.if --5.............!/_ �-t-- --.4^�.1------••---•---- ----------------
to Construct ( )IRpa!r ( ) an Ii p'vldual Sewage;Disposal System
at No..-•-•3_ -------- I .�-........Q'.. 1t9 s .... ...._.`.---�'--.......lam...-�"-�------......---- -- ..
• ...................................
Street
as shown on the application for Disposal Works Construction Per o........ ...... D ((`�. ........................
oa d of ealth
DATE....................f /-- 7� r
FORM 1255 HOBBS & WARREN, IKIC.. PUBLISHERS
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APPROVED BOARD- OF HEALTH
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DATE AGENT - g" SCALE / -4.0 DATE
14ED GE ENGINEERING C0• ING� CLIENT
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- ( ; CERTIFY THAT THE PROPOSED -
EGISTERE REGISTERED JOB NO. ��_�96 oUiLDING SHOWN ON. THIS PLAN
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DR. BY �'9 ,%F :n'1 aC'O;NFORMS.t TO THE ZONING LAWS
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TGTAL E.?T/MA7.-D FYODV 33 d G+4L.1DAY SO/L TEST O/ SOIL TEST*R
I4(G/ILIBER OF LEACN/Nle P/T5 I r^EGG�d! 9 7 �ELEY• ,D.�T� Of' 12 /7
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