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HomeMy WebLinkAbout0008 CAMELBACK ROAD - Health 8 Camelback Road,Marstons Mills c1 11 r i , TOWN OF BARNSTABLE q G `LOCATION n SEWAGE # VILLAGE �('"�, ASSESSOR'S MAP & LOT-JI/� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY U _ LEACHING FACILITY: (type) �G� �- size) NO.OF BEDROOMS �- BUILDER OR OWNER PERMITDATE: /�—q— COMPLIANCE DATE: 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 Pr �3�c : .z�- No. � � Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprtcation for Migool *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components LocationC Addrert N_ o.L ri s Owner's Name,Address and Tel.No. Assessor's Map/Parcel M P c�� InsWIer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /'✓i«+� 3 M& 0 2_6 7v Type of Building: Dwelling No.of Bedrooms S Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow S 3 y 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 Natu of Repairs orations(Answer when applicable) 2— y X �� Date last inspected: Agreement: The undersigned agreesCtos.)etmhie construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisf5 of the Env' nmental Code and not to place the system in operation until a Certifi- cate of Compliance has beends oard al Signed Date Application Approved by Date Application Disapproved for the fol wing reasons Permit No. > - %,5 Date Issued y 7t .y. No. J -� / l/ } Fee 1 THE COMMONWEALTH`OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION,-TOWN OF BARNSTABLEs MASSACHUSETTS ZIppfication for W60w6af *pgtem QCottgtruction 3permit 1 Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lat No. Owner's Name,Address and Tel.No. �' Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. © 26 7v Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 y 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 Natur of Repairs orations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to e e the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provis' ns of Tit 5 A the Envi nmental Code and not to place the system in operation until a Certifl- cate of Compliance has been sued by t s oard al . Signed �y'�^ Date / ` g / Application Approved by Date Application Disapproved for the fol wing reasons Permit No. Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance t THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(Repaired (,�<)Upgraded( ) Abandoned( )by �O-L4;►, at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. /�7- -?S—dated /Z-y' 7 Installer' Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - U - 1 Inspector --------------------------------------- No. ? /— / 57 Fee �,5 n THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Miopozal *p.5tem Con.5truction Vermit Permission is hereby granted to Construct(/ )Reair( Upgr de( )Abandon'(, ) System located at 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: - LI c/ Approved by I019197 NOTICE: This Form.Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION TROUT DISPOSAL WORKS CONSTRUCTION PERM ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at c� �-�� 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 HDI 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) /0 B)Observed Groundwater Table Elevation(according to Health Division well map) 5O SIGNED: DATE: LICENSED SEPTIC STEM 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:cert ` _ ........... ::��� �: �� l i'�-�- ,. � -�3 Yx�?x�z6� r- ��y ` , `c, Bo ,_ .,,, TOWN OF BARNSTABLE SEWAGE# LOCATION VILLAGE . ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. . A CITY odd AN K CAP PTT . T SE . LEA0PG FACILITY: (type) -2- size) 3� ' N&W.-DEDROOMS 3 t BUILDER OR OWNER q PERMITDATE: 12- `F r7 1 COMPLIANCE DATE: Separation Distance Between the: Iviaiiini Adjusted Groundwater Table and Bottom of Leaching Facility Feet Privi, Water Supply Well and Leaching Facility (If any wells exist on:slte_or within 200 feet of leaching facility) ,�TlJ Feet Edge::of:Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Z s-Z x q y ;t iId J TOWN OF BARNSTABLE LOCATION/6o7G (�,Q�P/ �• �C/� SEWAGE #,?u/' 3 VILLAGE/y ,v.5 / /I���_ ASSESSOR'S MAP 6z LOT ul � /9 INSTALLER'S NAME & PHONE NO. p10 7"too1 ' t SEPTIC TANK CAPACITY /D 0 LEACHING FACILITY:(type) j� �f)0o (size) /0490 \ NO. OF BEDROOMS 3 PRIVATE WELL OR UBLIC WATER BUILDER OR OWNER 1/JPO 6AI5�, �_ 50• V,t9AeWot`% �0 DATE PERMIT ISSUED: 6 13d i DATE , COMPLIANCE ISSUED: .3 VARIANCE GRANTED: Yes No ,/ Lot d G No....... 6.���� Fps..-......................... THE COMMONWEALTH OF MASSACHUSETTS E®ARD F HEALT _ "�-r�✓ F...... .... --ram .. .. _......•-- _ Appliration for 11hiposal Works Tontitrnrtiun Prruat -Application is hereby made for a Permit to Construct (,�} or Re air ( ) an Individual Sewage Disposal System at: 11,11*11"1-111".46...............±�....... Location-Address Glo....... ..�!fAWff.-.v.r....................... W Owner Addres Installer Address ®® U Type of Building Size Lot_t F..Q.__ Sq. feet �-. Dwelling—No. of Bedrooms............. .__.__......Expansion ttic ( ) Garbage Grinder ( ) aOther—Type of Building _� No. of persons.......... .............. Showers ) — Cafeteria ( ) Other fixtures�^ A ------ W Design Flow................. gallons per person er dyf Total dailyflow.........3_..3__Q...................gallons. i WSeptic Tank—Liquid capacity/.gallons Length__ . ___ Width_ Diameter................ Depth.... x Disposal Trench—No..................... Width......e............ Total Length............................. Total leaching area....................sq. ft. 3 Seepage Pit No-----------'-------- Diameter.........6--__----- Depth below inlet....._......... Total leaching area..!-ly7---sq. ft. Z Other Distribution box ( ) Dosingjank ) '—' Percolation Test Results Performed by-___J� '_C,l�!�' ,ltll /,1��......... Date........ r�__-> a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water ..i_/�WA 6e f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water ...................... --------------- , //rr �g /.....---•-------•-•----1--. . Description of Soil--------------------.CA..6ll..G.... _.. Il�l Y ------..../�/ .............................................................. w ---•••-•....•----•-•---••...........................W IP- >�------� ---•--------------------••-------••------•------•--------•---------------•------------....-------------•------•---•••-•--•------------•---•---------•---•-•-----------------------•-------------------- V 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 TITI:' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by he b ar of healt ned. 1 --- .............. ='• __. --�' Date Application Approved ......... --........c-- ----------------------------------------------•-- _._�!3/s Date Application Disapproved for the following reasons----------------•----•----------------------------------•------•----------------------------••--•--._......------ .......................-................................................................................................................................................................................. Date PermitNo....................................................... Issued_....................................................... Date �------- --- -- -- -- ---- --- ------ --- ----�____ �. ------------------- -- No................--...... FEs........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH • .--x,.�'1.,�'.:_I ..........................................................! i`r L ' Appliratiou for Disposal Works Tonsirurtiun rruti# Application is hereby made for a Permit to Construct (}r) or Repair ( ) an Individual Sewage Disposal System at: r ............ � ._. .... r-.. ----f....`....�-_/.. .............................?.................................................... ' c Location-Address G -- r-. or,Lot No. -f i l 14 e-`T/r^'ml / i"I V �r l ' !-Y' f // Owner W r�l-. t ---I ft lr J7 At Il a / n! 't � . /41 a 1-1J^................... '� $„� ^^ ...ddr ... ............ ......•....... � Installer Address ,� ,.�r� Type of Building - Size Lot_.... `_.:..(LSq. feet Dwelling—No. of Bedrooms.............:..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ,D..A No. of persons /.:............... Showers ( ) — Cafeteria ( ) dOther fixtu�re�.......---•- •• ----- �"................•• -------------v------ ----------------- �----------..-.........•------------- W Design Flow___.._. :._.. gallons per person pir day,: Total daily,f flow__._..._ '............................gallons. WSeptic Tank—Liquid capacityf f,`..gallons Length._?! Width._r.._._.. Diameter ............. Depth.... r� x Disposal Trench—No..................... Width....... ............ Total Length...............----- Total leaching area....................sq. ft. Seepage Pit No----------I--------- Diameter.........r....... Depth below inlet......:-......... Total leaching area_.. . .:? .sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by . ...`.... .k'............................................ Date .....`.._.�..r Test Pit NoJ_q . 1................minutes per inch Depth of Test Pit.__._.............._ Depth to ground water._,_. i_. ..!;�. /` 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground waterf``/.................. a ............... O Description of Soil...................... f.•l .!t.'! .�'_...: ' `r-t / -J )�` ') 7 it �•i-� / 9 F // 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 TITLE 5 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: Signed, -�--------------------------------......-•--•---------------------------•-----P--�� ate Application Approved By..._--••••-•-••••=-•- .........../.�''.�� — - ` �C��..rte.......--•--- - ....................•.. D Application Disapproved for the following reasons:--•------------------------•-----------"•-----------•-------"--•-•-"•----•-----------------••----•----"-------•- --------------------------------------•-----•---...--•---""------"-----••--...--"........-_._...----...--••"--•""-•-•--"•---•----••-•••--•--•---•--"-••-----"•-"-••"•-----•••••-----••-•--............. Date PermitNo......� .................. Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH,. , ........................•. ? ''i ...OF. t -, F »,�► /ri �` /�1 �' .........!� ............_........................................... ........ Trrtifiratr of TuutpliFattrie THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (- ) or Repaired ( ) by--------------------------------------- •-"---•"-•"-... ......................_....:r....................•---------..........--••----------"--.....---•--•----•--.......-•-•--------•--•--. Installer at...........................-------•-••-"......".......:...... � _I" f j ------------------•---•-...---"-................................... has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... 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 ��'` , z -- ..........''.... �'' t n l?..OF.. l f` r J �y A �1 .��," fl No.. _rf.^ _.`?.... ....... FEE..... .... Disposal Works 10.1,1austrur#iuu, grub# f _ "- r-r=_ 7 , Permission is hereby granted...........:..................................._ �` to Construct ( -) or Repair ( ) an Individual Sewage Disposal System at No ! R- Street as shown on the application for Disposal Works Construction Permit No------`.......... Date•'d.... _ ' . ............ ............ ,... DATE Board of Health ------------------------- FORM 1255 A. M. SULKIN, INC., BOSTON GENERA 4, NOTEd i AI., E4 E'.kA T10NS 31�0,WN APE P1 TCH ABC 4d NES MlIV f�L1 f/Ll } ! I f f I f I if C) O o0 O (1) (� ZIN4 ES5 OT,iE, WISEIt SPECK 1E I i 3 AFL P/PE5 T©ANp IN T14 SYST'EAI 5H,4 4_ � BE CAST 11?0/1%4R SCHEP414 E" 40 i'VC. G 4 444, SEPTIC TANKS, VI STR/BUTION 450Xz--,5, ri� , .4Nt2 k EAC,71/NCB RIT.5 SH,44 A. BE' vE.51CN�"j2 000 ,i "' � p F'C�R N Z t� vVtr��'E.C, .L D,4l�1Nv S lM,zr'�c`n,l I o f �: O O 0 0 O 0 0 0 0 �� UNPER P,dY/NG` 5 Re,440YE 4,CL�, UNSU/TAE3� E MATER/A 4- 4 .r O BENEATH rHE INI/C/i"T E4EMTIONS > = I �' O 0 O O O 0 of THE v/FFUSOR6 FOR A P1,5 TANC E OF ` SAN/T.4RY T£E a ANP BACKFI1..C, wI Tt! CkA Y-FREE i ! l�; SANG ANP 6,f4VE1. :7AWING A PE9604 1T/0,'1r 12 ' ! TYPICAL PISTR/BUT/ON BOX :i � � � �,a T€ o� ,� MoN�ITEs PER rrvcN OR __ 7 I CAS, 4V CN/NS P1 T Uo waT�rz r�1c_outJ�-�2>=r� N4T TO SC.4�.E - __ ` ' n�.. - __: _ .__ _ THE ' B4ARP OF �IEA.(,THMUST vc '7 PI,57-RIBUT/ON BOX AND 1YM GA>-. NOT TO SCALE BE'- NOT1F1�'i� WgEN Th'E SYSTCM/S NEAR OBSERVATION PITS RE/NFDRCC GP 64-PTIC TANK BY C01OR Z-TIONAN10 PR/fJfi' TO BAC�YF/,GLI1i/G. TYPICAL � G,4�,. S�E'PT/�' TANI'C A1G/E1'?1CA1V PRECAST 4/R EQUA 4 7. lIN4 ESS O THE'R W 1SE NO TEP,AL 4, SYSTZ-W PERCO.".AT101V RATE = �' a.�iL t /VOT TU SCA44,E C'"RONENT.5 SH4� ,(, BE INS7441 C,9 IN OBSEif'Y�4T1ONS BY- A C- f QC-,Lj B0ARP OF HE,4 L TH "f NC TE r'�4/VKS RE/NFOfs'CE s� THh'UUGNQ U T ACCGfis P.4NCE tti'/TH TI T�,E Y DF 7f�E ST,rI TE WITH 4 -,ECTRIC WE1 G'f yYM:Z kYIT,/ Z4, 1W SANITARY CODE ,4NP ANY ,©CAI, RUkES EEC., RO P6 /N TOP Bp T TOtif. � - � f-� _ �,� � 1rYh1/CH .SAY ,�qPP�,Y CDNCA'ETE 15 -¢,ODO P,51 7FST -- >� NOTE. ACC E 55 1'401904,E5 TO .5E�T/G TANk� Al �1 �? °' , n._. � A ND L EACH/N6 P1 TS TD BE E3U/,LT LIP TO IZ L3ELoW F/N/SN G,eAD,E. cg _FrN1�5.Y GRAPE OI1ER T,4NK FINISH G,`94f�E LEk o r :, Ft, „0„BUX -4q+� �Lt -47 t4 E s_c� E:CE1! i .�EV = 4et LEA H/NFL P/T = 4�ts 11000490 1IVY coo o O �sop�o� F C? O o o� 's Z q I INY 47+t5 a 4 da 0 0 © 0 CD °`�S l OF 3/4-1 12 " i _.._.__ JOOEJ U.4a`, /ti/ a_. _ O/ T. BC3X - 0,000 RE`�NF4fr'CEO 0 0 � 0 03 9 d� C,2U5HE0 5TONE C LNG', 'E,E (TC1 BE L EYE'G 0 0- 0 � �� 0 0 @°. 0 � p � v E P7'/C TANK � �8 BOT TON OF P/T 5 TO BE .t,EYE.G F STAB,Lf) /NV=a 6tsa c� _� 44r5 �.►'� r \ 4,E"ACHIAVG R1T t�� (TO AC LEVEL 5rA6ZE) P i r d? A� " TYPICAL 5E'WAGEE 5Y5TEM P2OF/,LE tk NOT TO 5CALE ij Shy Tsc �1 ` -�' ✓ 'r r �fl.4P SECTION PARCE,C._ /,O T AE70RESS .�'ONI/VG P1,5T flCT Fl D0� H,4ZARP.TONE 7 - �-� � - Pi, oPoso oQ TiaN OF vE�,,�,rN PE`S16N ORME`RIA4 �C,EGEN, ' E NUMBER OF BEDROOMS __ _ ____. 1ST CON1`4U/T ___ __ _8 ���►``�€ y � SEMA6E 0%5PO-544 �5YSTEM PERSONS PER BEOROO�N ... PROP06E"P CON rOUP' �L 6A4,4,ONS PeR PERSON PER PAY ._ _. _ _ E)(/6T SPOT ELLS E -4'r �N 4 EA CNI/VG REQUIRED .SSG ?ROPG?SEP SPOT E 4,EV,4 T10A1 6.10 1>t !`t.k a__! �'. - K f A ,C,EACN/NG PROVIRFP .l .. PERC01,AT10N TEST iZl _ _ _ 'f ' .4PP41C,4N T , ENGINEER : Nd ©1SP45A1. OBSERVATIC,�N PIT' m , _. ..►� ,f ARROW ENGINEERING INC. n. O E. F,4�,MOUTH HW Y. ,. R-A Ei{ S'El�YEER f`ES/Gib T , SIPEW,441, _ t x 7 ,r 4 � '2 5 z 1� A B4 T TOM = IT x 4 2 X ► ,c SCAG E: RATE \5HEE T x ,46 NOTED 771 ClP c .-� atil. o �7 fg TDTAI, = 4-7-7 ct=i> l�RAi�#''N BY: CHEG iMP BY: 4^P. '' O Y: Rk,4N NQ. tr;