HomeMy WebLinkAbout0166 CAMMETT ROAD - Health rA
METT-TONS MILLS
99 036 - - -
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TOWN OF BARNSTABLE
Lt�CATIiO d ��_ '< f��r�st�Tr L ® SEWAGE # 2
VILLAGE �i/l rg-rD.'s m il's _ASSESSOR'S MAP & LOT 0 J -Q�o
INSTALLER'S'NAME&PHONE NO. 417 2- D.?4 Q Jose,?
SEPTIC TANK CAPACITY /DDT
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: -45'air-0 I COMPLIANCE DATE: 5--�4�- G/
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet_
• i
Private Water Supply Well and Leaching Facility (If any wells- xist
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 faci 'ty) ; Feet
Furnished by
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Fee
+�+ J THE COMMONWEALTH OF MASSACHUSETTS M Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
" Rpplt atiou for Mtgaar *pgtem Com5truction Vermit
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.
f
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No.1;'711— Designer's Name,Address and Tel.No.
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 �J9rzr:ft/
Nature of Repairs or Alterations(Answer when applicable) :V-17 srxgll —,5^d O (�o zqa�� e-el"�
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 9f Health.
Signed Date
Application Approved by 1/ Date y
Application Disapproved for the following reasons
Permit No. ?.cam 1 Date Issued Z
No. /— 2 Fee STJ
41
` THE COMMONWEALTH OF MASSACHUSETTS '"-"" Entered incomputer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
/GG ea ii �l is tion for ig ogar *pgten"Congtruction 'Permit
Application for a Permit to Construct( 44<epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components 1
Location Address or Lot No.A" Cfq, ,vo-G7r AW /7 Owner's Name,Address and Tel.No.
9
Assessor's Map/Parcel
D D_5li /6 L /Og.' A.
Installer's Name,Address,and Tel.No. 4/177— o��Q Designer's Name,Address and Tel.No.
Jdscp4 ve_
Type of Building:
Dwelling No.of Bedrooms J� Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow t' gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
r
Title
Size of Septic Tank / Type of S.A.S.
Description of Soil S.+pticf�/
Nature of Repairs or Alterations(Answ5f when applicable) ZhST•6al/ -,$"!10 �la� ��</ c�//'��
f�F14 Srah
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 Eby this oaarrdof Health.
Signed l-c�'� icy Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. -7," I Date Issued Z G
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS �&&j ,.., 6o U- 06,v y
BARNSTABLE, MASSACHUSETTS A cGaw,(�—
Certificate of Compliance
THIS IS TO CERT/IFY,that the On-site Sewage Disposal System Constructed( 4,�<epaired( )Upgraded( )
Abandoned( )by t/Gts �r'o
at 166 *1e_ has been constructed in accordance
with the provisions of Title 5�aad the for Disposal System Construction Permit No. 2 0'()t— Z-rl dated 3' 2 — 0
Installer Designer Z2,,
The issuance of this permit hall .
of be construed as a guarantee that the sys e ill f I s designe
Date Inspector
---------------------------------------
No. Zoa/— Z 0'v?,—0-It Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mopogar *pgtem Congtruction Permit
Permission is hereby granted to Construct(G:.�gepatr )Upgrade(�Aba�W ) A / 7�System located at 6 A"vr7 - / G.
MAdr.5 TO,W_S kPi /A'
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:Constructs n must be completed within three years of the date of this t. s
Date: ��/°I Approvedb U C`
1/6i99
NOT?C]Z: This Form Is To Be Used For the Rep°dir Of Failed
_]
Septic Systems Only.
CERTIFICATION OF SKETCH .-ND APPLICATION FORA DISPOSAL
WORKS CONSTRUCTION PERtiQT (WITHOUT DESIGNED PLANS)
hereby c--rtiry that the application for disposal works
construction permit sinned by me dated ,--/ ^Off' conce.�tina the
^ � `'� a/ _
properry located at /6 ��� �l �il�s, meets all of the
following criteria: !r
The failed system is conne^ed to a residential dwelling only. There are no commercial or business
uses associated with the dwellins.
��Tne soil is classified as CUSS 1 and the oercoladon rate is less than or equal to 5 minutes per inca.
��'Tize:e are no wetlands within 100 fee;of i.he or000sed septic system
There are no private wets within t 40 fee;of the oroposed sepuc system
�The:e is no increase in flow and/or change in use oroposed
There are no variances requested or ne`ded_
;/<_11 bottom of the propased Icacain;faclity, xill not be located less than five fee; above the
ma.==adjured-oundwater table elevadon. (Adjust the groundwater table using the Frimntor
method when applicable]
• if the S.A.S. will be located with 250 fee;of any vegetated wetlands, the bottom of the or000sed
leaching facility will not be Iccated less than ,oureen(lam) fee;above the ma:.(imuLm adjured
..oundwate.,table e!evation,
Please complete the following:
A) Too of Cround Surface _:(r/aeon(using GIS information) �a
B) G.'N. E'.e^yation .3:2, -the �L�=C. -igh G.W. AdjtLssneat
D rT R"i CE B ET-WE N' a.in 3
SiG +FED D A i c:
(Si:etch proposed plan of;use n on bac:c1.
q:.cz h;oidcr.
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~TOWN OF BARN_
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/� rs�rs>•ta rl 1 0 SEWAGE #
LOCATION ` l
VILLAGE ASSES M ASSESSOR'S AP & LOT
INSTALLER'S NAME&PHONE NO. 41�7 D?4 q ✓D S eiQ�i l�� ��.r1�'.ao'oS
SEPTIC TANK CAPACITY /4D19"
LEACHING FACILITY: (type) 2^S��G�� �✓4 �//oI'�s(size) �S�
NO:OF BEDROOMS nn
BUILDER OR OWNER /4�
PERMITDATE: —Z—�! COMPLIANCE DATE: :5 _�y- U
I. 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 :.
I.
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 fa.i ty) ---
..Feet
Furnished;by
zwJ
an.
V
1 AJ
.r ..:..: .IV
16
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3 �IV
s
10 CAT IO SEEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME j ADDWESS
Ls
R UIL D 0R OWN ER
DATE PERMIT ISSUED , E.
DATE COMPLIANCE ISSUED
ow ct
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THE COMMONWEALTH OF MAssAo*ussrrs
��K~��� �� .
_--'l�-x�L0'l--'���--��°��&.��l~�8JLJL8.�-~---.---._'-- �
�.°� �K
���u��lir�otiou» �uu� ��ms��x��/*o� wnwork%o Tono4r44r4�on ramKt
Amol�u�oo is �crcbv ooulc �or u ��rod� to Construct X
or Reaic ( ) uo IndividualScwuge Disposal^^ . ^
Sys)jm at:
'------' .......................
�
or Lot �
_________ __
din Address
------------ ------
-------_'-------'-----'-_--------'-------'----_---'
Type of Building �� S�c Lot-_----'--'-'--'So feet
Dwelling—No. of 8eGr000�u------���.................... ....Expansion Attic ( ) Garbage Grinder � )
04 C)t6ez--Ivoe of Building ------------ No of persons........................--- Showers ( ) -- Cafeteria ( )
04
~� Other -- .....................................................................................................................................................
Design Flow _ gallons per ^ To_- -�-�-_-----���
Septic Tank--L�u�\ Dian`cter.--_.-. '
��
'- Seepage Pit Nu-'-][---' Diaoetec.-- Depth below inlet.................... Total G PD
z Other Distribution box (,,-/)
Dosing tank ( )^~ Percolation TestResults Performed by-. �K���[�. .--__-- Dut�.--l�/V --
Test1.4
Pit No. l--�$�'..nnioutca per inch Depth of Test Pit ���� .. �'----� Depth tv87ouod nmter.3'Doi��........
Test Pit No. 2................minutes per inch Depth of Test Pit................... Depth toground water-------'............
-'-'_-.-------'_-____--_----__'---'---'----'-'-'------'--_--_-'---'---'---..
0 Description of Soil.
................................... -�----_--................................................................................................... ...............................
................................................. ................................................................ ...................................................................................
U Nature of Repairs or Alterations--Answer when applicable.................................................................... ......................
-
-------.....................................................................................................'..............................................................................
Agreement:
The undersigned agrees to install the o6oredcocribed Individual Sewage Disposal System in accordance with
the provisions ofIZTi lZ 5 of the State Sanitary Code ommn�e the ��m �
. --_--.--_ ................................
..._. '— Fps `�=2..._
-j ,
r THE COMMONWEALTH OF MASSACHUSETTS
K
BOARD ,OF HEALTH
,. '
_..........- .. .. ....:...........OF........._.......e.,_ ........: ..........................................
` ppi iration fox Disposal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct (X or Repair ( ) an `Individual Sewage Disposal
System at:\
....t .......... :;.... .1.~�� ......................•------•---..... ............................� ........
--�...............................................
f --!Location Address or Lot No.
r, ' ....................................... -•-------....._......•-•----•--•------_.... ......_.._•-••--•-----._.._...----....._. ..
--finer Address
a -- 1'�'_�.5 .: ^'?�� .............. ......................................................••.....................................•....
Installer Address
Type of Building Size Lot..................... .....Sq. feet-
✓ Dwelling—`No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder,:-(" )
aa l Other—Type T e of Building No. of ersons............................. 1Showers —
YP g -----------------------,---- P �Ems' ( ) Cafeteria ( )
Otherfixtures ---------------•----•••-•-----•-•---•--...--•-----.....-•------•--------...-••--•------..-•--------•--•:--...._ ....---------•--....._.......
w Design Flow............ .......................gallons per person per,day. Total daily flow........ .....................gallons.
W Septic Tank—Liquid capacitv.1 .gallons Length. ..t�'_a_W`�_ UVidih.._!_: .__ Diameter............:...,Depth...44.1
.......
x Disposal Trench—No ____________________ Width...................!,Total
Leerigth..................--. Total leaching'area_'................. ft.
3 Seepage Pit No.___....�............ Diameter.......' _ 4Depth below inlet............... Total leaching area__�a p� Taq t:G
Z Other Distribution box Dosing tank'( 9
aPercolation Test Results Performed by____ ;1 ":. .1. .1.P .j::9y_ _______________________ Date....... � !...............__..
Test Pit No. 1....� minutes per inch Depth of Test Pit .--....... Depth to ground water 6G110•.......
fs, Test Pit No. 2......... ....n nutes,per�inch; -Depth -of Test Pit.................... Depth to ground water........................
�+ ..�.. . ----•------------------•---•---•-•--•-•--....................._...
ODescription of Soil.....-----•-----� ............•--...................----......---------;.---------------------...---------------------------•-•-•--.....----------------
--------------------------------------------------------------------------------------------------------------------------------------
w -------------•--........-•-----•-----------•--•-----------------••-------•.....-•-•--------....!.---------------•-••---------•-•--------•-•---•-------------------------------------••--................
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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
eratio Certificate of Compliance has been issued by the board of health.
.. ..* 7
ned ............................................... ................................Date
A ....... {._... `PPlication Approved By... ate
Application Disapproved for the following reasons:---------•-----•---------------------------------------------------------------------•----....-•-------....-----
...................................... ..:: .......................................................
Date
PermitNo......C::` . ��•............. ..... ......... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... N.........OF......
.. .-` ° .f. ? :...............
Trrtifiratr of Tontplittnrr
THIS I .__TO CERTIFY.-That the Ind:vt ual Sewage Disposal System constructed ( t-a--or Repaired ( )
a-
---.
) Installer
-------------
t
at•---•---.._...(...._:.: ��..-----_--•-- -------�• t' �' --------------...-`"'==-�� -----------------------------------•-------_-----------
has been installed in accordance with the provisions of TITLE. 5 of The State Sanitary Codlbejis described in the
application for Disposal Works Construction Permit No.--- ."::�._-�� dated........ . . _�-_ �_._...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. �w
pi . Inspector...
f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD_.OF HEALTH
C
......................................... 'M
C OF.. Nr?. ••. s_
No...�._'�7_.._... z.,.� -- FEE..`....,. z...
Elisposal Works Tanstrnrtion Vrrntit
Permission is hereby granted_.....fi..:-`:::-- c...:........: _=��s.a1!�1 .................................
to Construct ( o"'i epair ( ) an Individual ewage Dispo Systems n
sue,,. _ ::_._.... '- Y--�` ...........................................................
Street
as shown on the application for Disposal Works Construction Permit NJ`.,.-_-.k D'at f
..................................�_...._--.
` Board of Health
DATE. �. � A
x _
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