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HomeMy WebLinkAbout0072 CARDINAL LANE - Health 72 CARDINAL LANE,MARSTONS MILLS I TOWN OF BARNSTABLE J- LOC-A.TION Q� ��• SEWAGE # VILLAGE NE e1/IS /�II��S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. A-040 `r e52MZ- SEPTIC TANK CAPACITY /,aloe r L LEACHING FACILITY: (type) Aztl l t/m/6 os �3� (size) X 0 ,c, NO. OF BEDROOMS ,► f� BUILDER OR OWNER Deb�� GJD �" Z 0/ , PERMITDATE: 2—�Z—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 ge. -- . e� S � r t No. , Fee 6 dzo THE COMMONWEALTH OF M SACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS T 01pprication for Iiioaal 6pg4em Con.5truction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System L"lhidividual Components Location Address or Lot No. 7Z /-74 IOd A,, Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Add ss,and Tel.No. ✓ / Designer's Name,Address and Tel.No. u �v��-dG�l�% Co�6r` 771— 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 gallons per day. Calculated daily flow 331el gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank rl Type of S.A.S. Description of Soil /f 7?/A' , Nature of Repairs or Alterations(Answer when applicable) ly`le C • ' 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 Bo d otflealth. �, Signed 4 Date Q Application Approved by, Date Application Disapproved for the following reasons Permit No. Date Issued '`� TOWN OF BARNSTABLE LOCATION % C�r�`��9� ��✓� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO._hf/'Ot l / 4111,5%•• 7JJ-9399 SEPTIC TANK CAPACITY 4 eve e�C LEACHING FACILITY: (type) ik r/'A (size) NO.OF BEDROOMS 3 BUILDER OR OWNER DeS�� G10 PERMTTDATE: Z�Z—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) 11 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ch ` lk - tea, No. � � Fee . THE COMMONWEALTH OF MA SACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprtcatton for Ot!5ponl *potem Congtructton Vermtt ` Application for a Permit to Construct( , )Repair(%,/)Upgrade( )Abandon( ) ❑Complete System M Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 72 Car �a� �, Assessor's Map/Parcel 71 Installer's Name,Address,and T el,No. Designer's Name,Address and Tel.No. 4T �i/?J�s/t,L� CtJ�fvl 7 7/-- Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder(� Other Type of Building e5 ehrtf No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ile gallons per day. Calculated daily flow 33� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15,yjsll,yo /G"9GG'yli/ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) le - �acd if 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 issue thi Board Aealth. „- / Signed . Date Z/ Application Approved b ✓ - Date Application Disapproved for the following reasons Permit No. `' Date Issued —————————————————————————————p——-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE TIFY,that the On;sit Sewage Disposal System Constructed( ) Repaired(Upgraded( ) Abandoned( )by ✓�`dG�y�� ��-� at 7 Z e It has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ' dated -"� Installer Designer The issuance of this permit shall not be onstrued as a guarantee that the system will function as designed. Date tea, - f J Inspector No. �q_ _ �� ----=------------- ---Fee"ti/�! -A� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS MiOPO4ar *p!5tem ongtructton 30ermtt Permission is hereby gran ed to onstru t( Re U rade )Abandon( ) Pam( ) Pg ( ) ( ) -t System located at 7 /� ' ���fs�`DsrS 1715 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 thi it. , vim . +� � �I Date: rat � l� Approved i .r 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) 1, �Q� / �lf�C�, /' , hereby certify that the application for disposal works construction permit signed by me dated 12�9� , concerning the property located at 7 Z meets all of the following criteria: here are no wetlands located within l0o feet of the proposed leaching facility There are no private wells within 1-40 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. I� If the proposed leaching facility will be located within _�0 feet of any wetlands, the bottom or the proposed leaching facility will 0Z be iocated 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) 7 B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED : DATE: 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.art C12 s ' t S 'i-- L ON1"Rr CAab © 'I w�hl�sT u Js ,A&.L V Vi 5 l0 � A ION r SEWAGE PERMIT NO. VILLAGE INS LLER'S y� N�A/�ME & ADD SS 6 l�f A • (91/6(� . e U l a E R OR OWN ER Ike- DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ;17 �/� �,O �..5 E, g a , , � �(�� 0 O f � ?- ��' � / i�' No....... ..yL_.4 .............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ................0F.......... n..S ���......-----.....------------ Appliration for 11ispAiitti Works Tumitrnrtiun ramit Application is hereby made for a Permit to Construct (5ej or Repair ( ) an Individual Sewage Disposal System at ..�"lr D..... a� ........:-� ,1----Ln... M.A r 5.---.M i 1I.S M F ........ ....... ... . -- Location-Address or a �-•------...i ^.s......-. gip: y f ..1n`!1_ (� �h.-- .. 'v ..d...._.. W Obe } Oy.t-Owner, .±- ?-..... .`�1 .1.a.. 5`'�fdSr d „- ------.a � Installer Address Type of Building Size Lot.Z9/9Q ......Sq. feet Dwelling—No. of Bedrooms.._�rC.0...................Expansion Attic ( ) Garbage Grinder ( ) per., Other—Type of Building F-le............ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - W Design Flow..........55...........................gallons per person per day. Total daily flow.......... .....................gallons. WSeptic Tank—Liquid capacity.l PPO.gallons Length._`.(6e.1... Width.4/10".. Diameter________________ Depth.5"_.B." x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. � Seepage Pit No.--_--_-_--I......... Diameter------1 P___.__.. Depth below inlet..... .__........ Total leaching area..?AQ.(P.....sq. ft. ZOther Distribution box (V< Dosing tank ( )> ( Percolation Test Results Performed by_. ��Qb _1t !. er.................... Date... ..._......_.. �a Test Pit No. 1................minutes per inch Depth of Test Pit---Vz:.......... Depth to ground water-__n�!��.__. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ ........................................................... 0 Description of Soil---Q.-.. ........ .AM 17-1...... VS --•-------------------------------------------------------------------•----------...----•-------......-------•-------------------•--------------------------------•-•-----.------ W ---------------------------------------------------------------------------------------•-----------------------------------------------------....-------------------•----------------------------------. VNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------------••-•------------------------...............-----•--.....-----------------------•----•-•----------------------------------------••------••------- Agreement: Th t ndersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with *ci of i TL�E of State Sanitary Code— The undersigned further agrees not to place the system in a ert• a ompliance has been issued by the board of health. Sign M' (�-------------------------------•---- i is ----------- _.... �c' D'e proved By--••------•- f_._�Date sapproved for the following reasons:------•--------------------------------- -•-------•----------------------------------------........----•--- --....-•-•-•-----------------------------•................-•-•--•..------•---------•------•----•.•--•---•._...........---------.------..------------------------------...--------.... ----...-•---•. Date PermitNo......................................................... Issued....................................................... Date No.....15-..�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q .................OF........ 1i ....._...._.._........... App iration for Disposal Works Toustrnrtion Prrutit Application is hereby made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at: ........................................... =n-Address ` NA Q� -------------• ---- - I. - ..... ... - .... . ......................................S '. eo C,.(. R_----- _..... f (Addres t .......... Installer Address Type of Building Size Lotto,0. 0..--...Sq. feet U Dwelling—No. of Bedrooms.. -...................Expansion Attic ( ) Garbage Grinder ( ) �`4 Other—Type e of Building - ( ) YP g --Cry-�-•------------------- No. of persons_._..__._.........__.____.._ Showers ( ) — Cafeteria dOther fixtures .-------•---------------•----------•-------....------..---------------------•----•----••-----•--•---------•---•-•-•-•--•------.........--.........---• W Design Flow.........5�K...........................gallons per person per day. Total daily flow---------- .0_-....................... p�al�ns. WSeptic Tank—Liquid capacityIP'_Q..gallons Length.��..'(a_'.... Width`¢`'.i V f.._ Diameter................ Depth __.._._.... x Disposal Trench—No..................... Width.....d.............. Total Length......---.fi 1....... Total leaching area....................sq. ft. Seepage Pit No----------±.--.____ Diameter.....!�...._._. Depth below inlet.................... Total leaching area.:.?=.....sq. ft. Z Other Distribution box (V_� Dosing tank ( ) y` '-' Percolation Test Results Performed by. �? ��s_ _�_`..... ...... .. ' � -�1 9,' W --- -----• Date. . 04 Test Pit No. 1................minutes per inch Depth of Test Pit. .�'.-.•...._.....•.. Depth to ground water. ..?. °.. ._.... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t� ............................................... i ODescription of Soil....`' _.---•-4. 1 ---••-•-------- -•------------•---•----•-----•............... x V .... ?'. .� ...-•--------•...............•---------......--...--•---------....•.....----•-------•-------•-----------------------•---------.._..------•---------•--•-•--------•-•------------- W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------••-•--------------------------------------------•-----------•-•--••---•----••--•------......----•-•----•----••------•---•---•-------•-----•-----•-••------------•--••----•-•---••---•-........-- Agreement: _,e'gndersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the ppovi ons of i 'IS 5 of State Sanitary Code—The undersigned further agrees not to place the system in oppratio4 tinfil a er •fie to ompliance has been issued by the board of health. i / Signed-_ed ___.. -. � �".r_.�..._ t pt --------•----•------------------ --- -- - App is i Approved BY...................................... ......._.... --------//_ . Date App ication Disapproved for the following reasons----------------------------••-------------------------------------------.------------.......................... ---•--••--... .............. Dam PermitNo......................................................._ Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t r�,^• r 1 ...........OF...... . rt�- 7 Y Trdif irat a of ToutpliFanrr THIS ?S T CERTIFY, That the In vidual S wz e Disposal system constructed 9<) or Repaired ( ) by. .�?�"�T.�......_Q.°� � �� ----- ..... -- ?.`. `... t Installer has been installed in accordance with the provisions of TITLE 5�f he State Sanitary Code as described, in the application for Disposal Works Construction Permit No.......A��_/ ........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTVED AS A GUARANTEE THAT THE SYSTEM'W/I F CTION SATISFACTORY. DATE....Y - M...................................................... Inspector 2K------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...9.... FEE.....l................. Disposal Works Tonsir ion rrutii Permission is hereby granted.....ai� +..._ 6 -D r ...-•------•--.•-•••-----••------•-•--•----•-•--•--•-••-••-•---•---••••.....--•.............................. to Construct O) or�Repair ( ) an Individual Sewage Disposal System at No... Street as shown on the application for Disposal Works Construction Per No.._.._/..__�__.______. Dated.......................................... DATE_ �/ r. Board of Health 1 - --------•---•-•-•---•--•.-•-• 4 FORM 1255 A. M. SULKIN, INC., BOSTON a, tarn) u Ac.r�r�—N 3 7 o 0�.� ' ;� �N.G T}v i✓ r 3� 19 �F,r�.gnrsroy'` r Z.0 OV0 jr,F: 6 Pr Ll ol N 4: \ / / i �% ona GAr ' �- h N lr1 4 Q 5 "'o � .4 310 ' ` rr� N. OD q N N r✓/r,6Pv s q$ 4o ZdNc- R'. G6T-' 71 / 1 /Z S U D _ -`�ro w a y L A uls APD OF b� �. `_.S 3 — bS_ -- - - q° f �H Mass Fo G-- 11 c,ara��ilk. l a.y q AL tiN C ��D/N��L , i �ANE RSE N P/? I ✓ATE `1 No.10951 O - -- — — e 90 FGISTEP�\�k``' �ccST.l� -roc./N c.Jir"rE7z -�-'Po� cFSSfONALE� --- (� N1GLL. LEGEND CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION 00 EXflSTiNO CONTOUR --- 0 --- ��o� '�"s Lo T c���r�.r 4.11/Vie FINISHED .SPOT ELEVATION Qs �``� � RUBE'RT ,n .FINISHED CONTOUR 0 -V BRUCE '" � IN -LORE APPROVED BOARD OF HEALTH 3 �� ��, �.�• ���, a ���• DATE AGENT — SCALE, � �" 3� r DATE S Z `! �ORfDGE ENGINEERING CO. IN M�-K � T. THAT THE PROPOSED `( CLIENT I CERTIFY EGI3TERE REGLSTE�RED Mpg Np. e¢ BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENO ER RV DR.BYt '� OF BARNSTA LE , MAS 1 MAIN STREET . CH. BY, R • >3 E� S' S 8 _.�-- T 2 M S _ y +. HYANN I $t,�-:Mk5s- $HEET..LOF 71 - DATE REG. LAND SURVEYOR II IV07"F : /F F/TNE�? THESEPT/C TAN/C OR 20 FT. M/Al LE/fCN/iVO A=P/T ARAF MORE TN.gN /2NBEJ.OJV /O PT. M/N. rRAOE� f� 24'O/AMETER CoNG'R.FTE� COYE.� SMALL BE B�PD�/6NT TO 4.TAOE.64N-,SrrRA CCNGRCTB .¢"FVC P/Pe t/E.4VY CA ST /RO/Y COYE� .S/V.41.L DE USEO o COVERS AWN. P/TCN /f/N pR/VA=- W 4 y EL, t3 /�►'PF,p FT CO ✓ER CLEAN -TA N.0 _ t/941/0 LEVEL CAST - - 2 LAYER /ROlV P/PE 14700 GAL •.Y o e e o QF I8 -'SIB L. r • . . . .• ► e M/A/.P/TC// •4 D/ST o WASHED S72�NE SEPTIC TANK 6oX • • • • . . . . . . , , �• Ntl t&r AU,6T. �. � o �rp• 1 1 •�EL'f%VE 1 • , r 314 ,g9- F3e-WW • • ► • • DEPTid • • • • • e . WASACP STONE LAYM 377 113,1 x /.0 7�3 i es • • • e • • • •• . a •f y PRECAST SEERAGE lNiiBRT ELEY�OT/O/VS 90 � OR EAU/vP1T C�/ .q c T • o . . . e . l INVERT AT &VILDIMG 9•7.o FT. lNL E7 .SiEPT/G' Ti�4NK 9 3..5 FT. /2- FT O/fll�9. C SEE TABI/LAT10N) OUTLET SEPT/C TANK 9 3.3 FT. INLET D/STR490710M-BOX 9 2,SF j GROUND WITER 7A- ALE -VECT/ON O F ourzEro�sTRie�rrioN eoX f r. S�jyAGE 0/SI�G�TA IA Zt E7- LEACHIAW "17' 9'6. /: FT TA�W4 ATIO V LEACHING P/7' 3 S CALE D/MEN.S/OAl A J DES/GN Cft/TE14lA o/�.�-ors/oa �--�-.F'r'- NUAfIQE.4 OF SEADmod S 3 D/MENS/ON C FT. ,4t/N,, I GA,gaAaC-0 SP05AI-(/MIT A10411 SOIL LOC. TaTAL.E3T//rL«'EG FLOH/ 3 3 O G.4L./Di4V SOIL TEST#I SOIL 7L�ST#2 `�®�� '7��$T' JVUMBER OF LdfACRI)VT P/TS f f'ELC'✓. 9 g/ ELEY, GATE OF SOIL TEST 54 S/DF LGACH/NG PER P!T. l Sb•3 ,SYt PT. _4 ' RESULTS It//T/VESSED BY`/nD `-)^C 3/ dOTTOAI LE�IC'N/NG PER P/T l/ $Q. RT. AwmcoLAT/ON DATE / Liu //1/�IINCH ! TO TAG LEAC/•///VCr.•�REA �� sip. FT. � 5-U6.5viL AEXCotAT/oNRA7A,-A2 7 "- M/1V.//IVC/V , { RESERtxEGEACHlN6 AREA Z6Y SQ. FT. ctA-y . Z o 4' /z ' Svlc TEsT )1-1- 3 2y7 - Mei�iu OFA1,4LOT .CR RD/NA L LAi✓S rL�4i7 ALq€Rt� �, t Nl4-,4 S T©/VS 6�'J/44-S !! BRUC$ as C3 f -TAQR E N 10951 o ELOf?EDssEEAhG/N�1P/IVrts GQ,JnoC. ? 7fZ MAIN STD NYANN/9, MASS. iS—r �PpFFSGIST����� �L ' NT1r EO CL/EA/T: DATE 2 S¢ ND 5 �ONA 1 {$ NO G/TOl//VD YYATE/P E/VCOl1 R McK�on/ 5 .9 Q. G/e0 Uwo w- 7—.,e A 4EZ.E JOB ilaa 0EST z o� 2