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HomeMy WebLinkAbout0130 FOXGLOVE ROAD - Health 130 FOXGLOVE ROAD Marstons Mills / A = 149 - 022 I No.� —� Fee / THE COMMONWEALTH OF MASSACHUSETTS Ent red in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Mtgooal *pgtem Curi!6truction Permit Application for a Permit to Construct( )Repair( V)Upgrade( )Abandon( ) O Complete System U4dividual Components Location Address or Lot No. 1 o r x be rd Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. n V`_ avl i Designer's Name,Address and Tel.No. ' 7-7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A60 Other Type of Building J Ce No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ala- gallons per day. Calculated daily flow 330 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 9� . i�%s7`Jgg Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /iX/e 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 s Boar f Signed Date Application Approved by Date /t Zip Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION /�� COX SEWAGE # ZA,-& I VILLAGE t SSESSOR'S MAP & LOT 4/ "-C'Z Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) sae) f.,Vd!x-4 ekal, % io (size) /Ast ,2r o � NO.OF BEDROOMS BUILDER OR Cv 20/7 e- PERMITDATE: / 4192 OMPLIANCE DATE: ego 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 15C-ir- __ _ _ _ _ �/.?d e�'�d� `�_ -.'' �®� �3D ��. �� ��d' i �1 Yn' 'V Pt, i+r •�' 1,. � _ • i `Af' ' • �eY�' ..'C �. TOWN OF BARNSTABLE LOCATION l3� GOX�� 1' SEWAGE # ZG -65-7 VILLAGE (,Pj9 /'�/�/�L� ASSESSOR'S MAP & LOT/Z/ -OZZ i INSTALLER'S NAME&PHONE Na Bo/� L�'l / CG�IZST 7 7/-93�9 SEPTIC TANK CAPACITY l GCd G/�t✓ LEACHING FACILITY.: (type)TOO 6rif! l '(size) /2•f 9.i' > I NO. OF BEDROOMS_ BUILDER OR S�� PERMITDATE: / "COMPLIANCE DATE: ? Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 67t 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 L G f � j 6jNo-�✓V y y � 'Fee J v 1 THE COMMO F�/4YT1�i OF MASSACHUSETTS 'Entered in computer: Y/ l Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppCicatton for ;0i0poga1 bpgtem Construction Permit Application for a Permit to Construct( )Repair( r)Upgrade( )Abandon( ) Complete System 2' ividual Components Location Address or Lot No. pa ray /lye rd Owner's Name,,�ddress and Tel.No. � - Assessor's Map/Parcel e .co.�elv;01 e Installer's Name,Address,an Tel.No. Designer's Name,Address and Tel.No. 7-7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(_I�b Other Type of Building e✓ «' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //651 gallons per day. Calculated daily flow )-3� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank D��` atiY/s7 s�9 Type of S.A.S. 2- Description of Soil io.1'3D�1'Z f Nature of Repairs or Alterations(Answer when applicable) 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� 's B f ✓ Signed Date Application Approved by I Date r Application Disapproved for the following reasons Permit No. Date Issued 4 =—————— =— ——— —————————— ___ —— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance � THIS IS TO CERTIFY, that wa e O -site Sge Dis osal System Constructed( )Repaired( )Upgraded( ) Abandoned. )by �d/�5 at l ") �i�1 OG� �N�Z°l^!// h been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �vv—6J dated Installer Designer 77L . r> An The issuance of this �j�Y�2, t s fall ofb construed as a guazantee that the syst m wil unction di n�d� // �� Date �/ � Inspector �if --------------------------------------- ZFee THE COMMON.' 6ALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mfigpooat *pote Conotructton Permit Permission is hereby granted to Construct )Repair )Upgr de( )A andon's ) System located at /3� &,ry�D r� ?e�Ile) � 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:Co/tru�tio n�ust be completed within three years of the date of tlu Date: Approved by i �?0 i a e//e®> clew Pie? 5i/mil Aly/ �i�Yr�r i �r 66� L 1/6/99 sz 'F 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) I, a�OrtT 'd®rl-�)49�i, hereby certify that the application for disposal works construction permit signed by me dated 11 L`00 concerning the property located at !Jo f'OX9�1� I'Y� � Nl�� meets all of the following criteria: (✓ The failed system is connected to a residential dwelling only. There are no commercial or business s uses associated with the dwelling. /,The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the septic stem proposed P s5' F�There are no private wells within 150 feet of the proposed septic system t✓ There is no increase in flow and/or change in use proposed ./There are no variances requested r q o n eeded. Y 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 ma.-cimum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 6 v r 0 B) G.W. Elevation +the MAXgh G.W. Adjustment. ,✓_ l '/ X. DIFFERENCE BETWEEN A and B 2- l SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder:cent y = - Hc,-6,0�50WN OF BARNSTABLE i OCATION % SEWAGE # �- �,, VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 6-L4-AS i9f?&oS, SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) (bcDo , dNO. OF BEDROOMS � PRIVATE WELL OR PUBLIC WATER `r� BUILDER R OWNER t T-.4 DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: -7 VARIANCE GRANTED: Yes Now ��. �� �I �� -. . m ���� �� '� i �_�_. No..t.�.�l....s- R.� THE COMMONWEALTH OF MASSACHUSETTS _t ?y BOARD OF HEALTH To w ........ .h...............0 F........J..---....v..5 T�b... . ----•--------.....----............. Appliration, for 1ioposal World Tonstrudion VPrmft Application is hereby made for a Permit to Construct ( , or Repair ( ) an Individual Sewage Disposal System at: _�� �1_ov e.................,_ c��-s �•s.Yl►lls ....................................2 Plah C� cl`i..�..P`.�.:�3 .......... .�l. .k.................'o�l Address ......... ...__...._._.. .........--• .......... Lot ........ ..........«._.._.. per .Address w �,.T �.�:A s ................_- .......Installer.. .......----............••••.................Address......... ............................. Type of Building Size Lot. a 45 .Sq. feet U Dwelling No. of Bedrooms.....3................... .....Ex Expansion Attic� ng— ---...-.. p ( ) Garbage Grinder ( ) Other—Type T e of Building No.. of persons............................ Showers — M YP g .........:.................• P ( ) Cafeteria ( ) p' Other fixtures W Design Flow..............SS............-•--.....gallons per person�tgl day. Total d�jly flow.......-.�J3.......... ............ga I Rkr, WSeptic Tank—Liquid capacity.�O°.gallons Length..88.......*?:n... Width::;../. ... Diameter................ Depth...�.}-..S:. x Disposal Trench—No.................... Width Total Total Length............ . Total leaching area....................sq. ft. 3 Seepage Pit No....... ............. Diameter...�6.e 'Depth below inlet.._� Total leaching area. �: sq-fc. GI Q Z "Other Distribution box (�K) Dosin tank ( ) ►-� er�ov - Percolation Test Results Performed b �.:.�.............. ,. :C.C.:........ Date..g...�'......�5......... ....:....... ,a Test Pit No. L.: :�. ..minutes per inch Depth of Test Pit...166��r... Depth to ground water..h�'^e.......�r� Ljr Test Pit No. 2................minutes per inch Depth of Test Pit....: ...... Depth to ground water........................ O Descript on of S il.. �.y.: 1...:0-�2�- v o►I }�2t`-Go, Soy. 5�'�s©r�� Coo l -.1C®�s'..... _G�ea� c ►"r+ yvNe�ju M :v�E mar� : \T. 2. ©: 12':�o Paz,% ...... U .................... W ,Ztea....... x 7......................................... _..............--•------••--••--•.---•-•-••--•-----••----•---.....------..................................................-•-............. U Nature of Repairs o Iterations Answer when applicable............................................................................................... .............:.................••--................................--••-•---.......•---•...........................-•----.................-•---•--•--................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of.:ITL U 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. d'' Signed... ................ ............_..........•••••.... ....•.. ...... ...... ff at; App ication Approved By.. ADate ........_ - :............................. ......... �6. Application Disapproved for the following reasons:............................................................................•-................................. ^ S.l ........ ............................. .......... ........... ............. ............. •Date.............. PermitNo......•-•••••.............................. ..... Issued.........••.... •Date.......••-....................... P No. .rJ.... ...... - 1 .F$iL......:r �� THE COMMONWEALTH OF MASSACHUSETTS _ •, �. BOARD OF HEALTH :.........O.�h 1. ................OF..... carvt� -�, f 0 .............•----...._............. Applir�ttio' for Disposal Works Tonstrudiott f ermit ` Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at, c�rs6�s '�i 115 1.. ca�' �1 d,h � .•3�1`�1 P 4 e 3 •�• Locatiou-Address .....•...... .._._. .... .. .............. ............. / or Lot No. -Address Installer Address Type of Building t Size Lot..4 8 ..Sq. feet .-� Dwelling—No. of Bedrooms.........).................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building ........._.. No.. of persons............................ Showers , a YP g .........:...... P ( ) — Cafeteria ( ) 44 Other fixtures _ W Design Flow...............`�.5..............._.....gallons per person per day. Total daily flow...........�......�...... ............gallons; WSeptic Tank—Liquid'capacit*y...2.gallons Length._�`••..-11-.... Width:�;�.�:.. Diameter................ Depth..x..j:�- x Disposal Trench—No. ..... Width..:....:........... Total Length ,-,,Total leaching area....................sq. ft. 3 Seepage Pit No......\.............. Diameter...!;� 'Depth below inlet............» "Total leaching area5�.-..-.sq:--ft. G i�). Z Other Distribution box.( ) Dosingtank ( ) `" Percolation Test Results Performed b '� 'N..cQar�oyq�-I • �'�'� Date._.'2'.�-�S ay- f.:__... a.._.... :................... ..........---•••...... Test Pit No. 1... 4..minutes per inch Depth of Test Pit... ?��'. .._. Depth to ground water..:OO"--....... • .. ... water f=. Test Pit No. 2................minutes per inch Depth of Test Pit....Y``'-.:�... Depth to ground .............--........ a O Description of Soil.....�.:N.:4' I....:©-12•" p oi` I'2"''-Go"So 'M S.abSv�\...<oc ` -'.1�0�"= G�eah .._.... ►"�+ vsne.��v m ;v�e San I . 1'Z"- ')2'................................................... 1� �_ tee SQc W �• � Ny ............... � 0.� ........................ . ......................................_ ....... , ..... ......._........... ........................ .........2........................................................................................................................................:..................................................... V Nature of Repairs or Alterations—Answer when applicable............................................................................................... .............................•--------•-------•---.......•••---....y.........._ .........-•----............•••--.......•-------...................-•----...................... Agreement: s The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in { /operation until a Certificate of Compliance has been issuAed by the board of health. *'' V Signed. 61c-4,, ......... .... ......... ...... �.. " =1 to _ a Application Approved By---------------------r...........`........---......,.....----.....................----- ............ ....F Date Application Disapproved for the following reasons:..................................................::.......................................................»» .........---••--•.................••----.......................................................--•--...............---...................................--•---•---•----................................» �lf:J Date Permit No.... .... Issued................ ..................................... Date THE COMMONWEALTH OF MASSACHUSETTS �---" BOARD O.F HEALTH t�i�rrvOF ... Tpr#if irab of faompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..........» � ¢ v �/L_ �'ti�.-t- i�l..--4I ,1 « - .'A."­ ........................................................ �-...._....... ........................»........ at......... ... ................... ... has been installed in accordance with the provisions of T1TQE 5 of The State Sanitary Code as descr b in the , application for Disposal Works Construction Permit No cS dated........:..��_ _ --.. ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. /.`� ..................................... Inspector......^� .. ... ............................................... r - 1 Al THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH <- 7r - .OF.. ` -.� L,� ......................................... FEZ........................ Disposal Works Tonsku diott f amit Permission is hereby granted.......... - � - L..f�✓2.� -`I............................................. .......... ..................... ...... f...... to Construct ( y) or Repair ( ) an Individual Sewage Di posal Systemr t at No........,� =� >I a C t V �%+►- Street as shown qn the application for Disposal Works Construction Permit-No..................-D ated1 z...!..�2��-' ............... ...... -• ----------------••----.........-•••-............._ Board of f{ealth DATE.....:.�a... --------