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HomeMy WebLinkAbout0124 GOOSEBERRY LANE - Health 124(OOSEBERRY LANE MARSTONS MILLS A = 102 068 � j �1 ' �OC• TOWN OF BARNSTABLE LOCATION /Z7 Dee--5e y �! SEWAGE # VILLAGE !j?Q�'S 0/�5' /yI/'/I5 ASSESSOR'S MAP & LOT/110 7- INSTALLER'S NAME&PHONE NO. XOPI?1&0�leO%S - ? SEPTIC TANK CAPACITY o6011 LEACHING FACILITY: (type) fao Ckl t~5 C444-g (size) NO. OF BEDROOMS .� BUILDER OR OWNER ors PERMIT DATE: 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 G `' .a.� ��a y f R��r 34 �3 b „��. �� �y i�� O /��(� TOWN OF BARNSTABLE ` I:OCATION / ' SEWAGE.# y '._ _ • �� VIIyLAGE lY ASSESSOR'S MAP.&"LOT •/('t4-U6g= .INSTALLER'S NAME.& PHONE NO, SEPTIC TANK CAPACITY' ' LEACHING FACILITY:(type) ,� , (size) �p®d NO..OF,BEDROOMS ' PRIVATE WELL; OR PUB IC WATER BUILDER OR OWNER DATE PERMIT ISSUED: • . DATE.. COMPLIANCE ISSUED: ' VARIANCE GRANTED: Yes NO.. ' ._ . 04 r Y. .I'�"_' ice. � _ •� `�. � .__.�� ` �.�...w. ' -"`' _� �� � '� � 3 �i �� ..� ,.--' �� r ' � Qr t .+� - No. q(50) _Oa� Fee SO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS RppYication for �N!5poar *p5tem Cow5truction Vertu Application for a Permit to Construct( )Repair(V/)Upgrade( )Abandon( ) El Complete System 9/individual Components Location Address or Lot No. Owner's Name,Address and Tel.Pio. Assessor's Map/Parcel �� `_�IIZ15 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. te©r/7 , 7 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(,WV Other Type of Building e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L1® gallons per day. Calculated daily flow 3312 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank .0 e Type of S.A.S. Description of Soil 1 Z. Sif' 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 n in accordance with the provisions of Title 5 of the EnvironmentalCode a d not to lace the system in operation until a Certifi- cate P Y P of Compliance has been issued b his Bo d of al Signed Date Application Approved by 1CXYU '-AV '�`_L, QP Date Application Disapproved for the following reasons Permit No. 90O 1 0,S Date Issued 111a I o / f TOWN OF BARNSTABLE LOCATION /Z7 DOG9ye 41 SEWAGE # VILLAGE !y9l/�5T4�5 /�r'l�/�y ASSESSOR'S MAP & LOT��Z INSTALLER'S NAME&PHONE N0. P�� ''ll SEPTIC TANK CAPACITY 4,-oea 6igl LEACHING FACILITY: (type) Say CMl 1~o Ctiww -i (size) >.•?rS xaf NO.OF BEDROOMS 3 R1M..DFR OR OW� 740M-0 I r PERMITDATE: 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 j: on site or within 200 feet of leaching facility) Feet j Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by G l O h� T cheli ,(PRY 4 ,�10 1900 t 'OaS Fee so THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓/ Yes •.PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTB*- ZIppYication for Migpozar bpoem Construction Permit Application for a Permit to Construct( )Repair( ►')Upgrade( )Abandon( ) ❑Complete System ❑O Individual Components Location Address or Lot 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. 7 7/ l Type of Building: Dwelling No.of Bedrooms Jr Lot Size sq.ft. Garbage Grinder( � Other Type of Building�/7/Q SI .f'G✓l e No. of Persons Showers( ) Cafeteria( ) Other Fixtures �t t Design Flow gallons per day. Calculated daily flow 3.�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /a ©��Q✓' Type of S.A.S. Z Description of Soil Z. 57,'L 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 his Bo d of Health. Signed Date Application Approved by lLOrl.(.o^ Sc. Date ) la /o1 Application Disapproved for the following reasons Permit No. 2 O U 1 O a Date Issued ! 1 a l O / THE COMMONWEALTH OF MASSACHUSETTS /0 Z BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by N/ / at /7 1/ AoAS err r� �//..etas been constructed in accordance with the provisions of Title 5 and the for Ilisposal System Construction Permit No.c-W) Ud S dated Installer Designer The issuance of this permikq alltfo e co strued as a guarantee that the systeemwwi�l-function as designed. 17 Q Date Inspector a � --------------------------------------- No. J00! Oas f�Z �O I� Fee J �— \ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpo$al 6potem (Construction Permit Permission is hereby granted to Construct( )Repair(✓)Upgrade( )Abandon( ) System located at /Z ,h 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 ILILItt NOTICE: This Form Is To Be•Used For the Repair Of Failed Se `tic Systems. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT OUT DESIGNED PLANS hereby.certify that the application for disposal works canstruction permit signed by me dated Z le / concer=sz the Property located.at `z a®Dv���j`d� l�, , / �Q���®!1� �j/�mEets all of the f9llowinz criteria:. The failed system is connected to.a residential dweling oniv. There are no commercial ' , a- �:ses asswated with the dwelling. .�,al or atstn� Y i ne soil is classified as aAZ—S I and the pe^roiation rate is;--,Zs Jmn or Huai :o.. :111nIIIeS 7e: :IlC1: There are no wetands within 1o0 ,,oI le proposed S=UC 37SIem :here are no we'is within i:o fee:oI the proposed se—pric yvae:n. 1ere is no inc--,,se in flow and/or.change in+.Ise proposed The:e are no variances-requested or neeaed. V The bottom of the proposed leaching;aciliry will not' > - -r —x located less than iv Ieet above the ma.�mum adjusted grmmdwat-. table e.rration. (Adjust the�oundwate:.table using he rimt;tor / method when amficable]. if-the S.k.S. will be located with 250 feet of any veveat. ed leaching facility will not be located less than fourteen(14)ff=above the wetiands. the oma:artt=adjustedottom of the s ground- ater table elevation, Please complete the following A) Top of Ground Surface EIevation(using GIS information) B) G.W.Elmdon l 5 +the MAX iitgh G.W. Adjttstment, ? _ Z D rp'Er RENCE BETWEEN A and B 3 7. SIGNED :� DATE: (Sk=h proposed plan of system on back]. ¢bum toiler.out of PICK 2,9 I 114 c� r"a eke r�^r l� , i4_ O �. No- .................... ?/ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT !1� O OF , VVfiration -for 13hipaaii al or 11 agtrurtion Prruid Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst t- 1 -• -- - --- P a y 1 ..--•- Wj l� Loc n � -° of o. e Address ---•---------••••---------- ---------•-•--------------•-- •--------•----•------------------- ------ -------- nstall Address >>�� ��..��,,ff UType of Building/ Size Lot__.`/U-J.;,l----v..vSq. feet -, Dwelling.�No. of Bedrooms................ Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ._------------------------- No. of persons-_-_..__--_._---.-..------ Showers ( ) — Cafeteria ( ) 0.i Other fixtures W Design Flow.._....._..- f� � per person per day. Total daily flow--------- ---ll✓-...gtllons. WSeptic Tank Liquid capacity .-_ _.__ tllons Length________________ Width................ Diame r_..-_-- ._.___.. Depth.--............. x Disposal Trench—No. -.-__-__------__-.__. Width____________ _ _ __ engt 1... ._ .........-- to aching area---..-..------------sq. ft. Seepage Pit NoI-_____-_-___- Diameter ep oN IIIo a each' trey __. -----------sq. it. z Other Distribution box ( ) Dosing tank) eai�� a Percolation Test Results Performed by--------------------------------------- --.------- Date-------------------------.--_------_._.. Test Pit No. 1--------------_minutes per inch Depth of "Pest Pit-------------------- Depth to ground water._-._._-__.._.--._---- �14 Test Pit No. 2________________minutes per inch Dep of Test Pit.................... Depth to ground water-----................. .. a ------ ----------------- -------- --------------------------------------- 0 Description of Soil-------------------------------------------- -----•- -- ---------------------- --------------------------------•--- --------------------------------•----------- V --------------------•-.-- .. -------------------- -----------------------------------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 Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee i d y t bo d f 8ali. , gned----- -- --- - - ------- - -- ` Date Application Approved BY---- •. ----. . . ..---- - Application Disapproved for the following reasons:-.------------------------------------�f�--------•-------------------------•------------ate-------------- ••--••-•••----------------------------------------- ----------------------------•--------•--•---•-------------------------------- ....... ...------------------------------------------------------ Date 7-77 Permit No-----------_----------................................. Issued-----� --------__--- --------------•--. THE COMMONWEALTH OF MASSACHUSETTS OAR® HALT ....._.OF....... d.*/�6.. 7 Appliration -for Ditipaaiia1 or t rttrtiaatt'` rrttti# Applicatio is hereby_made for a Permit .to Construct ( ) or Repair ( } an Individual Sewage Disposal syst t C lV37E Lloc� - n- 1( 0 ------ - - - - - ---- 4/ ----- - -0.- _ imOwn Address -- ---- - nstaller Address dType of Buildi�� Size Lot... ._� ` ... . S feet Dwelling K No. of Bedrooms._::._ ______________________Expansion Attic. ( ) Garbage Grinder ( ) Other,—Type of Building _----_-.-_---------------- No. of persons--------:_.-_-_,Y---..-_.... Showers ( ) — Cafeteria ( ) Q' Other.fixtures ____ ______________ W Design Flow ______________ . ..•. ___ s per person per day. Total daily flow-------. A0677-7-7.-...` gallons. Septic T,tnk-�`Liquid capaciG allons Length.........=...... Width-------=-------- Di:une r._------...--•.- Depth..---..-.---.-. xDisposal Trench—No. ------------------ Width----._...__ �` ength__._- ..__..__.._ to a�g area_........___........sq. ft. Seepage Pit No.__•_ ___ Diameterf nl �+'s'r_ o a each area -- -----------sq. ft. Z Other Distribution box (��•) Dosing tank;) v aPercolation Test-Results"'. Performed bY----•------= ------------------ •----------- -------- Date........ -- •-------- .......... Test Pit No. 1----------------minute's per inch Depth of "Pest Pit---------------------Depth to ground water..........__............ (i Test Pit No. 2----------------minutes per inch p p g De of Test Pit____________________ Depth to round water............_...___.. ---------- ---- -- -•------•••--•••-/-. -------•-•------•------------------------------------------------------•------ Description of Soil------------------------------------------- xV --------------------------------------------------------------- ---------------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 Article XI of the State Sanitary Code— The undersigned further agrees-not to place the system in operation until a Certificate of Compliance has ee i e by tl bo rd V a h. gned - --- -----------� --- -�Ze ---Application Approved BY------- - Applieatipn Disapproved for the following reasons: - --------------------•------ ... ................................ --------------------- --------__-_-.-----•------------••---•-•------•------------------•---------•-••-----•---------- ---•------------------- --•---------------------- Date PermitNo........................................................... Issued........................................................ Date THE COMMONWEALTH 'OF'°MASSACHUSETTS BOARD OF HEALTH .....................: .................OF................... .............. .................. ... ......... Tr fifiratr of (91ii1tpilaurle a, IS IS TO CE<'r I ' , That Individual Sewage Disposal System constructed ( r Repaired T b - // ......... --• -- ...•- ------ " Instau�r ,C/ has beenn histalled`in ac dance with-the provision Article 'I. The State Sanitary Cod as scribed in the application for Disposal Works Construction Permit No..._... 4.:_ ,.............. dated-.,�d�e f/7—.Z_-.-._.--____-____ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS�GUA 'NTEE THAT THE SYSTEMW CL FU TI N SATIS ACTORY. DATE ( � _.. Inspector. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEAL TH �� + �!Z...:.....OF....... .. ... ----- ........ ........ .....+� No.... / FEE Dino a larks t,�tr f at rr,rmif Permi'ss on s by granted'_. .'-------- .._.---='--- _<_._._.... to Constr or el it an Individu• Sewage Dis o System atNo. - -• - . --•- --- •-- .... ...... ----A-- w - .-.„.,.,.c•,•.,,,,..,. Street -y ., as shown on the application, r" +isposal �Vorls Constr` io er it N atecj_..��... ...7-7..___._ :~ _-- - ----- '- ;�4.+$/t• -- •-----------------------•--- Board of Flealtl DATE...... ........ ------------------ w FORM 1255 HOBeS & WARREN. INC.. PUBLISHERS . �` .I `" c ; _ '- .... . "�- _ 1 , v _.'� f � tea"3�•�. ,���y� r G rOW10 E_� dip' c..v.�a � r r - a .�� ram;��_ � •' - `� - �� /40. ©a - - V. COP - 4Z� + "RAM �.. ��� e5'l T,E s�L.��l, 4.�' le�-cl tom. [77-77 p 707 c ((( (q Q/ST<K4,. a " � -�titld��.'" FOB - _ � :�•,; p �` F 6�i1/�e�z-�'L4 � f�c1._^�k:!'.�-ems SC.�3C� /" - 2� �JG� !,�'►'-��,s '. i