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HomeMy WebLinkAbout0027 J.B. DRIVE - Health LA ' 7 J.B. DRIVE,MARSTONS MILLS =101.033 a / TOWN 0 S OF BARNSTABLE ► ✓ ► LOCATION 9 1/i'►�/i. SEWAGE # f� -- 8 VILTt,AGE M , l(n ASSESSOR'S MAP & LOT /d/ 03 3 INSTALLER'S NAME&PHONE NO. y 7 0.3 5'9 JaS�p Li D� /3i9ry'bS SEPTIC TANK CAPACITY /d 0 d LEACHING FACILITY: (type) 2-Sao G41 d//"N /s (size) ?fX /3 '2 �• NO.OF BEDROOMS 3 / BUILDER OR OWNER krn WeVal-k—i,qh PERMIT DATE: 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 faciili�') Feet Furnished by L/,` i Fri"T y P, - ---- J �3 No. , Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS RppYication for aizpaal *potem Convtruction Permit Application for a Permit io Construct(!/jepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ! 'f 7 /3 D/°'i 1//.5' Owner's Name,Address and Tel.No. q j Y+— 9 a 5 S( ingrs ro11 S vyl;%/ ken k eV'or k t iv, J.13 01^1 v/_ Assessor's'Map/Parcel Lon S -N Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ✓SC,04 D.e_ 13,JP1-0,5 8 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 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 S# h Nature of Repairs or Alterations(Answer when applicable) tell r .S' 6 oo 6,41 illalls ,r • o 14 uv " - 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 ot Health. Signe _ Date Application Approved by Date Application Disapproved for the following reasons Permit No. �' Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE -Al ASSESSOR'S MAP & LOT/D/ 0 3 3 INSTALLER'S NAME&PHONE NO. 3 y 9 a p Li /�luri SEPTIC TANK CAPACITY /b 0 0 LEACHING FACILITY: (type) _�-SPP G41 ,Or,4 u/;f/ (size) NO.OF BEDROOMS 3 BUILDER OR OWNER k r� lc� /Orki�rl PERMTTDATE: COMPLIANCE DATE:- /%2- 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 �.. ✓(7 •.ti 6c fN No. Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricaction for Migonl *potem (tongtruction Permit Application for a Permit to Construct(1., epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2'/ J 6 0r1 V/_ Owner's Name,Address and Tel.No. v 2 s— 44P5 f Assessor's Map/Parcel rn�*ris rar S M,/f kl,n k-e I/Or k i mm j,O O t✓1: a/ 055 ohs M, ' IS Installer's Name,Address,and Tel.No. y 7-2_ 03 9 Designer's Name,Address and Tel.No. .has e pti d,� /3a rr o� 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank // Type of S.A.S. Description of Soil / I •Nature of Repairs or Alterations(Answer when applicable) Zk5Ts4// 2 - c2a 614 Uj/'Z/S c�ITli y�STOYIr 64!^UVN 2 ��P�69 S'rO�i{ 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 of Health. Signe ADate Application Approved by Date Application Disapproved for the following reasons on Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( wired ( )Upgraded( ) Abandoned( )by J0<5F4 l),d SA0~0 S at t ,%/ h� tFvyconstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer /9, /��,,,vc Designer ]::pl, dz o 3 The issuance of this permit shall not be construed as a guarantee that the system w I function as designed. Date i _ R - Inspector oFee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS 'Wi-5po5ar *p5tem Construction Permit Permission is hereby granted to Construct( e) pair( )Upgrade( )Abandon( ) System located at 7 J 5, /'.^► 1114r5L2/2 S 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 localprovisions,or special conditions. Provided: Construction m st be qompleted 3kithin three years of the date of this pe it. ia" - Date: 1 A roved b /{! � � _14 N � �c PP Y l 0/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Styptic Systems Only- CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, hereby certify that the application for disposal works construction pemAt signed by me dated /2- /7- 9 f , concerning the property located at 2,7 -P,vr-' meets all of the following criteria.:: 4--Here are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within ISO feet of the proposed septic system y(-'—There is no increase in flow and/or change in use proposed �areriiances requested or needed. • If the proposed Ii:aching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will aid 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) 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:cent F'rCAI T' o �nrSrfN� 1 p0 .J b �/ �rr'VI L AT I N 5EW O (C E PERMIT U O. VILLAGE ' IW TALI. R 5 W&ME ADDRESS BUILDER 5 Q &V AE e. ADDRESS DATE PERKA T ISSUED '- D ATE COMPLI &MCE ISSUED : r 61 i L UT � A le t� Se7z'77C 771UA 1\or k4,r, WILLIAM rya 4E. •A{ CC- )e -I F'ICD PLOT PLAnl t,.yC.AT►U►J P .A.�S'�`UrJ,;� N'l � ►_t,.. 5 T"i ry'rRA T- 72YC PWR,4, u G 51,bWAv HCZ96,AJ e-OA PGYS Wiry TM 'S "r,t3,4 Cor1 fZG- u i 2eMEti/i c��= 7 -T" i•4-- TUl Pt_A Q R3C-O < Z4-7 PA 6 G' 144- ►J�E , 1►ic P.�G� `aT t7 t�AuD SVZ✓f-7,(oes a 7�/ Zo 7(9 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF...'...... ....... ............ ........... ................................ Appliration -for Ui.ipoottl Works Tonotrurtion P.erutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: TO Location-Address or Lot No. -� .................. W Owner Address Installer Address Q Type of Building. Size Lot---------------------------Sq. feet U Dwellingl No. of Bedrooms............................................Expansion Attic (go) Garbage Grinder (/QC) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------ Design Flow____,?.Q------------------------------gallons per person per day. Total daily flow----- _0.o_-_---____-__-_--.-........gallons. �4 Septic Tank Liquid capacity_1-0-W-gallons Length................ Width....... Diameter................ Depth..._..--._.-.._ x Disposal Trench—No- -------------------- Width----------- .s-_- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.......1------------ Diameter----1_9.9.._ Depth below i et.................... Total 1 achil g area.---..--_-._-_-_..sq. ft. z Other Distribution box ( ) Dosing tank �• Percolation Test Results Performed by------------------------------------ ..................................... Date--------------------------- --------.... Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...-___--_--_._._-.-.--- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O ------------•---------------- .. . .. . - Description of Soil -- c = lit �J--Lr�'c4 --- �r-.9----- -------------- x U �1 W x --- --------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------•---- Agreement: The undersigned agrees to install the aforede ibed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary _ — he dersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issu y t e bo �'f healt Sign e ...... •--- Date 4 . Application Approved BY 't�1 --�'------------ -----�--`-`-----`ate Application Disapproved for the following reasons--------------------------------------------------------------------------•----••------------D--------•-------- --- ••••--------•-------------•-••---•---------------•-------•------•----•-------••-----.-•-- Date PermitNo......................................................... Issued........................................................ Date No......................... Flnc.....,< .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H / -t/1 �....... OF........... ............................ r Appliratinn -fur 43iapnattl Warkii Tnnatrnrtinn Vrrugit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: L fJ j -_H 1 _:,--. B . 1IfC 1N1 AQS ones n ��1�j ----- --•--•------•-------•----••------ •--••••----------•----------••-•------------------ ----------• -------•---•......---•--................................................ Location-Address or Lot No. br.!....!...�..Z.._...t�C��t :�. -�'�R!.. ------------------••-•--•-•-......_...................-----•----•----•------•-----------•-----•-. Owner Address E7L A CG ---...-•--•----•- --...-----•--•---•--------------•--••------ Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling`—/ No. of Bedrooms----3----------------------------------Expansion Attic (4 J) Garbage Grinder (&c) aOther —Type of Building ---------------------------- No. of persolis............................ Showers ( ) — Cafeteria ( ) Q Other fixtures --------------------•----------------------- W Design Flow.....>.j2..............................gallons per person per day. Total daily flow--__-3_ 0---------------------------gallons. WSeptic Tank'Liquid capacity.lr?.00_gallons Length---------------- Width_.............. Diameter---------------- Depth-.-..---_-.----- x Disposal Trench—No. .................... Width-_--_--__--�p__ Total Length.................... Total leaching area-------------.------sq. ft. Seepage Pit No........------------ Diameter____!4_s?.d.._ Depth below inlet.................... Total 1 aching area------..------___-sq. ft. z Other Distribution box ( ) Dosing tank ( ) e) --2 Percolation Test Results Performed bY------------- ------- ----------------------------------------•----------- Date--------------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------- ---------------------------- --•- . . .- --- -- ------. .......•---------•------f-•-•---••--•-••--•--"-•---.._..----- O Description of Soil t,---•------ ------ �//._. f �1- %.Lln-�— ----.- ���!/..l`1 VG�-C. i r r._----_---x ----- W l UNature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the afored^e/scribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary dcbde— The dersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issu y t e bo f he . Slgne • ...... ------- Date Application Approved By.. /�.. . ---------•- '`3 Dat�G Application Disapproved for the following reasons:--- _ .....---••--•.............•-•---•---------------------------•-------------•-•--•-••......-•----••------.. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / /1 1...........OF.......... ......................... Q,rrtif iratr of tom rliaurr JtS IS 0 CERTIFY, That the Individual Sewage Disposal System constructed ( �r Repaired ( ) bY.. ..c..... - --- �� rf �/i. , nst at--- - aller �J ©�.. . -----1./. .lJ .._ct/ ........-���'� �4---- t� has been installed in accordance with the provisions of : t'icJle NI of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nov_-__ _________________ dated...__ ____ ............... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. C DATE '� --- Inspector---------. --� ...-- . .--•----- --•-.••--- ...................... THE COMMONWEALTH OF MASSACHUSETTS 741 BOARD OF HEALTH .l..........OF.......� cS :G ................... No. ........... FEE........................ ua aP.. nnuitrurtion Vrrmit Permission ' h reb ranted_._.. Y g ---- --------- 1..................... ----- ..................................................... to Constr t or Repai ( ankIdi'vidtial Sewage Sal Sys _ (/ atNo 1 1 'r -------------------•---------- Street as shown on the application for Disposal Works Construction Permit ;_. Date _ _._` `-_ 3d 7C ............................... $ aFd of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS