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HomeMy WebLinkAbout1241 OLD STAGE ROAD - Health I 1241 Old Stage Road -- -- --- _— Marstons Mills A= 173 — 00'.9. h. i I i i TOWN OF BARNSTABLE LOCATION 12 Ue-,o sn4`f- Atr'1� 6 SEWAGE#. 8.9 'Z2 VILLAGE � ��!'Sytarr,s NJ iC.LS ASSESSOR'S MAP&PARCEL /7, ,A , 0® Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /000 LEACHING FACILITY:(type) (size) Pi �e J NO.OF BEDROOMS w ,o OWNER 41 71-lt12 £ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: P ffS `7 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 lea ing facility). too feet 47FURNISHED BY S. f f i � 41 L O CAT ION �T3 _ ��d S E A E PERMIT NO. So r / .3 " ,2 2 VILLAGE. INSTA LLER'S NAME i ADDRESS JOHN A. AALTO .BACKHOE SERVICE IbU Walnut ree West Barnstable, Mass. 02668 ® UILDER OR OWNER 'qv DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��YG�+ I . 23� ;lye.. � �� .. � c .� -� ' - � e v � �� ., � � �,M ���� .ty I � , � . i Na..�. : ��.'� Fus.....//10..............._ THE COMMONWEALTH OF MASSACHUlSETTS �� D3 BOAR® OF HEALTH 3� ,�pPration for Dtipnsa1 Workii Tomitrurtinn Vanfit Application is hereby made for er it to 41strucA Y) or Repair ( ) an Individual Sewage Disposal System at: � �s!;dlvS�/)1rLt.$ �.dT... 2.4C£ .Ceti Location-Address. H -- � or� No. /1E�� .? E ... ....._ � r ... p.....l .� ner ............................................Address... a — ....... ....-•----. Installer Address Type of Build ". Size Lot-----•-•-•-----_----•---._ U Dwelling j—/No. of Bedrooms.--....... 4....... .Expansion Attic ( ) Garbage Grind Cia Other-T e of Buildin No. of ersons....... . Showers — Cafeter Q, Other fixtures -------------------------------• - W Design Flow............................................gallons per person per day. Total daily flow.................._........................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width.......----...-- Diameter-..----_----.-- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter....--.......--..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - �' Percolation Test Results Performed by---------------=............................................................ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.----............... Depth to ground water-_-.-----.-.---_---- G%, Test Pit No. 2................minutes per inch. Depth of Test Pit.................... Depth to ground water....................---. ----------------------------------------------•--------•------------------•-----••--.......-----•------•-----..----------------•-•--....... -•-•-------------- 0 Description of Soil........................................................................................................................................................................ x W --------------------------------------------------it----------------------------------•--------------------------...------------------------------------------------------------------------------••-- UNature 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 TITLL 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. lgne --••••--•-•--•-----•-•-•-•...•----•----•-•-•-••••-•-----•......................•-•-• :.......•••• �5 e ApplicationApproved /By....'. ----- --- --••••--•--•-------------•--••.•--•--•-•-•-••-••-•----•-•-•--. ••. Zf -----•..... Application Disapprove following reasons:-------•----------------------------•--••--------------------•--------------•--•-------------...............•. ---------------------------•------------...--•--••----------•--------------------•----------•-------•----.............---•--------•-----------------------------•--•-------------------------------....._ Date ._.Permit No......................................................... Issued....................................................... ` JI � 7 No......................... Fxs............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ....................OF.......................... - Appliratiun for Dhipo al lVorkg Tomitrurtiun Vamit Application lication is hereby made for a Permit to Construct or Repair pp y ( ) epa ( ) an Individual Sewage Disposal System at: Rf 7HtJ.��... -�---.e`on-AV, E$ � --'T���21��E o No./�I�Fu�� I�A, •-•--....... -- ••-••---•------------•--.........-•--- ... ------•••...---••---•-•.......................................••.---•--.r............... 'caner Address �j ......................................................................... ....-•--......•••-•---•....-•-........-••-----......................................... ... � (/ Installer Address UType of Building Size Lot............................ Dwelling 1—�No. of Bedrooms......... ...- -.---.-•-•-•___-__-ExpansionL�ttic ( ) Garbage Grinder Other—Type of Building No. of persons ................ Showers � YP g ---------------•--...-----•• P ( ) — Cafeteria-( ) Otherfixtures ----------------•----------------------------------------•--•-•--•--••-----------------•----••-•••-•-•-•-•-••-•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity........_._.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.........._......... Total leaching area....................sq. ft. > Seepage Pit No--------------------- Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank (, ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test P' ----- '''....... Depth to ground water........................ ; L14 Test Pit No. 2................minutes per inch Depth of est ........... Depth to ground water........................ O --------•----------------------------------------------- ,g ....................................................................................... Description of Soil 4 " . ------------------•------------------------------------------•--- xjot, +J - ----------------------------------- .------------ ---- if ,t ------•------------------------------•-•......------...... UW -----•---................................... J` Nature of Repairs or Alteratio s )A WsWer when applicable............................................................................................... ----------------,-;--;VXn X'Z---------------------•----------- ----------------------------------------------------------------------•----------------.------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 . rj',Fof the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Comp1'anc as en issued by the board of health. wingreasons:----•--------------------------•----•-------------------------•-------------------------------------------•-----..........-•...............•--•-- Application Approved BY Date Application Disapprove o t •-••-....-•-••••-•------------•-•----•--•--------------•-•-•-----••••••••--•---•--•---•---••--••--•-••----•-•-•----•••--•••-----------•-•--•---•••-----•----•--•-•-•--•--••-----•-•----•••---•••-------- Date PermitNo......................................................... Issued........................... --------------•---•-•-•-•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Trrtifiratr of Tootplittnrr ,,•-'� THI I TO C TIFY, That th .Individual agegIstem constructed ( ) or Repaired ( ) by.... ._. ... ----------:a ...... Installer at......-----------•-•--......-•--••. •-•-•---...........---...........------•-•---•-•••--•••••------------------........---------------..__......._.... ----------- has been installed in accordance with the provisions of TIM 2 PTMhe State Sanitary C� in the application for Disposal Works Construction Permit No....................................... dated_._.__ _._._._-.._______.___.___...._.......•... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR E® AS A GUARANTEE HAT THE SYSTEM WILL FUN TION SAMISFACTORY. DATE.................... Inspector..--••._----••�- THE COMMONWEALTH OF MASSACH SETTS BOARD OF HEALTH p (f -3-/a s ......................................OF..................................................................................... !�� No......................... FEE........................ i Disposal Works h ajotM1,j#p famit Permission ' eb rant =------------- ----------------------------••----••--•-•----------------.-.----.- Y g to Constru or Rair In al Sewage Disposal System 1 �� at No.. .............. -••----------- y ' Street as shown on the application for Disposal Works Construction Permit No............. .::. .kJ' d._..._._____...__._......._.......:,._:... 4 ......................._ �•� �• Boar/of Health DATE •. --• -----•••.......................... FORM 1255 HOSES & WARREN, INC., PUBLISHERS i� - i �s 43 � 1 00 LfN 4-1 n . 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O -'7- 3 AND LSACM tI PIT TO 13S dF RED rJFoRc�t� Gor.�C.RETE ;�-<. � PROP05EV LEACH+ CAPACITY 3 0 � Ac.eE-s �- Mltil C.o�JGRfs.'f'E ��NGTl-13oo1OP51 �` � — — — — "e .- N ( 0 L OA D i r Ca t ± y,41 /.t,v C 101 Tri w ,/ os p�Z 1�/F Ay �10'r To D E LOC,AT-DPLAN l OVER Wil-Em L1NISPI�_v k-I- c.0 r�E:wARG , 1 9E5163N LOAMW4a UFO �r � �E.SEKYE GE..�'s �,r- .�::.�-t,� � A I✓� Pi PF� -ro 13� V�ATE�T�NT ,Gj E I :r!&2t Im wAD LOG All 0t-4 7-U .c'f 4E.j rT-.4-✓ , slsyc c-AV 5y�-rH-1 Tb D5, � ► RAA 54h, dAVE. , �ARr�. a�, of vE�Ds 'DES`s : C,ACiir jRatil M PIRS-CASE' t�A : T��. ;,� PLE# ,,v E.a .✓,,,,� a E,.r 4'v6P ENGINEERING G?EYo'vo A.vo REvC.�c�-G ,�,'.�,• CoRm DESIGNING BUILDING p. B f� C t E.Q.v MEvi�w► s'wwl�. - - - MORTNG � APP90VA DENNIS. MASSNEAATM AGF► 385 -2831 ' /C� MLBANENE ,YI` MRi MITECTS' STANDARD FORM