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HomeMy WebLinkAbout1297 OST.-W.BARN. RD - Health 1297 OSTL %4. v - - -- -- MARSTONS MILLS TOWN OF BApR®NSTABLE i �C8 ✓ i��»ATTO;'� 97 Osl�/, �f /tGr SEWAGE # � �f3 VILLAGE // ASSESSOR'S MAP & LO -o OfS INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /OVlJ Ems, , • ti ' ,-.LEACHING FACILITY: (ty (size) NO.OF BEDROOMS � BUILDER OR OWNER Cd�.�S/�/' // v PERMITDATE: COMPLIANCE DATE: 1,9 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ��y 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 10 within 300 feet of leaching facili� �� Feet Furnished by_ ®479//y Gp r LOCLI,TION SEW&C,E PERMIT UO. lW5TNLLER5 U&ME ADDRESS BUILDER 5 Q &"F- ADDRESS DATE PERMIT I5SUED DATE COMPLI &MCE ISSUED : r NSW�Z•.✓ � �! /L�✓rr o.a S G dTc�/ � l f� No.- v� .......... Fsic............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH G Q'� '2 4-----.OF........ .... �q t Appliration for Di-q uiitt1 Workii Tomitrurtion Prrutil Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .................. ��00Vrwf 1 , �-AY5 "mil m� �,��r �o���...of.R��r.��.�, ....................................... Location-Ad r ss (�p� or L t � . '----•--...^.'.'.------�=./ �!:!`..ot.-----... -�----�--•---•-----*--------*-- ---••-----------'- �.1..............^---- /......... •'�j�, Owner � �ddre� ---------------------`�-"!!...------a......671............................ --.............�l'$ �"�'�`'T s {---. ��e�aS/4,fj Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ---------------------------- No. of persons_.----.._------------._.. Showers ( ) — Cafeteria ( ) a' 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. Seepage Pit No..................... Diameter.................... Depth below inlet--.................. Total leaching area-------.---------- q. it. 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...--------.--.------.-. (� Test Pit No. 2----------------minutes per inch Depth of Test Pit..------------------ Depth to ground water........._-.------_.--_- a ----------------------------•----...----•-------•---------•••-••••-•---•••••......--••-•-••---............................................................... 0 Description of Soil............................. ------------------•---------------•----------------------------------------------------------- --------------------------------------_-- x -------------------------- ---------------------------------•----•---....--------------------------------------•••- ----------------------------------------------------I........... U Nature of Repairs or Alterations—Answer when applicable------4'-.... .----�We.f44= ......AAawe .-. .�> ----------------------------------------------------------------------------------------•--------------------------------------------------------------------------------- -------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n i ued by the board of health. Signed..... .... .........�',... • - ---................................... ... s Date Application Approved By... ... � -1e Application Disapproved for the following reasons:............. -•--------•-------------------------------------------- ---------•-- .. -----•--------------------------------------------------------------------------------------------------••-•---------•----••------•----------------•--------•--•---............-----•-------••-•••••-•-. Date PermitNo......................................................... Issued........................................................ Date --•• `t ;r Fima..............••---.......... tT� ' r •✓' THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ` .......OF ....... -. Appfiratiun -fur Bispusal Works Tunstrurtiun ; rrufit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal t #` System at f� r►3rbg./ # ' 7vg,t W4W le K! � lw ! ! t ,�Location A ess /�j� y1r� or A .......................cAt l!!':!-`..----- ....................................... .............................................s h,li %����1- -Owner ddr ........................................ ►•� /ems dv� 8!� l+r//,�/•�p S 'Or' s' ---•------•------------------•------------ s Installer Address Q Type of Building Size Lot.............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) dOther 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. Seepage Pit No..................... Diameter.................... Depth below inlet............_------- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----•---------------------------------- a Test Pit No. 1----------------minutes per inch Depth of Test Pit...................... Depth to ground water------------------------ 0:4 Test Pit No. 2....._..........minutes per inch Depth of Test Pit..................... Depth to ground water........................ Ix -------------------------_------------------------------------------------------------g...........................................................________-". ODescription of Soil...............................................................................................z------------------------------------------------------------------- U -------------=---------•----------"-----•-----------------------•------••••-••--•------•------------•-•------------•-•--------- _._.•-----------•---••-•-----•----•------------------•--•------------ ----------------------------"--- ---------------------------------------------------------------- -- .........--------•-•---- ------------------ V Nature of Repairs or Alterations—Answer when applicable.;___ WFi"_"_....'�+ .._........ P� 7 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 hastl5bran • sued by the board of bealth. Sign d: Date , Application Approved BY - - 4.. - � to f Application Disapproved for the following reasons---------------------------•-•• --------------•----------------------------------------------a-------------•-- Date .: Permit No.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS ....� BOARD HEALTH ` � r L. .......OF......:. . .. .. .:.: ........-..""..:...............-...---------"" t '."��"r Trruftra f TOMphana T I TO CER That �� ���ivid 1 age Disposal System constructed (+R') or Re aired by` -.., .+� R ......... has been installed in accordance with the provisions of :Article f he State Sanitary Co jasscribe in the application for Disposal Works Construction Permit No..--------- ---------- dated------ c tJHE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -`-� -�.-- "�------•-------------•----..... Inspector_- ................................. S THE COMMONWEALTH OF MASSACHUSETTS BOARDa HEALTH ......OF.... No---� /.... FEE---- . BI- pa al or CEun #i a rmit Permission is hereby grant _ .,Q__ .,: _ __;,�:____ ----------_ _ _ ----- ... to Con t or Re it an Individual ew a ispos System 4)_ �} �. , ' at No.-' 7,e4- . - •- Street as shown on the application for Disposal Works Construction Per o.._.:__._ a ............ oar of ealt DATE.._.. .--- - • e�-�7/........................-.................. . FORM 1255 HOBBS & WARREN• INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION _,�r�,�yy r�� Os)-A �arr R� SEWAGE # 5�✓ VILLAGE_ /,l'/*,-f/OSS M��s ASSESSOR'S MAP & LOT_ y� INSTALLER'S NAME&PHONE NO. J04-7 SEPTIC TANK CAPACITY /OVv LEACHING FACILITY: (ty —4 9i ' h % rp , /O, (size) f 3,9 X Z ' NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: ��—�— 9 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 Ir within 300 feet of leaching facili�) �� Feet - Furnished Furnished by e QL' , 1 zx, t'£ X, o/ ' 64 .99 di „9 rc rtJ / -------------------- • ?�pornl �s'� � /s No. 9/ 5 Fee l �✓v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ks PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(pp[ication for Migo!5ar *psstem Cow6truction Vermit Application for a Permit to Construct( )Repair(V-)Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot Now.- / Owner's Na/me,Address and Tel.,No. /G97 0frf// 12IfpJ'O ,p/�arcel Installller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 31 Air 1100-5t"7f /YI/7/S 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 SoilG. ck Qe,�prre l/ Nature of Repairs or Alterations(Answer when applicable) 4 y+ fr /O �X 30 ��ti�L• ����� 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 B f ealth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued A No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppficatiou for �Bigoal *p.5tem Congaructiou Permit Application for a Permit to Construct( )Repair(Upgrade Abandon( ) O Complete System O Individual Components Location Address or Lot Now,- Owner's Na/me,Address and Tel.No , /'�9'7 ©S/fr�l �l o�!'i"; �iiv/�5/4�✓/4i" ChBf�f r /T//l7Gc/>S �J�er�.t c>{.�.. Assessor's Map Parcel ,-2 s- O/ /V/11//s Installer's Name,Address,and Tel.No.. Designer's Name,Address andTe� / Tel.No. 'ITrpe 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 SoilfG�� ck crye rl Nature of Repairs or Alterations(Answer when applicable) O f r /O "X 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 BvRof ealth. Signed Date /Z /'— 9 Application Approved by 12 Date Application Disapproved for the following reasons Permit No. V '' Date Issued P --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER �, that the On- 'te Sewage Disposal System Constructed(�) Repaired ( ) Upgraded ( ) Abandoned( )by �-frz /- at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated j 1� Installer A Designer The issuance of this e t shall t e nstrued as a guarantee that the sys f nc 'on s i Date Inspector No. �— / ———————————————————--- Feed G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Xi5p9al *pMem QCow6truction Permit Permission is hereby granted to Construct )/RAe�pair )Upgrade( )Abandon ) System located at / ; 7 4�� ,(/f�Jt/1� , 22� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to cemply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thi e it. Date: 1 Approved �� 1/6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTMCAT ON OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERIN IT (WITHOUT DESIGNED PLANS) I, in /T�lly hereby certify that the application for disposal works construction permit signed by me dated /2-/ - 9 concerning the property located at /;Z97 0st- 141' '911.117 .5foi Z Ad meets all of the AlI,411, following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolationrate is less than or equal to 5 minutes per inch. • T'nere ale no wetlands within NO feet of the proposed septic system • There are no private wells within 150 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. • The bottom of the proposed leaching facility will not be located less than five feet above the ma.=urn 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 maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation `0.0 '; the ivIAX. High G.W. Adjustment DIFFERENCE BETWEEN A and B SIGNED : Q'/' DATE: (Sketch prorsed plan of system on back]. q:health folder.cart Gafay� r 1 � t r � r 1 1 r f 1� TOWN OF BARNSTABLE . r LOCATION 1779 0-7- 4 U' b",'^5""kEWAGE # VIL4i.AGEIt:S 4�15 V14+ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �G� Q' I (size) � d o��'f�t���►f NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 9J DATE COMPLIANCE ISSUED: 'O —6- " f-3 VARIANCE GRANTED: Yes No c./ r i - r 4 f� � �� V � ` � �� � � 3 L1� I' � .��, �� S�� � . �,�, FRic THE COMMONWEALTH OF MASSACHUS NO: BOARD OF HEALTH Fr�" , TOWN OF BARNSTABLE Apphratiott for Ditipoital World, Towarnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal System at: 50 s ion- or Lot No. . -I ! DLv --- ----------- ---- -------------...- �� O� er ress a �.1. 1s C'a- --------------_--------................... --- ��� Ir ��C.,X7,f��'✓'1r.f Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.-.._.______ --.--Ex ,,,ion Attic Garbage Grinder aOther—Type of Building W--d9. . ............ No. of persons------- --------------- Showers ( ) — Cafeteria dOther fixtures --------------------------------------------- ----_- --- - ...................................................... W Design Flow.................. ---------------gallons per person p r day. Total dail flow...........3-0...................gallons. WSeptic Tank—Liquid capacity`M0_galIons Length.... --------- Width---- ----- Diameter._............. Depth_..�.._.._.. x Disposal Trench--No. .... .............. Width-------------------- Total Length.........._._...... Total leaching area....................sq. ft. 3 Seepage Pit No..__--10.0..... Diameter--------Ze....... Depth below inlet........4........ 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 Pit.................... Depth to ground water........................ fzq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ M --------•----------------------------------------•------.......-•---••-•------••.....•-•--•----................................•-•-••..........----........•. ODescription of Soil........... ---------------------•--------...---------......-------•-------•------------------------------------------------•-------•--•----..................••-•-••... x c., w --------------------------------------------- ------------------------------------------------------------- ------------------------------.............-------- U Nature of Repairs or Alterations—Answer when applicable _[Y) ._.Q ...._ i- ................... •-•.................................................................................••••••-•-•-...._.._.______.-----------------•.._....___._.__................__......._.............................. Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp ' ce has bWissuthe boar f health.Signed .... . ... ... ....... (9�i�B. . _.................... ...Application Approved BY = � i`?st............ ....... e"...Dar �.— Application Disapproved for the following reasons: ...................................... T-----.-...........-------............---......------*.......................-- . ...... .................................................... . .. . . .............. . .. ..................... ................... ........................................ Permit No. ....✓'7.......9 ....... ................ Issued --------/141. 1 Da----- ���e...... te t s No., LIZ r Fx$....n THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH TOWN OF BARNSTABL'E Applirtt#ion fnr Diripagal World, C onti#rnrtion rtmi# Application is hereby made for a Permit to.Construct ( ) or Repair ( n Individual Sewage Disposal System at: •----��--��--�---��Q,l�::-_��4�n_��A�i�p--l�cf�---....._ .��r/Q`f,��,�r1.1.2�T �.�.. Lota'ion-:\ddress or Lot No. O cncr A-ddress Installer Address UType of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms_____________ __._Expansion Attic ( ) Garbage Grinder (4,6) aOther—Type of Building �!�r�p. ............. No. of persons......... Showers ( ) — Cafeteria ( ) Other fixtures ________________ _____ ___ _ �/� -------------------------....--------...------...._..-•---- ---•---•-----•--: ----------•-••---••----------•--•------- W Design Flow.................. .. .��...............gallons per person per day. Total daily flow.............-.3 ...................gallons. WSeptic Tank—Liquid capacity/44M..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 ( ) )-•4 Percolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----•-••----------------------------------------------------••-•---•----............--------.............................................................. 0 Description of Soil...................................................................................... --------------------------------••--------------------------------•......_....... x U .................. --•---•••--•--•--•---------------••--•----•••----------•-...--••-•-----------•------•--------------•-------•------•---•----....-•-•---•----------------------.............---•-------- w x -------•-------------------------------•-••-•---•-••---•••-•---------------•-•----•--------....•-•-----•---------------......__...•-•••-------•••••---••-••-----------------------........--•---.....-- U Nature of Repairs or Alterations—Answer when applicable��� _11� _____1�2___ ..._.?,..��0.....�................ ------------•---------------•---------••-••.-•-•-•---------•---------••...--------------.............----•-----••-••----•--------••----•--------•----....---------•-------.......---•--.......------..-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp - ce has be issu d'by the board f health. Signed ..........,�.. ...... . ... �.....Z P /...................... ......�h�7 �..... g Dace .Application Approved BY .- ,......- fit _�,!..... ... . .. ,!✓^ � .1r- ... .................. V Application Disapproved for the following reasons: ..................... .................. ............................................................................................ ......... . ................................ ..................................... -- . ._.................................................... ... ............-................ / Dare Permit No. ......... ....> ------------- Issued ......... J '..../.... _��J ........ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C ((�� ertifirate of VlIImpliartre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by -------- .-QZ�=-.C'.d. ..-..--_-------------------------_------------ -----_.....- ...--....... ................... ..................... .................. .._..... at ----- .`.(.?........zt) C-.l--..-:......1..'� 1. 7.11•C.f �C' -- l �'' ./ F'�7 c- I%h. t. ....l<.............. 6-�.......... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No -. .. dated�,�. THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ..._-------.-.�..........�.�.._.-. ` .....-.. Inspector ......... �. -a -- -------------............................__... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , Uhiplasal Vorkii ranti# Permission is hereby granted.............�.._.�- 1-.,-.- '��,1. - /1�a -......•- to Construct ( ) or Re air (�n Individual Sewage Di�s/posal System at Nose .�..-.7. - .;/ ' a r '✓� > V �/Y .�,_... Street as shown on the application for Disposal Works Construction Permit N9a��._✓.`.��3- ated__ = .... . �' ----- ................... Board of calth �.J DATE...... ---�----- -------•--------------------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS