Loading...
HomeMy WebLinkAbout0158 PEACH TREE ROAD - Health 158 PEACH TItEEj }mac q d ' n A=056-060 No. Fee �! THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for -Mioozar *pgtem Conotruction Permit Application for a Permit to Construct( pair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./Y$ Pend, rp+�j ls' /2 Owner's Name,Address and Tel.No. Y2 g 3 1/7 Assessor's Map/Parcel 0 4o 0 60 Installer's Name,Address,and Tel.No. 41%//_OYz/y% Designer's Nade, �Address and Tel.No. 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 5'4&i Nature of Repairs or Alterations(Answer when applicable) wts7i.1 _ (e d X eft "/,A—ilore,417 c L5_ :2 Z2- Igo x'51 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. Signed Date 1�1 / —9 8' Application Approved by Date y/� Application Disapproved for the following reasons `f�� Date Issued /� No: Fee THE COMMONWEALTH OF 1AASSACHUSETTS Entered in computer- Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppficatfon for Migpowtl �&p!tem Cougtruction Permit Application for a Permit to Construct(repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No f$'8 ply-jgCl.y�'p>,ff Rol. Owner's Name,Address and Tel.No. Assessor's M ap/Parcel\ Y 060 Installer's Name,Address,and.Tel.No. 4/11`!—10:74,4y Designees N e,Address and Tel.No. 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 F� Nature of Repairs or Alterations(Answer when applicable) .. tf*./ g2 X 6'X 2 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 EnvironmentafCode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date 41 Application Approved by Date �/—�- Application Disapproved for the following reasons 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( Repaired ( )Upgraded( ) Abandoned( )by J4 Q,. — at I-rX k ,9c�_xe e ,*r rg z,2,r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 — dated Installer y45<4Z Ut / eG s Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. A Date Inspector -= .. No. t7 =6 �/� ---M------------------------Fee '_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS JI i� ogaY *patent Cow5truction Permit Permission is hereby granted to Construct(4o Repair( )Upgrade( )Abandon( ) System located at_ / S� zi,Wc� 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 Mrmit. Date: Approved by 1 TOWN OF BARNSTABLE LOCATION /5 SEWAGE # VILLAGE /kg.,sToes- ASSESSOR'S MAP&LOT 611, • 0b0 INSTALLER'S NAME&PHONE NO. y 7 7-0 3 y,7 ,Jai ep/ D-e- Oar.-OS SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) .2 -T/'cn6,4b'S (size) Is�x 5'X 2 NO::QF:BEDROOMS BUIL DER OR OWNER ()*son PERIViITDATE: 5COMPLIANCE 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:gf Wetland and Leaching Facility(If any wetlands exist Within 300 feet of leaching facility) Feet Furnished by 40 I q GN )14 Q 1 TOWN OF BARNSTABLE . C, ✓ LOCATION /58 Pc-14e T{ti SEWAGE # 98 ��Q9 VrL!,AGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 5'77-03 5'9 I�s�p� U� Q.arroS SEPTIC TANK CAPACITY l d0 D- LEACHING FACELITY: (type) .2 -T/Y:r/�1'�S (size) �S X Y X I NO.OF BEDROOMS qq BUILDER OR OWNER �494"Al4e `),*son PERMTTDATE: 41 COMPLIANCE DATE: FIT' 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 ffac1'li_ty)) Feet Furnished by f 9 3 N p f Y I ll/9/97 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 ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated y —! — 9� ,concerning the property located at— /S8 ' 'n' ��`�- meets all of the following criteria: G` There are no wetlands located within 100 feet of the proposed leaching facility 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. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will Dpi 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 F— [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:cert FX/srl ° a0 u ---------------- �Qc►�QUt�q % ' ( �—�GL, G r�6�-_ D �/1rr grew, P rtt9 �� 0 L`O CATION SkW A G I PERMIT NO. VILLAGE INSTA LLER'S NAME A ADDRESS ✓C f� B U I L D E R OR OWNER A�e-11 o DATE PERMIT ISSUED DATE COMPLIANCE ISSUED Tree No.._ . ` ............... J THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................O F.......................................---------------------....I.._...................... Appliration for Uiipnsal Works Tonotrnrtinn Vamit Application is hereby made for a Permit to Construct (I/jor Repair ( ) an Individual Sewage Disposal System at: . ................ ......_...................................................................... .......................... .�u. . - -L°? ................................... Location-Add r s or Lot x'^ �Q--------------------- --------------P- --`--kk2. ...�`a.A. ,.M�4�Ia�pNs__..l`1�Ir�,►�iq Owners ( —y f� Address a �.........cIl.Irlx � 4�5.�T�,. C`" __....._.... (e1?sl ekl.E... 1f. Installer T Address Type of Building Size Lot__-____--_•__••••_••___•__-_S Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grind p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ) Pa Other fixtures ------------------------•-•••--• . W Design Flow............................................gallons per person per day. Total daily flow............a_,30....................gallons. WSeptic Tank—Liquid ca:pacity.1,Iodo..gallons Length....:........... Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No----------------------- Diameter.._. Depth below inlet........._fo....... Total leaching area..................sq. ft. Z Other Distribution box ( L--�— Dosing tank ( ) aPercolation Test Results Performed by.......r^!.R d•.r--! ....... ........... Date__...'?..-___ Y__-_l_9. ._.. Test Pit No. I......1......minutes per inch Depth of Test Pit.......L.7........ Depth to ground water........-............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.---.................... a ........................••••.......................................r------.....`-----------•-•--••-------••---•••••......-•-•••......••-••....----.....- 0 Description of Soil.......��. �0�.--------------------��.�t!t^. f S�`b.4S_d_c-l...----------------•--•----------------------------•--------....._..-------- V ASC¢..........--...�''t e ------------------------------------------------------ W 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 iITI.L 5 of the State Sanitary Co'11sued — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has by the afd�of,hea� Signed..........................................•-•--•-•••_-•... ---•--............... ......./.........r ApplicationApproved •••• •••• •••••-••••••••••-•-•......__....••••••••••-••-••-•••-•-••••-•••••-••-•-•--••-••._.... �/ -• .ice Date Application Disapproved . r t e following reasons------------------------------------•-----------------------------------------......•-•.._......••••••.......... --•..........................•-•----•------•----.....---------------.........------------...---------------•••••••••-•...•••-----•••----•.............................................................. Date PermitNo......................................................... Issued........................................................ Date NO . .7A--..... Fi4............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF........................................................................................... Allp iration for Diipnaa1 Marko Tongtrnrtinn .rrutit Application is hereby made for a Permit to Construct (L-'J"or Repair ( ) an Individual Sewage Disposal System at: r ................ ...............................7 . ---........--------•----........- -.---.....................�k,.,,.L :-..(fa)--•-----.................---.........--- ocat:on Address � or t .........: ......r._....._....... .. D..�_d1......IV�A.......-•-------------- ��,. e 1c .a L ..!:`? �7yu...1.`a:�l.Jtl�[.� Owner Address PQ Installer r Address Type of Building Size Lot............................Sq. feet .. Dwelling—No. of Bedrooms................3........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers a. YP g ---------------•--•-•------• ------- (----)--- Cafeteria ( ) Otherfixtures ----------------------------------------------------------- --------------- Design Flow............................................gallons per person per day. Total daily flow............3.3 0......................gallons. WSeptic Tank—Liquid ca.pacity.1,.0dA..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq.,ft. Seepage Pit No---------------- --- Diameter.• C.__6...... Depth below inlet....fc`............ Total leaching area..................sq. ft. Z Other Distribution box ( cvY Dosing tank '-' Percolation Test Results Performed by W ___s_ ...._..p._._.G(. -N...................... Date..__._ _-_ .Y-_.r�' o.... 1.4 Test Pit No. I.......s;......minutes per inch Depth of Test Pit.......I3....... Depth to ground water..... .............. LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••----•••----•---•---...•-•-•--•---•----.......-•••-•••----••.......-•.............•---•---•-•......--•----••---•-• ......._.....----- O Description of Soil........... �---2.4:.•..— ...�e-` '^ f ss.s�.�_s4l ---------------------------------------------------------••---•--•-•--- W 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha _ iss ed by the bo mod`of lth / igned-•- D e Application Approved �" "-------------•-•--••------------....--------------------•-•------ Application Disapproved r r t following reasons:.............................................................................................................. -•-•-•--•-•......................•-•---------•-------------------------------------...-----•------------..__....--•------------------------------------------------------------------•-•-•••-•--••---•--- Date PermitNo......................................................... Issued--•------•-----•--•-------•--•..................••---•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................:.....OF............. ....................................................................... Tatifiratr of Tomplinnr THI10--C ERTIFY, That the Individual Sewage Disposal System constructed ( ,er' epaired ( ) - --- --------•--•-"r....-------•• ---------------•--•---•------•-•------•------------•------.-----------•-•---------- ------•--•--.-----.-------................by-- f""'�'' Installer at............ -------------•--------------•---------------------...__.....--------aRNTEE --- .................... has b en ins .lle/in accordance wiih th�provisioZ�s of TITLE 5 of The State Sanitary sc ibed in the application for Disposal Works Construction Permit No.... __ � �................... dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A G THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................................5-13'�• Inspector....._.G' ---------------•--...--•------•--............•---••----•-•-•-•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF................ No.r�'.Y-00 :..••• FEE.410.............. 13t �, &/orkg TonstrnriUan rrntit Permission is hereby granted _- 1 .�.._ to Construct ) or Repair ( an Indio' ual Sewage Disposal System atNo. _.... •--.--• •........---.----- t �f�� / �� ��, Street as shown on the application for Disposal Works Construction Permit No......... ........ Dated.......................................... .................. .,ae-_'_^'.. ._._.....---...........................................--....... / Board of Health DATE.......... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS S YS7E1' O-#P 0A74 E NOT TO %rc**974L E TO.o FOrA - u tea` �' 1 F✓N/S// (;RlgL�E' F/N/SN G�PAOE OVER OVERT/C T/7N� Z. ,_ _ ;, _ �/�,� < .�- /� LEF,7C/•//N(j P/T G?a S _Y ;i';F-% / N O 36~ CEO -- R/C�G . . o ° CONC.pETdr'✓T. /00 LBS.OUTL ETNFOiP a2M/N.EA O d Jy'/1V. a uII.9�a Y• '.c'p' .� 0 •A.,d:>n'°a a44 I o z �d G��C✓ da Q. "�U �o o d'oo ,q a TEES s� � . ✓ /Y ••aa.s�• oa a 4 �`a I d ' OUTLET I r _ a E1 SMUT FLR. a o g ., I ► oa EL. ° c ° /^O'-T T.qL L ON L EVEL B•9.6E- `3/4 TO /;* °° r ° .oRECF�ST CONCRE7�E I e a a WAs yEO ,p f-�RECF��'T d ,y- /O •PE/NFO�PCEO Q° c.Pus.�Eo CONCiPE 74iE- . `sQ n�oa, �iov �J a STONE ° Ar 'v.Q.O.P �. °V e �• d ,• a a f;V°a cv ' ✓. 6 Q Al- JO APE/NF. • a a' , t 6`7d dip T/CTANS o I /NS Ti47L L ON LEVEL B•�7SE NO TE EXC.QY.gTE" TO ELEY. �� L OWE.P TO ,eEMO VE A7L L L0.911-7 OR CL.9Y ^f,4C7TER/IqL BELOh/ Ti5/E 4Ef7C.�,�/N .PEIo4,0gPCE EXC,,7V•,77 AO MA7TER/RL W/Ti�s' !p" 6° - 6 CLE•S7N�CG•4Y--EPEE G,P.QVEL. R /p G EFFE C T/✓E O/.�7ME TE.Q GENERAL NO TES ; k ' O/. .o/.oES /N SYS TEM MUST B E C.qS T/.PON _ O.P SC/,/EO lJL E -40 R V.C. /NST.QL L ON L EYED BASE �. / w - f.O I+/.yEN CONSTRC/CT/ON S COM.oLETE, �R/OAP _ TO 6•9C.E-F/44/NCj . 48SERVi4T/D/1/ %T ' .�7N ES /iN Tf•//.V ,oLgN MC/ST BE .9.o•oRo✓EO B wc�ly`re r C�1u-/%7 •'17 y BOA7.P0 OF//. Tiy.9Nd Ti�/E ENG/NEE.Q .�ERCOL/qT/ON RATE s - W,40'0 SE S T•gM.o .9.o oE.Q.PS ON T.V/S © / N /N yrTNESSEO BYM.9TER/Q NL � SE = .9CCORO.QNCE W1T/71 T.NE ST/7TE S.qN/7 Y �� � f le;�iv r e-� �+ COOS- - T/TL.E ✓ /7A/O 4OCF7L .gio.OL/C.gBL E OES/G/V O�7T.q' RUL ES ANO .PEG G/L.(7 T/ONS. C '�'i fT/4r` BO. OF HE19L TN 4' : 4i 6O/VO•PT// .�7R.POh//S NOT TO BE USED F`O•e C� Nl/M.B ER OF EORODMS `� _ SOL•gR wR.�OSES �i-�c��� Cor,c, � O GiS7R6.4GE O/SAOSAL O OO .5✓.�7Z.gRO Zon/E Al ," �.�. �:f �?,30GgL. _ T � � o a oA/LY F� cy✓ ® j✓.gTER Sl/.0P.�L Y � .c /, OGG'GgL i t °l. 3a , D/s ©x r _ a/ OOQ G, t //ort & QGPO .01 37 cob 0 �, hi BOTTOM .AREA. ® ENO M e �` t v r-r! L EAC/�//N� PRO Pel O E_'o tN GEC s ylrj f LOT- !?_ .o.PO/�OSEO EGEVgT/ON EX/ST Cov TO�,Q 15�" N o Vk r � 2 2, :�.5 C> s.� � � ® OB SE�P✓.S�T/ON �/T ❑ O/ST.P/BUT/ON BOX �♦P O.o OSEO SEI�✓•�-;7�E D/SPOSAL SYSTE/►'!Y __..__._._._,...._ - ...- ---- � '� M/N/MUM CODE O/STFi�NCE • a O�D L EF7CH/NG P/T /� /�� Q � C "T/ °�` r'"> ✓ `�' ,,� o o SE.oT/C T.�7N� / 1 �/V NET B. B O Y0° D. 0 lo rr L D T #/2 _�E.4 C y TREE R 0,4 D .BARN S TA BL E C O 7" //T /�Lq S S. AL O 7- .04.47N �D, 5l1 .a/.�E /A/VER7' EL E✓AT/ON ..__ a. .�'RQF3E.4'TY L/NE ��. 2,9i CgoE /SL.�7NOS St/.P✓EY/N�� //VC. - .SC•�,7LE= .�75 NOTEO .�?O. <90k' 7 4ff-A7T✓C/C'E7 M.4.5'.5'. Mqp SEC .00G•4 GOT NSE 7 -