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Home My WebLink About0040 ROSELAND TERRACE - Health 40 ROSELAND TERRACE,M. MILLS A=103-119 i \ � l TOWN OF BARNSTABLE LOCATION "7 D )q03 f 1u-^ail 7e rraC e SEWAGE # VILLAGE. Ae'rsh"-S ��.��S �3 �� 1 r ASSESSOR'S MAP & LOT o GIB INSTALLER'S NAME&PHONE NO. � �G� '44 ho L 0 SEPTIC TANK CAPACITY LEACHING FACIL TY: (type) �2-J-00zft-?/ /4-o'7A�1 (size) NO.OF BEDROOMS 3 BUILDER OR OWNERP� PERMTTDATE: �i® vZ S��/'�� '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 t 13 af 30 o _ TOWN OF BAMSTABLE LOCATION I{'p—ra,--e SEWAGE # 1 15 3 VILLLAGE A,rsf��S ASSESSOR'S MAP & LOT /�3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /00 0 LEACHING FACILITY: (type) ,.2-.S k2 (size) NO.OF BEDROOMS 3 BUILDER OR OWNER—___ G�'•-��<�� c,- f� 1 PERMITDATE: 3 " vZ S cI 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. A Ile" K a 3 3�' 3 0 3 y 3� �� !2-go), i x.'St v 3 ° p;r � y Wew S No. l ` p Fee THE C0MM0NWe4LTH_6F MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for MigPont *pgtem Congtruction permit Application is hereby made for a Permit to Construct( )or Repair(--)"a`n On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. y� Mol T,-"cC jil/1•,��// s " Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J04--I laA /t y*-9s 9 57 Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3y gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title l / Description of Soil Nature of Repairs or Alterations(Answer when app}icable) sr�` S S , C ti fi j , h o vD a/ C -O- ` 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 al . Signed Date 3- 9S Application Approved by Application Disapproved for the following reasons Permit No. �lS 3 Date Issued 3( ——————————————————————————————————————— No. /_ / Fee THE COMMONWt AL1T bF MASSACHUSETTS ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01 prication for Migaal *pgtem Cott!5tructiou Permit f Application is hereby made for a Permit to Construct( )or Repair( �n On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. G/PJ /F4202,»off W11,A// 6na/I,,-c S 411111 -5tF �!!N Gss c/r'C 1, C Ar^.4v v,/1•e O 6 J1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. jo All Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other` Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3y gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil y f' f Nature of Repairs or Alterations(Answer when app)icable) h s '�/ S�,S , cuhsi 13 o X SvD a/ c w Date last inspected: --�'`- Agreement: r 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( f H alt . Signed y Date 3— Application Approved by c Applicati n Disapproved for the following reasons i Permit No. / S�-? Date Issued 3/ Z 5-1/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certifirate of Compliance - THIS IS TO CE IFY,that to On-site,Sewage Disposal System installed( )or repaired/replaced( on by �"' � l0 'o for as ZVk' C.t' } - 1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. � — 1- 3 dated `y Use of this system is conditioned on co1'pliance w` h the provisions set1forth below: s No. �,Ir 3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wigo l p!5tem Construction Permit Permission is hereby granted to `��'` ✓ Y !�J to construct( )repair((,,�an On-site Sewage System located at y0l d % f 6e , 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. All construction m t be completed within two years of the date below. 0,41 Date: / Approved by �' 1/6/99 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 DESIGNED PLANS) 147, 9� //,—, hereby certify that the application for disposal works construction permit signed by me dated 3--J 5 9 V , concerning the property located at 'l b If-.3 1111114, meets all of the 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 percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 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 maximum 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 +the MAX.High G.W. Adjustment. 7 = q DIFFERENCE BETWEEN A and B y SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder.cert �I 1 O �Y- If� V� � 3 �s loaf r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE ,Apphration for Disposal Works Tonstrnrtion runfit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System a�a rf� / .............. ..._.. ..................................... -----------•..................---•--.... .. .. . -�- Location-Address or t No. f� ti/.! ............................................�e.r� v� firer t.....�1 ........ .�W � r H stAddress ��/Vi ... ..� O pe "so 1 /�, 1a �) Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a Other—Type 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 Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ a •-----•...... = x . Description of Soil................5'�i� _... d�?tr-z- -------------•--•-..... U .................•-•--......----•-•-•-••--••----•.....------------•-•-•------•-••-•---------•--•------•--•-••••---------.....-----•--•---••-----------•-•-•-•.........--•.......-•---•----•••............ W ••••-•---------------------------------------------------------------------------------------------•--••---•--- •---- �r r �y U Nature of Re air Alterations .Ans r when a licable__....y�.t�_ la� Cw r'r .h- !._. c�<9c PP ---- -- -`7 U / r ............. Agreement: e` 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 Compliance een issued by the board of health. ,a� .Signed ................... l/ Application Approved B --.----.-- - � -------..._----........................... .....--------'-.-........._----.......--.........--...-.-....--.................._ ----_... .-Date----- -----'---- Application Disapproved for the following reasons- --- ------------------------------------------------------------------------------------------------------ ------------------------ --------------- -------- ------------------------------------------------------------------------------------------------------------- -- -- ....................... ---- ----------------------- ------------ ------- ---------------- Date PermitNo. /`---.......�`�.......��...-- ----- Issued --------------------------------------------...................... ......------.- .....-... Date • � r t / } r No Fm:im THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliraa#ion for Disposal Works Tomitrnrtinn Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( t- an Individual Sewage Disposal System atf,1 .hk.. f'..............................�✓i'`a c f .lf�..� ......r / Location-Address or Lot No. c -----------w - ................................................. ............................................, T._. ,��. .... '.:...---......._.. .,a 7d4" OAer /SU / /H N Address .............•--- !,.!?0_ ........................................... ......................................f � �±t /f //............-•-- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........�_J?..............................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures ...-•-•••------------------•-••--•••--------------•---.•--...-------•------------------------•-••---------••------... ...--•---• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank— Liq capacity gallons Lengthhidth.... . ... Depth--Dsposal TenchNo .................... Total Length . .... . Tootal 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___--_______-._.-_---. 44 Test Pit No. 2................minutes per inch Depth of, Test Pit.................... Depth to ground water........................ 0 ------------------/---------- ----------••--- --•-------------...----------.------------------------•-•-•-•-----------.------------•----•---•---------.----- 0 Description of Soil............... ....•�vkze.e.�-----••-•----•------•-----•---•-•••--••••-... U ---••----•--•-•---•--------••---------------•----------------------------•••--------•........------•-•-------------•--••.........---...--•---• •--------•---- VW -----•--•---------•---•---•--••---- �- --------- -- . Nature of Re airs lttions Answ r when applicable._..__. h_�1ti.��___._.o.......... vw... luc- ��} Agreement: V 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 Compliance een issued by the board of health. Si ned .......... - -- 2 — Application Approved B ------------------------------------------------------------------------.....-------- -----...... --Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------- . . . ................ ........................... .... . .... ............. ......---.......................--- -----------. ......... ....... ...-----.----........ -------- Date Permit No. .�_ 2�� ........... Issued -------....................--------------------- Date L � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . TOWN OF BARNSTABLE (IlPrtYftrate of C11II�tyfianre THIS IS TO CERTIFY, ThatP_e Individual Sewage Disposal System constructed ( ) or Repaired ( v) by ....... �7vy.h......../7 ' �aQ --------------- --- ----------------------------------------------------------------------------------------- ------------------------------------------------------ Insta I r at '� USI �a 7✓vrGl-P �. LO.-.-...1..l........................................................................... .. ....... ............. --------- ------ ----------. --.--------... -------------------------------- has been installed in accordance with the provisions of TITLE 5 of The Stare Environmental Code as described in the application for Disposal Works Construction Permit No. ....`"!(..... Z 6(0 >-:�-__---<_--.-------- ------ ------ --- ------ dated --...........- •-�-t� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .............. 'r-' � Inspector .. % V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cyr TOWN OF BARNSTABLE N ..................1 V FEE....2 4 .•.. Disposal Work.5 T.nnntr ilan ranfit Permission is hereby granted...............�UJ^ 11 ) A to Construct ( ) gqr Repaj (k '�an Inc'vidu 1 Se�rage Disposal System at No.--------•-•---•-- 7O /i o 5 4e Z'_„_G!......7✓vv 4-CX..-------•--- /1//, .--------•-•-•---•••••....•...._ Street as shown on the application for Disposal Works Construction PerStreet .��C/Z_--G-!__ Dated.��("/5.�.................. Construction: Cam' -•----------------------•----....._--••---------•----------_...-•- DATE. r ................................... Board of Health FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS No..... /01_- _- Fu$............................. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH � . ..... .... ... .OF.....� .....------------...---------------L'1"� Appliration fur Biip.ugal Worko Tomi#rurtion Vrrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal ,w System at Go tion_Address y o t No. -•. -•-••• ' --------------------------------- �� _-d ...... Ow r I" Address W Installer Address �Typ of Building Size Lotv.%.ZY------Sq. feet Dwelling—No. of Bedrooms-------A--- -------------- - -Expansion Attic (X) Garbage Grinder ( ) PL4 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_ ______________ _ram Width._..............._.. Total Length-------------------- Total leaching-area--------_-----------Sq. ft. Seepage Pit No LDiameter____________________ Depth below inlet-------------------- Total leaching area------------------sq. it. Z Other Distribution box ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date-------•-------------------------.------ c Test Pit No. L_______________minutes per inch Depth of "hest Pit-_--___-.__.______-- Depth to ground water.....-_---.-------__._- (� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ f� O Description of Soil--------- — /Zl9U�G F %------1� �-----e---------------------------- -------------------------•------------------- x U ..-•-------•--.....•-----------------------•------••---...--••••••-•••----•••••••-•-••••••••••.._....-•••••-••••-•-•--•••-•••••--••••---•••------•--•------------------------..............----••--- --------------- ------------------------------------------------------------------------------------------------------=------ ------ ---------------------------------------------------- V 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 been issued bry�,,the bpayd of health. Signed. fl------t1_----'--------rQ ^----'----------------------- 1is... _6r,23 Date Application Approved By------------ - --------- • '/�-•--•-•-••---•---------------------------•---•--•--.._.......-•-•--- -----f Date Application Disapproved for the ollowing reasons----------------------------------------------------------------------------------------------------------------- ••-••-•-••••-••---•••-----••-...---••-----•-••---•--•---------•--------------------------•-••••-••-••••------•-•-•••-•-••••-------•---------------------------------------------------------------- D e Permit No. ......................................................... Issued..,.z_ ---./ -- 7. i Date No.. � ----••--- Flnc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARDj OF HEALTH _. ...../.6 P14/V%---- .- -------OF'.....1�dx!L!�? AAphration -fox Bitipmal Works Toni#rurtion Vrrulft Application is hereby made for a Permit to Construct (x) or Repair ( } an Individual Sewage Disposal System at /a--------- ... _ .�..� - .. � �--------------------•-••--•-----. �/� -o ation-Address � / o��/},t No. --!.f!:..� � -- ------------------ !!/b'r ......�Ci�- Li_ -•-- •..... .................... W Ow r w„� Address a - -------------•----•-----------•---- Installer Address UTyp of Building Size Lot.Aj._7*?J...._.Sq. feet Dwelling—No. of Bedrooms-------- ............................Expansion Attic (X) Garbage Grinder ( ) Other—Type of Building __.__-------_-------.-.-. No. of persons---------------------------- Showers ( ) — 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...............n_ Width-------------------- Total Length.._._-_------____-_ Total leaching area......------:_-.-.-sq. ft. Seepage Pit No----& ``'.'Diameter.................... Depth below inlet.................... Total leaching area----.-------------sq. tt. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date-------------------------------------- a Test Pit No. l----------------minutes per inch Depth of. "Pest Pit..................... Depth to ground water...._...__._----- .___. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........-_.------------- ---------- --------------- �............::---•-----.....................................----................................. Descriptionof Soil----------`-------------------- -------------------------------------------------------------------------------------------------------------- x W U -........................................................................................................................................................................................................ - 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 b n issued by the b d of:health. ° Signed-.�!!T�1. 1.i.•. 4_0 ------------------- ---- °............. Date Application Approved B ................ -- _f" -- PP PP y----------- �1-.------•---•-•---•----•--------------------------•-•-•-•--•---•-•--•--•--------•- --•----- Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- ---•------•--••--••--------------•-----------------------------...--------------------------------------•--------...-----.....-..-----------...----------------------------------------------------- D�arte Permit No. Issued-- '°" ' "'+f ........ Date THE COMMONWEALTH OF MASSACHUSETTS LL BOARD OF HEALTH ,d'Lf�4:................O F. ............................... OvIrdifirate of Tomphanre TH IS TO CER IFY ,Tshat the Individual Sewage Disposal System constructed ( `a or Repaired ( ) by a- 4114-------------------••------- ---- Installer has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ •X THE ISSUANCE,O-F THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL*FUNCT ---------------- ION SATISFACTORY. wwt�DATE �" t" Inspector ` ,•�' lt ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH +�?1:. ... ..OF. .� �C. " .Q............................ No.......?l. � FEE........................ �i��>a�tt1 ork,� �on;��r�r�ioat �rrntit Permission is hereby granted------ - ------- �`--------------------------------------------------------------------------------------- to Construct ( ) or Repair ( ) In ividual Sewage Disposal System at No.---`-�---. ----- e� --- street Street a- as shown on the application for Disposal Works Construction Permit No...... ; ..�' .. Dated---------/X:A*.._D....... ......._..--•---.....•-•----------------------------------------------------------------------- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r� LOCATION: tio*lo �� SEWAGE PERMIT N0. g VILLAGE: INSTALLER'S NAME & ADDRESS: BUILDER!S`NAME--& ADDRESS: ��IN' � /aahorhl.1°'t 171 DATE PERMIT ISSUED: 11 i 6-7:3 DATE COMPLIANCE ISSUED: �, rr �� P i 3c 1� ,I !f r' V+ n1 t 1 r CB(d/ti �/j/cF I�