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HomeMy WebLinkAbout0045 ROSELAND TERRACE - Health 45 ROSE LAND',•'(Ua�� `ZARST. MILLS A=103.128 kg TOWN OF BARNSTABLE LOCATION S I a TQ� SEWAGE #, VILLAGE M/i YZ S --iV A ASSESSOR'S MAP & LOT to 3- .INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ( (size) Z.©e NO. OF BEDROOMS 2— PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i F,`� �� r�L. t6�®° � �� �--=' - �,r..,x �-,°.�- ,�� . ,.- ��-. _- TOWN OFBARNSTABLE ' �- LOCAT:Oi! `C n t�A�� Te- SEWAGE # ' v VILLAGE r S�-C? 1`�t. \S ASSESSOR'S MAP &LOT /a 3- 1`IR INSTALLER'S NAME&PHONE NO. '--CZ SEPTIC TANK CAPACITY C Mx-- LEACHING FACILITY: (type) n �S (size) �� I NO.OF BEDROOMS C BUILDER OR OWNER PERMTTDATE: 1 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 , l on site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /vt1/vc: Feet Furnished by Old O � o CJC3ox a a9 A 4-, OQ eii Z3-( TOWN OF BARNSTABLE LOCATION SEWAGE # v . ASSESSOR'S MAP & LOT /d 3- 119? INSTALLER'S NAME&PHONE NO. "a L,, SEP"' •TANK CAPACITY \C�C>n (..r( Q�C?n X —. .�•. LEACHING FACELnY:.(type) — -eyy size) NO.•OFBEDROOMS BLTIIDER OR OWNERQ PERMIT PATE: COMPLIANCE DATE: Separation Distance Between the: Max mute Adjusted Groundwater Table and Bottom*of Leaching Facility Feet PrivBteYWater Supply Well and Leaching Facility (If any wells exist on;st.te;or within 200 feet of leaching facility) 1"y Feet . Edge.of;Wetland and Leaching Facility(1f any wetlands exist W . n'.300 feet of leaching facility) ll/\Q. ':.Feet Furtu Pied:by , • :a �� '$r No. �+-J Feet/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migaar *vmem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. O is Name,Address and Tel.No. Assessor's Map/Parcel(4Z Q'(3� �C� Installer's Name,Address,.#nd Tel.No. -��s,S�yGl Designer's Name,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 Nature of Repairs or Alterations(Answer when applicable) V J Ma X 1 ,X W f W k SSz,,t_� ���.•-d 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 beAid this Board o )Sign t:�: Date a� Application Approved by Date —� L/��' Application Disapproved for the following reasons Permit No. Date Issued Ff �SJ , Fee ' No. r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / � d 4S N, O is Name,Address and Tel.No. lose �cn 'act C r � Assessor's Map/Parcel c? " Installer's Name,Addres54nd Tel.No. �21-S-bl�GI Designer's Name,Address and Tel.No. 2-y P(cvA cZd ) N -s Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building T 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 \Q>C� � Type of S.A.S. Description of Soil t Nature of Repairs or Alterations(Answer when applicable) A j 14G ChM CJ-St C4�� S �S EA r rx..,, -j 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 o 7 Signed Date Application Approved by Date '�"f?�i Application Disapproved for the following reasons Permit No. sr Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO TIFY,that the On-site Sewage Disposal System Constructed( ) Repaired( V)Upgraded( ) Abandoned( )by ma's at r M r.�/ � ` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. f- 0 ted — 2 Installer C y IV\ c'ti / Designer The issuance,of this permit shall no a construed as a guarantee that the syst wi unction as designed. Date 7 g Inspector No. � � —�� ------------------------—Fee ate/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS ig oar pgtem on.5truction Permit Permission is hereby granted to Construct( )Repair )Upgrade( )Abandon( ) System located at C( ; - C?n:,4 k C.JN-8 !L-r,r c-- r-I C rg-fu J,_ (tn 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 rmit. Date: — �Z Approved b L it ', t Itll9/91 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) ��� \•r-t�.(`�' , hereby certify that the application for disposal works I,— construction permit signed by me dated �a� ��? ,concerning the property located at Rwa0 t't'� f -� meets all of the following criteria: ere 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. r f the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: y p A)To 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:cert Co - SEW&(:�E PERMIT-MO. IWSTQLLER 5 Vl&NAE ADDRESS BUILDER 5 Q &MF- P. ADD.RE.SS DATE PERNA T 15SUED 0'� D ATE COMPLI W-ACE ISSUED : ' =`�=7 r I � Z,i.,� � l No....'12. . ...... Fas. .. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARR OF HEALTH Al..........oF.. � -l .............. ............._........ Applirtttinn -for Dhipattttl Works Tote iartiou Vatt;it Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewa? i'i§, osal System at: _ r� L - or L o. � Lnd ......... � - -- -- - --- -------- -----------••••-- ............ e V 0 _.. L------------------------ wner ddress 00 ----------------------------------- Installer Address Type of Building Size Lot..94/A u � Sq. feet Dwelling—No. of Bedrooms----- ---------------------------------Expansion Attic X� Garbage Grinder � ( ) `, Other—Type of Building No. of persons a YP g ---•----•------------------- P V------------------ Showers ( ) — Cafeteria ( ) a' Other fix ttres ---------------- ----------------- W Design Flow..g............6..-.----_-._-__-_-.---_-..gallons per person per day. Total daily flow,__--_-:_ .11 Q..-..._-:..........gallons. R; Septic Tank L Liquid capacity/AAA —gallons Length................ Width.......--------- Diameter---------------- Depth---._----_--- 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 ank ) -�� a Percolation Test Results Performed by----- --- r .. ........................................ Date....................................... a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth-to ground water................._...... L4 Test Pit No. 2................minutes per inch Depth of Test Pit................--- Depth to ground water.........-._--------..__ �+ r+ - - r r `^•... - Description of il 1 /- 0 /--�---- - � i,® r Y-P 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Legg issued by the board lth. Sigd ------ -------Q�----- -------- --- ------ -- �1 y .. to _ ---------- --=�. . -4 Application Approved By..._ . D.a.t_e Application Disapproved for the following reasons--------------------------- ------------------------------------------------------------------------------------- ------•--------------------------------------------•-•----------------------•----•---•-----------------•'-----------------------------------------------------.......-----------------------....-------- Date Permit No......................................................... Issued----` -- -'5-- - Z . ....... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH N...._--- OF.. ...�4>l� S.7- .('�..L.. .. ................... Appliration -fur Ui.iVuott1 Morkii Tomitrurtiun Punift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ C�2I? � �... 1�57�►!5 /�I/CGS ,_e,-,7' f Lo n-Address ,Q I _ or� T`.. / �2 y /_zvV ............... .....!/Vt S .............................................. Owner _ Address w ----------------------------------------- --------------_le.------------------------------------------- Installer Address U Type of Building Size Lot_ `0j. feet .-� Dwelling—No. of Bedrooms-----4-2---------------------------------Expansion Attic 045 Garbage Grinder ( ) p, Other—Type of Building ---------------------------- No. of persons_.....17./._................. Showers ( ) — Cafeteria ( ) 0.1 Other fixtures i ------------------------------ y �t W Design Flow__ ________________________________________gallons per person per day. Total daily flow____..._..�_Q-Q_-.-_-------------gallons. WSeptic Tank l Liquid capacityYW 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 ask ) di_QC j /d-,, --- Date✓ a Percolation Test Results Performed by.- ___,---------------------------------------- ____.........._.._._.....-_._...... Test Pit No. L---------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water---------.-----..------- i L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-...-.---_-.--------.--. P, O Description of S its' --- W x -- ------------------- -------- --------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- tJ 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 \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b�eak issued by the board of IT, Ith. P � � Sigd •. . .--•- -------- ---------------------------------- --- D e Application Approved By-- — �-' ... -�------------- ��- .5 .-. Date Application Disapproved for the following reasons:---•------------------••--------•-------------..........------......------------..............-•-------------'-- -•-----------------•--------•----------------------..--------------------••-•-•-•-------------...------•.•----•-•---------------------•-------•-------------------------.......------------------..••-•- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......OF..... /9 .11 .71 �3..L..L— Trrtifirate of 1.1.1.11mphaurr TILS IS TO CER" IFY, That the Individual Sewage Disposal System constructed (�or Repaired ( ) by........Ji.dN.•---•• G ,-----------------...------------.....-------------------------------------•-------------------...------------------'------------------- at./-.1)-7........... ......... ......' &/VD.--�'d_C-!t.---------t--L----------------------------------------------------------------------------- has been installed in accordance with the provisions of Arti I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.- J _:!/0/............. dated...... ...._.7_\--� __...__.... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------------------------------------- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ..... ..OF./ o� '�/ 3.... . No......................... FEE... .............. Diripotitti ork Tonitrurtion Vrrmit Permission is hereby granted----o—d---------�A 4..W------------------•--------------•----------------------------.....----------••------. to Construct_(�or Repair ) an Individual Sewage-7Disposal System^ at No._.4A_- _*...�-1J...---'-- -S-�-•--+�A�!!l�._...... _ . % HG-� ✓S7J/L/s... /��1/�( ' Street _ as shown on the application for Disposal Works Construction P No.___ i____ Dated___.....-............ ............... /�^ 71' Board of IIealth DATE'------- -------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t1 I ROSIEZAND 7 RJR CE 3 o 37 V I i • 0T 40Ci9TION Mil RSTONS. MILLS s CALF /p= Go' DATA /011117S_ �, •a _ .. PLAAI REF BK 16y Pr `// iaq A�,tH A F��s 'FOR EYE�Z ETT vv. PAANANEA1 LLOYD f/ERE Br c6RTtFY THAT 7-11E x ST- , TIMEft /AI& FO u1V p R T/ON .Coc AT/oN IS Co eRIC;r 95 S tIOlUAI )}AID D O S E COIN FOR t•f w 1TH THE 8V1LD06: SE7,9ACK REQ r9ENTS M OF jJ/E 7-OWAI OF BARNSTAZiLF_, RAG �G/aNp SuRvEYaR TOWN OF BARNSTABLE ly c LOCATION C C�(��P l�f� A-e« SEWAGE# VILLAGE - 1`S —i IS ASSESSOR'S MAP&LOT—Li-_LlS, INSTALLER'S NAME&PHONE NO. --'NCa S� c SEPTIC TANK CAPACITY LEACHING FAClLrrY:(type) (size) Ck ��tY�Q✓ NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE:_�L(J!4 1 t.1 Y Separation Distance Between the: �7 Maximum Adjusted Groundwater Table and Bottom of Leaching Facility I!( Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) v Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by P�S D � (�cc.t/L of Dow, 4 I I I