HomeMy WebLinkAbout0031 SASSAFRAS LANE - Health 31 SASSAFRASS,MARSTONS MILLS
A=9-"-069
TOWN OF BARNSTABLE
LOCA'aION -?/ —51'41 106-1a3S ZA5W SEWAGE #
VIL` AGE ASSESSOR'S MAP& LOT —
INSALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY f400
LEACHING FACILITY: (type) 2-Soo�hl Q^y w<�� (size)
NO.OF BEDROOMS 3 ;
BUILDER OR OWNER (.l4i^o� D1fF�/� e
PERMITDATE: rfT�Q� COMPLIANCE DATE: 9Q
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 facility) Feet .
Furnished by
coo ,
�jg9Sl�f/�+35 C.e9q�
No. / Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Application for -Miopoal *pmem Comaruction VCrmtt
Application for a Permit to Construct( )Repair(L- Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
cAeal d'U-eff2ttr
6�/'�Assessor's Ma /Parcel
s G�4
Installer's Name,Address,and Tel.No. Z%'7 7-O J1i Designer's Name,Address and Tel.No.
Lid) Jos'-cPlr O-e
Type of of Building:
Dwelling No.of Bedrooms 3 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 Sa�he'
Nature of Repairs or Alterations(Answer w en applicable)
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 11 Date
Application Approved by aIler Datey-/6-22
Application Disapproved for the following reasons
Permit No. — Date Issued �
if• "
No. iR. , +' Fee v — • �_—
THE COMMONWEALTH OF MASSACHUSE-�TS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Application for Migpogar *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(4,�-Upgrade( )Abandon( ) ❑Complete System El Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor'sMap/Parcel 3/ S''4SS l4SS Qu-elferl-e
Installer's Name,Address,and Tel.No. y71-
035� Designer's Name,Address and Tel.No.
9
Jet3{ply 4),_ /3�r�^os Josepy...p� Q.gr^d s
Type of Building:
Dwelling No.of Bedrooms 4 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) f�J� 41 �-6taa l o Z/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 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 14 Date c,j-Zr--_ 0?9
Application Approved by Date
Application Disapproved for the following reasons / ---
Permit No. �i _ / Sr�7 Date Issued L/_ //— 2
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
l Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by
at 5/ has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer/ ��' 100,61,. Designer ' � r .pj
The issuance of this permit shall not be construed as a guarantee that the systepywill function as designed.
Date_/ � Inspector
No. ——Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS
Migogar *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair(Upgrade( )Abandon( )
System located at .r� C �, c
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 a it.
-"/l1' F
o
Date: � � Approved by l���„ 6
ti 1/6l99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. i
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, 1:g'007 d-e- hereby certify that the application for disposal works
construction permit signed by me dated concerning the
property located at 3i ,f'.93S�Fo"�4s,P Lr�n-e- meets all of the
following criteria:
�e failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
r The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
I
They ,are no wetlands within 100 feet of the proposed septic system
There a/re no private.wells within 150 feet of the proposed septic system
�Th 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 Mt be located less than five feet above the
mammum adjusted groundwater table elevation. [Adjust the groundwater fable:;sing 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 maxinium adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) Y
B) G.W. Elevation Cl S" +the MAX. High G.W. Adjustment._ 7
DIFFERENCE BETWEEN A and B
SIGNED :� 1(.e .�3 DATE:
[Sketch proposed plan of system on back],
q:health foider.cent
• Gxrst/hy /doo � •{.
•
NF w 2 boo Gil. Day u%�/s
� Gp
TOWN OF BARNSTABLE
LOCATION Y/ _57,4,5,4A,,45S 444C SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT® 9—45
INSTALLER'S NAME&PHONE NO.�17-0-7 4'9
SEPTIC TANK CAPACITY /000
LEACHING FACILITY: (type) 2-S���is���� Gdl,�� (size) ,2 X/?-2
NO.OF BEDROOMS 3
BUILDER OR OWNER V��77`f
PERMITDATE:_eT/ COMPLIANCE DATE: 99
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 facility) Feet
Furnished byn :r�o��
i
�i'anf
m
s
�ro95Pfrn�S �yn� .
S �f TOWN OF BAR NSTABLE
LOCATION �pT�c ,�(i�����Scas� �� sEWAGE # T9"W 1
VILaAGE �N a,snp S ASSESSOR'S MAP & LOT
n
v°INSTALLER'S NAME & PHONE NO. CORP- C Qa
SEPTIC TANK CAPACITY 060
i
LEACHING FACILITY:(type) c e C a ST \� (size)Cw W CX L4 '
NO. OF BEDROOMS O9: PUB�LIC WATER
Ik
BUILDER OR OWNER � �ckeor c e
DATE PERMIT ISSUED:
DATE .COLiPLIANCE ISSUED:
VARIANCE GRANTED: Yes No t/
�a
�3
fRenT
ASSESSORS MAP N0:
��3 4 PARCEL NO:
No.--•-•--•--.......-•--� Fps............._...........--
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
0F.................... ....... .
Appliration for Disposal Vurks Tunstrnrtiun Vantit
Application is hereby made for a Permit to Construct ( ✓) or Repair ( ) an Individual Sewage Disposal
System at:
Loc on- dress or Lot No.
Address
Installer Address
Type of Building Size Lot.................... .....Sq. feet
Dwelling—No. of Bedrooms..................3..........................Expansion Attic ( ) Garbage Grinder
a Other—a Type of Building ----- •�..__..... No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures
Design Flow.....•......—`�?` ...................gallons per person per day. Total daily flow.._._....? �
W .....................dons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth_....__......__.
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area_____-----..__----•-sq. ft.
Seepage Pit Diameter.. ........... Depth below inlet...Sn5l._. 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 escription of Soil...!W .....' ,•---
x
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 1-' L L
P 5 of the State Sanitary Code—The under iigned fur .er agrees not to place the system in
operation until a Certificate of Compliance has been ' a> ou.� th.
Signe - ..................•--••-••-... .... �3�3 XF 7
...........
Da
.Application Approved By......•. . ------------- --------•-- - �` /. -----
Date
Application Disapproved for the f ollo 'n reasons:............................. -._._
---•-----------------------•-•-----------•---------•----------------....-------------------•--------------------•...-------------•----•----•-•--•-------------------------•-----------------•--•--------
Date
Permit No.. �.?..... ..... ------- Issued......................................................
Date
No....... .... FEE.. `
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.Apure#ion for Disposal Works Tonstriirtion Prrmit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
ILI
Location-Address or Lot No.
............... - ... ---------------------------------------•---------- •------•••--------..._......-----•---••-----••--•--•-•-----••-•-•-•-••-••-.........-••---...-•--•-
Owner Address
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............. .........................Expansion Attic ( ) Garbage Grinder VVP
Other—Type of Building .....�' `=_ p ( ) ( ).. .__....._ No. of persons............................ Showers — Cafeteria
Q' Other fixtures ................................. .
W Design Flow..............5---;. ...................gallons per person per day. Total daily flow._._.....'..............................gallons.
Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit _.. Diameter.. 0_...._..... 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-___--__-._-_-__---_•_-.
li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----------------------------------.....------------------...........-----------..._......----................................................................
ODescription of Soil_. _1�.....�.......? /.J.........................••-----•--•--------•------••-•---------------•----••----------------•----....-----------------
x
U ......................................................-..................................................................................................................................................
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: J 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. ,/1
Signed _f_1"�r t .�, �� f ts±:'+ �= === 'ram 7
..
z Date
Application Approved By.....�al:V- .•---------- - ---•--•-•--._......_........................ Date
Application Disapproved for the f odloeasons:-------•--------------------------------------•-------------------------------•-------------------------...----
-•....••--•---•--•--•-----•--•••....---•----•--------•-••-•-•-------------•--.....--•---••-•----•-•••--•-•----•-•-•----•----------•-------------------•-----•--•--•----•----•••--•------•-•-•-----------
Date
PermitNo........................ ' 1 Issued-.......................................................
I
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............: ..L. .......OF.. ". i': ?,.� z �'r1` tea. -�:....................
Trrfif iratr of Tomplianrr
THIS,IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�or Repaired ( }
at../�f...... �--~-�A-e- t. `1 ;a c ... Installer
-- -•••....... ---•------- ------ ----•-...............................................................................................
has been installed in accordance with the provisions of T i TIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated----------.-._._--_--_____.___---------__-_---
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..................2..-..i� "' .............................. Inspector...... ...
THE COMMONWEALTH OF MASSACHUSETTS
J BOARD OF HEALTH
�r 3 � .......OF..... ' !.: %. " '�: CU
No- ------- --------------- FEE.. ....!...........
Disposal Works Tonirudion rumit
Permission is hereby granted_ ..........(..a ��...... ` _
to Construct (✓) or Re air ) an Individual Sewage Disp sal System
at �'o..._�,O. '.......... .. G� ------
J.d-1.1='?/�, ���:. ................................
Street
as shown on the application for Disposal Works Construction. ermit No.............. ated.._._ .........
_ J ---•----------•----------------•---
! Boar of ealtt
DATE................ ....... -r//....................................
FORM 1255 HOSES & WARREN. INC.. PUBLISHERS
2- oo `�g�L�• yz.� .
nor �y nor .27 ..
;Q'I
U� CO
PI
3
1 I
�A�S.
_ I ' Qo JOHP ,
;I JACOf31
No.
-5i95.5y,r,CAtS .Ci✓
Cl, ,p..
T�✓r v✓4 T
LOT ci FRCS �� tiNE
0
SCALE : / �o UPPE�C,OF'E ,E NG/•VEER/.V� ,Aad W.
PD.
0�4 TE•'_7 /G G SyEET of z
TOP OF FOUNDATION
EgNe tETE COVER I
CONCRETE COVERS
• � , E.4
: 4"CAST IRON 21,MAX.
n"n'•'r r*nr sn
OR SCHEDULE 4812 MAX. `
P.V.C. PIPE ' 4"•SCHEDULE 40 PV.C.(ONLY)
PITCH 1/4"PER.FT PIPE - MIN:' � LEACH
PITCH 1/4"PER.?DIS
PIT PRECAS
INVERT / -'
a ;;,: LEACkIit.
EL20,7.�.. INVERT INVERT % . �•: PIT OR
e'. SEPTIC TANK , T. wEOUI`'
INVERT . B0K ELlO.. .. ( >_ :•:�
/dam:. .... GAL'. 'INVERT :� a 3/4"TOII
` EL 9P INVERT
• EL WASHEI
' /4 : 41. E STONE
� � —�-•- � •• ' �ill•3
' g { t
6 DIA, —+
�-- y
.,• ". /o ' DIA.-•--�-�
_ Fes'-,3 -
•• • PROFI LE OF ,i/43 GR UND WATER TABLE ;
SEWAGE. DISPOSAL. SYSTEM
NO SCALE
P- 0 7
SIL LOG WITNESSED BY :
DATE .1/�C.�/�G ... TIME.. . .. . . . . .. T//P!1. ./��/Le-a A/ BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 \7 - Ti'>LCO/3 ENGINEER
ELEV.4• 'K. . ELEV. .. .. . . . . . .
��d /7• .4-X.64 (/rt
DESIGN DATA '
NUMDER OF BEDROOMS �. . . . .
TOTAL ESTIMATED FLOW .fl, . . , GALLONS/DAY
BOTTOM LEACHING AREA ? . SQ.FT. /PIT
SIDE LEACHING AREA . . . lo./` . .. SO.FT./ PIT '.
GARBAGE DISPOSAL . . 4��40 (500/6 AREA INCREASE)
TOTAL LEACHING AREA SO.FT
PERCOLATION RATE .4',l!!-5 S. ?. AIIN/INCH
LEACHING AREA PER PERCOLATION RATE .. . . ... SO.FT.
.... .WATER ENCOUNTERED
I NUMDER OF LEA' C ING PITS
z _
APPROVED . .. . : . . . . . ... . BOARD OF HEALTH R 3'�y �� �� (. c� _. 7F6PP- ,J� ice'- .
DATE. . . • • : .�•-2 .-.!6/` -.5.,-.�.�f� . G�O S/!Z'
AGENT OR.INSPECTOR I l O%
N-
ser). ANAL S
• ,PEriodE �,(,( �,t/QErPv�ali5 `�S\ N/9
,(oT -?;� .5yssAfQil -S /7ATf.2/A, wok /V/7- i�
A/�2EcFIN
7 .5. 4A1,0 7 d� � COB(
• _�' �� o No. 814
ER
PETITION r �P'a� 44. 7 /T. �:`� ,w � Piz v- )9 ddX r�zo 101110i.J6•
. C °NIA ,ZH of
"�/NQ/(14 S�U���t .fP/6 S•. I�i�E S C fig_ 4-V EA..