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HomeMy WebLinkAbout0045 SASSAFRAS LANE - Health ESASSAFRAS LANE, _(Y'�-_Q rs Jd n �►'�` Lam`', A=043-070 ' �'� k_ a/ TOWN OF BARNSTABLE �,T OCATION 6_ ` /,gssa'At 9S'S L,./ SEWAGE # VILLAGES Yl n 4-546w 5 M r 11 5 ASSESSOR'S MAP & LOT Lf if.3. 6 70 INSTALLER'S NAME&PHONE NO. 1<2u.,✓ S�s1�t�. � ` Zl 7410 SEPTIC TANK CAPACITY /U 0 _14 L LEACHING FACILITY: (type) 0 �� (size) NO.'OF BEDROOMS BUILDER OR OWNER /1- Q a A,,- S' PERMIT DATE: COMPLIANCE DATE:, 7- 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 o�leaching f cility),J Feet Furnished by ��L .,a//= } r i 3 3 d ,, r �, No. A9 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: J PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es ZIppYicatiou for Mi-4pool 6potem Cougtruction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. LO `- c, S hSS+p�tq.5 Owner's Name,Address and Tel.No. Assessor's M�p/P e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,9 to Type of Building: Dwelling No.of Bedrooms 3 Lot Size a -!sq.ft. Garbage Grinder Other Type of Building E S 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 00 d 1 Type of S.A.S. Description of Soil %;o S° t G(/AV ( ` ( Z , me v S',jw A Nature of Repairs or Alterations(Answer when applicable) S S-'O d ' ( d- �ti A"-, 14 k L/ ` 4 Il 44004z o w I B Date last inspected: rl -A J— (S 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 alth. �k Q 1J Signed Date U ( 1 Application Approved b Dates Application Disapproved for the following reasons Permit No. Date Issued " TOWN OF BAMSTABLE 4 LOCATION . g ,S�.s�cFn 9 VILLAGE L SEWAGE # 3 INSTALLER'S N ASSESSOR'S MAP& LOT AME&PHONE NO. _ ' 6 SEPTIC TANK CAPACITY /U 0 o S c - 7 y LEACHING FACILI Ty: (type)_ `�-S G� 9 , mac k � n~' res NO. OF BEDROOMS (size) BUILDER OR OWNER PERMITDATE:�� ~/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facili Feet on site or within 200 feet of leaching facility any wells exist Edge of Wedand and Leaching Facility Within 300 feet ol;leaching f cility (�any wetlands exist Feet Furnished by Feet C. A ` f y 3 1. � ✓ � �, Ll I No. r / Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippricatton for 33igpogaf *pgtem Congtruction j3ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L p 9 ,S nSS 4^ j95; Owner's Name,Address and Tel.No. p� "'He. aH 11/S '�-5'" , 14-D A " Assessor's 4/•& 2- Installer's Name,Address,a/and Tel.No. c/^f'jy n0 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size °L Qsq. ft. Garbage Grinder( )JS/4 Other Type of Building e S 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 100 0 { Type of S.A.S. Description�oU Soil a` /O go t n?P D 2,gw 0 Nature of Re irs or Alterations(Answer when applicable) '9 t 19 L/ ' S-7 e�y e .9 c o y t) w 1 Date last inspf cted: A 3— 8 1 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 ealth. A Signed Date r 9� Application Approved b 17 Date ' 2 2 F Application Disapproved for the following reasons �r Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance, THIS IS TO CE TIFY,that the On-sate S Di osal System Constructed(v)Repaired ( )Upgraded( ) Abandoned at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ^ dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector 1 -----�--�-------------------------------- No.� ' ✓ / . Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigogar *pgtem Congtructiai permit Permission is hereby granted t.Q Construct( )Re air air( Upgrade( ) Bandon( ) jJ System located at � � `� 5,�/-� � R, 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 thi` iit. Date: Approve b},. 10/9/97 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) s hereby certify that the application for disposal works construction permit signed by me dated 5 ? , concerning the S'ASS ���S � e �5�4�/1/Bets all of the property located at M following criteria: • 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 114.t 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) q1t 4,1 B)Observed Groundwater Table Elevation(according to Health Division well map)_ c SIGNED r7 DATE: �r (— � o 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 TOWN OF BARNSTABLE -LOCATION SEWAGE # VILLAGEr-�ot�S M,\\�_ ASSESSOR'S MAP Cz LOT *'INSTALLER'S NAME & PHONE NO. Coop Cook Se,gaa C-S SEPTIC TANK CAPACITY VOLEACHING FACILITY:(type)g(ecAS-T Q (size) 6m NO. OF BEDROOMS -n l►Tz+�[ E L O UBLIC WATER DUILDER OR OWNER )ATE rERMIT ISSU ED: DATE .COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No 10'1 yam. I - � '= ASSESSORS MAP N0: � No....0 1..... 3 4J PARCEL NO: 0 71p THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Applirattun for Btipuual Works Tonutrnrtiun Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: T'.' -`�-------.ass -------------------------------------- -------------------------------------------- -- ------- ------------ .---------------....---------....--------- Location•m Ad ss or Lot No. ��J-T� .................................................................................................. a ^ G w 22 T7 C Address ------ --•-- .......................... ...............................•---- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------3...........................Expansion Attic ( ) Garbage Grinderl�ya Other—T e of Building ?�E*5...._... No. of persons....................... Showers a YP g ----- - ------ p ----- ( ) — Cafeteria ( ) Other fixtures W Design Flow......._`~--5 ........................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.....L__0......... Depth below inlet.45!7....... 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..................... ._- fXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------•-------•-----------...------.................---------------•-•.................................................................. 0 Description of Soil_,1 ��d�-----. �I�I� x -------------------------------------------------------------------------------•----•-•------ W x ----------------- ------------------------------•--------•-----------------------------•-------••-••--•---------------------------------------------------------•-------------------------------•------- U Nature of Repairs or Alterations—Answer when applicable------------------------- ------------------------------------------------------------------------•-----------•-•-----........---------•-------------------------------------------......--•--------------------•--•--•--......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage D' posal System in accordance with the provisions of TTT=.,u. p 5 of the State Sanitary Code—T c signed fur r agrees not to place the system in operation until a Certificate of Compliance has i o, d h. Signe - ................�� `//3 IS 7 ADa Application Approved BY ... ...---- 'v Date Application Disapproved for the follo i reasons:................................................................................................................ ..........................................................=.............................................................................................................................................. ��--77 Date PermitNo.-----------�................................... Issued-....................................................... Y Date ram. r � 1� 3 43 v F�$. ..?.:S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F Appliration for Eliapasal 19orkii Tonstrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: x or ' r9 • 'may �rJl�l�.S� d W W e 1 Z)-s ....................'....».---•--••---....... .......---•--........••..............._..... -•---...••------•--•••--••••-----•-•-•......---•--•---•-----.......------..._•---....._......----- Location-Address or Lot No. �. C✓ / .........................................................................................._..... Ow er Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......... ...........................Expansion Attic ( ) Garbage Grinder,(Ve Other—Type of Building ...___ ........ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow........`'2 ...........................gallons per person per day. Total daily flow------5�. �2.......................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ W Disposal Trench—No..................... Width.....__......_...... Total Length___.........._...... Total leaching area--------------------sq. ft. x .� Seepage Pit No.. L'_ Diameter...../..0...... Depth below ........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W -•-•--••--••--------•--•-•••••---••-----------------------------------------------------••--•---•........................................................... ODescription of Soil . ' ' ' "�-------==-5 y..x ••-------••------•-••-----------•--••••----•--•---••----•-••--•••---------------- U ----•••-•••••••---••---•--•---••--------------------•--------------•--•---•-•---••-------.....-•---..........--••--•---•-•-•------•-----...•------•--••--•---------....._ W -•--------•----------•--••----------------------------•----•-•••••--•-••---•----•-••-------•----•--------••--•-------••••••-•---••-•-----•-•----•--•-•••----•------•----•••-•-•-•--•-••-••-----•-•----•- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•-----------------------------t.........................................................................................................................-.............................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Di osal System in accordance with the provisions of i i'= p S of the State Sanitary Code— The�,,,•� �� Igned fur agrees not to place the system in , operation until a Certificate of Compliance has 1 a�fd�of th. Signe ....._............. .......... `.�� , � ���1. ...------ ='=��'-' / "� / Dal Application Approved By....... Q/l ;• •�E �0.- � ....,... Date Application Disapproved for the f ollow n reasons:-----•--------••----•-------------•------•----•--------•----•------------------------------------------•--•----- .............................................. ......................................................................................................................................................... Date PermitNo.............. D - [-- -•-- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Twrrtifiratr of TompliFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Xor Repaired ( } by-�� .....6_v. tom`":�'`f ------------------------------•.... Installer .................. ..................................................................•-- has been installed in accordance with the provisions of i 1A L�L( "p'f he State Sanitary Code as described in the application for Disposal Works Construction Permit No._�._l�"_�`L............... dated.....i(.------------ ------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE T Z-3 Inspector .rc-..---.... .. —�_2"THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH — � No ---------------- FE <.............. 43Wpos al Workii Tono#a` ion rani# . y g Cam'; =;� , T r�1 r�-------------- Perm>ssion is hereby ranted f ..f� . to lConstq/ruct (� or Repair ( ) an Individual Sewage Disposal System at No.... ......... .......L---•------------- -- ---� -----...........................---........--....---.--....................._......._.._ Vv .. Street uu as shown on the application for Disposal Works nstruction Permit N .7'_�7.Z •-- •- � �•_%----- Dated--b-----Cam•=----�-:�.... ...-•----t---- - ------------------------------------------ - �`-•---� � Yfl of HeaRh DATE........ _ -' ( FORM 1255 H OBB & WARREN. INC.. PUBLISHERS z i �r�, fZ S • F�. I 92.0CL-- I sPAcF C7 6�PffN 19�lZ � I O LET Z ? v � � OWF � i I M • / E � I /e 1 �1 ' � I A L S �" ( H N Y JACOBI No. 8;y i u A yoAWAF ; UPPE�G4PE ENG/•VEER/.V� .roB �c/o. Po. DATE•' ���� .v lka uA SHEET ./ OF Z EL.73.<,Q. .. . ... . -Z h�/SEQ TOP OF FOUNDATION �ggGpETE COVER ,CONCRETE COVERS 4" 21,CAST IRON I . ��T E( . OR SCHEDULE 40 MAX. ir;"MAX. P.V.C. PIP ' 4 ,SCHEDULE 40 PV.C.(ONLY) . , E . : • PITCH 1/4"PER.FT PIPE - MIN. LEACH PITCH 1/4"PER.FT. PIT PRECAS o INVERT a LEACHIt. '•� EL.`S/.; 0.. �ItJ ERT INVERT �•: PIT OR _ .'. SEPTIC TANK DIST. INVERT. EL.. r.`. BOX fL j�./... >� EOUI1 a' EL.�OX 5... / D• :. .... GAL. IEL9pT�. INVERT rci ww �: :�. 3/4"TO I I EL8f-J WASHEI ' W 1 , ' PROFI LE OF A10 GROUND WATER TABLE SEWAGE. DISPOSAL : SYSTEM NO SCALE SCSI L LOG WITNESSED BY " DATE TIME.. ... . . . . .. TIJO7. . P�X e-o r/. . . . . . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 J'_ TilYpr3� ENGINEER FLEW. : 8. . . . . ELEV. .. .. . . . . . . et17. e T/o d 0 3 DESIGN DATA ZS ' NUMBER OF BEDROOMS . . . . ! TOTAL ESTIMATED FLOW .fl. . . . GALLONS/DAY DOTTOM LEACHING AREA ?D. . . . SOFT. /PIT SIDE LEACHING AREA . . . 1�.� . . .. SO.FT./ PIT GARBAGE DISPOSAL . . (50 % AREA INCREASE) i TOTAL LEACHING AREA . D.�7 . . SO.FT PERCOLATION RATE .��.� S. ?. . . MIN INCH* A/� i LEACHING AREA PER PERCOLATION RATE . . . . . . . SO.FT. ... . .WATER ENCOUNTERED I i NUMDER OF LEAC ING PITS z APPROVED . .. . . . . . . BOARD OF HEALTH 77-R - 3.'y1 (• �� _. 706PD. .f34% .�6 f _�j-7 4;Z�,7 DATE. . . . . . ' AGENT OR. INSPECTOR . 11 �S�pNAL SQ'Ni P,97- iA� FoR /p FT �,v At[ OH �1 JACOBI 19 AA0 7-D No. 81 Y /�SSE,S .�7�-3 7'.� A��PEcTio,✓S. dN 4 j. PETITIONER "'�N����� S�U���r .�/<�S•. .