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HomeMy WebLinkAbout0064 SASSAFRAS LANE - Health 64" SASSAFRAS' ,MARSTONS MILLS A = OAS _cr - O I III 2 i i 1 f f'/ ------ -- - TOWN OF BARNSTABLE G LOCATION 1x 4,�SA Eka. S' Lr U SEWAGE # °O' 3 VILLAGE /YJ. :/AIL fl S ASSESSOR'S MAP & LOT_dY ?�.6y i INSTALLER'S NAME&PHONE NO. M I p r./,Ga�' _S' .4,11L 2 �. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ^1,,VO i�TDk1 S' (size) V �>✓ �`, %�_ NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: moo COMPLIANCE DATE. + jSeparation 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 T'r z U . ,JIT�"z�� i Z ) Y I , ,1 TOWN OF BARNSTABLE � ,G L kAn'6N �Z! af4_C Sd/=vrrz S L. ,V SEWAGE # WM— )A 3 .LAGE /V1_ / ,��S ASSESSOR'S MAP & LOT Jy INSTALLER'S NAME&PHONE NO. /b''7 '14 Z �� SEPTIC TANK CAPACITY / ®ra 0 LEACHING FACILITY: (type) (size) i�` T7 NO.OF BEDROOMS BUILDER OR OWNER Z PERM TDATE: _ S - Imo COMPLIANCE DATE: — $ - aODa 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 v 1 A 2J4 - 13 4 . y FeeVs THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3.pplication for 3Dtopotal *pttem Con.5truction Permit Application for a Permit to Construct( )Repair( )Upgrade(1i)Abandon( ) ❑Complete System 10Individual Components Location Address or Lot No. (Q q I Owner's Name,Address and Tel.No. 1\% -VINN Assessor's Map/Parcel Gk�' . \I cv" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. N.% Vs ST, mat alc 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 - `1 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ��n� c. 0 Type ofS.A.S.iAO&CktIct e%-1 ja-47 Description of Soil Nature of Repairs or Alterations(Answer when applicable) \e 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 7of Title 5 of the En not to place the system in operation until a Certifi- cate of Compliance has bee y is a lth. ed Date 9—� 0V Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TA No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: VYes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Digpool *pgtem (Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(V<Abandon( ) ❑Complete System Individual Components Location Address or Lot No. totA f x—f,.j t Owner's Name,Address and Tel.No. ```Assessor's Map/Parcel f G Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. co— fl fie \ Type of Building: Dwelling No.of Bedrooms S 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 a9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 'sc:%S`t o Type of S.A.S. kA uV,cc,Dc"ct i'� ��- Description of Nature of Repairs o`r`Alterations(Answer when applicable) G& S� 04A D—` G�i S`t 3 h 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 Env,' ntat not to place the system in operation until a Certifi- cate of Compliance has bee zd tiys s ealth. Sf&d s, Date YY OV Application Approved by Date 1 Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CER ,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(J Abandoned( )by L 4 at U2 LA S S `S % 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 shraI not be construed as a guarantee that the system will function as designed. Date � ' (� ��^ Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ;Digpogaf *pgtem (Construction Permit Permission is hereby granted to Construct( )Repair( )U grade( Edon( ) System located at o, , 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:Cons 1, do must be completed within three years of the date of tbl"prmit.) �y) Co Date: Approvedby Ilrt�t / 5 - 1 !, 1/669 iriOTICE: This Form Is�Tio Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) T7 hereby certify that the application for disposal works construction permit signed by me dated 3-1,- 02concerning the property located at 5�4�S�C��� -� V��Y��� meets all of the following criteria: or (/• The failed system is cone`ed to a residential dwelling only. Thee are no commercial or business es associated with the dwellins. 6 The soil is classined as CLASS I and the r percolation rate is less than or equal to � minutes per.inch. 't', Zhe:e are no wetlands within too fer;of the proposed septic system (�T'ne:e are no private wets within 1-40 feet of the proposed septic system There is no increase in flow and/or change in use proposed /Triere are no variances requested or needed. OT"ne bottom of the proposed leaching facliry will not be located less than five feet above the ma..dmum adjusted —oundWaEe.table elevation. (Adjust the groundwater table using the Frimpror method when applicablel -Xf the S.A.S. will b?located with'_d0 f tr of anv vegetated wetlands, the bottom of the proposed leaching faciliry will not be located Less than founeen(14) feat above the m=imum adjusted groundwater table !legation. Pleyue complete the following: A) Too of Ground Su rface Elevation(using GIS information) ['2 � B) G.W. Elevation �"` =the M,� (. High G.W. adjustment���_ `7✓ r D �E�+CE BE-7 EEN a,and E r SIGNED [Sketch proposed clan of system on bac.c1. r c�G''Gt�_ '° �v �� l q TOWN OF BARNSTABLE '� I� LOCATION FrQs ��✓� SEWAGE # sl-�, S11-8 f VILLAGE Y�La 0-S-ran s vi•i ASSESSOR'S MAP & LOT (J �INSTALLER'S NAME & PHONE NO. �b �' �� n�eo-`a-c&ji �l7 7-(.735 j SEPTIC TANK CAPACITY I,oc)o I LEACHING FACILITY:(type) boo "L _ (sue) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER PJbLic_, BUILDER OR OWNER -V'. 6Z T? 5 -S1 n l � DATE PERMIT ISSUED: Q!(7 DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No a 44. II ( r i Fss.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN BARNSTABLE OF.............................................•---....._.....------.._..................... Appliration for Disposal larks C�nnstrurtiun Vrrnti Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: � 5 LOT 33 SASSAFRAS LANE /!�q, a�✓ .-......-�-LL .................._--- -•-.---.-.-------•-•--........--•- .._... . -Location-Address or Lot No. J I M S M 1IT U.-- ............................. ............ .. ..__ ... owner---- ....�.... ------•-'•^-- W - - -. _ -� gt� 4 �_J E ......... y� Installer !(XG�V a Address feet d Type of Building / Size Lot....�D,(�E}p --Sq• U Dwelling—No. of Bedrooms............ ..............................Expansion Attic (X ) Garbage Grinder (NC Other—Type of Building ._....R53..._......._.. No. of persons---.--___-_--------------- Showers ( ) — Cafeteria ( ) Otherfixtures --------------•"--.........-----.........----•----...........----"----.......---"--....---•-------------------•---•--------••---•••--.............--•- Design Flow......._...5 5...........................gallons per person per day. Total daily flow--"_-..-330--------.---•-• -•- h.. dons. W 1 p 4.------ WSeptic Tank—Liquid capacity.--00Qgallons Length.8...6..._.. Width..4..6...... Diameter-_- ------ De t ..__.. N Disposal Trench—No..................... Width....................Total Length.................... Total leaching area........_._------.--sq. ft. Seepage Pit No...ONE......... Diameter.....12-......... Depth below inlet...3...5......... Total leaching area....1g7......sq. ft. Z Other Distribution box (X ) Dosing tank ( ) Percolation Test Results Performed byUFPER_._CARF............................................. Date_____ �./.�8,�f3ro----------. ,`'a Test Pit No. 1.....X........minutes per inch Depth of Test Pit.....12.......... Depth to ground water-----No............. 1 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... a ......--••-----•................••-----...................---------......................................................-._........ 0 Description of Soil.. ._.".Z..... ...•.... _ ........<'.L?�_.....- ...................... W ---•-----------------•--. ------------------........-------------------•-------.........-----•-------•-•-------------------------....--....._-•--.................................................... x Nature of Repairs or Alterations—Answer when applicable............................................................................................... U P •-"---"-------•----------"--"....................•-............................_...------•-----•-------.........-----------------...._...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLILTIS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Co p nce has be issued by the board of health. Signed . --- Date Application Approved B ""--- f 7 PP y.................. .. ......... •..........._............• .... Date Application Disapproved for the following reasons----------------------•----"--------.....----••----------------•---------------....---•--------....--••--........ --.........-•..........................•--..�.......................----^----"-•------^---•-----••-......•-----------•-----•--------------"----•---............................ "Date Permit No. -_, IssuecL---f s� .�_ ..- �f,................._ ------•-------------- Date � T S No .:(L- .:::? 4a' Fss............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN ... OF...... ..... .. .... ...........------......---.....................••- Appliration for Disposal Works Tonstrnr#iun riermit Application is hereby made for a Permit to Construct { ) or Repair ( ) an Individual Sewage Disposal System at: ........LiOT—..33_.S,ASSAE1W...LARE....................•••.....• ••....••-•--------..............•••---....----•................................--.....••-••....... Location-Address or Lot No. ....... •- .. ... .................... - ----------------------------- - ^a-^-, Address a ........... �� �y� -----•-•. ................ Installer Address 20 00© d Type of Building Size Lot...........:................Sq. feet 1-4 Dwelling—No. of Bedrooms------------3-----------------------------Expansion Attic (X) Garbage Grinder (N p,I Other—Type of Building ------RES............ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ....................:.....••.•.• - W Design Flow.=...........5S..........................gallons per person per day. Total daily flow........330...__............-.--------gaJons. IxSeptic Tank—Liquid capacity_1Q©gallons Length._8 e. ..... Width_. !. .... Diameter_ _ Depth.............._. x Disposal Trench—No..................... Width.................... Total Length...........:........ Total leaching area._____ . . .....sq. ft. Seepage Pit No....ONE......... Diameter......12........ Depth below inlet.....Z!5....... Total leaching area..................sq. ft. Z Other Distribution box (X) Dosing tank ( ) `" Percolation Test Results Performed by-URPER...QAN............................................ Date...........p��28N�5 Test Pit No. 1......X.......minutes per inch Depth of Test Pit.................... Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ••-••-• ------------------------•-------------•-----------.....----••-••--•••••.._......._.............................................................. 0 Description of Soil.............................................•-......-•------•------•------------....------------------•----••-•.....----------•--------------------------------•••••... x 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 Certificatef_ + has been issued by the board of health. 7 �r Signed ® � . -.11 Application Approved By...................-= '.................... ........................................ Date Application Disapproved for the following reasons--------------------------------------------------------•------•------------------•--••.............-•••••..... :..... ............. .. ..................... ...... Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................TOWN.............OF........EARVATARLE............................................. Trritif iratr of Tomplianrr THIS IS 1Lat-*ke4ftdivR*\&ante Di ' " 7Tstructed ( )Xor Repaired ( ) by -.� .�. � .... ' 1�G T h'.rl 6' L ......................................... Installer at. LDT__.33__S1�SSA A^`' 1!�1A. iiii4m-s----------------------------------------------------- has been installed in accordance with the provisions of TITLE �5 of S to Sanitary Co4eCU-d0sVrib&4p the application for Disposal Works Construction Permit No................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION S ISFACTORY. DATE............... . ................. .., ... Inspecto � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cam ✓ ..........��?1✓. ...........OF........... ���'l✓ t ........... No.................. FEE........................ Disposal n QL-&r� Permission Is hereby granted - ------------- .........0 :?C✓ G;y�, to Construct ( ) or Repair ( ) an idividual Sewage Disposal System at No.... e n ` ........... $tree as shown o appli lion fo tDis�os�l Works Constru o aif Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN,`INC., BOSTON 2 �r 1 Q OPEN SIDA CAACCWff COVEN! CAACRM COMM i . , . 48.00 -d s"8460" 10 PVC + "�� •1•• ' _ • ��, ASTSraw il)• �l _ 1�• ;j, T IWlRT sr JL SAW TAMS EL EL ' "Al .„ R# av'_ Ott„ �+ $raw , L O T - 34INN- X -L 0 T 33. PROFIL E OF � Q? ilrI1D WA rM TA" _. . SEPTIC SYSTEM . .� SOIL L OG VAf GENERAL NOTES flow r r Q � O •o DESIGN DA TA _ TOTAL FLOW � 7� (�- BOTTA�/LEAaaw ARfA SO FT. SL7IE LEA OA WD ARFA p t n r SGt f1: h d' GA/P6L4G 'AE�'101SAL Are sox bwo~ TOTAL `LEAL7a1IID AI41E'A so Fr. r M - 7� PEMA MW RA rE' Arc//II r Q•05 P 9 s R ,� w�5� �",��.,:.;e ,�.'<*: fit`;,*'. . 'TOWN WATER IS AVAILABLE i GLOO •0 o - t PROPOSED 9 ' O HOUSE 0 E S/rE PLAN,_ OFLAND r4:) *T L OCA QED IN BA RNS T,4BLE o o ( MARS TONS MILLS � _ o � o M X — 90• EL PREPARED1 0.00. 90.Q FOR 89.5 ♦� ELEC.. _. -- _ MANHOLE t►+ s� E.T.W. ti G _ _PAUL A. N Q ;✓ v JACOBI JOHN �► �. saoseNo 814 , .. •. • N o SA .5.54 FRA 5 L A q e N oN F NE U SURVE W H o � w �O WIDE �A z ( POUT TANTS YAIV EESURV�'Y CONSUL OX 265) 143 ROUTE 149 . P.O. B o _�0 40 soMA02648 RS SCALE. / 20 ES F FLOOD 9 R ._ ZONE.' R L D. ZONE. C -PLAN DA :TE. 8/25/8 , N REFERENCE... 448/88 I.. I4 2 3 3