HomeMy WebLinkAbout0040 SHAMMAS LANE - Health Ea'r
40 SHAMMIS LANE;
A=065.004.004 Inn rs`78-n5 rn+
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iOWN OF BARNSTABLE
L'JCATION SEWAGE #
VILLAG ASSESSOR'S MAP& LOT 0 O 0 e�
INSTALLER'S NAME&PHONE NO. 6/717—0404 c/aSclo4 0�, Cl4N`^oS
SEPTIC TANK CAPACITY /4670
LEACHING FACELITY: (type) (size)` X
NO.OF BEDROOMS 3
BUILDER OR OWNER jJ.«I N-c.Tl' /2 d h 0 M i
PERMITDATE: 0I ^8 —9 F 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 faci�lity� Feet
Furnished by
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N.. ^ Fee
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1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Tippfication for 33itpotar *pttem Cougtruction Perron
Application for a Permit to Construct(1iTTtepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. q,0 /g,m R l/S Z_Ign/' Owner's Name,Address and Tel.No.
Assessor's Map/Parcel � r0619 f'�/ffS 91-1,44 c- 77' ®V10/'J?!�
6G_< Day 00�/ L'dT/3
Installer's Name,Address,and Tel.No. 14/9 Designer's Name,Address and Tel.No.
Jos�/a� U� 13a�Hv�
If /011
Type of Building:
Dwelling No.of Bedrooms .5 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 l Type of S.A.S.
Description of Soil
Nature of Re airs or Alterations(Answer when applicable)
,4rovay 7 y /'
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 oard f Health.
Signed Date 9P
Application Approved by Date 51, A
Application Disapproved for the following reasons
Permit No. Date Issued
TOWN OF BARNSTABLE
LOCATION 40 ,i��� ,,� � SEWAGE # �T- S �q
VILLAGE ASSESSOR'S MAP & LOT!/f 0 o y
INSTALLER'S NAME&PHONE NO. _ �i 7 —o�yg ��;=;oy �� �Y 5
SEPTIC TANK CAPACITY /o o
LEACHING FACELITY: (type) __3 (size) fO X
NO. OF BEDROOMS 3
BUILDER OR OWNER 1�-e-h;4-c" �,�h
PERMITDATE: 9 -8 —9'6 COMPLIANCE DATE: ? — y—
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
` �v647 Chi lis.-i.>✓y
y3 ;�
No. " Feed
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Application for Digpaar *pgtem Construction Permit
Application for a Permit to Construct(!/f Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. N(! S !y!,/$ LIv4� Owner's Name,Address and Tel.No.
)YIAW5 Too S f'17//�S
Assessor's Map/Parcelsoop?e rr 60,q Off!1,
61,5' avy ooy Lar�B
Installer's Name,Address,and Tel.No. 47�0/'a S41 Designer's Name,Address and Tel.No.
Joscpl, U." dwe'-a-0
Type of Building:
D�elling 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
r
Nature of Renairs or Alterations(Answer when applicable) 1h5T<9�� .�`l�'J�axis�iF_IS c lvnl, 'Y 'Sraol_
Date last inspedted:
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 f Health.
Signed V tst✓ - Date
Application Approved by Date
Application Disapproved for the following reasons * Y
t.19
Permit No. Date Issued
— ---=—-------------
T
THE COMMONWEALTH OF MASSACHUSETTS '
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(4-tRepaired ( )Upgraded( )
Abandoned( )by Jwel,,4 Q.G d .,wo.-/ .5
at YD .S OS A L H G ✓'� �" has been cons ted in accord ce 3}
t 1 F
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
ry
Installer�iu e_04 Designer as r 4 ,U4 .5
The issuance of this shall not be construed as a guarantee that the system ill&nction as designed. ' *.
' Inspector �4,Date
- -- - --- ---------- ----------------
---------------------
No. '� Fee
THE COMMONWEALTH OF MASSACHUSETTS oGs b04 i3
PUBLIC-HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
'Wi5pogal *pgtem Construction Permit
Permission is hereby granted to Construct( �e air( )Upgrade( )Abandon
System located at 40 � .4 'l149I S L,IQr1le % w�''
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 tion must be completed within three years of the date of this 9.
Date: �""" 7 Approved b
t 0/9/97
NOTICE: This Form Is To Be Used For the Repair Of Failed
Styptic Systems Only:
CERTIFIfCATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
hereby certify that the application for disposal works
construction permit signed by me dated concerning the
property located at_ old �1.�. � /� �� meets all of the
following criteria.,
A,--Mere are no wetlands located within 100 feet of the proposed leaching facility
G� 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
6' There are no variiances 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 W be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete'the following:
/10
A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) .�
B)Observed Groundwater Table Elevation(according to Health Division well map) f _
SIGNED: DATE:
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 94,,
(Attach a sketch play, of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
q:health folder cert
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'( a TOWN OF BARNSTABLE
LOCATION Lam1� �,r,� �� SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT 06s-Jo/6Or/
vNSTALLER'S NAME & PHONE NO.0b&7vwcr ����-S7-, /A/C f/ =
SEPTIC TANK CAPACITY oeeoo
Ci clool
j LEACHING FACILITY:(type) IR/7— (size) w .
NO. OF BEDROOMS PRIVATE WELL OR P LIC WATE
BUILDER OR OWNER AJ,40-F- 47urZ-y/A4 L' "7d�cee o�
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
Ze,pe-,m sir
/G►�o tl�-r4li
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
71N/V-------OF....... '2NST G ............................
NP.P irFation for U44poii al Workii Tomitrnrtiun ramit
Application is hereby made for a Permit to Construct (cam) or Repair ( ) an Individual Sewage Disposal
System at:
eSfli�-r7�A s G�/- �,Yi2s�.vs IYZZY s LET #/3
-•--......•....._-----------------•---......--------------....--------•-••-•-•••............••... .....-•-•-....-•---•--•---••••••••-------••••-•-••-•-------------••--------------•-.----•---------
Location-Address or Lot No.
..... T W 6 -----------------------------•••-• �i��2- r1 G
Owner Address .
W Q ?�`a --.. -----------------
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Installer Address
� Type of Building Size Lot._4 7__�3_._g q. feet
Dwelling—No. of Bedrooms..............`..._.._........._.._......_...Expansion Attic ( ) Garbage Grinder ( }
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
P4Other fixtures ---------------------------------•-----•---•-----...--•-•-------••----•------...•-•-•---•------•---•••••••••••----•-•-•--•--•---••--------•-•-••-•...
d
W Design Flow................
S-Zr__................__gallons per person per day. Total daily flow............ --3 ...... ............
R; Septic Tank—Liquid capacity.loaa.gallons Length._ Width._4.6...._.. Diameter................ Depth. _g.._..
W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
x
Seepage Pit No---------/--------- Diameter......14 Depth below inlet...!;F�...._. Total leaching area.t�Z— '>•-..sq. ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by....... .................................................. Date..........................._............
aTest Pit No. 1.... _ ___minutes per inch Depth of Test Pit_................___ Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
-------------------------------------------•----•-------•------------------------------...-•---•••••.........................................................
O Description of Soil---....._0_`1-�.1___4?qg-' --?-=5-`e z9 T/t�!G
x `-- --- - `�----•--•- --``��----- �A�/�
_
W ------------------------•---------------•--•----•-----------•-•-•-•...._....••••••••------------••-•••••----------••-•----•-••--------••-----••••-----••-•--•--•---------------•-•......•_•-----
VNature 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 i—I"i y g g p y
S of the State Sanitary Code— The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has been •slued by the boar of health.
Signed-•-- .- •• ....... ... ... -•-•-. ---- --•- •------- -- -------•-•••• -----' '-'I--
Date
. ....•-----•-•-••••...............•Application Approved By.......... . ��1
Date 7
Application Disapproved for the following reasons------------------------------•-•-----------------------•----•-•-----------------•---•..........................
---------------------------------•-•-----•---------...---•--•---•---------•----------------•-----•--------••-----•--•••••-•-•---•--•------------••-•---•••-----•---------•---------•----•---••-•--••--•-
C Date
PermitNo 0.-2.----•7-Q_6------------------_ Issued.......................................................
Date
Ff �
No... Fx$....7, ........-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. IN/../ ......OF....... ..............................
Appliration for Disposal Works Tonstrurtinn Prrmit
Application is hereby made for a Permit to Construct C,-) or Repair ( ) an Individual Sewage Disposal
System at:
------------------------••-----------........-----------,._..-------------------......_..._....... ------•--•----...-----------------•--......------•------•-•-•-•--•-•------------------•--------•--
Locat:on-Address or Lot No.
Owner Address
Installer Address
Type of Building Size Lot. ._J...I.3....Sq. feet
a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
p,l Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ................................. .
W
Design Flow_______________'`.............................gallons per person per day. Total daily flow...........-�34___ gal Ions.
1:4 Septic Tank—Liquid capacity/oP�P_.gallons Length.8_ ....... Width.'`_u_!�.... Diameter________________ Depth%.._'..........Disposal Trench—No..................... Width....... Total Length.................... Total leaching area___.......-___-.....sq. ft.
Seepage Pit No..._____L.._...... Diameter...../4_.._._.. Depth below inlet..!9 -4`!-._..... Total leaching areat4 F+...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by......... .....f 5-0. ....................... Date........................................
a N
a Test Pit No. 1...!!L�__--minutes per inch Depth of Test Pit-_i ...... Depth to ground water.----
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground
water
wa
ter-_-_--______--..-_.-____
-•-•--•--•---•-• -•••-•---•---------•-------•....-•-•••--•--•--•-•-=---•-----------•••--•-••---...----
D Description of Soil---- 24. .-4` `1_ 3 T4e-J /4 J4`=34" ;-)z1i�
S0 RI _ -• G
-- - ------� �-----'' "-�! --------••-
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=ry 51 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.
Signed-•/4 /. ' = ----
Date
A lication A roved B � _z s.t__. ...
PP PP Y
Date
Application Disapproved for the following reasons________________________________________________________________________________________________________________
-•------•-------------------------•----------------•---------------------------------•----•--•---•-----...--••-•-------------•-••-----------•-•-••----------•---•••------•----•-•------•-•---------------
Date
Permit No. C .. �_1'?...t� ._.. Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........T�r 4./4V...........0 F....... A 'NST h.. ... .. .. .................................
Trrtif irate of Tunipliatta
THIS IS TO CERTIFY, That the IndivAual Sewage Disposal-System con�struc R •ired ( }
by----------------- •--... 1L�C,1. C 4"?`T...!_.......r'r./.1� . ------
Installer
at.............�C'•f ---- I : / clrwc -- 5t .......!f!_�.Jl!i
has been installed in accordance with the provisions of TiIiTLIE of .The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.__.._�_7.-.._70_6._._... datel___________________________.____--__-.---__-•-.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YFIE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............J.-._1. 5•......Q__?................................... Inspector.................. ......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
751./Ai ...oF.. E3r � 7 ?. � .............................
�ry ..................
Disposal Workii ITnnstrnrtio rrmit � o
Permission is hereby granted...........
� � �,!_GD /...��.�/NSt�C.//
to Construct (i� or Repair ( ) an Individual Sewa a Disposal System YY
T �. �at No.--------.4,..� .. . 07-•-r--------------------------------- ------------------ -----
Street
as shown on the application for Disposal Works Constructio emit No??_.& .___ Dated...... __ ...
- ----- ---- --- ----__-
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••-•-•• Boar of Health
DATE--- = -•-••-•.. ...............•-....._..............._
FORM 1255 HOBBS & WA REN, INC., PUBLISHERS
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LOCATION 5,.qZAvS729'BG4j (iyARsTo^!s./iic�)
SCALE . DATE
PLAN REFERENCE .4W^!G . �� /3.. .
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OF
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L'LEY
o. 26100 0
I CERTIFY THAT THE ......
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
COAL LS+L AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
WHEN CONSTRUCTED.
DATE . . . . . ... . . . .. .
REGISTERED LAND, SURVEYOR
r • v/7f�C T Z d,-- Z 5"me s
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/off,ZS
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
I •�
2.7� •" 4"CAST IRON 1PSEP�T�IC.;
MAX. 12"MAX.
OR SCHEDULE 404"SCHEDULE 40 PV.C.(ONLY)
P.V.C. PIPEPIPE- MIN. LEACH
PITCH I/4"PER. PITCH 1/4'PER.FT. PIT PRECAST
° LEACHING
NVERT INVERT PIT OR
INVERT
INVERT /03 /Q. DIST. �oz,7 WEQUIV.
EL.. BOXEL......... ' : >s io3,ZL. INVERT INVERT ki va ::a 3/4"TOI1/2'
EL.. 7.. ELlot%�tr •- W w o•
EL/0Z,3o u- v`; STONE
lip
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PROFI LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
�Z88
SOIL LOG WITNESSED BY :
DATE .. . . TIME. . ... . . . . . . T'? G • BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 sf �! SAG�C3/ ENGINEER
ELEV. �o.?•.-3. . . . ELEV. .. .. . . . . . .
c-oA�•f �
D ES I G.N DATA :
c2, 103, 3o
144n9ewl"o NUMBER OF BEDROOMS 3. . . .
30
TOTAL ESTIMATED FLOW . .3.3d . . . GALLONS/DAY
BOTTOM LEACHING AREA /-�`3�. . . SQ.FT. /PIT/C,P.D.
MErD, _
SIDE LEACHING AREA 5 SQ.FT./ PIT/34WOP-D
GARBAGE DISPOSAL .NO"� (50% AREA INCREASE)
TOTAL LEACHING AREA SQ.FT
PERCOLATION RATE l-��35. �?'! � MIN/INCH
S. ,
LEACHING AREA PER PERCOLATION RATE , 38
.. . . .7.. SQ.FT./C,P,D.
No WATER ENCOUNTERED
NUMBER OF LEACHING PITS - RT.NiTf. . .
o% STbive- On/ A44 s/DES
APPROVED . .. . . . BOARD OF HEALTH
DATE. . . . . . . . . .
AGENT OR INSPECTOR
ZN OF Mq Ar
t
o`er EDW 135
26100
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PETITIONER