HomeMy WebLinkAbout0031 TIMBER LANE - Health 31 TIMBER LANE, MARSTONS MILLS - r
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C-. TOWNQ F-84ARNSTABLE
LOCATION ( 6P/� G`-/4�t SEWAGE # ��- �d g
VILLAGE � �� ASSESSOR'S MAP & LOT / L
INSTALLER'S NAME&PHONE NO. /Z1 P0
' -
SEPTIC TANK CAPACITY O
LEACHING FACILITY: (type) Aa (06Q <>A-1 (size) '
NO.OF BEDROOMS__
BUILDER OR OWNER fa,A 13e1
PERMIT DATE: 0 I - �� COMPLIANCE DATE: 10 P Lf
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
203
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clo c,
L
ASSESSORS MAP y v
l No. FnRCEL NO, _ 0 b Fee 0 l✓
THE COMMONWEALTH OF MASSACHUSETTV//�� Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Zipplication for Di.5pont stem Con.5truction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components
Location Addrec"r Lot Owner's N e,Address and Te.N Z
Assessor's Map/Parcel ;fin d4, 1_-
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
.� P 12o t ►I°U
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)
4'
Date last inspected:
Agreement:
The undersigned agrees to ensure onLarof
n and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of itle 5 o ironmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this B eal
Signed Date
Application Approved by Date rC y
Application Disapproved for the following reasons
Permit No. < Date Issued �����
SO
c 1� No. 94! Fee
THE COMMONWEALTH OF MASSACHUSETT Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
ZIpprication for Migooaf 6p.5tem Construction Permit
Application for a Permit to Construct( )Repair( ; )Upgrade( )Abandon( ) 0 Complete System El Individual Components
Location Ad ,Ar Lot Owner's Narpe,Address and Tel.No.
Assessor's Map/Parce
M' f {
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. j
.� P ik v/j r A) /r }(
Type of Building: }
i
Dwelling No.of Bedrooms rl Lot Size sq. ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 1
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
i
Size of Septic Tank Type of S.A.S.
Description of Soil pX
4y}J
Nature of Repairs or Alterations(Answer when applicable)
�� �*
Date last inspected: -
Agreement:
The undersigned agrees to ensur�jhe construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of rttle 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this B ar of Heal
Signed Date U-
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued �//.5�"l1�
THE COMMONWEALTH OF MASSACHUSETTS j
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site,Sewage Disposal System Constructed( )Repaired( graded( )
Abandoned( )by #0 &4 t l/
at o has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. �► dated /.0- 4/— l
Installer � Designer
The issuance of this permit shall not be construed as a guarantee that the system will f . ctio a esigned.
Date y//9 Inspector
Gr
—— —�I———————————————————————————————
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION'- BARNSTABLES MASSACHUSETTS
lwigozal *pgtem Construction Permit
Permission is hereby granted to Construf t( )Repair( 4_)-tTpgrade( )Abandon( )
System located at �i AI b-ex 4=4 sll j/A
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 it.
Date: Approved br-,,n—
-,
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LOCATION SEWAGE PERMIT NO•
VILLAGE
INSTALLER'S NAME i ADDRESS
5
ILDER OR 0 ER
DATE PERMIT ISSUED L-7
DATE COMPLIANCE ISSUED ����
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No.
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Applirotion -for Dispoal 39orkli (1ojifftWioo jJermit
Application is hereby"made for a Permit to Construct (1,,)/or Repair { } an Individual Sewage Disposal
System at:
..... .�._ - -.....�..�_.._._ ....�....� ............... ._.. ..n......,........�...,....��_�
/ wnerr / Address
w �.,, ........... ................
.............. ........................................-- - .....................................
1.4 Installer Address e3�
Type of Building Size Lot2J.. ..__. ._._.Sq. feet
Dwelling—No. of Bedrooms........��..............................Expansion Attic ( j Garbage Grinder ( )
... Showers — Cafeteria )
`a Other—T of Building �'�......- No. of persons._._-�.............. ( )
Ga Type g .........--••-•-----
Q' Other fixtures
WDesign Flow............. :-._..... _ ..... .gallons per person per day. Total daily flow-------.-A P................••..gallons.
WSeptic 'Tank—Liquid caliacitv100.gallons Length.,A..... Wi&114s .-C.... Diameter................ Depth..l .74 .........
x Disposal Trench—No..................._. Widt1-LA2...........Total Length_..t..._.........Total leaching area_- 'd.'-sq. it.
Seepage Pit No....../.......... Diameter.................... Depth below inlet........_.......... Total'leaching area..................sq. it.
z Other Distribution box ( } Dosing tank ( )
Percolation Test Results Performed �. 1r+. ....-f `Ss Date. �, Zc1 $ --•-•-
aa Test Pit No. L Wiz-.minutes per inch Depth of 'rest Pit.../Z..__... Depth to ground water.../�_�...�..
tz Test Pit No. 2................minutes per inch Depth of Test Pit................... Depth to ground water........................
O ......................'....................................
0. . ' ,_ ?.1.3G..._............................................................_......•---..
Description of 5oil...t�.... . .. ....... .. .......y.�.......
.... - ..-.. '. .. / ..�� /0... .:5,n .1c .................................-_---
� _.......................• ,. 1-may��... ... -----
w ......................................................................................................... .................................................
_.....
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with j
the provisions of Article XI of the State Sanitary Code— undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ' ued b he board%P
Signed. ...............
Date
Application Approved 13 !:A_ .._. _ -• -•--•---•-•-•-----...... ....._...I....--- a-te.........
PP PP Y--.......... •ease
Application Disapproved for the following reasons:............................................................................................
..............................................................................--•-•--•-•-•--•-----•------•--••---•----•----•---•---•------...--------•--------...---•------••-------•-••-•---........
Date
PermitNo.................................._..._................ Issued.......................................................
Date
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................I....................I................................
Apphration-for 43hipasal Works Tantitrurthin Vernfit
Application is hereby made for a Permit to Construct (tor Repair ( ) an Individual Sewage Disposal
System at: 7-
.......... moo
... . .............................................................................................
L anon•A dress or Lot Na
.IV A---------------------------
ner Address
wa .......... ......... . . ........... .... ............. ..................................................................................
Installer Address
Type of Building Size LotZ%2O5_Sq. feet
Dwelling—No. of Bedrooms .. ..... ..............................Expansion Attic Garbage Grinder
Other—Type of Building --- ....... No. of persons.....6:......... Showers Cafeteria
Other fixtures ....._.........................
........................
Design Flow ...................gallons per person per day. Total dailv flow...........2.....................gallorl'.
Septic Tank—Liquid capaciv/ !q-gallons Length?...;.....Width-57.:�_.. Diameter.......-......Dejnll__,�--------
Disposal Trench—No.....................Width-/ ...........Total Length...A.............Total leaching ft.
Seepage Pit No....../.......... Diameter.................... Depth below inlet....................Total leaching area..............--..sq. it.
Z Other Distribution box D;L'n tank s )
-FSOC, b/z Percolation Test Results Performed .................. ............. Dat,-.:/: .......?/
Test Pit No. 1.�!!n.minutes per inch Depth of Test Pit-.. Depth to ground water ..............
I� Test Pit No. 2................minutes per inch Depth of Test Pit....................Depth to ground water................__..._..
M 'i-------**...........* *....*............*.............------------- ------------------ .........................*................
0 Description of 3 G -7-0,0 ;'Z V6
.................................................... .............................................................................
................................ '..n. A V
.... . ...................................................................................................................................
.................................... ...................................................................................................................................................
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 Article XI 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...................................1/1-----I---I--------------- ............ .... ..................
Al Date
ApplicationApproved By.................. ................... -------........I............... ...................__ ..-
Date
Application Disapproved for the following reasons:................................................................................................_..............
............................................................................................................................I...................................................................
Date
PermitNo........................................................ Issued.............--................-........... -----------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... ..... 701.".../.. ................
Tatifiratr of (9nmVIlaurr
THIS IS TO C TEh�_ao Irrd' l Sew e Disposal System constructed (Vor Repaired
... . . .........
by.................................................... ....... ... . ................. .........................................................
at
i
at...........................2!�......... ...................................................................................................................................
has been installed in accordance with'h the provisions of Articl�f�xbvstnte Sanitary Code as described in the
application for Disposal Works Cofistruction Permit No....................................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............................. ................ inspector......... ..........................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
A
1040 .1
No... ........... ....................
FEE..........._...........
Dispolial 1904ts W,notr&fivit rprutit
;
Permissionis hereby granted...... -----_e............................... ...................................................................
to Construct ( )Lojlepair ( )-an-IndiVidual Sewagt Disposal -stem,
.at No.....................A,........................................................I.............. ........................................I....................................
Street
as sh6wn on the application for Disposal Works Construction Permit N79.......... ...... a d.........................................
....... .........................................................
Board of Health
. ........................
DATE.....................
FORM 1255 14OBBS& WARREN. INC.. PUBLISHERS
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SAN (TARY 'Di S'PO.S'AL SYSTEM `:
NOT. TO`:. SCAIE .D.ESIG:.N DATA
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BE.DROO,MS /
C. -RUCT.I0N O'F SANITARY DISPOSAL DESIGN FLOW 33a GAL/DAY
'. .SYSTEM -_SH`A:L.L. CONFORM 'T:O• MASS .`, LE .LZ
AC`H RATE M'IN�IN.
ENV1� ON MENTAL` GO:DE TITLE=Q P,ROP'OSED .C;:EACH. CAP`ACIT Y
A,N Dr;THE T.Q.WN OF 4XQeWS J /1I°Gt SOs�
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t :H.EALTH 'REGU.LATI0NS
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REF",ERE.NCEzS-/j,/ La7s/ qS s'N/' n/ pX/
.orio.J:eEc42C3EG7-:.0"97 Q•Cra✓ST 11— PEes/sT/'�J
DATE AGENT
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is .. �,xavaea ,J j MO(NAHAN, .lR d ASSOCIATES 4- '-
!t!° Y E' ' REGISTE tED LAND SURVEYORS BENGINEERS - yDI
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f z> f .651' MAfN STREET ✓DE:NNISPORT� MASS 02l`8�9 tFjO!7 _,:/ ,L_ ; }?
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