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HomeMy WebLinkAbout0150 WALNUT STREET (M.MILLS) - Health 150 WALNUT - -- A=149-042 h�GtrSlanS 1m Z 1S Lj No. !/s Z' Fee "-llZl THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for �Digogal *p5tem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade(VIAbandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �- �/ Owner's Name,Address and Tel.No. l SU ��/ice nT 57' �yl�t o�3 /�'/�1�s ri'& 4_3 Assessor's Map/Parcel 141 1.5-0 W-41A,"/iS/- Installer's Name-Address,and Tel.No. Designer's /Name,Address andTel.No. Type of Building: Dwelling No.of Bedrooms 41 Lot Size '9 ODfJ sq.ft. Garbage Grinder( ) Other Type of Building No. of Perso s 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 M erations(Answer when applicable) 11*c P lava S ct e••C r fs 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(2z� of He Signed Date Application Approved b Date zj!j�- Application Disapproved for the following reasons Permit No. Date Issued °' No. ��i/ " / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Mi-qpoe;ar bp!6tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(v)Abandon( ) El Complete System El Individual Components Location Address or Lot No. / Owner's N e,Addr ss and Tel.No. /SU w,/H�,T 57 A4y�f7•+s 1s 70 .h Ra Assessor's Map/Parcel 9r . �SU W.41h H f S� I/"S. '`-g , /I�//ws Installer's Name,Address,and Tel.No. �;T Designer's Name,Address and Tel.No. , Type of Building: Dwelling No.of Bedrooms 14/ Lot Size y 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 gr4 v t 4 sa„ Nature of Repairs or Al erations(Answer when applicable) /� 1G /Uao S f q �e.�t i;"5 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 is o d of Heafth. a Signed Date Application Approved by Date �� 7- Application Disapproved for the following reasons Permit No. Date Issued R THE COMMONWEALTH OF MASSACHUSETTS f BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded O" Abandoned( )b at A 1, V4,°`f- . - e, 4-(, _ 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 11 .. J -12— 19 Inspector Q �� THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwi!5pogaf *pgte m C on.5truction Permit Permission is hereby granted to Construct( )Repair( .Upgrade(7 )Aban ( ) System located at- _ ,45--13 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 thiwSIPInit. Date: '�' '' Approved) ��i1 �� " f f 3 4 ) i 1 ' 3 36 27d„ -W6 It TOWN OF BARNSTABLE LOCATION 1S7 SEWAGE # 99v 74 y VILLAGE /Y/ri t ��'��/S ASSESSOR'S MAP& LOT y2 INSTALLER'S NAME&PHONE NO. 70/-I 1? 19 SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) ;;�1,07f-4 D NO.OF BEDROOMS BUILDER OR OWNER Jo4, a Z2- Ro PERMrrDATE:-//-1` — 96 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 facility) Feet Furnished by TfTOWN OF BARNS T ABLE 'LOCATION T!&7 ��/� �Sl SEWAGE# `�3 9v 70�/ { VILLAGE /Y//,0yS(/o'4 s /Y�i Ids ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 101 P? 19 /7� SEPTIC TANK CAPACITY ��OO i e :LEACHING FACIL=: (type) ft-ehe4 NO.OF BEDROOMS BUILDER OR OWNER J04-7_7d PERMIT DATE: //-',— 96 COMPLIANCE DATE: 99 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Rr� � O d 22 9 3� � 27d„ 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) 9a l7 , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at /5-0 All, meets all of the 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=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) 711— B)Observed Groundwater Table Elevation(according to Health Division well map) 37, SIGNED : DATE: LICENSE 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 apnL 1 � LOC 7 V L//►�AT ION/ S E PERMIT NO. s �® VILLAGE INSTA LLElti NAME & ADDRESS B U PL D E R OR (OWNE,/, Al E DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 7 r CO05 �05� 0 00 xe� ,R. ti Fim THE COMMONWEALTH OF MASSACHUSETTS IBOARD Or F HEALTH .-------*OF....._./0 " ..�✓ ........................... Apphration -fur Uinpnsal Works Tonntrnrtinn Vrrntit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage`Disposal System at: r. ..................................................... ......... . L tion-Add- OF or Lot No. / f W �y�•-0-----IK i.. .. ...................................... /�G, V ---- -------•---------•--•--•----• '-----dress ......-----.....---•---- b7 Owner ---------------------------------------------------- ---- -------------- .......oe-�--- -- ......................... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.--_.-------.--..-.-----. -. Showers ( ) — Cafeteria ( ) aOther fixtures ------------------------------------------------------ W Design Flow............................................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./J-0.&....... Diameter.................... Depth below inlet.................... Total leaching area------------.-----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.............. ........................................................... Date---------------.----------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit.--...........--.... Depth to ground water...--...------....--.... f=, Test Pit No. 2................minutes per inch Depth of Test Pit.....--............. Depth to ground water--------------------_-- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ODescription of Soil.................................................................................................................................*------------------------------------- x W x ----------------------- U Nature of Repairs or Alterations—Answer when applicable.. �t. _---.--_Z.. 1.Q49-0--lYI-,--.-----.. 17 �> �'�/�rT ---------------------------------------------------------------------------------------------------------- greement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The and rsigned further agrees not to place the system in operation until a Certificate of Compliance has n ' ed b th o�rd of health. 77. Si ed- ------------------------ --� . Application Approved By._.!-! L —�?�� -e 7 .................................. --•---•.. ......Date Application Disapproved for the following reasons----------------•----------......---------------•------...------------------.....--------------------------•'•--- ----------------------------------------------------------------------------------------------------•----------------------------------------...--------------------------------------------..-..------- Permtt No. !-z� _79 -'-•`•----•----•-a.t.e.. ---•-- Date No.........................�iC' Fln$............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 ......OF...... 1� L ............ ............ Appliration -fur Elie uottl_� urku Tonfitrurtiou V rrntit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: �✓ /��,/ (Lo do •Add res or Lot No.- - * "dress _.�---- -•- -'`••--•--_..-••--•---__.___'_____'_---•-- ... ........................................••-------•-......----__.___.._--•'____._. `4 Owner d Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building __________________________•- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------ 'e _________________________________________________________ ________________________________________________________ __* W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 17 9 Septic Tank—Liquid capacity------------gallons Length---------------- Width-----........... Diameter................ Depth.-----.-.--_-- W Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area:_=..__-_.-..__-_--•Sq. ft. x 3 ,Seepage Pit No./�.#j....... Diameter____________________ Depth below inlet.................... Total leaching area__...._._..___-_-Sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-- p---------- ------•---------------------------------- ----•- Date-------------------:------------------ a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water___..._._--.---.-_.----- (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----------.___----_-._. Ix -•----------------- -----------------------------------•------------------------•--........-----......................................................... ODescription of Soil---------------------------------------------------------------•--•-------------------------------------.-----••-•-•-•----------.-.-------------•---------------------- V -------------------------------------------------------------------------•-•-••••••--------------------•••-•-------•••-•••••---.....__.......-----•--------••-----•-------------- ------------------ -- •--------------------------•-----------------------------------------------•---------------------------------- • ------------------•---- r"o----•------ U Nature of Repairs or Alterations—Answer when applicable.-. I f ____.___." _ _(a......� l._,'S--------. ��----A&.X-1f:r,1+�/C�------ . y"�'"��`-••---•-••----•-----------------------------------•-•------------••----•-•-----.---------- ------------------ greement: 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 and rsigned further agrees not to place the system in operation until a Certificate of Compliance has n ' ed th rd of health. ... ..........��. IIate Application Approved By..-_' - - - -•-------------- .?­ -7 Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- .......... ------------------------------------------- ---------=---•-------••-••-••--••-•-•---•-------••..-------------------------------•-•----••-----.........._._..........._.....---------------•... Date Permit No--------_--------------- ................................. Issued.. Date THE-COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , r •t,/..........OF:,: . .:f........................... �rrtif irafle of f�umphattrr THI IS C " FY, That the Individual Sewage posal System constructed ( ) or Repaired b ,, / ..._,.. �t�s---��----------- "' / - ,i y...._... .__. In Il r ------ has'been installed in accordance with the provisions of _< XI of The State Sanitary Code as described in the application for,,Disposal Works Construction Permit No.___-_.-___-G�-_0__6� ..__..__.... dated__._--?`--;Al---_"_7____-_-_•-•- THE ISSUlTNCE OF THIS CERTIFICATE SHALL NOT BE .,CONSTRUED AS A GUARANTEE THAT THE -SYSTEM WILL FUNCTION SATISFACTORY. fDATE------------ ................... .7•--------••-'•-•-----•----•-•-- Inspector ••... .............................. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. ©!�`. ......... .....of....... '� � ........................ FEE ►'�` .._. Dilivooa notrurtiorl":, remit Permission is hereby gran te -•--- - i1 " --- -P " --------------------- ...................................................................... to Construct ) or Repair (� an Individual Sewage Disposal System at No..../ ------ ------- ± ------------------------...----------------------------------------------------- ------------------------------ Street ����� '>+}r as shown on the application for Disposal Works Construction Per No.____._ f_ ._.J__, (ated-----________________________/_____._.._._ ' t✓/iF �- . iZ - t / _ - Board of Health DATE---•' ------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "'h -