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HomeMy WebLinkAbout0036 WOODCREST ROAD - Health 36 WOODCREST MARSTONS MILLS A = 030 076 - I i TOWN OF BARNSTAB E LOCATION 5 LO X—SEWAGE VILLAGE - - A 'SOR'S MAP & LOT 1*3 A','0 7t� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)t.*�- Z .(sii �' NO. OF BEDROOMS BUILDER OR OWNER 6e4;Y PERMTTDATE: 7-0071COMPLIANCE DATE: 41�r 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 leac 'ng facility) J Feet Furnished by �Y / -- /Y' owl 14 No. _7/y 0( �o s ' . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprtcation for 30fopooal *Potem Conotruction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. �� �pO 0-e�S� Owner's Name,Address and Tel.No. Assessor's Map/Parcel © - 4Zl� Ins is''N//ame,Ad�yss,and Tel.No. Designer's Name,Address and Tel.No. 6 J.5 u c p" O w c. 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 Re 'rs or Alterations(AnswerJ�'hen applica e), )Fe 4e c c ,� �� 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 provisio a vironmenta ode and not to place the system in operation until a Certifi- cate of Compliance has bee s ued by f e Signed Date_1611,20 f Application Approved by Date 6 /Z o Application Disapproved for the following reason Permit No. ��36? Date Issued 671 v 6 — r le No. + .+;:�:. M Fee S�I • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: v Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for �Disspo!ar bpgtem Conelruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � ( Oo . C e s� Owner's Name,Address and el Assessors Map/Parcel V p� 4 - 076 Installer's Name,Add s,and Tel.No. Designer's Name,Address and Tel.No. t� C 6NS)rVC1, 6,_, .1 �1�- .;o� _ �� _ 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 s` Nature of Re/n irs or Alterations(Answer hen applica e) e I A t e A c (�" c q(� / 0 $ O,uC Date last inspected: Agreement: The undersigned agreeJ 0,.ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provision k' &eironment a ode and not to place the system in operation until a Certifi- cate of Compliance has bee s ued b t oe „ Signed Date / D Application Approved by Date /Z D Application Disapproved for the following reasons Permit No. ?zy l—3G? Date Issued 6 z f ------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY t th n-site Sew a Disposal System Constructed( )Repaired (x)Upgraded( ) Abandoned( )by CO at J c r has been constructed in accordance with the prgyw itle�5 and e for D' posal Sys Construction Permit No.�/' �6 dated (7 /L a Installer /' C o J S l v c Designer The issuance oothis permit shall not be construed as a guarantee that the s ill functio. s de fkned. Date '" �� r� � / Inspect i 4 ----------- No. t,Q / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpooar *pgte Cottgtruction Permit Permission is hereby granted to Constru t( epair(�)Upgrade( )Abandon( ) System located at S 0o o ff r +r e 5 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. I Provided:Construction ust be completed within three years of the date of this t. Date: G �/�/ Approved by �� V 5/25/01 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated 6 f , concerning the property located at meets all of the following criteria: • This failed system is connected to a.residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation (using GIS information) / B) G.W. Elevation + adjustment for high G.W. _ �q 4GND CE BETWEEN A andE DATE: �� O NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:percexmp V l_ / t r _ • "f ?�' F ft .r� {J' r 1�� n ,ram ^r Z�vjY�wS �r��X �` �, ,..FsS`r�. -�,'s-.you.!fir �2�in-�.t` ,� r i'i': �'.' a. tY TOWN OF BARNSTAB E LOCATION. ., .. SEWAGE #;; &-a 1a VILLAGE ASSESSOR'S MAP:& LOT 4,3 D''D 7 k INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY - k LEACHING,FA ITY (type)�b�- 14`�3 I Py _ y] _.-.V ,{� Sal' ♦(S ' !T✓ - i�.: G r.L N0. OFBEDROOMS .. BUII.DER OR,OWNER e4 0-14' . - PERMTTpATE 7—pef'f CO - 7 ' MP LIANCE DATE 4'�.---. Separation Distance Between the, Maximum-Adjusted Groundwater Table to t'he Bottflm of Leaching Facility. Feet Pnvate Wafer Supply Well and LeachingFaciLty .(If an `wells east on site of within;200'fet of leactung facility) Edge of Wetland and Leactung Facility.(If any.wet'lands exist Feet w1thin'3:00 feet of leac ng facility) h z Feet Furnished by i ~Z.S' �� 0