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HomeMy WebLinkAbout0031 WREN LANE - Health i v 31 WREN LANE , MARSTONS MILLS \ A =`029:013 r -f 'r �TJMJt44 i Of � i cre Xj\ f t C � f 1 Zi TOWN OF BARNSTABLE 3- tse Y LOC'-yTION. I SEWAGE # 99 7 y VILLAGE } (�"` ° 1 `\S ASSESSOR'S MAP & LOT WA —0 i� P INSTALLER'S NAME&PHONE NO. L,. SEPTIC TANK CAPACITY OU-0 ' LEACHING FACILITY: (type) LI `t►�1`y►� �Y'iz' ) ''g NO. OF BEDROOMS BUILDER OR WNER �� PERMITDATE: �- �9 A ' 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 leachi cilit Feet Furnished by f 'y 'ter I'S (7 Ok • n h. ( —� r ,.r Fee kS �1 No. .r' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION o TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mizpooal *potem Cott5truction Permit ( )Repair( pg ( ) ( ) O Complete System �Individual Components Application for a Permit to Construct � rade Abandon Location Address or Lot No. 1 wv-,v'N Owner's Name,Address Tel.No. � Assessor's Map/Parcel ✓l 09 100/3 To V%_1 Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size J.3 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) ®v t S tbv.e,. pl; axe 1 S'>-ti s 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 b this Board of H alth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. 7 7 -7�q Date Issued - r ��• -.. ��� .. � , . �, �--� 29 � � 1 i� � , r � ��,.�r _ 24 �� .T., 1/6199 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 PERINUT (WITHOUT DESIGNED PLAINS) I, hereby certify that the application for disposal works construction permit signed by me dated 1—, S concerning the property located at 3 t Y"AN-1 meets all of the following criteria: • The 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. • There are no wetlands within 100 feet of the proposed septic system • 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. • The bottom of the proposed leaching facility will not be located less than five feet above the macimum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: 1 A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX. High G.W. Adjustment . DIFFERENCE BETWEEN A and B SIGNED DATE: I r`�J [Sketch proposed plan of system on back]. q:health folder.cert _ — No. / / —�_t / ;� a�' Fee THE COMMONWEALTH M SSACHUSETTS.s._ Entered in computer: ✓ Yes PUBLIC-HEALTH DIVISION=TOWN OF BARNSTABLE., MASSACHUSETTS - 2pplication-for-Miooml *p5tem Congtructio.A.. .ermit Application for a Permit to Construct( )Repair( Kgrade( )Abandon( ) ❑Complete System &1ndividual Components Location Address or Lot No,,'31 Wr-e v` Owner's Name,Address a►� Tel.No. k\j Assessor's Map/Parcel ;�- 1*0,gg 100/3 w��.rsror.S �1l Installer's Name,Address and Tel No. Designer's Name,Address and Tel.No. y y (tbyk t y N 1z e Type of Building: Dwelling No.of Bedrooms Lot Size /.3 sq.ft. Garbage Grinder( AD 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) ov e — _So0 Q e(16 � S tam 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 b this Board of Health. Signed Date Application Approved by I`_ Date i— l—°! Application Disapproved for the following reasons Permit No. — 7W Date Issued — 5 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( ✓<Upgraded( ) Abandoned( )by 0,C. Lw 9 0,s r at 31 Gj r-e h A h 2— /yt►S rms /&► // . has been constructed in ac o dance with the provisions of Title 5 and the for Disposal System Construction Permit No. —'7 dated IZ Installer . Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- No. — Fee 56 O Z _ U l 3 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Ofgpogar 6pgtem �C tructiort Permit Permission is hereby granted to Construct( )Repair( Ae pgrade( )Aba on � ( ) System located at 1 4J r-e m L e,.a e. Ala�S ran �S 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 tF rmit. Date: %i/C-��/ Approved by �� TOWN OF BARNSTABLE $3' LOCATION ai��1. is I SEWAGE # VILLAGE I�'� ``` ASSESSOR'S MAP & LOT 04n 'd i3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1, ouc LEACHING FACILITY: (type) L4 Syp g A\O"- �'5XIY 9 Y NO. OF BEDROOMS BUILDER OR CWER PERMITDATE: t i -- `39 COMPLIANCE DATE: " fig jSeparation Distance Between the: - Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 leachi cility(� Feet Furnished by b � c; le -I- lcS�.a_..... J FES._ o ............... THE:COMMONWEALTH OF MASSACHUSETTS ,r -;.--BOAR® OF HEALTH r;r ...O F. 2 ✓d ..:/ ......................... Appliration for Disposal Marks Tomitrnrfinn ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: _ .._. ....................................................... �------- ........................................... Locatio - ddress or Lot No. Address - ----------- 4y �....._..._. Installer C�Q.t.Ge Address f@E Type of Building •-� Size Lot ...................Sq. feet Dwelling—' No. of Bedrooms........ --------------------------------Expansion Attic ( ) Garbage Grinder (r10 Other—T e of BuildingNo. of ersons____________________________ Showers — Cafeterias C4Other fixtures ---------------------- ........................•------- --------------------------------------- ---•-••-----------•------------------•••----- W Design Flow............ .................gallons per person per day. Total daily flow.........:as. 52..................gallons. t4 Septic Tank—Liquid capacity/99®...gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No_ ____________________ Width_____..._...__._.__. Total Length_________._.._,____. Total leaching area....................sq. ft. x _ Seepage Pit No_____�0,� __________ Diameter.,,�< `_.__. Depth below inlet____.*._�__.__ Total leaching area,5.S7 sq. ft. Z Other Distribution ( Dosin tank ( ) '-' Percolation Test Results Performed ....._..... Y as Test Pit No. 1..... _ _minutes per inch Depth of Test Pit-_�,���'Depth to ground water-----eot.G Test Pit No. 2-___'5—_-'--_minutes per inch Depth of Test Pit__. { ` Depth to ground water____ /1'__._... Q+' --:-••••-•-----•-- ---•-------•................................................................................................. ---------- O Description of Soil..... �= I? � '0—a. ��°"� ,f--`4e,��-���1 C-=----- � .-----���� W x -•••••••-•------------------•-..__._._...--•-----•----•-----------------•------------•-•••••-•••--••---•-••••-•---------------------•--•-------------•••----•-•••-••••-•-•-----•-••••-•-•••--••-•..._.__ V Nature of Repairs or Alterations—Answer when applicable:_..__.�A.)A _____ ........................................... 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 Certificate of Com liance h E n issue y the health. - Signed-• .... .. -• •-•--------------------------------•--- 1.. ..._ Date ApplicationA oved By................... ......... ..... _ _ ___ __________________________ .... �__. _ -- c..--------- ate Application Disapproved for the following reasons--------------------------------------------------------------------------------•------------------•••.........-- Date PermitNo......................................................... Issued-....................................................... Date ' A THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ................r............O F. ..,;�'. �.� /'L_�,.i'- ...J ....---........................_ Appliration for Uiapsal Works Tomivation Permit Application is hereby'made for a Permit to Construct (`=-)or Repair ( ) an Individual Sewage Disposal System at: ............................................................................. ..............e ..---•-•--............... ...................................................... F _ Location-Address or Lot No.1 '.-bel i3�y��,,�, � �y► 1. Address a .3 +►i' r,* - ,,,a+mr�.,.wra�► --••n" _• -✓G�.......�,..�: .. �arbiiNi«e.wr� - ......--- -- ------ ---•---.. --------------------•--....----. .... .. Installer '1=7— Address _ U Type of Building Size Lot------ ..........Sq. feet Dwelling—No. of Bedrooms.......... ............................Expansion Attic ( ) Garbage Grinder (Hp Other—Type of Building No. of persons............................ Showers ) Ga YP g ---------------------------- P ( ) — Cafeteria QI Other fixtures ............-------------------•------------------------------ W Design Flow............ .................gallons per person per day. Total daily flow.......... ' -_n__.._____._._.._..gallons. WSeptic Tank—Liquid capacity,/;?oo...gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...... .......... Diameter_eer ......... Depth below inlet...:l_._` ..... Total leaching area..r_S�.sq. ft. z Other Distribution box ( `-)'`1 Dosing tank ( ) f '-' Percolation Test Results Performed by..?"'j__%--- ----- _ _ _r-_:.... .,�............. Date_.rG'��.1��-z ►-7 -, Test Pit No. 1.....�.Ls_minutes per inch Depth of Test Pit.__._...... . Depth to ground water.._..=_.... 44 Test Pit No. 2____-'--. ..minutes per inch Depth of Test Pit...:c''r'' Depth to ground water.... 1 ....... a' •--•••••--•-.._...._..-•-----•-•--•--••-•-•-••-••-•------•-••-••-••----••-•...............................•••-.................----•----••.._.......--.--•-- O Description of Soil..... �..."" --, t --5� =? - ! r'( k:fr .............................................................• -- .. �c ............ ..... ... -•----.........._ ............ W tl� ------------•---•----.....-•--------•--------••-----•-•--•-•---•--•-•-•----------------------------•---------...._...........---•------•-------------•--•-•-----•--••-------•........................•.. U Nature of Repairs or Alterations—Answer when applicable._..... llh t_!✓__.__1 �4_ , ` .......................................... •------------------------------------------•--------------...--•---------------......................................................•-•-----•---•---•-•-----••••••••••--......-••-•••.....----•----•• 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 Certificate of Compliance has-been is� the,board-of health. _. -. Signed---��•=-•••-=� ' '`-' - -�----'-�`--"--�-:..`"'�-----•--- -f-,/c'�•-•`=-•-�---- Date Application Ap oved BY................... ............ -4-----✓ --•- ---------- ---------- 'Date Application Disapproved for the following reasons-............................................................................................................. ---------------------•----------------.....---------------------------•----------....._..........--•---..._......_..•--•--•••.--••--•--••-•----•••----••-•------•--•••----•-••-•----............••...... Date PermitNo....................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w ........:.................................OF........................11.11.1...............................­1.................... Trrtiftratr of Tumpliattrr THIS IS TO CERTIFY, That the Individu ewlge Disp al System constructed ( ) or Repaired ( ) by--------------­- A' --------•-----•- .... i......... nstall �► has been installed in accordance with the provisions of TITLY, 5 of The StateSanitary Code as described in the application for Disposal Works Construction Permit No........8'X__e!�Tf............° dated................................. ............ . THE ISSUANCE OF THIS CEr-41RTIFICATE SHALL NOT BE CONST ® AS A GUARANTEE THAT THE SYSTEM WILL U CTIOW!MTISFACTORY. DATE.......JK _.._.1 ....................................................... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �3�/f,� .................OF..................................................................................... �!� No. { FEE....... --•---...... Dis jonttl Workii Tonatr mo -prulit.Permission is hereby granted.......... ----- ............. --....... ...................................................... 01, to Construct ) or Repair ( ) an Individual Sewage Disposal Syst Street as shown on the application for Disposal Works Construction Permit No._-_---_A_---______ Dated.......................................... ... ---------------------------------------------•---...._. „ Board of Health DATE..............(P 1!.- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS A`r y , a L04CAT10N /�p;,� � SEWAGE PERMIT NO. � 1 VILLAGE I N S T A LLER'S NAME & ADDRESS :,QHN Ai AALTO .BACKHOE SERVICE .F� `.":. i a nut I Street Wed Barnstable, Mass. M668 1 U I L D E R OR OWNER DA T E P ERMIT ISSUED DAT E COMPLIANCE- ISSUED (� � �- �J �;.� �� . ��� �� 9" 0Tl+ ' _ ZwIx 101 Z4 i ' 3H141 DA41 of - CD ILA I i � tt•• __ i f `t:•�µ� ;' '� --n. ter--j. — _. �._�.-�.o��.e�" �e� .��.. �,..`.. .��`, .. 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