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HomeMy WebLinkAbout0029 YAWL ROAD - Health 29 YAWL,&C,�_j �� �vtiv� A=098-034 TOWN OF BARNSTABLEr LOCATION � Y� 9 SEWAGE # � VII,Tom,^„GE L _ MA4V � /9NILESSOR'S MAP & LOT D 9e- C-3 tJ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY r LEACHING FACILITY: (type) (size) � I 'r NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 7 17 '< -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 L- � 9 It d Jo, �� `� No. �U L `� -.'"`:' Fee v " �— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Mi-4poof 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade 91j Abandon( ) O Complete System El Individual Components Location Address or Lot No. aq� f(4w L 0 sr, Owner's Name,Address and Tel.No. Assessor's Map/Parcel D 2 'A Installer's Name,Address,and Tel.No. c Designer's Name,Address and Tel.No. A 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 330 gallons per day. Calculated daily flow _3149 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank \Q21D Type of S.A.S. tS�j ,� Ca ���[Ali 11 Description of Soil S � Nature of Repairs or Alterations(A saver when applicable) -�--VWS T't9—`� 0 Q— Q C7 OU`Q t C-a, C(-I - S �.TT-' Ik 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 bee ' RR Signed Date 7- 7 'gV Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION 1 SEWAGE # 0_ VILLAGE (27ef,: /i-. ASSESSOR'S MAP & LOT-!;! il3 y INSTALLER'S NAME&PHONE NO. (Ifir, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) y x 8 ' NO. OF BEDROOMS �J j BUILDER OR OWNER �pp r- ,•.rrJ.yoo PERMTTDATE: 7-` 1 -1 _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 v + —lB 4 sl _ Z L. l41 1'ZJ`i -ZQ 'mot --- --- i No. �" 1 c = � Fee . '"'" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:1. Yes PUBLIC HEALTH DIVISION -TO�iWN OF BARNSTABLE., MASSACHUSETTS Application for Migaal *p5tem Construction Permit Application for a Permit to Constructs( )Repair( )Upgrade 9**�Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.C-9L-al � P,Lk)(, (7 ST, Owner's Name,Address and Tel.No. Assessor's Map/Parcel $-D3 Ins ler's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Pei Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 U gallons per day. Calculated daily flow -31-A l gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ���S� ':� \MI Type of S.A.S. (X 0 Description of Soil -,._,Nature of Repairs or Alterations(` pswer when applicable) -�- �`' ' O o Q v r o ov2 �-V c t`1 L S I��C q, , CO ?s Uj Wanj v,) ',-5'1 10-T-- - f t f V 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 besm4gsued-by Signed Date 7-a "g� Application Approved by _.t� - Date '7 2 7-9d;- Application Disapproved for the following reasons Permit No. 9 F-1117V Y�Date Issued 7- Z 7 I ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS I� Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded X) Abandoned( )by .1 IA S-e T at aL e1 y P,W� to�f - ©ST ii ay\Ive has been constructed in accor ce with the provisions of Title 5 and the for Disposal System Construction Permit No. 9�"y� dated 7- Z 7-� . Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- C, No. / Fee i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS Migozar *p!tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade andon( ) System located at -�.C-, 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 rmit.�"' Date: 7 r Z 7 Approved by C - � NOTICE: This Form Is To Be Used For the Repair.Of Failed Septic Systems Only. r CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT ENGINEERED PLANS) 1, ds hereby certify that the application for disposel works I construction permit signed by me dated contxrnirtg the - 7 t pt+opetty located a< 0s7C t`G meets en of the fo11 ng criteria: t >: There ere ne wetlands located within 100 feet of die proposed hstclting fktiity ` j'here Are to privets welb wHhM 130 feet of the proposed septk system There b no Inoree a in flow and/or dense in an proposed u are no valances wed or needed. If the proposed Wing fkflky will be located within 230 feet of any wetlands,the bottom of the IN oposed leaching fYeilitx will tart be locetedless then fourteen(14)feet above the maximum adjusted wowWwato table elevetkwL Please eons lets the h1lowle . A)?*o10row Llevetloe(s000rding to the Ensineer1 x Divislon O.I.S.map) B)Observed Oroundwater'hbk Elevation(according to Health Divhton well map) j j SIGNED: `✓ DATE: LICENSED SEPTIC SYSTEM PWALLER IN THE TOWN OR BARNSTABLE NUMBER_ 7 J tAeleeb a ek fth plea Ofdw propmd a OW&Ain 1fdo lkwand hMwtiw i dab plan*MM be submitted). pa«s..a eerrlAed plea plan. `} «AN1di A�11rr:eeR H LO CAT 1 SEWAGE PERMIT 0. 7 Z . � sa VILLAGE /wl/ INST °LLER'S NA E i ADDRESS , BUILDER OR OWNER � - v71 DATE PERMIT ISSUED _ DATE COMPLIANCE ISSUED \ l'J dv f P f r No........ Fizz.... .. .... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH Appfiratiun for R_gpvutt1 Works Tunitrnsttun rruttt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal at: S................stem ._.... 00 . .. . .............................. ------......-•-- --- ...._._............_.............------•. T ---___..- Locati....Address� .... .t No. . . -- '�'`3 j ...............•...... O er _ - AcjH}ess •-- .... .------•. ....... ............. ------------------•-• ---- .._....---------•--•...... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms- ----- .Expansion ttic ( ) Garbage Grinder ( ) 0--her—Type of Building / � No. of persons Showers ( ) — Cafeteria ( ) Pa Other fixtures ------------------------------- - - - - -- W Design Flow........... s?.....................gallons per person per day. Total daily flow_..........................................gallons. WSeptic Tank—Liquid capacityM gallons Lengthy..'.4•-'Width__________ ____ Diameter__.___ Depth x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----_------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b�y1 �_ ... Date. ' - ' ........... Test 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........................ ��_,,!�2 --•------------------------ ................. -------- •--.....----.-...----- --- -.---• -•---••------•------••-•--•-••-•------.-------- ODescription of �Yrt�-��c e �----------------•----------------------------------------------- x T U -------------- •--------------------------- •--•-----------•--•------..._...._............... •---------------------• ....... -.............................................................. W --•----•••---------••--•••---•----•-•-•---•--•--------•--------•--------•-------•...••-•---•.....•--------•-•-------•:•--•-----•----•----------•-----------•-----•----•------•--•-•-•---.....••-••------ UNature 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 iT LL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d by th ar of hea th. Signe . ................ .......................... Date Application Approved By•--•••--- ✓' - ----------------- Date Application Disapproved for the following reasons:................................................................................................................ .................•-••------•--•--•--------------......_....-----._--_._.......•-----••---------------------•••••----••----•--•-------------•----•••------------•---------------••-------•-•--•.......... Date PermitNo......................................................... Issued-....................................................... Date L L' .`.«.....« Fxs'...'"..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...----.....7�,—.?.J....OF...... .. ...................... Appliration for Bi_qpnsttl Works Tnnstrndion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _..««. � Location Address y� or-4,ot No. ......�.......f............� •:....?.( t/ ................................... ....1.�//G`. .✓J-_a'tR;......��== ^�_........................ O ner J Address ......................=. !^i!f( 1...._. ...:._ ' J ' -•-•• ----------Installer Address i Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.•_.___.____ ..1..... Expansion Attic ( ) Garbage Grinder ( ) Other—Type Te of Building /� —YL- � No. of ersons......... .............. Showers — Cafeteria J 04 Other fixtures WW -- ----------- -----•............••----•----•..._......................••.•......•--•••••............ -•••----•---•..... Design Flow.......... ......_.,-,.-.,.,-_._.gallons per person per day. Total yflow...• �3U _....__.._._..__d ons.--•----.__••-_ es4 Septic Tank—Liquid ca acit &U_agIlons L gthh..- "Width-_--__ ... Diameter-------fDepth.__ --••---•--- Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area..F---------------- i sq. ft. x Seepage Pit No..................... Diameter.................... Depth below nlet..........._...._... Total leaching area................:.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) • -1 '-' Percolation Test Results Performed by'21!�'?�_-:?:J-. t-� ':- ?:?�'�—� Date...............:. aTest Pit No. 1...r7.........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........................ A4 -----•••.• .................................................---•----••............................................... O Description of Soil__?_'�? . ----- x - f.. ...______.. -----------------------•---•---•------------------------•-------•-•••-----------------------••----------------------......--••--.......---•----------•-------------- V ---------•---•----------•-••-•--- 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 TITI:; 5 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....................•-------•------•--...........-------------•--•-•--•............... .................................. f Date Application Approved By.......... ;_. �..�, .3 z__. .......................•--•- -------------- Date Application Disapproved for the following reasons:................................................................................................................ ----••---•••------•-••-•••--•-•---•--••-•-••-•---••-•••-•••-•--••-------••-------•-•••---•--•---•••------••--•--•-----••-------•--•---••-•••---•-•------------•--•-••••••-•••-•-...----•--•--••-------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................../ -- �: �rrifir�t of Tuntlinrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ---........ . ._.....=........ '..----••---..r......-�_.....------•-•-•-------------------•----•-•--............---..........................---...... ---. 9 -� Installer 1 at ^.'.=r j '� = - --------,--a={......................?!< �- � �,, ,- f /�7' `/=� •---•------------------------- -°= has been installed in accordance with the provisions of TI i I 5 of Th State Sanitary Code as described in the application for Disposal Works Construction Permit No...........15_L-_�1...7.......... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................•--•----.......--•---............---••--•.........---•-- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....�. . !-'.'.*.. :' .....OF.. = .. .�...:L.-. . / sw. /..................... No......................... FEE.. ............. Disposal Workii 01nns#r ion rrntit _ . Permission is hereby granted.......... ...................... ........................................... to Construct ( ) or Rep/air ( ) an Individual Sewage Disposal System y/ - at No. n_!�. ,�� i_.` / Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ---------------------------------------- a lth DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS _ ____ TF .,tea,n, :::, - • . .. ,; - l I Al..l. E.L \/ S py./►J Ae-Vt MEAoJ SEA t; ------- Itu— .SelD c):.'i U• .C. G.5 . C�,ecr�►�1 C�1.�.,.1 E P I TC-W A.L_L_ I...I{J E S 01= vt>,,/v, --rr •• •� p ( � � � � � A LL Pt PE 5 To t fJ TN•�. 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