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HomeMy WebLinkAbout0042 YAWL ROAD - Health 42 Yawl..Road' Marstons Mills A = 098 :036 TOWN OF BARNSTABLE � T� AN 7 Z l� � k/� 2,e Z Z� SEWAGE # 01 VILLAGE /Y1 l ASSESSOR'S MAP& LOTD l`: -a INSTALLER'S NAME&PHONE NO. 60o- ZOe1 OAA/ SEPTIC TANK CAPACITY Zace e", LEACHING.FACILITY: (type) Ted 6,711 eA9,yi--J (d� (size) /m X 30�Xa2 NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE:—r l®��l Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility C;�- Feet Private Water Supply Well and Leaching Facility (If any wells.exist on site or within 200 feet of leaching facility) 41119 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by C t °6. a tr .y • � � � gyp' 4�, 90' No. �v ' Fee Entered in computer: , s THE COMMONWEALTH OF MASSACHUSETTS`1 � Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for Migooal *pgtem Congtructfon Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System 26ndividual Components Location Address or Lot No. � Owner's Name,Address and Tel No. Assessor's MapRarcel -/� M 4^1 U Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: a Dwelling No.of Bedrooms ✓ Lot Size sq.ft. Garbage Grinder Other Type of Building c " No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33!/ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank (� Alf Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ,,4 `L'- °a /� 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 his o of Health. �/1V /Signed Date ` Application Approved by Date Y-lr 0 1 Application Disapproved for the following reasons III Permit No. ZOv (-2Z Date Issued - TOWN OF BARNSTABI:E �� VILLAGE ASSESSOR'S MAP & LOTO INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) f-cV L4 1-1-&j � (size) /v X-TO NO.OF BEDROOMS ,Go 1,7 1L h BU --- OR OWNER • i v f PERMITDATE: ��l�� L�/ COMPLIANCE DATE: Separation Distance Between the: um AdjustedGroundwater Table an B f Feet Maximum � . d Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /v �i Feet Edge of Wetland and Leaching Facility(If any wetlands exist,. within 300.feet of leaching facility) Feet Furnished byS�r .. .'. �t 17 hr h K3.6 iS b t� No. s Z Fee ram.�, c� ' THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricatiou for Mizpoal *p!tem Cott.5truction Permit Application fora Permit to Construct( )Repair(V)Upgrade( )Abandon( ) O Complete System Andividual Components Location Address or Lot No. ��� —`/ wner's Name,Address pnd Tel.No. Assessor'sMap/Pazcel Installer's Name,Address,and Tel.No. T Designer's Name,Address and Tel.No. r tolo/6 C��y Type of Building: t Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(-1(4 Other Type of Building 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated;daily flow 33//�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank INZ's ;�O 1 51 1 5 1//7�7 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) x-J// e :t 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 this Boardiof Hf alth. Signed 'ems Date fQ Application Approved by Date Lf-/001'0 1 Application Disapproved for the following reasons Permit No. -Uy 279 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CER Y, that the On-site S wage Disposal System Constructed( )Repaired ( graded ( ) Abandoned( )by ' Obl S at D'Gr W? Y �57�1 l//, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z&V 1-2 Z9 dated q-/,F`O, Installer Designer The issuance of thi_tym&tn not be construed as a guarantee that the sys!Wt' l functae design Date / Inspector --------------------------------------- No. d/— Z 9 Q / f ® 3�ra (� l Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi6pooal *pztem Construction Permit Permission is hereby granted to Co struct( )Repair( Y Upgrade(_ Abandon System located at y 7 O*/ IAJ:�fj 1,15 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:Constru7/,�, ;/o Approved by n must be completed within three years of the date of this it. Date: y r 2� n17 th c I I r I I ; x f r j , f DLS!CN/A P? CA i ON-;Z Or B DROOMS=, dcsi=�6_zD'—� s E .DwALL: I-1 �® X wide ao. sides I .a_� widti X.ao. sides J1QewaII'arm ® , BO'T olv - =total a:to vhq 7% _ l P dcsigne (appu.:�on r:;e) _aIlo�sJd�y y 30 _ yLl NOTICE: This Form Is To Be Used For the Repair Of Famed' Sep-tic Systems.Only: - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) JL12 �°✓�� �D�rD� � hereby certify that the application for disposal works Construction permit signed by me dated �l/6�i�/ concerning the Property located.,at yZ Y ,�/ D�y��r✓�/�� meets all of the following criteria:. �/ i ne failed system s connected to a resid=acal dwelling oniv. mere are no cotnnercai or bu:ness uses associated with the dwe+ •ng. i ae;oil.is c!zssiLea as CLASS I and:he=-oiation mte is its Lhan or eqL W :o_5 !=pules per nc:L /ne:m are no are lanes within I00 i e are no nrvale wP�_n 5 h1 IlT.I1.t_e_t�._of: e:,ropeosed se tic:.stem Ihe ds��tic sva o m.c r 4_2e^:-'e is"10 inc.-;se in flow and/or change in-use xoposed. 1 ne:e are no vaances.=ueTtd or nmde-+ The bottom of the proposed ieachin; a Iry viU.not be located less ;'ran five feet above the Mn—amunl adristd,,—poundwater table elc ration. (Adjust the -oundwaten tabie.isin;the Frimptor f/method when applicable]. if-the S As S. will be located with=50 feet of Inv veptated w -e:1and_, the Doran of the propose: leaching facility will not be located less than fourteen(1 ) loot above the rta-amum adnst ;routndaater table elevation, - ed Please complete the foilowing: A) Top of Ground Smface Elevation(using GIS information) 6 d 3) G.-W.Elevation —the MAX rit = Z gh G.W. AdJustment, D rc C BAN A and B 3 1 SIGNED : ' DAM / 1-511 (Skelrh PaPosed p12n of system on mil. T.6elm hider:eat lio� :L . TON IAI'Z- ,SEWAGE PERMIT �O- J VILLA 4 E WA 4 INS- TA LER'S NAME i ADDRESS e U I L D E R OR OWNER ::L6 -4��W,9 DATE PERMIT ISSUED �Lo DATE COMPLIANCE ISSUED -- �' PIT'. ° A I-M , � s 4 r J - • _ No.. /..=. 3 ... Fis :..............._ TH'E"(CQMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .Apure#ion for Uiipooa1 Worko Tomilrnrtion rprmit > Application is hereby m de fora Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... _.....1 ......- ;9 -`ecd.j �! . . .... !�L ........................................... Location-Address Lot No ...................... .....may r. Own Address . ........ ^.................................. ........ ................................ Installer Address Type of Building Size Lot.... Y-Sq. feet Dwelling—No. of Bedrooms__..... ............................Expansion Attic ( ) Garbage Grinder ( ) 114 Other—Type of Building .._ No. of persons__________6______________ Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------- -------------------- ----- 94 W Design Flow............ ............................gallons per person per day. Total daily flow__._.....itX .Q....................gallons. 04 Septic Tank—Liquid ca.pacityAW._..gallons Length.L-�..l..-'. Width__.a ....... Diameter________________ Depths-.. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-__% ......sq. ft. 3 Seepage Pit No----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to ( ) 0-4 Percolation Test Results Performed ..--•---C�� �?.. �.-----. Date-----VZ�� ............. aTest Pit No. Lam-.........minutes per inch Depth of Test Pit..., _........... Depth to ground water... Li, Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water........................ Description of Soil.. ...... �,1 y----•-•------ 1-e! �i�- ----- ------------...... -.... -------- V -----------------------••-•---------------•-------------------..........------------...............--------------------•---------------•-------•-------......---------------------••------.....-------- 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 TJI'i TLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued W the boa of h�lth. Signe ... ......................-........................................ /D.te Application Approved By----.----. ------------------------ Date Application Disapproved for the following reasons:............................................................................................................... ........--•--•----------------------------------------------•---.........•-••--------------•----------....---------------------------------------•--------.............................................. Date PermitNo......................................................... Issued....................................................... Date No.. .fr... ... FEE`'' .../.......... THE'`COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -v...............................O F Appliration for Disposal Works Tontrurtion Prrutit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ,PS;..Duerr l s / Location-Address r Lot No._ �j� Owner Address -�--••----------------•--` •------"Instal ler.............-•-•----.................-- -------•-----------..................._ Address Type of Building Size Lot... feet Dwelling—No. of Bedrooms .....�-'..............................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Buildingf `._. .. No. of persons.........r............... Showers ( ) — Cafeteria ( ) Other fixtures . - W Design Flow........... '.............................gallons per person per day. Total daily flow.............................................gallons. R: Septic Tank—Liquid capacity ?.....gallons Length%�..t..... Width.. .......... Diameter................ Depth ............ 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 ....... !jii2-....... Date..... / // aj Test Pit No. 1!`............minutes per inch Depth of Test Pit-- ........... Depth to ground water.. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P - .... ------•-•---•--------------•-------------.----------•---- D Description of SoiL�_'I' _�f*t�-�_.____ n�.___ 4 !y� 2t1__. ��' U .....•-----•--•------••-----------------•-----•..._..••--------••-----•---..........----------•---•-----•-••-----•---------------•-----•-•-----•-•--•---------._...--•-----....••. •-•-•-----•................••-----••-•----•--•------•-------------------•---•-••••--••••--••---••--------•-•--•----------••••-•--------------•----•••-----•---------------•......--•-•----•••------.._. 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has7bessued by the bo d of health. Signedr--- .�./ ..... r%6,`.._.... r Date Application Approved By------........ ;,• /3�t ................ " Date Application Disapproved for the following reasons-------------1-1--• ------------------............................................................................. ----------------------------------------•...•---......---•----------•--•......--------.......-------•--•- Date PermitNo..................................................._.... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................OF.........4�'.��/�%� r�l���`(............................... %anr#ifiratr of Toutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Dis osaJSystem instructed%( ) of Repaired ( ) by--------'•��'-- �.5------•--------/7 -- --._... - . =f 1 �%?l'_. ',/r.r����,G..... Installer at.....................•-•------•--•-•........•-------------------....•-----................----------------------------------•-----------------------------....-•--•--------------••••-•------•-•----- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. +; ... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION 4 ATISFACTORY. ..DATE....................... _....� �'�.... ..............•-•---•---•--....-•---. Inspector.............-••-.------.....-----...--------••--•-•---•--•-----------•--.....----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 OF���i�JST�'I�C.......................................... ..............I................... "tom I&...... FEE........................ Disposal Vorks n udion Vrrmif Permission is hereby granted_. to Cons rust ` r or Repair an Individual Sewage Dis s System'/ at No .. ( .%� C._ " .........-_'//� � � ` ._. ....--.- ------ ....1 � _�� .............................................................. Street as shown on the application for Disposal Works Construction Permit No............:........ Dated.......................................... ---------------------•--•---•--------•---- Health Boa� DATE.......................... 'h'' v!'---......---------........ y''` FORM 1255 HOBBS & WARREN. INC.. 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