HomeMy WebLinkAbout0022 FLICKER LANE - Health 22 FLICKER LANE
MARSTONS MILLS
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TOWN OF BARNSTABLE G C'
LOCATION .� <G L 4 SEWAGE 1 0'0
VR.LAGE A7V, �`��� / ASSESSOR'S MAP & LOT �D
INSTALLER'S NAME&PHONE NO. �6 f� i R. cf S�$7
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) -3"S C7 C (size) /,P- G— ?.
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:/U
Separation Distance Between th .
Maximum Adjusted Ground ter Table to the Bottom of Leaching Facility Feet
Private Water Supply W and Leaching Facility (If any wells exist
on site or within feet of leaching facility) Feet
Edge of Wetland d Leaching Facility(If any wetlands exist
within 300 fe of leaching facility) Feet
Furnished by _
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No.` Ct Fee 5 0
THE COMMONWEAL
TH OF MASSACHUSETTS PIdE tered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for Digpozar *pgtem Construction Permit
Application for a Permit to Construct( . )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
A?sessoFs p aretLane, Marstons Mills Dwight Giddings
l3 -0 :s 1
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P 0 Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms q, 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- Sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system on s i S t-i n g
of a gas baffle, and 3 precast concrete leach chambers with
stone all around.
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 oar of Hgalth.
Signed -etl Date/J U 6"''6
Application Approved by Date S —Uz-z--
Application Disapproved for the following reasons
Permit No. 'Z-V'Zy—6-M Date Issued lU -r Z w
TOWN OF BARNSTABLE
LOCATION .� �s C.1�a K /_•(j SEWAGE #�aC�
VILLAGE��'d�,l � ��� ASSESSOR'S MAP & LOT �D
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INSTALLER'S NAME&PHONE N0. �� �- 77 -74
SEPTIC TANK CAPACITY rG �
LEACHING FACILITY: (type) 't,7, �-- �. (size) 3 G
NO.OF BEDROOMS /
BUILDER OR OWNER
PERMIT DATE: �� �`-� COMPLIANCE DATE:`U 2�3- cC,
Separation Dist /eeth .Maximum Adjuster Table to the Bottom of Leaching FacilityFeet
Private Water Sd Leaching Facility (If anywells exist
on site or witf leachin&.facility) Feet
Edge of Wetlandg Facility(If any wetlands exist
within 300 fe facility) Feet
Furnished by
ell
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TOWN OF BARNSTABLE
LOCATION SEWAGE
VILLAGE -,t?�, . ASSESSOR'S MAP & LOT-04
.INSTALLER'S NAME&PHONE'NO.� �h i s�. .s rf 7 5'-7-7 �
SEPTIC TANK CAPACITY /6-o►-0 4
LEACHING FACILITY: (type) _ S "r CT '� L. tr (size) y f NO. OF BEDROOMS /-
BLUDER OR OWNER
PERMTTDATE: 16 S=Cr-tr-C, COMPLIANCE DATE:/0
Separation Dist/feet
th .Maximum Adjuster Table to the Bottom of Leaching Facility Feet
Piivate Water Sd Leaching Facility (If any wells exise
on site or witf leaching facility) FeetEdge of Wetlandg Facility(If any wetlands exist
within 300 fe facility) Feet
Furnished by.
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No. ee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
Zipprication for Miopogal *p5tem Construction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
22 Fl*er Lane, Marstons Mills Dwight Giddings
Assessor's Map/Parcel M / 3 —O :
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P O Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms d 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 SoilSand
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system consisting
of a gas baffle, and 3 precast concrete leach chambers with
snone all arounct,
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 issyed bBo of Health.
Signed !� G C Date
Application Approved by - Date
Application Disapproved for the following reasons
J,
Permit No. 00 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS ,
Giddings
Certificate of,Comphauce
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( )
Abandoned( )by Wm. E. Robinson- Septic Service
22 Fgiker Lane
at Mars tons M i 1 1 4 haskeen constructed in accordance
with the pr vision of Title 5 4nd the for Disposal System Construction Permit No'Cdw 6 dated /� `S" ?ems
t�lm. Robinson Sr. t ' Desi ner .
Installer
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The issuance of this permit shall not l�e�cop d as,tru ,guarantee that the sys m w 11 nction as designed. :
Date 1�r(( '7 t✓ Inspector /.1
No. "0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Giddings ligagai *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
Systemlocatedat 22 Flicker Lane Marct-nna MTI l c
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 jnust be completed within three years of the date of thi rt. p
Date: ��� /� Approved by- �_ .�/�
f
116199
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTI]H'ICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
1, W i t l iata E. Rob ins on,S eby cenify that the application for disposal works
construction permit signed by the dated /G �� , concerning the
property located at 9 2 F 1 iek e r Lane, M a r s t o n G M> ) 1 G meets all of the
Mowing criteria:
• The failed system is >nectei to a residential dwelling only. There are no commercial or business
uses associated with dwelling.
The soil is classifi as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
There are no we ands within 100 feet of the c s —
ProPased'epustem
There are no p 'vate wells within 150 feet of the proposed septic system
There is no' ease in flow and/or change in use proposed
• There no variances requested or needed.
• The m of the proposed leaching ficility will ngt be located less than five feet above the
trta ' »m adjusted groundwater table elevation:[Adjust the groundwater table using the Frimptor
od when applicable)
• the S..-VS.will be located with 250 fee of any vegetated wetlands,the bottom of the proposed
leaching facility will W be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following;
A) Top of Ground Stttface Elevation(cuing GIS information) �6 Z
B) G.W.Elevation +the MAX High G.W. Adjustment.
DIFFERENCE BETWEEN A and B S —
SIGNED � DATE:
[Sketch proposed plan of system on backl.
y:health folds cen
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LOCATION SEWAGE PERMIT NO.
VILLAGE
I N sw ER/�'S NA E i ADDRESS
�`15
BUILDER OR OWNER
DATE PERMIT ISSUED ±z _ �d
DATE COMPLIANCE ISSUED
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,No...��....�(� ~ _ � Fmic......................... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTHvrGl E
/...O.l /. ............0F.... ...... 79.............................................
Applirafiou for BhgpmFal Vurkfi Tongtrurtion ranfit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: ,
4A^..e......./444a7.'5_Avas.................... /--.O.r-------lkl............................................
�catio - ddress or Lot Igo.
., -S`4l�� :........ LL--c .e ......-(P--{-�-•.....................................
Owner ,I A Address
I taller Address
d Type of Building Size Lot.. °�r___v.�..Sq. feet t
Dwelling—No. of Bedrooms___......_4............................Expansion Attic ( ) Garbage Grinder (D—)
'_l Other—Type T e of Building ............... No. of ersons_....................__..___ Showers — Cafeteria
R, YP g ------------- p ( ) ( )
a' Other fixtures _______________________________ __
W Design Flow......... ........................gallons per person per day. Total daily flow_-__-___-_'���0....._ gallons.
WSeptic Tank—Liquid capacity/5 gallons Length-Jo...... Width....5_._..... Diameter---------------- Depth_.!q�_ .....
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area----------_.........sq. ft:
Seepage Pit No...... - ��
__.. Diameter. _._. Depth below inlet.....3o.J _. Total leaching area... P...sq. ft.
Z Other Distribution box (pC) Dosing tank ( )
~4 Percolation Test Results Performed by----- .....LOW-- ._ �-d___ Date........................................
,`�a Test Pit No. 1_ .....minutes per inch Depth of Test Pit....44."'. Depth to ground water-ov0_:7'__------
(i Test Pit No. 2__ .Z-.-minutes per. inch Depth of Test Pit__-1_Z...'_.... Depth to ground watert51)jW V.7-i54-'6Z>
.....................................fit} 9'-. •.-��'{�,�' f�/+.-•.... ....... ..� '..--•---........--t.............. ...........
il
Description of Soil-- Q. --_ --------- lZ-••••-•.
hDx.... �_p
W -----•-•----------.. - - - ........0 .
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'TT�..;.
p 5 of the State Sanitary Code— The undersig d furtl er agrees not to place the system in'
operation until a Certificate of Compliance has isstt y t ar chealth
Igned. -- ... • .............. ................................
Application Approved BY--- --- - - "--�- --------•.............•------• �1_Z---
Date
Application Disapproved for the following reasons----------------------------•---•----------------------------...................................................
---------------------------•----------------•-----------------....---•-----•----.._...------------------.-----•---•---------•-•------...-•-•----•-----------------------------•---------------....._....
Date y'
PermitNo......................................................... Issued.......................................................
No... 0 ' �'. * _ ', FRs..................
THE COMMONWEALTH OF:MASSACHU'SETTS i
" BOARD OF HEALTH ►�i �,� ,
bJ. oF.....
1AV .? 3G...E........................ k t
u Ap iratiou for llhipviia1 Workfi Towitrurtinn amit ..
Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal
System at:
r
Lo i U l......................................----•-
Lo�c`dtion-A dress or Lot .
• � N
Address..�...... .....................................
caner
_..._.._�'
a
� ns ler, - Address '
Type of Building Size Lot__.4w'__5_:_5 � S feet t
d yP g � ------- - ... q.
U Dwelling—No. of Bedrooms.___.___.__`7___...........................Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type.of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------- -- ---
W Design Flow..........5_5_ ________________________gallons per person per day. Total daily flow........... • ...................gallons.
- „
W �U.
Septic Tank—Liquid capaclty� 0'gallons L'ength___f�.__._ Width.:...� ..... Diameter________________ Depth....
x Disposal Trench—No_____________________Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._I___ ..z--._ Diameter_._.._ Depth below inlet......Z:57_.. Total leaching area.....r-4__'?j9_.sq. ft.
z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by.._... EUA2.6�_--_L.oW__.d... Date________________________________________
Test Pit No. 1__�•'�._._Z._:...minutes per inch Depth of Test Pit----/4# ". Depth to ground water.-NU_T-------
Test Pit To. 2___`�__.4___minutes per inch Depth,of Test Pit..___La. �__. Depth to ground water�>;IlC_QC1.SJ��
Description of Soil•-- r /--------Q.. J. ..... ft t.....................
x -.. ="'---�. ..... ...._.5C,xJA
U W •-•--------------•----------------•---=........................................................`---------------------------------------•---•------------------.......................................
UNature of Repairs or Alterations—Answer when applicable................................................................................................
._ i
Agreement: ,.
The undersigned agrees to install the aforedescribed Individtal Sewage Disposal System in accordance with
T!•1:�•
the provisions of f'1 T ">_. 5 of the State Sanitary Code— The undersign further agrees not to place the system in
operation until a Certificate of Compliance has b issu b th o I- eiealth.
? igned.- •--- - ............ ................................
Application Approved By........ dr ?. ...................... �/-` Date
Application Disapproved for the following reasons:-------•----------------- ---------------------------------••-••-----------------------•----•------------....
-•----------------•---•----------------------------------------------------------------•-••••--•••-•••-•••----------•••----•--••----••••-•-•..__...--•..._-_.._..••--••-•_•---
Date
-----------------
PermitNo............ ......................................... Issued.......................................................
Date
rtl
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
. .....-OF...... ...... ........:............................
rdifirate of Touts haurr
T:FI S IS`TO CERT Y 3 the Indvidu e age is p 1 y✓stem constructed ( or Repaired ( )
Installer
_-
at---'•"-'-•---•
f - -- • - 1---- '
has been installed yin accordance with the provis• ns of T-I i LZ 5 of T e State Sanitary Code as described in the
application for Disposal Works Construction Permit No._ ___ _' _ .............. dated------------..:................................
R.. THE ISSUANCE OF THI&7CERTIFICATE SHALL NOT BE CONSTRIID a S A G ARANTEE THAT THE
1. SYSTEM WILL FUNCTION�SFACTORY.
DATE. !- / _....._...._ Inspector.. :_::-._ _
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ,� EALTH
........:.... "'L1�1...... .....OF................ faL/ '? a' ....a
'ti.
i u 1 rk� pan tri gr
Permission isreby anted _-"-'
to Constr ( G.or R ai ( an I lividual Sewa osal yst
Street
as shown on the application for Disposa N-Yorks Constructio P it N�o-----
�✓✓�...............
�Daleedd..........................................
J/ Board o alth -
DATE.................. - --•----------- //
FORM 1255 HOBBS & WARREN. INC.. PUBLISHF,)2S
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