HomeMy WebLinkAbout0056 GRISTMILL PATH - Health 56 GRIS` �l'`uMARSTON o iv s
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TOWN OF BARNSTABLE yGo v
LOCATION Czai5�tit`(( vq,:_ SEWAGE #
Q
VII,LAGEl/ I � sS ASSESSOR'S MAP & LOT —00
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (ty ) S lti l ,Yf''u (size) .. e
NO.OF BEDROOMS
BUILDER OR OWNE
PERMI TDATE: 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
i`:e
N Fee o.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zlppfiratton for Otgoml *patent Cow6tructtou Vermit
Application for a Permit to Construct( )Repair(Vieulpgrade( )Abandon( ) ❑Complete System AUndividual Components
Location Address or Lot No. ( I sS Y /r Owner's Name,Address and Tel.pNo. _
Assessor's Map/Parcel ��
Instal Address,and Mo
Designer's Name,Address and Tel.No.
1 S 1 t�.tk.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures kip
�``
Design Flow y kid gallons per day. Calculated daily flow q`4( gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 0�2 Type of S.A.S. (_-rZ),6,,C,,jj (ti � f6
Description of Soil
Nature of Repairs or Alt rations(Answer when applicable) —ev
r-e
i y
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 is s Boai Hea th.
Signed Date —�
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
TOWN OF BARNSTABLE
- LOCATION �1(( SEWAGE # �
VILLAGE I/ 14�� l!/r �l S ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE N0. ?UT.0 Z- �46 T
SEPTIC TANK CAPACITY
LEACHING FACILITY: (ty ) S /i?}�1 %Y��-" _- (size) l
NO.OF BEDROOMS
BUILDER OR OWNE
PERMITDATE: 15 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;
I Sir
1 .
i
1
No.—Zee) _" U 2 �a.
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWWOF BARNSTABLES MASSACHUSETTS
Zipprication for Oigaal *pgtem Cow5tructiou Permit
Application for a Permit to Construct( )Repair(t�grade( )Abandon( ) ❑Complete System individual Components
Location Address or Lot No. r I SMF Th / Owner's Name,Address and Tel.No. _f
Assessor's Map/Parcel
InstallZar�e,Address,and T Designer's Name,Address and Tel.No.
GdAK, 1
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ff. _ Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow �i gallons per day. Calculated daily flow `l 1 gallons.
Plan Date Number of sheets Revision Date
Title 4 ,t
Size of Septic Tank MAU 94116,Zi Type of S.A.S. C,
Description of Soil' �� a.a,e,--e_ cs
Nature of Repairs or Alt rations Answer when applicable) i1, ' 7 nn�
b� 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 provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue.&* 's Boar-d-of Health.
f Signed \ Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
- ---------------------------------------
�.
THE COMMONWEALTH OF MASSACHUSETTS /
BARNS ABJLE, MASSACHUSETTS ��� f �`
Certificate of Compliance'
THIS IS TO CERT at the._On-site,Sewa ,e DisposaLSxstem Constructed( )Repaired( Q-1 p�aded
Abandoned )by t� _ - k X:fM _
at _ ��'s. has been construct
e n acc rdance
with the provisions of Title 5 and the for Disposal System Construction Permit No.ZOO '6 Z dated t l Z 2 v �.
Installer Designer '~
The issuance of this pe sh l not be construed as a guarantee that the-sys em will function,as designed. I�
Date �!1 /"1 Inspector 24€, "till //\.X (i 1 111 11li/X . s
r
------------------------------------( �j''�---
No. -zoo / — d Z� Fee J "'I�I
THE COMMONWEALTH OF MASSACHUSETTS
/ PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
30igpo5al *pgtem Cou5truct" u Permit
Permission is hereby granted to Construct( )Repair ) pgrade A andon( )
System located at -5� �v
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:Constructi n must be completed within three years of the date of this pe
Date: l t/Q Approved by _
1/6/99
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 PERMIT (WITHOUT DESIGNED PLANSI
hereby certify that the app
lication for disposal works
construction permit signed by me dated_Q , concerning the
property located at -T g-7— lklt&I meets all of the
following criteria:
4* is
failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• e soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
here 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 maximum
adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when
/- If
licable]
he 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:
A) Top of Ground Surface Elevation(using GIS information) d
B) G.W. Elevation ,�v' +the MAX. High G.W. Adjustment. +t
DIFFERENCE BETWEEN A and B
SIGNED : DATE:
[Please Sketch propose Ian of system on bares .
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:cert
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.�2, 6
LO C AT ION S G E PERMIT NO.
VILLAGE
INSTALLER'S NAME & ADDRESJ CRA14G MEDEiRQS
142 Corporation Street
R OR OWNER Hyannis, Mass. 775-0828
,€-sue;'19 S'7
!A" i J �7�C h A41 I'l S
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED �Y
s / s '
ASSESSORS MAP NO: - 4 -7
- PARCEL NO.: `?I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.... . ............0F.....7.
Appliratiuu for 0iipuiia1 Workii Tuu.strurtiutn rantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: ` � �A��.�,
__.. . ..............
t n-Address .L! t o.
Owne Address
. ................ ....................•..... \
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
adOther fixtures ----------------------------------------------------------------------•-------------•----•--•--•-•--•-••----...._............_..-----•...........----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons._.,.._
WSeptic Tank—Liquid capacity............gallons Length................ 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 by.......................................................................... Date--------------------
-----------
.-------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
PG -----------------------------------•----•--•--------•--..............----••-.................................`.......................
Description of Soil..... ................
x ............................................................- ------------•-----------•-••-....--•-••--•---.....-•--......-- ••--•-----•....... •••-------•--•-----
(� ---•- ..l..l...._.
W -------•-•-•----------------•-----•--------•---•••------------•------------------------....---•-•-----•---------•- ------------- -•-- -••--' ---- .. ---..............
-
U Nature of Repai �lteration��Answer when appl .___
L -�
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 be issue y the board�..lth.Signed.... ...............•...... ----...........- -----------.....-•---•----• � ._....
Application Approved By..- -�.................. ...... ............. `��l /e
... . Date
Application Disapproved for the following reasons:................................. .........
--•--•----•------------------------------------------------------------------------•-•----••--•-----......_..---•.........--•---......--------------------------•---......------------------....••-•••---
Date
PermitNo............ .. ...... Issued........................................................
Date
:Ir -
No
J BUJ
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...............................OF..... !�' "°.,,w. ........................................................
Appliratiun for Dispasal Works Tonstrttrtion Frruti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: _� #
...........�• .... ........................................... .�....�..=....... .... ... .... .....4... ...... ........................
Wa .1' VVV Owner _ Address
.........— ... ................. ...................... ..._ ...�'..... ....... ..---...-•• -..•.•... ......
........................... Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. .of persons............................ Showers — Cafeteria
a' Other fixtures ..---•--•....................................•---- -_...
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................
x 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 tank ( )
~' Percolation Test Results Performed by.......................................................................... Date........................................
14
0-" Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
ri Test Pit No. 2..........I......minutes per inch Depth of Test Pit.................... Depth to ground water........................
------=------------ --•-•------•--•-----...............-----•--•---.--...-•-•---------------•----.._................. -------•-•----•-•-----------.....
O Description of Soil.--
-.-.-----•-------...--•-• .................................... ........... . -....... .................. -•- ........_......
U .---
W ---------
_ -`.
UNature of Repairs or Alterations—Answer when applicable...... -� � - P
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 be issue y the board of h lte h^ "�
IL
�P�+ ✓
Signed•--- .---......... ........ ..... -........ �tr��';
..
/ t1 '
Application Approved B ._---s � .. ......-_. ............... .............. l .....`-3---------
Date
Application Disapproved for the following reasons-------------------•-------------•-•-------------.........-----•--.......-----•--.............-------•.....___
...----•-•...............•----•-•---.......-----•-•--•------•---------•-•------...............-----------.---•-•----•----------...---...._.....-•--....------------..........--•..-•--•.......------..._
ca _.
Date
Permit No......... ........ _ _.... Issued...................... ...._.....-• u•----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OO,F HEALTH
� /�...... '`..........+1. ......O F...-..(.�. '.. ...............................................
Trrttftrttbr of faoutphaurr
THIS IS T ERTIFY, That th Individ .a% Sewage Disposal System constructed ( ) or Repaired
by........ ...... ...... (( ----------•-. •irt taiiu...--•--•....................................................................... . -_...._
at. � ....: f .s ...!!a:f i .... - ---------------- _. --.----
has been installed in accordance with the provisions of TITS 5 of The State Sanitary Code d7--
THE ribed in the
application for Disposal Works Construction Permit No...... dated---.-{-� �................
ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......................... I�� ---------------------•---- ' Inspector... ----•---•-----•-----•------------•••.......---••-•••..............•-_..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
2>!c? ' �•'
............OF......... ....... ..............................................
No.
Diupou IV ku (9janstrqUan J[rrutt#
Permission is hereby granted r ro'Wge
...to Construct ( ) or Re air ( a I dividual S Disposal System
at No.............�-r_4----. _2_r1:-i.. ...Y_..� •-----... . ....._
Street f�_-
as shown on the application for Disposal Works Construction Permit No":�._.... a.? Dated..-__I-A--� %�?...............
� - ..........................................
I
J --...--.•...... Board of Health
DATE---•-•--•-- -r--�... ..---`-- •-}-+- � i
FORM 1255 A..M. SULKIN„ANC., BOSTON
U � t9
No.....y� -------- F$$.,�. .....................
THE COMMONWEALTH OF MASSACHUSETTS
®AFC® HE H
6...........................
y _
.. OF........ ....... '�,,,,•,, .
Appliration fur :41aposal Marko (9janotrudion Vamit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
.......L 0 r= �.f:.. ..1-ST..�G..... f9/. ......... ..................................... &eyto ...... /GGS...............
Location Address or Lot N
........ .1.� ......... E fC., � .................. ........................... °:.L..!r0/.o...Z" f--..-A�
Owner Address
� ......... :.................................Installer........................................ ...............................,............Address...........................................
Type of Building Size Lot...:.9.ft.- 4-i!...Sq. feet
Dwelling—No. of Bedrooms........3....................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type of Bu:ldin No. of persons............................ Showers — Cafeteria
a' Other fixtures ...............
W Design Flow......... E2._.-.......................gallons per person per day. Total daily flow.................................._.........gallons.
WSeptic Tank—Liquid capacity.A 4!?gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No/Oo2g A4_. 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 by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-.-_._.___-_-_-----
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
1:4 ------------------ ---••--------•-•--........--•--••••---•-----•-----••-----•---------•-•------•----•••----........•-•-••••-•-•--..........._.....-----•--•-
0 Description of Soil---X_---------------- —-A-EGA>.. `�� ��!���L
x ...-••-------•----------------•••--•--•---•------•------------------•-------•-••--
V •-••----•-••--•-•-•-------••--------•-------- ----••---•----•-•-------••-••-----•-•...---------•••----•--------•---•---•--•-•••-••-----••••••••-•-•----•----••--•--•-•-•-•----•----......-•-•-------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--•---•----------------•---
U Nature of Repairs or Alte-_ations—Answer when applicable.--.............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu y the board of health.
Si ed-- r . ---- jl.
Da e
Application Approved By__e,.-0?q1
Date.._......
Application Disapproved for the following reasons---- ----------- ------------------------------------------------------------------------------•••-----•--•---•
.............••--•------•-----•------•-----------------------------•---------------........•---•----..•--
` Date
Permit No. `�1/
v Issued ��
ate
_-.� ..-.... .�.- - �. �_.-.�........---- -------------------------------
I�
No...... �, ........ Fim...... ................_
THE COMPONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_ _ .
a.-Fa....... .. .0 F........ .. .yam .:... ...;j7
Appliratiou, fir DiMpasal 10orka Tonotrurflou permit
Application is hereby made for a Permit to Construct (; ) or Repair ( ) an Individual Sewage Disposal
System at:
t r nr
fy. l S jf e� j r'd;• �0 :J 6.,,`+ •F-. ,+3 J' N - f
...... ...... ......... _................�r ':..__..__ r-_t�-.......! ,-. .. ._.. . - j....... -'. !? . ............
Location Address or Lot No
f I..... 7_ r.r.f'r f^- Jt � ' ds�,!. .,�' /( .{sir r Kx./. ..�,
W
Owner Address
..................
Installer Address
UType of Building Size Lot....f..r.�..,I>n':�•..Sq. feet
Dwelling—No. of Bedrooms....... .................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons.......................... Showers — Cafeteria
a 'Other fixtures ......................................................................................................................................................
W Design Flow........�' to...°.......................gallons per person per day. Total daily flow......._............__..'...................gallons.
WSeptic Tank—Liquid capacity...f?'::_..*allons Length................ Width................ Diameter................ Depth................
x Disposal Trench— 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 ( )
aPercolation Test Results Performed by.......................................................................... Date.........._..........-------.._...------
.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 --•--•--•--•------•----------------•......-••---........--••••............-••------•---•-•-•••..................... ........................................
O Description of Soil--- •-•--•......-- =:k:>.u '` ........'. . F�
A--------------•---------------•--•---•-••--•----•-•------•--...-•-------•---•--•--
W
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••--
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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu y the board of health.
Si ne i .'a ._t;� r� - -••----,-------•----- - �'-=`... '
Application Approved B 4 .> . ��. �� .....
Date
..........
Date
Application Disapproved for the following reasons:.................k f--...------------------......-------------•--......-----------•--------------------•------• .
...................•-••-•----••--...._••--••--------•----•..........._...-----------•-•••••--------••••---------•------------------•------------------------•-•----•••••••........-••-••-•••--..........
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
-•. ,BOARD OF HEALTH
t OF.s
„••; .� � . ........,...............
(In ifiratr of Tourpliattri
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed. or Repaired { )
by............. ..............
ale F +9
sK" 1�
a
at p
1�.... ....4�1
has been installed in accordance with the provisions of Article XI of The State Sanitary XaVes -') m the
application for Disposal Works Construction Permit No------------ ---------------•- dated.. ........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A GUARANTEE THAT THE
SYSTEM WILL FUNCYION SATISFACTORY.
//
DATE------•---•- ---•d'----..73-••-•--------------------------------- Inspector-•--• - --• - -•-- --•-- ....... .. .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OE HEALT
A-14 {.:....... ....................
No......................... FEE........................
.
Permission is ereby granted....................................................................................................................V...............
to Construc { or Repair ( ) an I i idual Sewage. isp 'Syst < re
treet - / !1
as shown on the application for Disposal Works Construction P�init 1 �`Y �Q... Dated. . � ....��.....................
ww �•�,
DATE.....7 -....�--
......................................... Board of
t
- ----
FORM 1255 HOP,SS & WARREN, INC.. PUBLISHERS