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HomeMy WebLinkAbout0011 HIDDEN VALLEY ROAD - Health r11 Hidden Valley Road 9 Marstons Mills - A = 098 008010 - TOWN OF ARNSTABLE / LOCATION 11f e� !'✓��� SEWAGE #o?00t-/95' � � �/ P� ASSESSOR'S MAP & LOT VILL`AGE ��fiiicy� c INSTALLER'S NAME&PHONE NO. �a c�-/�"s✓ - ya8-spa q SEPTIC TANK CAPACITY � T�' � '' ,Z( LEACHING FACILITY: (type) ��Tc"C 3��\s (size) NO. OF BEDROOMS BUILDER OR OWNER C!e4 L! CV l�s PERMITDATE: �J .3 O O 1 COMPLIANCE.DATE: f-/7- Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 o 10 r e � _a r,,r iS /: v x I t� 417 3 e ms!1 Rt $- TOWN.OF.M ARNSTABLE Y Al� SEWAGE #--�00/-/95' VILLAGE �fz2vi� c ASSESSOR'S MAP & LOT INSTALLER'S.NAME&PHONE NO. /CLLG/�s7�� - 2 SEPTIC TANK CAPACITY X ( &7rn i C-cTc,L 33o�s size LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNtR_ Gl2(li g C.v F, "s PERIvITT DATE: 3' 3 CO' O l COMPI:IANCE.DATE:: Separation Distance Between the: j I Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on,site of within 200 feet of leaching facility) Feet Edge of Wetland andleacEng Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ,r 'r.:;• t. fly "fU .. _: 1 /9 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS �� 01pplication for Migooar *pgtem Construction Permit Application for a Permit to Construct( )Repair(Y)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.,// j4,411,1 /ep Owner's Name,Address and Tel.No. 0 � rVIL C'1�19� l u•Ins Assessor's Map/Parcel / V Inl f 11;30 z')k4011y 12w Installer's Name Address,and Tel.No Designer's Name,Address and Tel.No. 01 c,,,/�< 11d8-SS c��t' 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 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) 000 3-C'V/7EC0 mb<Ps w, 31ar 318 4 S-,u 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 been issu d by this Rpard of Hta h. Signed Date &ArCH,3©--a/ Application Approved by Date 3-30- Zoo 1 Application Disapproved for the following reasons Permit No. Date Issued -3-3 d-9y No.2�� T w Fee THE COMMONWEALTH OF MASSACHUSETTS _ Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Ye✓'"� 01pplication for �Bigpoaf *potem Con.5truction Permit Application for a Permit to Construct( )Repair( k Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / / ��� c/I KA/��� / � Owner's Name,Address and Tel:No. vs;�2,,,•,l� c.�,�5 cam,-�-,s Assessor's Map/Parcel / ,l Installer's Name,,Addressce i'7,andc Tel.No. Designer's Name,Address and Tel.No. , 1 �zu .,C� 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic'hank Type of S.A.S. Description of Soil Nature ofr Repairsor Alterations,(Answer when applicable) Dj� - 1'v/Tr o / 5704C — �/8 S-Tone o on l„ 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 Board ofra SignedC Date /�A r Ei �o-n 1i Application Approved by C. Date 3-3o- 7 w 1 Application Disapproved for the following reasons Permit No. 'fib E- I q Date Issued ————————————————————————————- --.—_ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS `3 Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired ( p-)-Upgraded( ) Abandoned( )by C,eA/G' Our7 f at Y/ Ali 9 0cl Vt' v 2oi1­�) has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No." d t-i9 dated 3 1 v 6 Installer 'l32 vc Designer The issuance of this permits all npt be construed as a guarantee that the syste 11 fun oonr designed Date U��?!�� Inspector e112 —————/—f�———.——— —--———————————— ———.— _ _ - No. V �' ( f c7 F ? / ; Fee " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mwi5pogal *p5tem Con0truction Permit Permission is hereby granted to Construct( )Repair(sue)Upgrade( )Abandon( ) System located at 00(-r j'AfA d sirrr,I1r J 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 m -st be completed within three years of the date of this permit. Date: ?�/�.J , Approved by f , - j, 1/6/99 R� N� 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 PLANS) hereby certify that the application for disposal works construction permit signed by me dated /-2.9%'CH 3 f- o! concerning the property located at // ,//i !)c/J YOO/%y r ©�j�,e�i/� meets all of the following criteria: • This 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 maximum 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: A) Top of Ground Surface Elevation(using GIS information) S B) 'G.W.Elevation +the MAX.High G.W. Adjustment.- 3 -3 DIFFERENCE BETWEEN A and B SIGNED � DATE: IIA-4eC>y3Q _10 [Please Sketch proposed plan of system on back]. 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:cent Q 1 F r f o 0 C 33D ttAold?-j i I i i i I I I � I '1 i i i i A�SIESSOR'S MAP NO. PARCEL 00�-- D!U LOCATION SEWAGE PERMIT NO. VILLAGE 0 -I arTIA n C iyi f -NSTA ILER'S .NAME ADDRESS e U I L D E R OR OWNER cl DATE PERMIT ISSUED �2- 1 DATE COMPLIANCE ISSUED 2�1 � �. _ �. �.� .,,� �� .. -®� � � � � , /� �,� s 1� No....... FSS.. c� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......0 NV IS.I_.........._ --.OF >Ea. =...._.... AvOrFation for Bigv ,aai rk� C��a� ra�r aaa rraiTit Application is hereby made for a Permit to Construct System at ( or Repair ( ) an Individual Sewage Disposal KIM ................'--•--•--. _p � tion-Address or Lot N.. /`ow �,p _ O..i l.a_L........................ t!1 A�XY (/�,_ /A��ddres / [1 Q 1 ...... ......t ltl'J 4 Q a ........0'a<e..l_a............. Instal er Address d Type of Building Size Lot. ._.1.1.._..._--Sq. feet a Dwelling—No. of Bedrooms-_....�--__ --------------Expansion Attic V6 Garlage Grinder ( � Pk Other—Type of Building ............................ No. of persons............................ Showers 04 ( ) — Cafeteria ( ) d Other fixtures ...._.. W Design Flow.......55.............................gallons per person�pertday. Total dailyflow.....o � ��0---------------------•---dons. WSeptic Tank—Liquid capac>ty:.�4 -•gallons Length a^ _..--_ Width-A!l(�_! Diameter"_._'—'—"-- Depth....G.�.__ x Disposal Trench—No. --------_.......... Width.................... Total Length.......... .____..Total leaching area--------------------sq. ft. Seepage Pit No---------I-------- Diameter.._.10--------- Depth below inlet_... Total leaching area..5-l.0....sq. ft. Za ter Distribution box Dosing tank Percolation Test Results Performedy ( ) _ �1•Fdu.cDate.___ �• Test Pit No. ------minutes per inch Depth of Test Pit.................... Depth to ground water.-fit;;.- (� Test Pit No. 2................minutes per inch Depth of Test Pit-__--__--_-_-__-_ Depth to ground water.___-__-_---___-_--.-._. Description of Soil-----Q. �`-'---''Z......----�Sr��1. .�3r�a ----�=---- ------ . ----�� - �-Z.- � - x ... _; _: CW� �-------------3------------------------------...------------------..---------------- w x •--•-•-----•---------•--•-------•---•--------•--•-••-- V Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ .------- greement ---------------------------------------------------------------- : _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of IIT P 5 of the State Sanitary Code— The undersigned further agrees not to place the system in o ation until Certificate of Compliance has b issued by the oard of ealth. S' ned.. - ................................ Application Approved By..� Wa' Date ----- --------- ... t5.7..... Application Disapproved for the following reasons:..................... ---------/­ 6ate ............................ -------•------------------------------•--•••-----•••---...---- .-----•------------------------------------------------------ ••�� ----•-----------------Date----------^-- Permit No.......... ..... _�..I_.......... > I . THE COMMONWEALTH OF MASSACHUSETTS BOARD ®F HEALTH .....------.....OF.... ,Apure#inn for Uiivnsal Workii Tomitrnrtinn ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: g _._.. --• cation-Address or Lot No. 5 :>4 '� v W Ow� Xer .,.==- t!i n ""7bL_ Address Insta er Address Type of Building Size Lot�l.__ 3 ____+__Sq. feet U Dwelling—No. of Bedrooms._____________________________________Expansion Attic 0) Garbage Grinder Ab 4 Other—Type e of Building ______________ No. of ersons____________________________ Showers — Cafeteria a YP g -------------- P ( ) ( ) PL, Other fixtures ------------------------------ -- W Design Flow_____: _.___ _.____ ..gallons per person per day. Total daily flow...... .0..........................gallons. R: Septic Tank—Liquid capacity.` _gallons Length 86::1 WidthA .kd! Diameter_777=77 . Depth___..-------- W Disposal Trench—No.......A........... Width........... �___ Total Length________________ __ Total leaching area....................sq. ft. x y� Seepage Pit No__________ ________ Diameter.._.�i ........ Depth below inlet____ ____ ___ Total leaching area__ _�_ - _sq. ft. z Other Distribution box ('Q Dosin tank ( ) 7 Percolation Test Results Performed by . tG_ _�.'_k - __________________ Date__ ............ Test Pit No. I__ _____minutes per inch Depth of Test Pit _________________ Depth to ground water. ..... _ _..-- c LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .........................................-• '" ••• - O Description of Soil....... •-`-7.......... ._ sf ��" `'� _ rd 1� 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in oppiation untiV Certificate of Compliance has bcan issued by the and�ofeal.th. •" � ^� } � 5n � ate Application Approved BY _-11.........------------------------..............? ------� '� ;- ate-- ---------- Application Disapproved for the following reasons_________________________________________________________________________________________________________________ .........................................................••-•------••--•---•--•----•------•••--------•-----------------------------.__..--------------------------------------------------------------- * LAN " Date PermitNo.- .._. ......------ --------- Issued-------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................:................OF...............................................--•--`..-........_.........._..._... �rr�ifirtt�le of �um��t�nrr ` THIS I TO CERTIF,r, That tie Individual Sewage Disposal System constructed ( ) or Repaired ( ) b ...... ` --------------------------•-- . �iV 1 s aller at V MYYN --------------------------------------------------------- has been installed in accordance with the provisions of TIC _5 of The State Sanitary Code as des ribed in the application for Disposal Works Construction Permit No---- da.ted_._-- _- ?_ _ _______________ THE'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL U CTIO SATISFACTORY. �t,� �� DATE............. .... ��_: � - Inspector....... ------------- F, THE COMMONWEALTH OF MASSACHUSETTS BOAR HEALTH No. FEE.. .............. Disposal nrkg It Vamit Permissidn is hereby granted------- �.....................-----------------------------•-------------------......--------------._...••-••-...-----•-•_..... to Construct ( ) or Re air, ( ) an rtdivldual Sewage Disposal System atNo........ "i:........................lr.;�,..----....a il" � `) - �.---------------------------------------------- ------- ----- ....----- Street as shown on the application for Disposal Works Construction Permit' � �....... © 1d,%Board of Health DATE................. ------r`.--------}r ------ --------- FORM 1255 HOBB & WARREN, INC., PUBLISHERS �:,,_ i at►.IGLc FAMtt_�( - 3 BEpR�oM ,j Na GARBAGE GcztND6t'Z �a•IE� '�� ,. FLOW 110 x 3 - 7306.PP !! 5EPT1G TANK = 33Ox15o% =-49'96.P. Q u5c- l000 GAL. Iyt5Po5At_ Pr'r vSE 1O00 6AL,. II S DcvJALL AV-SX 72S.t^ at-,A BOTTOM AREA= • 9,5F• •�L+�. r---� � �i 75 S.F x I• o 7 '. G.P jl '7oTA t_ 'T•a•rAL. TDA IL'-? 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