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HomeMy WebLinkAbout0026 INTERVALE LANE - Health -26 IIVTERVALE LANE MARSTONS MILLS y n A. THE COMMONWEALTH OF MASSACHUSETTS BOAR® ,OF HEALTH .......... ...............................OF....................---------...........---------------•--....._........................_. Appliration for Disposal Works Tonotrur#tun Urrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: fit% A�Li� �c17,7 Ae', .o i�c�S / ............�.__.. ---... . A2..................... .......s. ...:---....----.....---....- ......... ............................................. Location-Address or Lot No. ........... GC. ...------------- ________________________ --------------------------- ----------- -- _-_____________-............._. er Address W --------------•-•--------------•-------_ .....---•---•••••......•••.......--••••---. ........_..........•-••-••.....--••--•-•-•.._. Installer Address t� Type o Building Size Lot....... .Sq. feet Dwelling—No. of Bedrooms.................. _._........._•.........Expansion Attic ( ` ) Garbage Grinder ( ) '04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .._ ...__.. W Design Flow.......................:.________.___.gallons per person per day. To d al aily fl ow_ -------------------------- n gallos. WSeptic Tank 1 Liquid capacity./UP.gallons . Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......L------------- Diameter-__ __- Depth below inlet.................... Total leaching area.67.iU........sq. ft. Other Distribution box (V) Dosing tank ) - j 2 z . Percolation Test Results Performed by.... ____ _ -... l ry.� (� . _.J...................... Date.._j_:_.2_ _ ? ............. Test Pit No. 1................minutes per inch Depth of Test Pit......t..._._...._ Depth to ground water........................ ti, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............._.......... a .......................... ............ ••. �. .... O Description of Soil-------, .0 --2•-----. ......u�/.�.. ...... .. D" 1F ` E�:�•.J ........................................... ---- --------*' , , 7 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 LIT,LE 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--_,. ...................................••-•._...•---•-••-•-•--••••••-•••-••-•••••• .......................... Date Application Approved By-•-••-� 1 . . ---;Z.......6.-f._--._Dat ..... Application Disapproved for the following reasons----------------------------------•--•--•----------------------•-------------•--••------•---•••••----•-•---••--- .............••••••-••-••:--•••-••-•-......_......-••-----•••-••-•••-••--••••---••-•••--•--•-•••••--...---•-••••••----•......•---••••---••-•••-•••••----------•••------•----------- -•---••-•••••••-- Da Permit No.............................................•---•-...... ;; Issue(L-- -----?l••--77 f....................... Date �•.- No.. .................... Fzx.......... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................I...................OF.............. "Posal Works Tonstrurtion Famit Application is hereby made for a Permit to Construct ()<) or Repair an Individual Sewage Disposal System at.tv,­ ................................................ ............... .......... ...... .6e44A............................... Location-Address or Lot No. .......... ...................................... ................................................................................................. Address .. . ........2 ., 07 ................................. ................................................................................................... ,, I.�. Address Building Type of Size Lot...._. 1104YSq. feet U Dwelling—No. of Bedrooms.................A.......................Expansion Attic Garbage Grinder 14 r4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures.................................................................................. ................................................................. Design Flow....................... ......_..gallons per person per day. 'Total daily*,flow.........4� a........................gallons. C4 Septic Tank-I'Liquid*capacity,./OidO:gallons , Length................ Width... .. Diameter..._._ Depth....._.......... .......... Disposal Trench—No. .................... Width... ......_.. Total Length.................._. Total leaching area_..................sq. ft. Seepage Pit No......I............. Diameter--- Depth below inlet_.................. Total leaching arca..041.......sq. f t. Other Distribution box,(V Dosing tank Results Performed by...��---- Dat Percolation Test Res -------------------------- 1--4 e... 11............ Test Pit No. I................minutes per inch Depth of Test Pit.......11�........... Depth to ground water.._.....__.._.......;._.. 44 Test Pit No. 2...............,.minutes per inch Depth of Test Pit..................... Depth to ground water........................ ............................ ................................... ..... .......... ------------ X. 0 Description of Soil...... . ....A.... . . ............................. 4.................................................................. --------------------------- ................ ............................................... ... ......... ..............­-------------- -- U Nature of Repairs or Alterations Answer when applicable... : -------- --- I"y......................................................... .................................................................................................................__.......... ...................................................................... Agreement: The undersigned agrees~to"install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TILTIL, 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.,, Sigped...,. .........;............................................................... ... ............................... Date Application Approved By....... . .... ... ................................. ...... ................. i.......... Datef Application Disapproved for the following reasons:........... .......................... . ......................................................................... ....................................................................................................................................................................................... .................. Date PermitNo......................................................... Issued...................................................Date THE COMMONWEALTH OF MASSACHUSETTS irr i B,bARQ'l0 HEALTH ........ OF ........................ (Intifirite of Toutpliaurr T S CfEFAYt the Individual Sewage Disposal System constructed 41�®r Repaired by------ . ........ Installer� . ........... - --------- -- -- ------------------------------------------------ 40 ..... ... . ....... .... .............. t..r a .. has been installed in accordance with the provisions of The State.Sanitary Code as described in the Tdated_-..-__---'.-'12 r 7 application for Disposal Works Construct onPermit No..6..... .................. .......-..7,------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL}FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH .......... .....OF-::..... ,c7i ,�7/ ... ................................................. . No......................... FEE....2.E.......... Map I orks atu&udiott prrmit Permission is hereby granted... ......... f-......................... to Constre 4'r'or R it IndividuaV-Sei&",,age Dispo Street ... as shown on the application for Disposal Works Constr on :Per No...._ Dated.._._2..`----$1 7. .......... .......... —----- ..... ... ..................... t h Board Health -------------------------- DATE_ ........ .... ................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION OgLa ►`�`b� �A-yt'k SEWAGE # VILLAGE-M426tM M1416a ASSESSOR'S MAP & LOT ,ditt 3`AZ y INSTALLER'S NAME&PHONE NO. m LAW Le-- t/GOV] `4U"_6_2Sq SEPTIC TANK CAPACITY A U U LEACHING FACILITY: (type) size) �� ��'�•� ,a, NO. OF BEDROOMS° 4 BUILDER OR OWNER�����- Get e nxTie p- twnar-s PERMITDATE: LA` < COMPLIANCE DATE: - 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faci 'ty) Feet Furnished by # ' r. IV /60 46 P /n. In 16 , n7 /4. i No• 0 Fee_�O_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes Zipprication for Mie;pogal *p5tem Construction Verrnit Application for a Permit to ons ct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location ress o , � Lot No. nAc - L 4 .Q_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rrn"W-Q P_I--Abct�, C rraetc- P4Wc,nn�4 GoV-A4-"--0:1S Type of Building: Dwelling No.of Bedrooms Lot Size 2-0 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. E5CQ' C 4� Description of Soil 2- ✓�G d�2er�. 2-'— 'q 41 Nature of Re airs orAlterat'ons(Answer when applicable "' n e4Z& V'r 410�J3 x Z C. Date last inspected: 69 4K e-e 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 y this oard It Signe Date Application Approved by Date Application Disapproved f the following reaso Permit No. Lvm Date Issued ONO r No. Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: v .-Yes. "-PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application for Migonl *p.5tem Construction Permit Application for a Permit to onst ct( )Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components Location.&SaNss o Lot No.' "v)Acr-1 j(5.UL 1—Aj.V_ Owner's Name,Address and Tel.No. Z' b rn11t26"in-15 ml US,mp• ,5 Assessor's Map/Parcel 2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rrn tL.KUa P-t.-,0bL& Type of Building: Dwelling No.of Bedrooms Lot Size -201 O?lq sq. ft. Garbage Grinder( ) ` , - -.� Other Type of Building No. of Persons Showers( Cafeteria( ) ' Other Fixtures s 1 _Er „ ..Design Flow. gallons per day. Calculated daily flow gallons. Plan Date ` Number of sheets Revision Date Title An, / Size of Septic Tank /---L��J �/n Type of S.A. . /5—�//Y! ?44& L�/a117b� Description of Soil 2 y/� �, 41 cd�e­14- .Ck � Z t�' �vnJ/h e �-r 40LC 'Yx Nature of Re airs or Alterations(Answer when applicable) �GL ,U, 6/z U /, SOX AK Z L% 1ti, 6 06 Date last inspected: © 4/ oT e 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 y thi"ard Signe a Date Application Approved by v Date Application Disapproved f the following reaso Permit No. I ~!::— JVL Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, thpit the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by I (,kW— lC,bUUQ at 1 tn�Vclkj . L-VI W ) I i e n constrwtefl� a cordance with the provisions of Title 5-and the for Disposal System Construction Permit No. "/ ,ated f Installer Designer r The issuance of this po }�shall not be construed as a guarantee that the sy will cti'o'n�sdesigpe ,} _Date ! ! Inspector l� ' __ �aQ�� --------------------.--- _���� No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS migoot *pgtem Construction PermitA o Permission is hereby gr t toMCRe a' ( Upgrad ( )��txdo n )System located at 12 and as described in the above Application for Disposal System Construction Permit. The applicant recognize7his, er duty to comply with Title 5 and the following local"provisions or special conditions. Provided:Cons ctioousco pleted within three years of the date o t Lpe it. G Date: Approved by _//7 / - f,1 r�1 9) yt ` "" 1/6/99 s' 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) I, �L�y / , hereby certify that the application for disposal works construction permit signed by me dated 2 , 2zo l, concerning the property located at _Al4, cV4-&_ D2 A16,/44-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) a i B) G.W.Elevation +the MAX.High G.W.Adjustment. _ ` J DIFFERENCE BETWEEN A and B SIGNED: DATE: 'Z l [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for 2/__bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health.folder:cert 0 LOCAN SEWAGE # VILLAGE— Y eStf-9f) ASSESSOR'S MAP & LOT 6 L6 INSTALLER'S NAME&PHONE NO. (Qw '4-n--6-2S4 SEPTIC TANK CAPACITY 0 LEACHING FACILITY: (type) OC�2- 4 NO. OF BEDROOMS oIr 1 BUILDER.OR OWNER X1y1%Q5 4-: LV—Nfe k7i PERMITDATE: L4— COMPLIANC E DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility any wells exist: on site or within 2.00 feet of leac'hing facilit.y) Feet :' Edge of Wetland and Leaching Facility (If any wetlands exist ithin300f6etofl hi i4ty) w leaching f g aci 'et; Fe Furnished by T—:411f ZIA 3 /30 ow AE AFCW .4 E-- P size f• A /3 L0CAT10N SEWAGE PERMIT NO. VILLAGE �- i INSTALLER'S NAME 8 .ADDRESS lI A,AALTO!BACKHOE SERVICE e West Barnstable,-Mass. 02668 IUILDEIt OR OWNER �- C� �YCY 19 DATE PERMIT ISSUtD DATE COMPLIANCE ISSUED L .� P3 �`-- r 're /'� � ��.l / � d � � '� R � ' . �w �` 1� �►�" � "/ ' �ff .A 0 4 p, , p low I } 9 q. 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