HomeMy WebLinkAbout0042 KERRY DRIVE - Health 42 KERRY DRIVE, MARST.MILLS
A=043.030
i
1
&ATL�0 V �0 %L 6e0� E W A G E PE�`RMIT NO.
Jam.4, a
VILLAGE
�0
✓t';INST LLER S NAME i ADDRESS
i
BUILDER OR OWNER
I�
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED ��
��
�\
`:
.V
• �� � 0�10
. . 3 ;�
��
� '�
- - •� � �
9
* , .
TOWN OF BARNSTABLE �
LOCATION -e, r k�-q_ SEWAGE #
VILU,.GE r iM�`\ t ASSESSOR'S MAP & LOT t3�—E
INSTALLER'S NAME&PHONE NO. M'tX)—C-OA 1
SEPTIC TANK CAPACITY Sz c= k MM .Q,�\aw
LEACHING FACILITY: (type) _LLfs C L (size) 5 ZCt'l'ifa'
NO.OF BEDROOMS T
e
BUILDER OR OWNER C l =i oYI-0
PERMTTDATE:_,,� -� 0 -�� 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
t, 3
`® Q
�3 q9 '
I
i�
�I
_ 1
L_ s
No. ♦LL' Fee<�10 —
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIppYication for Msspogal *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(_14pgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Y_Q If ICYf NQ_1 Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 093—OZD C3:z v�- o
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Q0, �Y QDolfvf5
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures t q
Design Flow A0 gallons per day. Calculated daily flow '"1 \ gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank `12�`MS< '-- 60�7YD Type of S.A.S. Or%\%cxc pct `3: 1P
Description of Soil tf vas Il���u
Nature of Repairs or Alterations(Answer when applicab e) a IJ' 1' oc �
411— 6, .101e-�03 w �� c S� 41k j ewe
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 ode and not to place the system in operation until a Certifi-
cate of Compliance has been s o e
Signed Date
Application Approved by Date d!:a 0,.9 r
Application Disapproved for th ollowi reasons
Permit No. Date Issued
No. I le'�O Fee
THE COMMONWEALTH.OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TO'WN OF)BARNSTABLEs MASSACHUSETTS `.les
kpprication for � gpogaY *pwm towaruction Permit
Application for a Permit to Construct( )Repair( Upgrade( )'Abandon( ) ❑Complete"System ❑Individual Components
Location Address or Lot No. Y f I�.... Owner's Name,Address and Tel.No.
G /� ir•
Assessor's Map/Paz �v,1\s
Assessor's-Map/Parcel O I��W
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
U�I : {'Ir E - Qc1
1�-e.V f 5
, l aAie✓ r'r��c� N� c�►��15 aa��
Type of Building: `-
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( ) )
Other Fixtures , q
Design Flow q�1 o gallons per day. Calculated daily flow t L Y 1 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank ,,�� Type of S.A.S. �� GC-Qt-t I
V
Description of Soil vim-s�A
f
Nature of Repairs or Alterations(Answer when a plicabl ) w-S�
Date last inspected:
Agreement: r
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 10 ea 4
Signed Date 3-ad 7 Cl
Application Approved by Date
Application Disapproved for.the ollowi reasons
.ter
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( 1l�
Abandoned( )by r�` F2o v,2 G t f 5
at Z�q 0 V I V(f M jl V���'C°°�)S M l ( I S has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date y - .1 Inspector
————————————————————— --
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
Mi-gpogal *pgtem Cl- ngtruction Permit
Permission is hereby granted to Construct( )Repair( grade( )Abandon( )
System located at f.� L L, �'V ti} 6 V I V(f t t G-1 V I L(S
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 must be completed within three years of the date of this permit.
Date: e� —�(�=4 0 Approved by �•,
fir. . -`; Il1NN1 '•
NOTICE: This Form Is To Be Used For the Repair.Of Failed
i
Septic Systems Only.
; j
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED
PLANS) `
INRED
i ;
p ( V- L'.l� hereby certify that the application for disposal works I � f
G of ;
construction permit signed by me dated - a b `q g concerning the
8
Pe
( S meets all of the i
• property located at q2 • � f
following Criteria: !
' i
�/• There are no wetlands located within 100 feet of the proposed leaching facility 1 a
'✓• There ere 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.
/ If the P roPo sed leaching Facility will be located within 250 feet of any wetlands,the bottom of the
G4>u :;
Proposed leaching facility will W be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
i '
Please complete the following: i
A)Top'of around Elevation(according to the Engineering Division O.I.S.map) ; I
-��� j
well map)
B)Observed'arduundwater Table Elevation(according to Health Division w4-
DATE:
`� 1
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
i
[Attach a sketch plat or the proposed systatt.Also(fthe licensed Installer poassrea•eertlAed plot plat, ;
this plan should be submitted].
z ° 4•k 9th Wee an
eC/
1
TOWN ORBARNSTABLE q
: .'LOCATION a r SEWAGE #
;:AULAGE Y y��� ASSESSOR'S MAP & LOT d y L�
INSTALLER'S NAME&PHONE NO. M I SJ-GtA�Se t l
.:'SEPTIC TANK CAPACITY `zc��STc: lt7TJ'D .C F�l�c«v
LEACHING FACILITY: (type) al �— L (size) 34?6(l Y,4/
IvO.OF BEDROOMS T
::BUILDER OR OWNER C is=r Q>2
. KRMITDATE: Z 10 '9� COMPLIANCE DATE:
Separation Distance Between the:
.:;.Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Fr;vate 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 •
I �
i
bh t� ;
AI
No................ .... FEs.......1.....®............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............... ....................OF.......................... ...........
A.Votiration for Di-gVviial Workii Tomitrnrtinn Pprutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys'—:.a................./............. ................. ...... -- --------------------•-........................................ ...... ....
--....................
/� JL 4 ry �Loo.
A.
.....7�6"G .1-. �. Locat.. ii . ..... ^-...... .... .....5!..1.. c l (.!L....._-- ....NAd?*
.._.....
r
Aress
d Type of Building Size Lot............................Sq. feet
v Dwelling—No. of Bedrooms.......ca............................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP g -------------•-•------------ P ( )..— Cafeteria ( )
Otherfixtures ...................•---•--•--.......------...--••---•-.-----.......-------•------•-•------•------...._..........---• -••.-•----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area...7.............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........................
Lr. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
................. ----------------••-•--••--••-•--.................••.........------•••••••--•--••-•-•••••-•---.......-----•-•---------••-••--•--••----
0 Description of Soil........................................................................................................................................................................
x
c,
w
---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
-------•------------------------•--•------------•-•-----...._....--•---------...._..---..........-------•--.....----------------------------•-••.•-----•-••---------•-..............---.............----
Agreement:
The undersigned agrees to install the aforedescrib Individual Sewage Dis 1 System in accordance with
t_ze provisions of iITLL 5 of the State Sanitary Co The ndersigne furth rees not to place the system in
operation until a Certificate of Compliance has bee ued by 1 ea
-------------
Application Appro - -------- .... - ..... .........................................
-- ...............
Date
Application Disapprov for e following reasons: .........
----•--•-..........-•-------••--••-------•-....--•--....----•- .........••-••_.._
........................................................ ..._.........--------•---...._..................... -••-----•-- ......_.....
Date
PermitNo......................................................... Issued.......................................................
Date
y♦
No.. ..J..�._.a / FES............ ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF......................................................................•---...._......__.
Appliration for Dhipouttl Mork.5 Tomitrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys ° �`�---- A. ...... ............
00� � �
/�1 G D ...... ........... ...........
/C7 r1 Lacati �rd O a �%el ��o
..._......._. -------------------- ----------% ....................................._./'.�_.-..... AAW
..._....
._... ._._
Addr
._.....
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.._..._............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures --------------------•-------------------•-------•---•---•--•••••-------._.....-----------•..__._..........•--•---........_....---•-••-•......._._._.
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P+ •---•-•-----••......••-••--•-••--•------------•--••••--•••-••-•-...-••--•-•---•.........................................................
---...
•--•.......
__--
0 Description of Soil........................................................................................................................................................................
x
U ---.._...---•-•--•-•--••••------••••-•-•-------•--•....--•-•--••--•--•-•------••-•---•--•---•-----------•••••-••---•-------•-------••-•-•-----•-••-•----•--••..............•--•••--------•--._..._..._..
w
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
----------•-----------------•-•------•--••_•••••--•---•••--•-----•••••---••--•--------.......-------------•-•...---•----------••-----•-----.....•---•••-•••----•-----•--------------.._.._---•••--_-----
Agreement:
The undersigned agrees to install the aforedescrib Individual Sewage Dis 1 System in accordance with
the provisions of TITI% 5 of the State Sanitary Cod The ndersigne urth rees not to place the system in
operation until a Certificate of Compliance has been ued by ea
` date .............
Application Approv tl. . .......... -r- ..//
l-• ...............
Date �
Application Disapprov for a following reasons----------------------•-------------•--._..-----------...------------------------------.._...----------__------
... ..------••••------•----•.._...-----•-••---•-•---•-----•-------•-••--••-•----••-•---•---•-------•-----•---•---....••----•..- ---••-•-----
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tntifiratr of Tonmpliana
THIS IS CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by. Jc•� s f-_____.._ - -------------- ----------------•-----------•--•-----_______-_------__________-•----____-____--•-•-•---._......._-•-•----_-_-------
J Installer
at.....................;/6C.X............... A4......L��........................................................................................ ..........
has been installed in accordance with th provisions of T TLF j of The State Sanitary Co e as r' in the
application for Disposal Works Con ction Permit No. ..........
______________ dated_--'? �:._ .._ ._._._....._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WIX
U CTION SATISFACTORY.
DATE__.... ._be--...---•--.....-•--•-•............................ Inspector.. ... ...._._...-----------------•----._......_.........-••----....----........_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH ,�/
,v OF.......................-.........._......_................._........................ /(�
No.. ....... ...� FEE-•--•--•-•..............
VWVoua orkf�Tonu nrttion rrntit
Permission I ere by .ranted...__ _ �._._� :: _ Ct _____
`_...._._1 ...
to Construct (s ) Of-:R pair ( �) an In v•>zival Sel Dip sal System
at N
i" r�
o. ' Q= ......-�--(\--....................................................................................
' Street
as shown on the application for Disposal Works C structiori Permit No.... --,,. ....... Dated..........................................
........................ ....... -•---•---•••--------...--••-•--•...•-------••--•---•-•----..._------
Board of Health
DATE...............................-••---------------•-•-------__----------_...
FORM 1255 A.M. SULKI�11 BOSTON
ISINGLc- �!AM�L.`( - BGORo0M ,
►.1� GA:R�AG1= `jWtJDE2
how : Ilex 3 = 330G.PP.
'
!I SEPTIG =r�►�K = 33ox150% = �95G.P. R
y5E- 1000 GAL.
II 015Po5AL Pl-r U-Se 1000 GAL. 91•vS I '`
'5%DaWALL A2CAa = 1506,11. �r PPP /oZ. B I
150 S.F, X. �•5 r 3?5 G.Pq f
5OTrO/K pREAs �0 S,F, �
,k
I Sp S.F x I• o
II "foTA l- C7 5-St�N * 42 5 G.P
-TOTA%- DA I -`{ FL-0v4
I, PrmZZcoL.AT10N RAPE I''IN 2MIN o� LASS =
I I TO2.Z
44sar
ZI{Of�f,�s� '• ��P�,1M Of At 34.
,
RICHARD yGfi ALAN 0
A. W.
BAxTER ti JorvEs k;xivr + eycry
wo a4049O No. istoo ` _. .._._.._ 25,oo
STIlt GIs -- Icy 9 Iou,c 49.q
i
-r�,T To P FNv=tc�-
Y/Y
INV. 101.4
. LnA►y 1000 INS•
SJ8�D14 6v INV. 56PTIG /o/.z
3 S 1000 INY /a/•o TANK 10
c7a1.. /cam
LEAGu `
PIT INV. INV.
W I T u
6TvN6
SANt). �Cq�
•°� ( CEZIT IFIGD PLoT PL_A►•J
P?.OPIL� LoCA-rloN
b No 5U,La SCALD
a W ATE Poust os at> RE P E 2eN c er
I CERTIFY 'THAT 'fN1= : SNoWN 1
NE.REoN GoMPL-`(5 YJITP-THE
AuD 56T5Ar, 6QV NTt�, C)P 1
Tv W N O F j?;.AZaf�,L6 A N,D 1 S �Or
LOGp.TED WITNI T E F1 0oD P AIN
DA-7 E t I-2>�3 t
BAXTEcz.e IJYE INS.
REG I ST rcZr=lD .A11 D S u fZY EYoeS
Tu►S PL&KI 15P No'T (3n5[=p Ob AN OSTE�VILL� ass. 4
�� iN5.1-RuM6NT 5u2vt�Y 'THE D1-F,SET5 SuouLD �QT � �
N0T D♦Gc 'V5EDT0 L7ETEFt1nIN� �.oT -INE�j APP�.ICA►-IT AL),
5%w(,L$ FAMILY
j NO GAAA. 66wtJD6i2
SEPTIG TANK ^ 330XI501K - 14956-Ph R
use- 1000 GAL.. ;
I ,1
91•cs
I' 015PU.6AL PIT V4E 1000 GAL. i
_ cp PAP
��D�YdALL ARCt►. 1� 5.� tXP P
150 5.F x 2.5 = 3?5 G.P P MCA
h
BOTTOM AREAS lco 5r• T (� •� t
5A $.F X I. O 5O G.PO l 3•`
II -ToTAI- P6.516N * .42-5
TEA 1I-%( FLOW = 33o G.Po tl�
I, PE2GOLATION RATE + 1''IN 2MIN oR_1-E55: r =
(S / Aa /• rAWL102. 13
/02.\ .O * ;}
,I ``''�,<'f'• � 1�SE Imo,
t tH-OF M 1H Of 34
M,�
RICHARD G� ALAN -0
�i A W.
BAXT
ER to JONES ^ Wr:� I d b'XIS1' •} EXIST
Na 24048O A No. 251 ` _ 25.0o WELL 'Wrc1L
4°�s•r�a�a�• ��sT .^ t � --. . _...... .. ,ate 9 la�.� 49.9
su
}
f
• Y >t
TE'�T 1 �� FL= Ia3 Top FNa=kca4-
HoL.f- Io/S/83 �'L4 �n3h5
LvA►y loov lwJ.
i < eso�V DIST• INS. 56PTIC. /o/•z
III
3.S IGoo INY, TANK 10 01
LEAGu kI
PIT INY. INY.
wITII
L' 11 3/q•I%L 4
Me> WA Q D '
,. 6TvN6 •
• �AN'o. t=19� �i
GERTIFIGD Pt-oT PL_AtJ
'! PSZ0PI L.�
� L o C 4'T I o N /Vl Q�To�, ,/YI Il.•!��
e NO. SCALE VATa
Q W AT{ � c�Pvi�r� P>_p 1.! REP 6 2E► 1 GE
I c6 RT1F Y 'THAT THE ( oust✓ 5Kc) 1
grp9SoN COMPL`(5 YJITO'THS. Slo�L1N � �
AND 56'T5ACK �t�..6� Qu1'2EME t4T� 0Ff1-1�
I -ra W N � $ GZ 0 T'A�te, o o ►4.�, fiat' I G• G, S ( g�
I L0Cp.T`E0 -WITNII•--
DAT E �I"2S3 BJN-A+a . Wye: INC.
R.EG 1 S,T1c2E.v'I..Aw o S u PLY
Tull PLQN ►5 NUT 4n5r p o►d AN OSTEi2.VILLE ' ,v`p.S$.
�I I uSTR•V M6NT 6 V$ZVe ( �-'T HE 011F5ET5 '5P0UL3> 1
No-S• 4rc 'VSEOTO C�E'TE.>;Z,/^1NE �.�'r -lNES APPL►CA►-I r A27r 'Da
ij