HomeMy WebLinkAbout0346 MISTIC DRIVE - Health 346 MISTIC DRIVE
MA.RSTONS MILLS --
----- -- -
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TOWN OF F3ARNSTAELE �20
LO''t#[rOIv3 Y(o ?'i� Qr SEWAGE # D l" 0
V ILAGE OP97,14-f &i l/f ASSESSWS MAP & of LtO2T D XD OJO
INSTALLER'S NAM v.1 e,�'li 19.E E&PHONE NO. ,07 - J/ ,/�.f 4,0-"A.S
SEPTIC TANK CAPACITY'_ Q00
LEACHING FACILITY: (type): ° CGl rh_"G e/VM*VE 9-&—(size)
NO.OF BEDROOMS--? f
BUILDER OR OWNER
PERMIT DATE: ,l�, / COMPLIANCE DATE:
r
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 facili ) Feet
Furnished by
Gar tit �.
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ysr�c
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TOWN F O BARNSTABLELOCAM
SEWAGE #
VILLAGE np.4 ,!/
ASSESSOR'S MAP & LOT D O
INSTALLER'S NAME&PHONE NO. f"1,� -y?1 yy -4 �2o
�
SEPTIC TANK CAPACITY
Q¢
LEACHING FACILITY: (type) 5ibr
(size)
NO.OF BE 2
BUILDER OR OWNER
L...
77777-77
` , PERMTTDATE I— .�,5'-�d/
COMPLIANCE DATE.
f. Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching
Private Water Supply Well and Leactun Facili Facility Feet
g ty (If any wells exist
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facili ) `
Feet
L. Furnished by7.
Fee-----------------
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No. Fee /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplication for Migoal *pgtem Construction permit
Application for a Permit to Construct( repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. y(p "b�S�'(� 0/-, Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
0.9
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.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 Tank Type of S.A.S.
Description of Soil .5 iqh
k Nature of Repairs or Alterations(An when applicable) 9'/_543 `� 3
Ul1Tyj �/S1C7�1—c I�rUU/�7
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 thi Board of Health.
Signed Date
Application.Approved by 42 Date
Application Disapproved for the following reasons
Permit No. Z Date Issued
No. O Fee /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓✓✓
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE- MASSACHUSETTS Yes
2ppfication for Mt,5pont *p!tem Construction Permit
Application for a Permit to Construct( impair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
�j�rS�hS 6Yli//S /QiG,Gj�p� GG/!�d'/�0
Assessor's Map/Parcel
0130 G ,e 0
Installer's Name,Address,and Tel.No. Gf rJ rJ—C�=��1 y Designer's N e,Address and Tel.No.
✓os,�pti o� ����d®s ✓�z�ti a� /3,���vs
/ C sa�o2v-e oaf l�t'l�rs tah �f/ S�v�� 'i
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 I4*1_
Nature of Repairs or Alterations(Answe when applicable) h'Stl ��
wlr6 3''S?ae,c. 14rvvo7
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 thi Boaardjpf Health.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
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( e-)-Riepfaired( )Upgraded( )
Abandoned( )by 45-e_� 12{ grJy°t��S
at --/G / less W S has been construVZS
in accordance
with the provisions of Tide 5 and the for Disposal System Construction Permit No.�V I`0 dated Of
Installer Vo_S cA,-,4 a,_ s4/''s^pS Designer 4Y_-
The issuance of this e t shall of be construed as a guarantee that the syste funcron a signed`
Date �G d Inspector .
1V
_ _ _ _ cy_____
D 0 0�✓0. �....
----- ---------- ----
No. Fee_��_
HE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
li5poe;af *ps�tem Construction Permit
Permission is hereby granted to Construct( -Repair( )Upgrade( )Abandbn
System located at G 5,rlC
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: Construc eted within three years of the date of th
Date: Approved by ; ! -
{
l/6r99
NOTICE: This Form Is To Be Used For *the Repair Of Failed
Septic Systems Only. -
CERTIFICATION OF SKETCH .kYD APPLICATION FORA DISPOSAL
WORKS CONSTRUCTION PERKY IT (WITHOUT DESIGNED PLANS)
I, J4.3e)k�f �.e �,�r��S hereby czzrdi' that the application for disposal works
construction permit signed by me dated conce.-lips the
property located at meets all of the
following criteria: r
•VT'ne failed system is canner ed to a residential dwelling only. These are no commercial or business
uses associated with the dwe!linz.
fie soil is classified as CUSS I and the percolation rate is less than or equal to 5 minutes per inch.
/w"The:e are no wetlands within 100 fee;of the proposed septic system
mere are no private wells within 1:0 fee;of the proposed septic srse n
There is no increase in flow and/or change in use proposed
There are no variances requested or needed
i fie baaom of the proposed leacaing faclity•xill not be located less than Eve tee;above the
maximum adjusted goundwate.table-!evadon. (Adjust the zoundwacer table using the Frimpcor
method when applicable]
• If the will be located with '-50 gee;of any vegetated wetlands, the bactom of the oroposed
leac tin-facility will not be Iccated less than "ouneea (14) fee;above the ma.-cimum adjusted
Q*oundwater table e!evauon,
Please complete the following:
A) Too of Ground Sur ce =:(riauon(using GiS intortrtadon) '� ��;7
B) G.',V. Elevation _the:VLA-K '-Ligh G.W. Adjustment . _
D FF—ERE`+CE B E T ZVEEN' a,and 3
(Sketch proposed plan of on bac!:).
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a;p A ION ILSEWAGE PERMIT NO.
5 _ r
-VILLAGE
wr
cb INSTAkILF
jRS NAME i ADDRESS
BUILD R OR OWNER
I �
0 DATE PERMIT ISSUED z Z Zri
DATE COMPLIANCE ISSUED L7 ��
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..............
THE COMMONWEALTH O% MAS SETTS--;
BOAR® OF i4_ A -
...........................................O F.........................................................................................
ApplirFation for DispaoFal Works Tonstrnrtinn ramit
Application is hereby made for a Permit to Construct QVQ or Repair ( ) an Individual Sewage Disposal
System at:
AIL•L.
L cation-Address or t No. 2�
evo
Owner Addres�
.......--•--•........................... .......................... ..
........................•---..__.....--•---••-•--------•-- ---•--.....----..........------._..__...__.._... -.---.....--•-•--•-
Installer Address
Q Type of Building Size Lot...Y_Y - ....Sq. feet
U Dwelling—No. of Bedrooms...____________________________________Expansion Attic ( ) Garbage Grinder
Other—Type of Building—SzA C6J.0...Fj.4M. No. of persons.......a............... Showers Cafeteria ( )
a Other fixtures --------------- -•--••------... ...
W Design Flow.............5..�......................gallons per person per day. Total daily flow........V_P_......................•._gallons.
WSeptic Tank—Liquid capacity.15oAgallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width...............----- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No:_....,1____..... Diameter.•.,,e,*'�.. . Depth below inlet......6......... Total leaching area.�n2 P._..sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aa Test Pit No. 1.4 L-.minutes per inch Depth of Test Pit----/.L........ Depth to ground water-----A1_129.........
t=, Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water........................
-------------------------------•--••----------............_........._ ......................
O ` /t ..-
Descriptionof Soil--------•----•-�3--�=ot.....---C=-�..�.--••----�----'-----•---------- '�--•-- -•---•-------------------•----.........-•---
x
U --•.....••••-•------•-•••-•-----------------------•-•--••-•-•------._......-••-•-•.....-•-••-•---------••---------------•--•--•---------------••----•--•---------------....-••-••......-•-•...._._..---
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 TIT 4 5 of the State Sanitary Code— The url ersigned further agrees not to place the system in
operation until a Certificate of Compliance has been y t and of health.
Signed. .. ..0
• • ------------------ -----••-------------••---------•
Date
Application Approved By---- ,•-✓` ----------------••---•--•-------------- -•--- -1 .—. ----------
Date
Application Disapproved for the following reasons:................................................................................................................
....•-----.....--•----------•......................................................•------•--•-•------------------•---••--------------•----•--------------------:.....------•---•---•--
�,
,.*k.. Date
................................................ Issued_.......................................................
Date
IrNo.g ..47 Fim .............
.-SHE COIW.14109'�IEALTH Of MAS TTS
BOARD OF
................... ................OF
Appliration for Uiiipoiial Workii Tongtrurtion runfit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
.................................................................................................. ............................................... -�7-------------------------------------------
Location-Address or 3�� o.
.... ..............
Owner Address
.... ......
...............................................Installer-----**.................. ........ .......*------------------------------------"Address'------------------------------------------
U
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
`LI
PLI Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
aI
Other fixtures ........................................................................ ......................... ...............................
Design Flow................ ....................gallons per person per day.. Total daily flow..........................................4allons.
1:4 Septic Tank—Liquid capacity.15veallons 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. f t.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by.......................................................................... Date..........................I.............
Jest Pit No. L._,-,.-L__..minutes per inch Depth of Test Pit------/.L....... Depth to ground water.._..:.fY-Zh, ......
44 Test Pit No. 2::.........:....minutes:...._minutes per inch Depth of Test Pit.................... Depth to ground water._...._____..__.....___.
---------- ......*"----------*----------
..............................*.........**.................*..................
0 Description of Soil................. .......... _L. .............................................
-------------------------*---------*----------------*-------------- -----------*---------------*--------------------------------------------------*-----------------------*---------------
............... ---------------------------------------------------I.........................................................................................................
......................
U Nature of Repairs or Alterations—Answer when applicable.____..........................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees:, o install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TME of the State Sanitary Code— The and rsigned further agrees not to place the system in
operation until a Certificate of Compliance has been I 'Vy t o-rd of health.
Signed... ...... ...... ... ..... ........................... ................................
Date
Application Approved By................... .................. ....................................
__/-------------------
Date
Application Disapproved for the following reason ..............................................................................................................
I
.......................................................1,
............................................................................................................................................
Date
PermitNo......................................................... IssuedL.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tntifiratr of Toutpliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired
by-------------------------------------------------------------------------------------------Install--------------------------------7----------------------**"....... -------
at..........................—re/.... ........ .......
. ...................................................................................
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ............. dated_....._..____._...............................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM Wl i FYNCTION SATISFACTORY.
DATE.... ...................................................... Inspector------ ..... ....................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ..........................................OF......................\.............................................................
N ..............��j FEE........................
..........
Disposal.Vorkv Tonstrudion rrmft
V
Permissionis h b_�pe y granted..............................................................................................................................................
to Construct or Re air an Individual Sewage Disposal System
atNo................ Zin . .........................................................----------- ...........
Street
as,shown on the a p ica Ii t' n for Disposal Work I s Construction Permit No..................1/7.. 19�ted.........................................
ZI% ..............................................
ard of Health
2 /��
DATE.....LIZ------ ...... —................................................
FORM 1255. HOSES & WARREN, INC_PUBLISHERS
NOTE : /f Erz7,VeT 7-,We-T-=R77C TANK OR
LErACsd/NG P/7 AitE IyDRE TXAA1 /2-JZLOW
SRAOF'j R d?4'O/.4M ET.E.? CaNCRETE COVER
SMALL BF @BOUGHT TO Gi;A oE.6�4, EXTRA
CO/VCIWd7't 4'PYC P/PL %rEAvy CAST /BON COVER -TAV�4., L- 3E USED
EL=94.S COYE/tS FN D
M/N. P/TC/�► / / R/VIeWA Y�S'PFR FT.
•--• , 2�(. MiN. CONC.e�TE
A / GJ�A0Aw CO P'ER
&ACX F'/4.G
UQUJD LEYEL 4t - _
2 LAYER
i o P/P6 f S oo GAL. . o . of
Afim.P/TC/V - D/ST. •' 1 • • • • • • ► s •�' WA SHED 5rONE
Rem 1'T. SEPTIC rAMM . • • • • ' • • .
do IP AV I
• b 1 r • ' DEPlN • • • ' • 1p . WA5NED STONE
i 89.5 x 't.5 4771 L,/D , o. • • • • • • • • • o ,�„ PRECAST"As-AG£
lIVYr ' ELEYAT/O�s Tb.S x 1.o 18 Cv/D / •• • • • • • • • • o P/7 OR EQ[//V.
/NYERT AT Q[!/LD/NG. 8G.5 FT.
ofT cAA•cir( : 549 v/D C/� D/AM. • EL= -78. o
INLET .SEP'T/G 7.4/VK 8.10.3 FT. Soot G-,LD 3f�G CHID �- I 0//4h1. C(SrsrIBUL�TlaN>
Ot/7►LET SEPT./C TANK !F�' �►sD sc37.
/HEFT O/STR/D&T/oN BOX 8S.9 p7 GROV VD �gTER T,�L E
85.'7 FT. sEC7-/ON OF RaLD Lccai�o►.,
odTLETD/STR/BtIT/4N MX. s�yy gGE O/SPO�SA L SYSTEM m =F
/A/LZr LFACMING PIT 84:O FT. ��-_ �2. o (3•,L• as
LEACHING JP/T 7A5ULATION
1tALE : %4' =O' O/MEN.S/ON A 8 FT
DFSfGN C FT.
Nu.�lQER OF BEDROO/�!S 3 D/MENS/CN C 4 FT. M►Q .
GARQAGED/SPO.S�SL UN/�'�-�- SOIL LOG ��� w4-r�Q
TOTAL E.7r,^l+fTED FW APv 330 49A1-.1OAV SOIL TEST.*/ SOIL 7FS7-#*2 SOIL TFST
NUMBER OF 4eACMIN6 PITS I f-ECEY. 09-4 Z-Etr•K 91.9 OATE OF, SOIL TEST -7 - 9 So
SIDE LEACHING PER P/T (S9 SQ fT. RESULTS iV/TNESSED dY WEE
T -�cu s PCM
aoToM L64CNING PR E P/T 1a-S4. A O -3' L d S = LcAg /'ERCOLAT/O V RA_r&rL f Lc�sS !y/ INCK
TOT.tC LEACH1WCr AREA 4. Fr= _ o-S W iTM Am*COL-1T/aN.RATE lk2 i w MIN /NCH.
REScRVELECtG'NIN6AREA�SQ FT. �'
�aC� aF' CLAD 2 .o
• CLEAw. �.
V OF Mfg .• CC>`P�.! M�(S'-CZ Gd.
p�►�/C
S-l 3 ut mD LLS
i SA-1-4 p
OREDG E EN&IMA"ING CO,/NC.
EL
L•"1Z4. . cL="19.9 7/2 MAIN Sr VYavwI-Rags.'.. .
Np Su [ NO G�OUNO.yY,4TtI! l�NCOIJNTfR'EO C•L/EN7':c�;�2,No DRTE 4 l I. 3
Q GROUNO WATEgp AT FLEV.
JOB No: _ e3o�-1 sHE,ET3�of�_
1bT1`= ALL Qa1JQ.4 _ GQ.o.nir, 1 -To LE,C.�f+,i+.j
Uf iDl'jTVP_NC-b ico fF .�M �AMP_L11-1 AQ.1..1b s
U,IJI CC�g p. urai'1GL CF ,1►.I�:I_T Is f L_�a
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LEGEND ,
EXISTING SPOT. ELEVATION Ox0 CERTIFIED PLOT PLAN
EXISTIN;O CONTOUR — p --
FINISHED SPOT ELEVATION 4 8i �1s vC
FINISHED CONTOUR , 0 — M � 74:) ��!« S
APPROVED , BOARD OF HEALTH IN
-W ASS
DATE ..AGENT SCALE, /" 40 ' DATE, 3/a.S-/93
W� t�Of M
QrELD EDGE ENGI EE ! G C .`IN Ga.►�s/v o��`�' �y
EGISTERED REGISTERED C�'IENT"" „ `� i CERTIFY THAT THE' PROP03ED.
10M NO. �3 0 6 7 g s BUILDING SHOWN. ON THIS PLAN
---�•--
ENGINEER SURVEYOR DR.Byu A-•,4, , Cl
CIVIL LAND CONFORMS TO THE ZONING LAWS
OF BARNSTA E, ASS.
CH.BY'T 12 MAIN STREET J.,,,�.�... su>
.� H YA N R I S, MASS. 8HEET_,L.OF, 2. -�—� .
DATE .0. LAND SURVEYOR