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Home My WebLink About0010 MOUNTAIN ASH ROAD - Health E123 untain Ash Road Mills 024 i v TOWN OF BARNSTABLE Ec- LOCATION / SEWAGE # UDot"30� VIULAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. 414 ,, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) v�"s (size) I;A _57/ NO. OF BEDROOMS :5 BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: —7 7 0,2 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) F�eegt� Fu she k #� rfoicl Igo&—sI C*6 p�0(� -_ ,,, N V q� y h� ` R�r�,a tiovs� ___ TV J � e � �. O _ j I; ,; ,� . c r w. No. L� / Fee� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for MiOo Y *pstem Cougtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f APIOV n.W n ,Ad fle Owner's Name ddress�n Tel.No. IM A-►2-S taws /d� l/p c%e Assessor's Map/Parcel (�x Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. C,�\Lead-y 63 ,S O btI Type of Building: Dwelling No.of Bedrooms �J Lot Size 5'L5s�.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 _ '— gallons per day. Calculated daily flow Y 6 gallons. Plan Date ''� 1`7 2Qo2 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) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site se�a" i r. stem in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operattz;:i until a C:er fi- cate of Compliance has been issuedfbx this Board of Uealth. ` Signed f Date LL. '77 Application Approved b Date Application Disapproved for the following reasons Permit No. 60-Z— 30 J Date Issued �y3 P -,1! ,.•: Entered in computer: /./1✓ THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pprication for 33i5pogal bpgtem Construction Permit Application for a Permit to Construct( )Repair( Ugrade( )Abandon( ) ❑Complete System "0 Individual Components %Location Address or Lot No. �� /'N�jV w1 T +i t �4 Owner's Name• ddress an Tel.No.l /'�'I h-t2 S TaV�S •;k,..l is na �� l7®t✓-'°l� Assessor's Map/Parcel + Installer's Name,Address,and Tel.No. 1 Designer's Name,Address and Tel.No. [.pwSowvenrt� �^ // y 1?,S J tI /i r4 *+ Type of Building: Dwelling No.of Bedrooms 11.3 Lot Size �3.S�s� ft. Garbage Grinder Other Type of Building rE No.of Persons Showers( , ) Cafeteria( . ) Other Fixtures Design Flow 3 3o gallons per day. Calculated daily flow V y G gallons. Plan Date 'f r7 100a Number of sheets Revision Date /v .- Title Size of Septic Tank Type of SX.S. Description of Soil r Nature of Repairs or Alterations(Answer when applicable) r �' �Date last inspected- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ac o dance 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 this Board of Health. �» -Signed m:,.--I,/- Date Ju ! Application Approved b r Date r. Application Disapproved fort`e following reasons Permit No. dU '" '5O 1 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTA;BLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site"Sewage Disposal System Constructed( )Repaired(Upgraded // ( ) l 1 Abandoned( )by H r e L av fl 4 c r fi?A at Jr Af n"N i Z.,., A, & /l 4has been constructed in accordance with the provisions``of Title 5 and the for Disposal System Construction Permit No. dated 'fit Installer kF.c �4z (1p)v -W- Designer _5'111.✓a.. �..� The issuance of his permit shall not be construed as a guarantee that the syste^me ill fu tion as desqne Date Inspector --------------------------------------- No. �/5C� `�lJ� Fee (S �f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigoga[ opelem�Uv;grade onetruction Permit Permission is herebyranted to Construct( Repair( ( )Abandon g ) PU. w System located at Vo u�V. �. `: n�� !�_ _�l i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to J� comply with Title 5 and the following local provisions or special conditions. Provided:C2grWuo ion must be completedwithin three years of the d to o� f Miss permit. Date: < 0 ✓ Approved,b', 4 �v TOWN OF BARNSTABLE EC.. LOCATION �0 �� F ,� SEWAGE # �GDo1"30( VILLAGE /ate' ASSESSOR'S MAP & LOT 12 3 `17.2 L/ INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �—s (size) ` ,& 'i 5— dor NO. OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE:4 COMPLIANCE DATE: 7 0 a 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 Feet within 300 feet of leaching facility) Furnished by S a o __C � O o . to '\ f i �flow�, 1� � rIcI,-e-45 t s � s � s c�✓ V'v : itf,-? ��9� LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NA-ME B ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED z , DAT E COMPLIANCE ISSUED f5 W e�� No. ti .`S ® Fps............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � .....`:...OF................ 5i.Vo fe!:.,�.......... Appliration for Biipuual Works Tunitrurtiun 11nmit Application is hereby mad for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,�P ,(f�/7 ...............•-•• ......_..... Location.Address or Lot No. Owner `� </p !1/g.G✓v a u. Ad'i/if ress ... 2. Installer Address U Type of Building Size Lot. �sn, S s, feet Dwelling—No. of Bedrooms.....................................Expansion Attic ( ) Garbage Grinder ( ) Other=Type of Buildili pa yp g ............. No. of persons -------- Showers ( ) — Cafeteria ( ) d Other fixtures ................. . ------......---•-•-•----•...-------•-------------- W Design Flow.............. 21� .......Jo&.o._.gallons per person per day. Total daily flow........... ....................gallons. WSeptic Tank—Liquid capacity gallons Length.C!'-6 Width....._.._.. Diameter................ Depth...., ..._. x Disposal Trench—No. ..................... Width.....I............ Total Length.................... Total leaching area....................s . ft. Seepage Pit No.__...../......... Diameter............. Depth below inlet....015............. Total leaching area.4i :... ft. Z Other Distribution box (P-111), Dosing41/ .tan ) Percolation Test Results Performed b Test Pit No. 1.......;9 .minutes per inch Depth of Test Pit......�37...... Depth to ground water.._._,d1i�� + 44 Test Pit No. 2........9�.._..minutes per inch Depth of Test Pit...ZJ........ Depth to ground water...... x .. -----------•--�-.d. �.-.-F..�t.�....�....�...�...�•-------- -•--•---•--- ---------. ------.----. . . -•---••--- ODescription of Soil--------4---. ....�.......�" 4 ................................................................................... 11.....- c6C ..... .......................................... cW --•-------------------------•----•-•••••--•-•-•---•••-••••••--------•---•=-----------•------•••-....---•-•-•-•-•---••----•----•------ -•-••--•--------------••-•-••--•-•-•-••-.....--------•-•----•---- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------=-•-••--•-•-•--•---------•-•-•-----•--•-----••----------•--•-•-..............•---•••-•---••-•••-•--•-••---•-•-•--•.....••---•--•-•-•---••-••-•-......_••••--...............:•---- Agreement: The undersigned agrees to install the aforedescribed Indivi ual a ge Disposal System in accordance with the provisions of iITLi: 5 of the State Sanitary Cod T e I d further agrees not to place the system in operation until a Certificate of Compliance has been 'ss ed a" of health. >gned "_--.._.. .-•............................... ------•- --•--• ... ........ Application Approved B >. .,_. � Date Application Disapproved f t e following reasons:---•-----• ............................................................................. ---------------------•-•----........--••-....._.....-•-------.............------. Date Permit No.------•---•......................... Issued---------...---••-----••-------------- ----...-- '---...._..._.......---•--- Date I�l'G.. /.Y FEE......... ✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Dhip ti al�IV orkii Tonitrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Q3 . Location.Address or No �j Lot r �f alFr/✓ ! �.: ........ n 'GlG.lsa .l� v °.. .... . . .................... �^+ Owner d ress ................. _�P-� .:.�!C►��1��-----•................-•-••-•... .........•--••.�".�.& /'�s�r� �'��'ry.� �•,��L�� Installer Address Q Type.of Building Size Lot g':�' c,�:,,,t.Sq. feet U Dwelling—No. of Bedrooms.............:�'�_ .......................Expansion Attic ( )- Gage Grinder ( ) aOther—Type of Building ________"_-_--_•__-_______ No. of persons ..__.___. Showers ( ) — Cafeteria ( ) Q Other fixtures .----------••-••••-••--.....---- W Design Flow....................5-0.._......7. __gallons per person per day. Total daily flow.........�3 1.....................gallons WSeptic Tank—Liquid capacit?2M gallons Lengthl_.9?._:_d. Width... .'... Diameter................ Depth....- -- x Disposal Trench—No. .................... Width.... ------------- Total Length.................... Total leaching area....................s . ft. l� p g --........ Depth below inlet..46.�......... Total leaching area#. 2. ft. See a e Pit No.___._,l.-.,_._._._ Diameter..,t, Z Other Distribution box (�) Dosing tan ) `" -Percolation Test Results Performed b a Y----- - .t .. . .::---- -- - .......... Date.....--y�-=+� Test Pit No. I.....-+'."_'.-`-_-_minutes per inch Depth of Test Pit...../,,3....... Depth to ground water.....4,4o,tf%" G14 Test Pit No. 2......�'�..:-_minutes per inch Depth of Test Pit,e j......... Depth to ground water..... 9 ••.-• -- ... ...............••-••-•-•----•----••••......-----•••-•-..............-•------............ ` O Description of Soil....... --------- saT''7� $ d �=a--------------------- x ---------•-•---"-"-----------------••--........_....--•••-..... r, ---------- -----------------------_aZ `~'/ '` C"G __... '..��V, e� .�1U�' .......................................... W UNature of Repairs or Alterations—Answer when applicable................................................................................................ --------•----------------- ---------------•--....---------"--""-•-------"------•--.........--•-.....--•-••----•-......-•-••--- ......... ----------•--•-------- -•---•---------------------- Agreement: 000 The undersigned agrees to install the aforedescribed Individ,t, 1 S a e Disposal System in accordance with the provisions of TITIZ- 5 of the State Sanitary Code he n si Ied urther agrees not to place the system in operation until a Certificate of Compliance has been is ed by et-oar health. igneda.... ................•--------Q- .......•... r. • D x Application Approved B ................ .......,........................................... Date Application Disapproved for the following reasons:.......... ..-:-•-.................................................. ......................................... ..------•-•-----•-•-----•------•----•-•-•-------•-•••"--------------•••--•-••-••--•-.....•---•-..:.'=�-••--•-•-..........•••--•-•--•---•----•-•-•......-----•-•-•-••.-----.....---...........•..... r Date PermitNo......................................................... Issued.-----•••-•-------------------•----••.................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trrt firaU of (font itittnrr THIS IS TO CERTIFY, That the Individual,Sewage Disposal System constructed �e) or Repaired ( ) - y Installer at.................04;..... _ ......em s__tofzw...-1-0 07—T,, 0 >�.....--• •----- has been installed in accordance with the provisions of TITLE 5 of State Sanitary q/ Bribed in the application for Disposal Works Construction Permit No...... ...... ,}�_...�__...... dated_.�!__�_._�.......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT g55BE CONST AS A GUARANTEE THAT THE SYSTEheIL NOTION SATISFACTORY. DATE.. //—-------------------•-•••-•----............-•••.._......._._. Inspector- ................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' 2;� ,.....oF.-----. .....---"................ Noce" .:..:..... .............. FEE.............................. Diipo,s al orkii- Tonstrnr#ion prrmtt Permission is hereby granted........ .........; w� .................... to Construct ( fir Repair ( ) an Individual Sewage Disposal System atNo.+4;t4 -...... d.C---=-Xxw----- ---------------- ----------------•-- ---- ---•-........ Street as shown on the application for Disposal Works Construction Permit No.......:...:.:..... Dated.v__._/.Q..:..................... ............................• ---- ------------------ .............. .......................... Board of Health DATE....................................... ........,:.0? FORM 1285 A. M. SULKIN, INC., BOSTON /` "7 ................. / THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ....................OF......... F......... .............. Appliration for Bi_qpoottl Works Tatuitrurtion JIrrutit Application is hereby made for a Permit to Construct W) or Repair ( ) an Individual Sewage Disposal tem at: SYS ,� .. = . s -----/ •................. ............... .. . Loca ion-Address or Lot No. ... ....... ................ ............ ._...._. Owner Address ------••--••--------•-•--•---....--•------•.............:......................................... ..•-----..............----......_.........................._............................. ...... Installer Address dType of Building Size Lot._. � ...... q. feet V Dwelling—No. of Bedrooms.__.__________________________________Expansion Attic ( ) Garbage Gri er aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafete Pa Other fixtures ................... ......•--••- W Design Flow............: _.......................gallons per person per day. Total daily flow.........;q......................gallons. WSeptic Tank—Liquid capacityt ..gallons Length................ Width•............... Diameter.___-___.____--- Depth................ x Disposal Trench—No. .................... Width_.j_...__._........ Total Length.................... Total leaching area....................sq. ft.. Seepage Pit No........../._.____.. Diameter...._9.......... Depth below inlet....C'd'.............. Total leaching area...0.'?•-.1'V....sq. ft: Z Other Distribution box DO Dosin tank ( ) AJ Percolation Test Results Performed by aX *!l.. <.W-_ 2! �fl_�.�Date...... (..,. ........... ,a Test Pit No. 1....._�-..minutes per inch Depth of Test Pit..../............... Depth to ground water..__&......._.._._. Gi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..................... a ................................................................................................................................................... ......... 0 Description of Soil....................... . ----------------- -.. ------•-------------•---------------- ....... 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 iITLL 5 of the State Sanitary 96de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n iss y the board of icalth. " Application Approved By.... ... .l�` ............. •. l r-_.. ......... .................... Date Application Disapprove or he following re¢sons-............................................................................................................... ...........................................................-............................................................................................................................................. Date PermitNo......................................................... Issued_....................................................... Date .�...... -------- ------------------------------ ................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ................... ........... . . ...OF.......................................--- ---....-----------...........---------- Appiiration for Uiipoiitti Work.5 Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •......................................................•---................._••••-•••-•••--•--•-•• -•--..._....._...-••-----.........---....--•-••....----••-•••••----••-.........-••................ Location-Address or Lot No. ......................—............................ .-•----..............--^----........---•- -•--•-....--•----•---•---------•--...........___ .------^----.......---•-.........-...-...... Owneerr Address W Installer Address d Type of Building Size Lot........................:... feet U Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Gri er aOther—Type of Building ------•_____________________ No. of persons............................ Showers ( ) — Cafete ' al Other 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........................................ W Test Pit No. I................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........................ 9 ...-•-•--•-•---------------••-•--------•------•---•---......---...................--•---•-•-••-----•.......................................................... 0 Description of Soil........................................................................................................................................................................ W ...................... 0 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 TITIS 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. Z_' ` ig _-____ ------------------------•------------------------...._..--- ApplicationApproved `- ---------------•-•-••-•--------•----._...__.........--••----•--_-----• ••_ ._.....__ Application Disapprovelowing reasons:...................•-------•------------••-•----•-••--••---------•-•-•----------------•-----nate.---•-----•-- ----•-•---------•-•----•------•-•---------•------------•-••--------••-•....................................----._.........--•----•---•-•-------•----•--•------•------------••-•---........_-------------- Date PermitNo......................................................... Issued•....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... C9rdifiratr of Tontp iatta THIS IS TO CERTIFY, That the Individual Sewage Dispos y to constructed ( ) or Repaired ( ) by - ............................. ...c ----- -•---• ••--..._.....•-•-----•-•......--•-•-•............._..------....._•-•---•-•- -----'------------------•-----••--------•---•-•----------• ...... ....-•----------•- has been installed in accordance with the provisions of TI F 5 of The State Sanitary Code r' d in the application for Disposal Works Construction Permit No.- ..... .......... dated_...`. .. . ........................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A UAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. cI DATE...............................' �� ..................... Inspector........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z- 4 �. ..................O F..................................................._..............._................. No. .�..�... �. FEE....................... Diopootti or�o �onofrudion rrutit Permission is e y granted.......6rjg �.`. _``_._ --••--.... ----- 9 _P'c=--•--- -....-•--•-•----•-•--------•-----------•••- ---- to Construct Repair ) livid wage pos ystem atNo..--- ••. ------•.-�•-------- - •-•--.....-••--•......----•-•---•- _ Street as shown on the application for Disposal Works Construction Permit No..... ... ........ Dated.�_.� ._. _... ................ ........................... --• ..................................................................... Board of Health DATE.........................•---.....---...------------- ......................- FORM 1255 A. M. SULKIN, INC., BOSTON11t• 51" �L FAME►-Y _ 3 BEORaoM ry (, II1•JO g'�,ct�AGE GR.lr.1DER. DAI��( F�a'vry rjEPTIG TANK = 33ox15o% = �49%G.R � _ 05c- 100o GAL. /oz IIo15Po5�L ( to P.r z C O'T PI'r v5E Ivoo GAL_ I 5%pcWALL AQ CA = 150 S.F i 15O S.F X 2.5 = 37 r; G.P BOTTOM AREA= .. 1��.�'`F•- �o/f I 'ToTA t- DESIGN = .g-25 G.P. D. � �U 3ox 9 � 'TOTAL DA I L F� o�( - v( � 330 G.PO, Q � 5.T /�/•/ • s I' PE2GOLATiO�! RA-TE : 1"Ifj 2MiN Or__l-E55 o ? i. f N OF a RfCHARD , ALAN sue` p A. i S W. BAXTER rn ; JUPJEs No.24048 arsYe 7 hp auk �� f'l�OV/�T/1//./ y✓l- hf ��'- T6'�T `J�Zo/� �6. .� r�Z•o -Top FND= /03 �>' .0 NOL�G�S�B3 /oZ•o � �� INv. 1000 II jvjjso/c—it MST. INS. GAL.SEPTIC z �000 �N�( BVX 99 G TANK , �A►.. 99 0 SiL�-- PIT INV.- INV. WITu 99 Z 99•� s • 113/4-I%L I WAsuQD . .. �� G GEcz'rlFtGo PLOT PI..Ar�1 P RZ 0 P 1.10 SCALE 5cALE / , SO. V P.T E ��Z3/E33 CERTIFY THAT T4+E PON,t ►+Sc. 5No4YN 1{ERE01.1 GOMPI-`(5 Y�1TN-THE AF.1D 56'f�.GK R.6QuIR.6MEN'1'� oFTµ�• B� ZSa �G/33 -(o W►� O F• gAQ t�lSrA.'3�.:� A N� �S fJoT' LOGp.TED WIT IIJ 1-iE Gl-DOD LAIN pATEG 3 Ct BAXTE2c PIYE INC. R.E615'[f�Q6V'I.AN D 5 u V_V EY�T�S 'TI 15 NOrr QnS�D o� AN osTE2.v1LLE - MAss• Iu j-r?-uMENT .5v2ve`( Jr-TNE oI=QTEV NE pUt,� APPLI G �'A,l'-4T ,eL.4i✓Z7 NoT C3E VSEDTO DETERln1N� t_. 5J�, F - i N Fee `------_ - -- BOARD OF HEALTH TOWN OF BARNSTABLE RpPlltation"Arloril cootriutionPermit Application is hereby made for a permit to Construct ( ), Alter or,Re air n indi idual Well at: -----A 4---- -- ---- -- -------------------- r. —-- — P - --------------------------- Location — Address Assessors Ma and arcel oaf/e.A C 10O.V-4, - —------------—----—--------------- /D--�`°"�'�li t K'_—�'S� —/J --------------------- Owner Address Ot U 6h / Y sF/ — ��— — — - --- --i--------- Installer — Driller / Address Type of Building Dwelling----Aso i-S-e--------------------------- 'IC� Other - Type of Building ------------ No. of Persons------------------------------------------------------- Type of Well ----------------- Capacity, Purpose of Wello.ues T c_ _cJ�f�r_____------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a CertificatUofCo' liance has been issued by the Board of Health. Signed-----=P`r-"-.'a------------------------ ------------------------ ------------ date Application Approved B - -- --_-------- ------------------ -------------------------------- date Application Disapproved for the following reasons --------------------------------------------- ------ - -----------------------------------------------------------------------------------------------------------------------------------------=--------------------------------- date Permit No. ------- - " - ------ Issued-------------- ------ - ------------- date No. -----`-- -- Fee- - --- -- BOARD OF HEALTH TOWN OF BARNSTABLE Applicatiou-*rIftl Cougtructioupermit Application is hereby made for a permit to Construct ( ), Alter or Repair-( Ian individual Well at: ----- ---------------------------------- Location — A _/ddress Assessors Ma.and arc G el I/ e rJ M C DOwG�N > /� � tilr i� /✓ --------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- Owner Address /1•JC la.�.v.a 1/ e I I ^4 a - T ---------------------------------------- ---------- ----------- Installer'— Driller Address Type of Building Dwelling �.•� ---------------------------h Other - Type of Building---------------------------------- No. of Persons-------------------------------------------------------- Typeof Well '2 -L-J----e-------- ---------------------- Capacity-------------------------------------------------------------------------------- Purpose of Well Ali_``"_`_'s T/r /..> /^ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. f� Signed— -- -------------- ------- Application -- �.� date Approved B -L �___.�______z - ----=----------------------- --- -------------------------------------- date Application Disapproved for the following reasons: -------_____________----_-_-----_-_-_--_--------____-______-__-----__---_--_______-___-___----- -------------------------------------------------------------------------------------------------------------------------------------------------- ---- ------------------------ -- ---------------- date - f Permit No.- - -F - ` ----------------- Issued - --- -- - -- date � BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (�) bD.� -�,9,�.�� l ------------------------------------------------- Installer Y----------------------------------------------------------------------------------------------- ----------------------------------------------at --------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------- --------------------- Inspector - ---- I =- ------------------------------------ ----- ------------------ BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con.5tructiouPermit No. = --- -- Fee--��------s_/-A--- Permission is hereby granted--n ILA"J-J'r /--------------------------------------------------------- to Construct ( ), Alter or Repair (r ) an Individual Well at- -fly <- �_ --� -----�----- ---------- --Age .— — -- =t No. -------- / �� "'s" �. - tra Street ---- - ' as shown .on the application for a Well Construction Permit No.-------- it/' = ,� =— Dated " 7 '` - "= -5; 7 ------------ �-�—— - ---------"---------------------- - J Board of Health DATE -`�--------------------------- tttff l: o 4 l DE51:aN DATA NOTES l) su wqLwo r9 wf ipL T 9 Single Family-3 Bedroom e ° I. Water Supply For This Lot is Municipal Water. G No Garbage Grinder 0 g ' 2.Location of Utilities Shown on This Plan Are Approx. oED c; —'-lam Daily Flow: 110 x 3 = 33 0 gpd l� {�G pui�• O At Least 72 Hours Prior to Any Excavation For This Septic Tank:Use Existing 1000 O i Gallon Septic Tank Project The Contractor Shall Make The Re uired CG Notification to DIG SAFE-1-868-344-7233. Ty P7 �. r LEACHING AREA 3.The Contractor is Required to Secure Appropriate m �� \oPno� C 160.00 q c�s 330gpd/0.74-446 s.f.Required Permits From Town Agencies For Construction o' ,ra` Ic • _ Siderrall: 2(12'+25')2= 148 s.f. Defined by This Plan. \ Bottom Area; 12'x 25'=300 s.f. 4.Install Risers as Required to Within 12"of Finished 448 s.f.Total Provided. Grade. LEACHING CHAMBER DESIGN 1 5.All Structures Buried Four Feet (4 ) or More or Al I Plipes to be Schedule 40 PVC. Use 2 Subject to Vehicular to be H-20 Loading. m -50t0 Gallon Leaching Chambers in 6.Septic System to be Installed in Accordance With 12�x?5 Washed Stone Field as Shown. 310 CMR 15.00 Latest Revision And The Town of /{� Barnstable Board of Health Regulations. 23,535 SF -�. �• r 7All Piping Lobe Sch.40 PVC. s W \ _ ` ?7% r(.�,P�.G `x- LOCUS PLAN JG0.; n•:\c>�,4` fox 1, F.G. 47.0 Ca a i��= 2000 F.G. 47.5 � =� �. (Assessors Map 123 dam' 2�,, ��N• ! ! cD -.,` O Hol_� I Parcel CIO 10 C*� 45.0 44.0 Grou rlay WP pECK i� T Exist.100071Gal e Top E1. 45.0 1 `mot 44.8 Septic Tan44.6 ri�� S- ;•_ STORY '} Bot.El. 42.0 I n Za' 44.4 44.2 5 ' Bedding as � Bot.Test Hole EI. 37.0 �'� Per Title 5 I/,'x -,5 y ' � No Ground Water 00. 'I-, \\ �- _DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM zG � Not to Scale � n w `•\ In `. c Ln Finish / ^•Q•. i- \ — G / O ('� , Grade ..— `J V5�` � � � /�O(��V � ' Filler � . '\ —4 1 4.03. �— f_ �//..7m � Fabric Cmpactad FIII \ ` 29•90' �/ � a Pea Sto no S i 7 Chaching mber Chamber ou _ 3/4'—I I/2"dble`� L-,IV Washed 4=10' I I_ 12-O" PLAN VIEW CROSS SECTION OF CHAMBER Scale 1 30, NOT TO SCALE TE 6T H.0 L- EL . 1i 7,s O 1_0 /ORG^N IC- y R LO., 13R!� 15�� YI�L. SAhIDY aq 3". LOAM o \rR e,14 OF SITE PLAN . Y I G H c_'RaioARstF- MUR SULLIVM SEPTIC SYSTEM UPGRADE C �,Q rl l� 1•G Y R (e y �+o Gaou��•wa r=ri r W.29M AT _; �Y: suLLl./Ala F Cl1l1d 10 MOUNTAIN ASH ROAD flATLZ- `-7 'ZOO'- I MARSTONS MILLS , MASS. The intent of this plan is to secure a Board of Health permit only. F 0 R Property lines are approximate. See Mortgage Inspection Plan by R 0 N A L D J. H OW E L L Olde Stone Land Survey Co. dated 12,11,96 for house ocation. SCALE AS SHOWN DATE: APR I L 17, 2002 SULLIVAN ENGINEERING INC. OSTERVILLE , ;MASS. I O 1 � l , _ � } I p i t i i - r i ....t .. ... 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