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0022 MOUNTAIN ASH ROAD - Health
22 MOUNTAIN ASH' cx MARSTONS MILLS - � - --- - - - - - ---- A = 123 022 1 :1 i ``1 TOWN OF BARNSTABLE 4 07 01, LGCATI ,4S/4 SEWAGE # VILLAGEAA12577ZW5 At t LL_' ASSESSOR'S MAP & LOT 1.3—6 2 2— INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Z (size) oc_:_> Al NO. OF BEDROOMS 7 PRIVATE WE OR PUBLIC WATER BUILDER OR OWNER y/�f, 4 & DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I!D' i DPP EX 1577AIa rUW�GG� ss�s� M p l/7V 7-R //W /9.S A/ JZ Do TOWN OF BARNSTABLE ,�/ f LOCATION :�2 Nl�d�7��.�► A 5d R SEWAGE # o700/'�2 4 VILLAGE 10.4r'S7'o�f /� f �J�j ASSESSOR'S MAP & LOT /-13 "©aa INSTALLER'S NAME&PHONE NO. 9� SEPTIC TANK CAPACITY l®60 9 LEACHING FACILITY: (type)y`Z�+ '�fdw7�a�S (size) /0'WAr 3d NO. OF BEDROOMS BUILDER OR OWNER g-n -J, PERMIT DATE: 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 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 o � - No..�. � �i � T t`. Fee '✓ ��' THE C61WMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprtcation for Migpool *potent Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,te as ���f�-.-, ��� �� Owner's Name Address and Tel No* � /Pl ��.�-� n! Af"lPs Leap-� Assessor's Map/Parcel 3 a,?;? as 20 0 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J.C 44 A01f�o� A0. 19o)e 3 3%i/,//i 4& G Y� it/l a ~ Type of Building: Dwelling No.of Bedrooms oZ Lot Size 33, sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 30 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) , 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 iss b his Board of Health. Signed Date Application Approved b 7�Z —'�� Date PP PP Application Disapproved for the following reasons Permit No. Date Issued ------- —_------_—_---- -- - —————— 7. A No. Zoy2z, q� ,? .v f ,Fee 1 d. TRH +67&MONWEALTH OF MASSACHUSETTSA Entered in computer ! �X )es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZippYication for Migooar *pgtem Construction Permit for a Permit to Construct )Repair( )Upgrade( Abandon ❑Complete System ❑Individual Components Application ( ) P ( ) Pg ( )Abandon( ) P Y P Location Address or Lot No. as �O�„;fy5� �� Owner's Name,,Address and Tel.No.i �fJ N M 1,.3 L�vs",Assessor's Map/Parcel `"' `�` _o?a /Elgin 7��'h 123 ®2R ) ygo -00 17, Installer's Namee , Address,and Tel.Now� De m Designer's Name,Address and Tel.No. J.0 ny//v Aa aw 3 3 y vs- t . Type of Building: Dwelling No.of Bedrooms oZ Lot Size 3 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons', Showers( ) Cafeteria( ) Other Fixtures ° Design Flow -3 3 L? gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. e. Description of Soil Nature of Repairs or Alterations(Answer when applicable). ,���s�� /t✓ - S�S Date last inspected: i 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 iss Wbis Board of Health. Signed v Date Application Approved b liP Date Application Disapproved for the following reasons Permit No. Date Issued' THE COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE, MASSACHUSETTS Certificate of Compliance T13IS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by at $Z I as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No., . ,0 1 ;�dated Installer_ Designer The issuance of this pe shall not be construed as a guarantee that the sys tll fu ctio a designed Date / b i Inspector a ----------------------- -- — -- --_— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5po5at *p5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at /` '1 O P v"1 i ry ,s-i c�4' c.D 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: Y e5.- . ems[t l Approved by "r/ -�1�� �- /.. TOWN OF BARNSTABLE ,�/ LOCATIONp4+Hfii.n ASG, � .. SEWAGE..# a� i' of �1��- VILLAGE �/1kri7'o�S /�Jf �1�- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 17 Y,Z 9J ySJ SEPTIC TANK CAPACITY " LEACHING FACILITY: (type)� 5 (size) /0�W�30 NO. OF BEDROOMS aZ BUILDER OR OWNER PERMIT DATE: '> /�-07 0�7/. COMPLL' CE DA IE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Pziyate 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(lf any wetlands exist within 300 feet of leaching facility) Feet F urnished by i : .. 4 _ , t j C" . i s l J � s. Cl�°n-�✓T��or i 1/6/99 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, 1_7A 194 hv , hereby certify that the application for disposal works construction permit signed by me dated la- 0/ , concerning the property located at -4e2.2 AlKy" F95-� 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. L . 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 an&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] i/• 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) ` 3 B) G.W.Elevation 3 S— +the MAX.High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B 3 0, 3 SIGNED io DATE: [Please S proposed�plansystem�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:cert A � l_. fl t44 � I�rG�1 ��r•�s f��^j L �° To ,Bf LOecAAON SEWAGE PERMIT NO. zo VILLAGE IN.STA LLER'S i MNE & A D�D RESS B U It D E R OR OWNER D A T E P E R M I T. I S S U ED DATE COMPLIANCE ISSUED I/: 3-77 i jw F�o�T oq B f 4 Fimic ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H A TH OF...... -- .. ---- -------------------------------- ............ . ........ Appliration for Disposal Works Toustrurtion tirrutit �L Application is hereby made for a Permit to Construct or epair an In vidual Sewage Disposal System at: W, V). A 4 0 ...........'C.'%0.-4 VW.271 4.Z 0 e!f$94 W...... ..................... ...............;3 5L Location-Address or E; No.- ................ :C1_"0........................................ .................6.1.... Owner Address �----------------------------------- --------------------- ........... InstallerAddress -� Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................. No. of.persons..........__..._..__._______ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow..................:!!4, ...._._....._..gallons per person per day. Total daily flow.___......._.;Z.-Z 4.................gallons. 9 Septic Tank—Liquid capacityt!5p- gallons Length./A"...... Width.67�_4--- Diameter................ Depth....__......._.. Disposal Trench—No-----_----_----":-Width.................... Total Length......__..........._ Total leaching area....................sq. f t. Seepage Pit No.__-----_-.Z----- Diameter.....1;0."6 Depth below inlet...&ice.... Total leaching area,"..4....sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed Date....- ........... Test Pit No. 1.�_2rn_minutes per inch Depth of Test Pit.................... Depth to ground water...A&e4Wjm6�..___ Test Pit No. 2................minutes per inch Depth of Test Pit____._..........._.. Depth to ground water..____........_......_.. ............................................................................................................................................................ 0 Description of Soil...........J ------- .......................................................................... --------------------*------------------------------------------------------------------------------------------- -------------------------- --------------------------"------------------ ........................................................................................................................................................................................................ �4 U Nature of Repairs or Alteratio;is—Answer when applicable................................................................................................ ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. Si e r- IC- 7.7 ----- ........I...................... Date ------- ------------------------- - _ 'Application Approved By..... Z 7.. .. ... ------P.... __ ..... Date Application Disapproved for the following reasons:..........................................................................................................I...... ................................................................................................................................................................................I........................ Permit No.__......... --. IssuedL41-410... ...... ....... ..... ..... .....Date ..... Date '� 1 `�'� ts• d "._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H A TH . ...........OF....... ---`............................... Applirtttion for Disposal Works Tunstrnrtiun Frrmit Application"is�herebXm�de for a Permit to Construct ( or epair ( ) an In idual Sewage Disposal System at: -�P f_�------ --------------------- 'Gr.. / - .". ---------------.........------. Location-Address or Lot No. ......................................... ---------•-------6 ------ ' Owner *a.u, N, Address W •---.......< . .1.�.r..Q.._.... '. ✓ / Installer Address Tye of Builading 41 ,l. Size Lot 1 Sq. feet Dwelling—No. of Bedrooms............................................�•� Expansion Attic ( ) Garbage Grinder <(✓� aOther—Type of Building ___________________________ s_No. oftperson ______.__._____________...,. Showers ( ) — Cafeteria ( ) Otherf ttures ------------------------------------------------=--------------------------------------------------------•--•-----------....--•----•---•-....--••--•- WDesign Flow..................... ...............gallons per person per day. Total daily flow............ � .................gallons. WSeptic Tank—Liquid capacity Wit.. .Ogallons Length_Z4:74.. Width.S.y_A__ Diameter_.............. Depth................ xDisposal Trench—No_____________________ Width.................... Total Length....:;.............. Total leaching area....................sq. ft. Seepage Pit No............Z..... Diameter....... Depth below inlet...4_-'e_6____ Total leaching area. _O____sq. ft. Z Other Distribution box ( Dosing tank Percolation Test Results Performed by-___. tt� �' :�J `.! � �z� .f ._ Date": >:__ 5._ `l......... a :r Test Pit No. 1._4..2,e._,minutes per inch . Depth of Test Pit ....... Depth to>ground water_._l✓�!�! _. Test Pit No. 2................minutes per inch w Depth of Test Pit...............'... Depth to ground water-------------,.......... ------------------- __________•--•-•--•--_-__-- --------------- .......... "-a__....._.. --•---•--=-=------•- O Description of Soil F �c'�.r �?!? i+ .�.?.+�'' ------------ ----•- s • -••--••••-•-- --------- •- UNature ofRepairs 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 StateiSaiitary_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. ��& Y-••-•-----•-••-•--•• __ Date Application Approved By. "` -•---- k,4 ` •------------------------ .. 17 77----- .• Date Application Disapproved for the following reasons:: `___•_______________________________________________________________.................................... - -------•----•-•- -------------------•--------••-----•---------------------- _____-----------••------_______ ,,. ., Date Permit No.............................................. --- Issued............ =' _.. Date€ ._. jt THE COMMONWEALTH OF MASSACHUSETTS a 1 ABOARD OF HEALTH O F"..... ..t... ..... C9rrtifi.ratr of Tout liatnre x. T IS IS TO CERTI17V That the Individual Sewage Disposal System constructed (3 ror Repaired ( ) nstaller �- at - '•-/1✓ "' /r�. ail 1. has been installed in accordance with the provisions of T11111 5 of The State Sanitary Code as describe in the application for Disposal Works Construction Permit NoZK ��L............... da.ted-----�`-C-�`-•77-------•--•-- THE- ISSUANICE 'OF„THIS"CERTIFICATE SHALL NOT BE CONSTRUED AS A GbARANTEE THAT THE SYSTEM WILL FUNCTION ,SATISFACTORY. DATE .....................:.:... 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH~ No [ 4 •---- --__........ .......��(/..+...... FEE Disposal nrk5 TnntrutUan rranit Permission <s,hereby granted ;: 1.1 _t�t�_....._ ` C__�________________________ to Con t'( or Repa ( ,). an Individu Se„c�rage ispo Sy em at No. �� s?• tf ': ;... ......-- Street as shown on the application for Disposal Works Construction Pe t No. __ Dated__. .............. •_.: .__. oar of Health 1 DATE--- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS • ,,;k4� r, t T`� A& No.V2� BOARD OF HEALTH TOWN OF BARNSTABLE Z1pplicat ion_*r 1Verr Con.5truct ion Permit - Applicationh -��— -- ( o_��epar.( )an individual Well at: � 'Qs hereby-made�for a permit to Construct ( ), Alter v , ,- i� ��� —-- = - — ------------------------------------ ]Location — Address ` ^► - Assessors Map pan(d�Parcel �n C. :_ e __ camn .-----------_------------- _�`=2_-!`�W lJ✓vt-�-- -,c-�a1 =Y---L--' =_--+==1LS_/�'V�LS p�� Owners Address • --e.h clef t tre-LL 1J r. L :_1'(___ - `4 Installer — Driller IliAddress Type of Building Dwelling------------- c--------------------- Other - Type of Building-------------------------------------- No. of Persons------------------------------------------------------ .Type of Well— — ---- -- - — - —----------------- Capacity------------------------------ ---- ----- -- Purpose of Well 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. Signed- - -_-Izzl--—_ ! --_—-- - - '� date Application Approved B ------- �r�J -- -- % ---------- �� --- ---------------------------- date Application Disapproved for the following reasons: ---------------—------------------------------------—-- -- — - --------------------------------------------------- — �,�/` r� date Permit No._�L'k'_-'"� ' '���------ ---- Issued—-- �-- —---------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS JS TO IFY, That tlX Individual Well Cg�nstructed ( ), Altered ( ), or Repaired ( )IT r by Inst ler ---------------- - ---- --------------- --- ---------- ---- 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. =° ated �- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------—---------------------------------------------------------------- Inspector—- - -- - ------------------------------------------- No.—-- -- --- BOARD OF HEALTH �✓ ,. TOWN OF BARNSTABLE 0[pplication for Vell Con5tructionpermit Application is hereby made for a permit to Construct ( ); Alter ( o Repair ( )an individua4Well at: $ � � Location — Address Assessors Map and Parcel !1J• !v`�t �C.S �'<:n_ —r_C_'C } — — t>•an minl� 'c� # fit✓."s ix! l"�t t S ----------------------------------------------- ------------------------------- Owner l� - --------------------`—Address - -------------------------------------------- r - -2 2-45---A _'_�� Type of Building Installer — Driller � � Address - � ' Dwellingt-11 a_n.ti--`°5- 'C= — - ----- Other - Type of Building----------------------------------- No. of Persons---------------------------------------------------------- Typeof Well—--------- - - ------------------ --- Capacity--------------------- --------------------------------------------------- Purpose of Well 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 issuedby the Board of Health. 01 Signed -�' ' ���< �+r_--'"' -------------------------------------- date Application Approved B ----� -- -------- ------------ ------- date Application Disapproved for the following reasons: ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ date Permit No.- ' " � _ - - - — —- Issued------------- '-..°_s ��+(y date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) - --- ----- -- ------------- t Insttaller w at-----�!�K �3 J irk'/ _•�1A/—----`-��-- ! = � Z'd ----------- A _Tt�_�_�'�--- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Priva e Well Protection Regulation as described in the application for Well Construction Permit No. J`•' -bated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -= '---------------------------------------------------------------- Inspector--------------------------------------------------------------------------------- 01 BOARD OF HEALTH f TOWN OF BARNSTABLE Ve[Y Congtructionj)ermit , / l<' , No. --- —---------------- Fee Permission is hereby granted---- �--'-'=---- ----'------------1 r� e,/&--------------------------------------------------- to Construct ( ), Alter ( ), or Repair an I dividual Well at: Street as shown on the application for a Well Construction Permit 01 No.------" ---------------- -------o------------------------------- Dated----- - ---------- = -------------- 4 _______________________-_______________________________-___-____-___--_-_-____-__-__-___-___-_- Board of Health DATE------------------------------------------------------------ 4 I i s i i r ' r i l i � f FINISH 6VAC10- IotXo rl/Vl4H G1PAvE INA" ",4r10 - '—"-- _ o vEx Ti+ N►c _ goo><S o✓Ea )0/7' 6w �x o - = , To p o f 616J P. 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