Loading...
HomeMy WebLinkAbout0041 MOUNTAIN ASH ROAD - Health 41 MOUNTAIN ASH t a MARSTONS. MILLS - MAP-123, PAR.- 019 1 t TOWN OF BARNSTABLE g LOCATION 1,,ll 1 Iflo�01VlO Q� lam!. SEWAGE # / 7`1136 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.d49rxa&,0'4i. 4'Iv SEPTIC TANK CAPACITY D 00 LEACHING FACILITY: (type) /ti (size) 00 �/() NO.OF BEDROOMS / BUILDER Oq WRa 5 PERMTTDATE: L Z/—0� COMPLIANCE DATE: 7 :7 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 _ �_ _. I _ �� 6� � �� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppitratton for Otopont *p!tem Comarurtton Vermtt Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Addres and Tel.No. Assessor's Map/Parcel �n y ,�j/ Installer's Name,Address,and Tel.No. / / Designer's Name,Address and Tel.No. 77/-5?,-3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( 0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 716? gallons per day. Calculated daily flow 3322 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ���m9q' L�X��7`!�� 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 issue by this oar f Signed Date Application Approved by \ Date — /— 7 Application Disapproved for the following reasons Permit No. P 7— `l Y c Date Issued (2 ��'� �. y . . t..., >.i- .. .. •.., � r .:.?�. 1`�.4 Tr*.-�'.M'r^.i'^'4. .J. ;-. .. .- J•Frs { rrt .., ' .-' � ��• 31i No. / 2 ��G� � ¢- `,,r".'. Fee J y J. ;'• Entered in computer: �M THE COMMONWEALTH OF MASSACHUS`�E�S Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE'., MASSACHUSETTS ZippYication for �Digpozal &pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(t/)Abandon( ) ❑Complete System D Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. s Assessor's Map/Parcel 6 /ems; 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 6140 5,i e'e-e No.of Persons Showers( ) Cafeteria(. ) Other Fixtures Design Flow / l D' gallons per day. Calculated daily flow 33e gallons. Plan Date Number of sheets Revision Date Title Size of Septic'Tank /1OD9o° Z Type of S.A.S. /e + �!Z r, Description of Soil Nature of Repairs or Alterations(Answer when applicable) /7`/� L/.rJ��IllGe°c� ©GG' �1✓ 9 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 bythis Board of Health: i Signed Date Application Approved by i ' Date Application Disapproved for the following reasons . V ' Permit No. 7-- `/3 C Date Issued (2 x+ �.2-�.= • --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of QCompliance .THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded(� Abandoned( )by at eti 15; has been constructed in accordance 1 with the provisions of Title 5 and the for Disposal System Construction Permit No. dated i Installer Designer ' The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 9 -- 7` L, — <?I InspectorLd No. 7� ��� —————————————————---/ ��y®�9 N—Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS { =tgogar *pztem (Congtru tion Permit Permission is hereby granted to Construct( ')Repair( )Upgrade(7bandon( ) System located at 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 ofthe date of this permit. Date: Approved by f I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA P. TA S PaSAL P IT y r E G X w 14T--kj ISS �.. It 51vevJAt-L AesA • 1060 .Z _ t�"v S�• �C'Z-•S�-IS•F = 3"15 GPD • � �S��weL SaTTOAA AQCA• .� 0 � , 4 tale/ TOTA t_ l> S16 N x QI•Z 5• GPO i M GP P 110 PEY.cot�-cto� �..tu 2 MrtJ 02 _ _ .. Id•( - -.,._._ ._.__-- lo(..Id • , • I Of Lf.4.r tLLIAM ' OA�T, o: !N �,. - T <,•: r� r "tea (A No. 19334 ' JJ 10 1 oP F►.�v • '�D3,O 7r,•fin c.T7C a-to� L•2�•�Z �G I o� c���'� fir' � . •`, tut[ LL�/� ¢ �iPE t►ay. . A � '�ot tu�r 4.dL. i••; b4t_. ��,•z �9 q L� p LI_ACU r ?t T V W�T�.1 17/4t'h , 1 %UASuo�D t cro w E. ! I � t C Ee T t F t D V--0T Pt_A �t i � • � o,2o Fi L_E=- l.rxarlo►,s N1,4��T�►J� NtKriS. t��. Wo , t PL at ¢ 'f-=zGLQc_f--- 1 crr-TtFY r"AY -r"v-- �V� D�U�1J S�b►�U .:HEtZE_Ot-1 Go�.cP�-YS WtTtrl •T�Ltc, Stein--►«= Ar,lD S<r-["9AG�G- : Jt>ZL+MS. l S ,TUE r� ' r^�., „�, `?n"=:., — gar i N,�-„ v rYr '.�.x�5^f ..{.:,',�•$h�` _k "�,�:•-. cf.3.+ `v'..'S�n 7�� Il� �*��g',�.. i. . f (d i0'`~��"�g.=F'S+'�,'"-K'�3 r `.,4t.+ ro....` „"''� ;is F:: _ f :,r•._.. NOTICE: This Form Is To Be Used For the Repair 10f Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) / , nerebv certify that the application for disposal works construction permit sinned by me dated �����y concernina the property located at rCl meets ail _•rhe following criteria: �6 1 a - '� edz� '! within `eter i C.:sere ..re �.o _�___as . ,thir�00 _.._� Jt ti:e orore_ed sevric s•.ste« per are 10 DP.`:ac=We is 14'izhin ,0 " OI-,he nr000sed=eot:^ syste n S IIe ob-11 i"d�Iv nQ��'3ler'aDIZ a — or ?_'eate. oeio�� [he -no Ji-.^.e teac:i - - / _ � � ��� _ _ 1Sc_ :ac:ii�; e,e is o increase m _ou and or hang-. in ,.SS -=—_os`d SIGNED : DATE: 911011'r4/ LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [.Attach a sketch plan of the proposed system.'Also if the licensed installer posesses a certified plot plan. this plan should be submitted]. a' '`a'r .'.- " sr k,"'*'.- .,.Md" ' .v`ova '�`•r. + ":.Yl ,'. `., y '. .�+` "i ,,°�, ., .e. i WN .}Ct� h", sa s � 1!"'.rtbT� '"ca�� x.: `'�✓��"ka"x� x�.a,��..mot, '�r ,» da a.��ken*c.�; ti "tC �� e M � w " ..5� �."�,k. t .: ..�,���`�3�`y��&� '4a,x'X''r3'�:n-Y'��°'t,.a."3r��� aK;�-,s.'�+ .,C,��,.�,- _..'� „t -<+�Y• S ..r�.?t e_ '`�.a �(`;,�a;� .. - ,. _ sc',r.-:.� F g�t�r� 'cG�Y-, health folder-cert S ax Y.y.°Pw!'t�e' i 4h 5 F1,�i$".° i •.1 P Y Y W+ v� << 4 L �_ £y"'R'4e f �le S „a;`.�i Rz�'tAfs. k 'mac -•°�' ,_'"`�w ,r��y'�'1�}'=,`y ,t, � x'�� �J'�"�'�.sa�-�,- ;,_x`��� �'-3 � �' �'' `-y`s :"-� �_• `e- ..�, " �_.��� 1` ' :' '7�;c 'st � y Mks "'� ..,r z�t `s'"��' �.,.��tr# '�, �,Ri�r-�� s"Y� ,�'.,,�•�r � � �T-y+f;,'�� c i llJJ TOWN OF BARNSTABLE LOCATION 7f �� ✓� /dl e.5,04 /� SEWAGE # VILLAGE.I�1c?n✓�/?5 y�/ �S ASSESSOR'S MAP& LOT/Z INSTALLER'S NAME&PHONE NO.�/;�diGJlzi CD�sr- ��/-y3yy SEPTIC TANK CAPACITY boo LEACHING FACILITY: (type) /,�, (size)LD NO.OF BEDROOMS BUILDER 04-OWl I l}i/ 5 PERMITDATE: 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) Furnished by Feet V C{! p �9 No... e �. y F$...3...................... THE COMMONWEALTH OF MASSACHUSETTS _ �i� BOAR® Off' HEALTH )a3l Appliration for Dhipusal Works Tonstrurtion thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat• - - ..................................................... - ocation-Address r Lot No. ...... ....... Owner Addres -•-• ----------- Installer Address d Type of Building Size Lot................ q. feet Dwelling—No. of Bedrooms........._��................................Expansion Attic ( ) Garbage Grinder (A(e) p`4 Other—Type of Building ............................ No. of persons.......'� ._.•--•••--_--__- Showers (2) — Cafeteria ( ) a' Other fixtures .--________•- _--_--_-•-.--•-... W Design Flow.........] ........................gallons per person per day. Total daily flow........32........................gallons. WSeptic Tank—Liquid capacity0_4P.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ Diameter.__'?-.P....... Depth below inlet_.. ...... Total leaching area.-......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by........4i ._ 1.14W:.................................•.. Date---- ........... a Test Pit No. 1________________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+ •••••-----•---------•----------•----•-----•------.. ...-------•........................®•--•-•----•---•--•--•-------•------•-•----------..._. O Description of Soil.............6• .5��''d....... 11' © x G, 0e �.� !�. --''1 ................................ ------------------------------------............................................ U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------.......................... ------------------------------------------------------•----•---------------------------•---....------•----------------------------------------•-----•-••••-............-------•••-••-----------------•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with theprovisions of TITS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' sued h oar li h. Signed..... • '-�-- . . _ T�o/,�f r � ) q ate Application Approved By.... --------- � � - ate Application Disapproved for the following reasons:................................................................................................................ Date PermitNo......................................................... Issued....................................................... Date FEs....1.. ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F...........................---.--.........------..------------------......-----....•. Appliratiou for Uiipu, al Works Tnnitrnrtinn rawit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -- Location-Address,. ' r Lot No. ,* �ci�/l! -- ............................... -------------..G?-�91A,W. Z e°`____-___---- 11t =--------- ... - _- L�jC j/ Owner y �� �AJddresg{/ a ..................../ {..'_.......-•---...----------.......................... ------------------__- 'T_.�i - .!'.7 Y.frI, i5-_...l�f ........................ Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling_No$o£�Bedrooms `.4 " t.........................` Expansion Attic Oe )ka 1' Garbage Grinder (M) r 6A.o p, Others" Type ofa Bu>ld`ing ,_.... ......... ...... No. of persons. `Showers , Cafeteria at ( ( ) Q Other fixtures . - - W Design Flow ,:. ........................gallons per person per day.?kT.ota1 da l} flow* .._: r �'. ...............gallons. W Septic Tank—Liquid capacity$1 .gallons Length................ Width-_____-__------- Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......r------------ Diameter._-.14 0....... Depth below inlet.. .'P...... Total leaching area.Z9C.......sq. ft. Other Distribution box ( ) Dosing tank (=;_ ) �{ 4• C�• 0-4Percolation Test Results Performed by.........&YYA ..f1/yW.................................. Date../t.:4P7_`_.A7.'.......... Test Pit No"-`i................minutes per inch Depth of Test Pit______-_-•-_•-_____ Depth tbejg ound water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit--------_----------- Depth to ground water........................ .....................................__.._.. - ----•---------•---•--------------------------------------••--ti----l•--------...._..------ A�p O Description of Soil.! a, ll a!1....^�_._1 �/0. :: /; '1 ". --------- ........................... �x-------------49 11 dj.;...............................................................................t .......................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------------------------•-----•-•------------------------------------------------=-------------------------------------------------------_-----------------------•--•..........__-••-•• Agreement: t s The undersigned agre�s,to, :Install the,,afored6scribed Individual•Sewag&Disposal System in accordance with the provisions of 1I. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has sued... h o�ar` h h. Sig ..- --------� ---------------------- •--•-------- Y-------------- nae Application Approved By--- z4 -------- Application Disapproved for the following reasons-----------------••-•------------•--•----...---•--•--------•-----••-•-•-•-----------••-•••.........••-••......-- •-•-•-••-•---•--•••••--•••....--••---••••-••-•-•••-••-••••-•---------------•--`-••••-•---•-••••-•--•----•'--••••................-••--•••••••----•--•------....---••••............•'•Date• ----------- Permit No.................................... .....................- Issued. .......................................... Date } f THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH ..........................................OF..................................................................................... (Errtif iratr ,af Tamptianrr THIS IS TOIJERTIFY, That the Individual Sewage Disposal System constructed (v') or Repaired ( ) by �... _... == ................... -� �Cstaller at '�'�z�'` l'��� t1s' ! S.:Ji� ,ff �l ------------- v�I2--ew/1 S` -- _. . .. -- -------- ,. has been installed in accordance with the provisions of TITLE j of The State,Sanit'ary Code as described in the application for Disposal Works Construction Permit No.___-Wi dated................................................ rr. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEHeI 19NtLLAFUNCTION SATISFACTORY_._::. �.-ri Ins ector=-------- -----............................. _--_--DATE �^ - . #` p # --------------•--_-•--- ~ ` THE COMMONWEALTH OF MASSACHUSETTS BOA RD OF HEALTH w ...........................................OF._..................... No..tS� FEE......re.�./....... Dispima1 Works Tonstrnrtuan prrmit Permission is hereby",' granted........... ....��+'..--se5-141.-•-------=------------•-•-------------•---------------------------==-----------------..__......._.....--- to Construct ( or Repair ( ) n Individual Sewage Disposal System / at No..___. �P/ � --•--- `G�' E11!z t 'i�' `.-----• ......�°-i . ,5' ......�, ./�-4--�rl!.............................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated_.................................. .._.. / ski x Board of Health DATE ••••-•••-• = r= FORM 1255 'Ho�BBSi&WARREN 4:•INC..rPUBLISHERS`1 - .tuGt_E �� --- - 5E9-RG TA�1�C • 3Cjti' ASCU%" 1 ' - u S vtSPo'SAL PtT V�� GX Car W �T1J� /' i ► 12f IS;.Z StvF A� Az&A Y. 1IS7C> �.:'�._. . . J-'�-- tN3c�ST►µ,eL. eoT-coAA AlZMA% .co-o tF O +r dot To ra 4Z.3. APO 1060 lN Of A1gS Jac <. r M p� YJILIAM ,IVfi ,p No. 19334 O �, f ;�� '' `•f C OI QiaTEtoo P io��ji�' - , 1G �Z roll Fuv • '.`p3�O ID o Ck LC� Q 4 ��P two. • �rPor DtSr t4�L 4Al-. �� �• t ~` I -r'A U 44 ICA Cl p 1.EAGU ' t ?t T V WtTV4 �� 1 waSu� 1 i cEe r t t= ' ;7`1Zo F:'l Lam- t_ a.Tto �A4�-�T��Q IZ l� . � d.lo ScAt E•_ - SGI�t_� .��1.. �CJ �1i'T��. �•v�. d w G.Tr- t T"AT T► f-- �2U1' ��Ut� t , S� v•.i 4�EtZt=.o�t CAMPS-YS wty'" -�uE �t �►►-�� t—.c� _ `A• A► I> S�—rl3AGeC SZ�c?vi��M�t � OF ><ZGD lbw►-t O� �-� c7-A I \fin. J vC�C DATE. , � � •�2- w L��-+.✓► �� D A X�r a rL. c U�(� �uC.. • 2sc.tsT� >�� �n.t.,n Svev,~pec T 41l S PLti t 4 t,10T 84 5 Ep O u Au T Io tit F�1T O S•T�V t L-L� AA 1.'S�S SUtrvt^( 4 TOs oFFSa-T; •5"DoLD •UOT ?5E USA ApPI.IGA►1T N� 4�E��SS) �� To wT LltlS,15.