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HomeMy WebLinkAbout0075 MOUNTAIN ASH ROAD - Health FL-75 Mountain Ashy v Os = 124. 033 �. men KAIS -� 4 TOWN OF BARNSTABLE LOCATION L'k3c 9a.4$t e � �' SEWAGE # ~ —T"1 c VILLAGE /V1G�i�S`�`iN� �\��� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �Dny=,la, 1 :ZQn,,atz\, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS �1C BUILDER OR OWNER (L`Ss v —?0\1 C; PERMITDATE. COMPLIANCE DATE: i1 U 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 !sack. AE-70 13 107 (p' � (� No. Fee h�v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for ;Digpogar *pgtem Cougtructiou Vertu Application for a Permit to Construct( ) Repair(,* Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. �Q ;N AA Owner's Name,Address,and Tel.No. mcas+arm WIS Y_rt5k_Ca 'POIce Assessor's Map/Parcel 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 14oc > yr No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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 Certificate of Compliance has been issued by this B Me lth. Signe Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. r�(.,/( Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application, for .;Di,5pooal_*patent CConttruction Permit Application for a Permit to Construct O Repair Q0+ Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. -7 5-m poN.f-c"'Ju Owner's Name,Address,and Jel.No. Mc•�s�c s AAMs Krts,rc-"N -PoNlce . Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0o0SNa Z) Ak 13(0t,, SOg-yl�to-�/S3�-/ r Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building H,Cze,r— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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) Y 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 Certificate of Compliance has been issued by this B and of Health. Signe , 11 _ Date / Q Application Approved by O) , Date Application Disapproved by: Date for the following reasons Permit No. y ( �' Date Issued THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE, MASSACHUSETTS /19 0 o/ Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (x ) Upgraded ( ) Abandoned( )by_�_!s Q�f „1 /Nz��1 at -7 67 &�� � 1 y��, �r��cv� (1�� C� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. / dated ;.- ' Installer c, Designer #bedrooms Approved design flow gpd The issuance of this permit shall notbe construed as a guarantee that the systemrill fun fion as designed. Date ' / / Inspector ----.�—� ———————————————————————————— __ No. �Z_1�43 ——— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lwigoml *p$tem Con5truction Vermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at 7 S MC 16 fa,,,3 AA 2 r,[S�0- n3 c AA i 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 th' rmi.., �. .�' Date / p Approved by /� "bE 14 CERTIFICATE OF ANALYSIS Page: 1 iot Barnstable County Health Laboratory Report Prepared For: Report Dated: 11/30/2006 Kristin Police Order No.: G0638859 335 Pleasant Pines Ave. Centerville, MA 02632 Laboratory ID#: 0638859-01 Description: Water-Drinking Water Sample#: Sampling Location:, 775 Mountain Ash Rd.Marstons_Mills,MAC Collected: 11/27/2006 Y Collected by: J.Police Map 125 Parcel 033_ Received: 11/27/2006 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen BRL mg/L 0.10 10 EPA 300.0 11/27/2006 Copper BRL mg/L 0.10 1.3 SM 311113 11/29/2006 Iron 1.2 mg/L 0.10 0.3 SM 3111B 11/29/2006 Sodium 12 mg/L 1.0 20 SM 3111B 11/29/2006 Total Coliform Absent P/A 0 0 SM9223 11/27/2006 Conductance 100 umohs/cm 2.0 EPA 120.1 11/27/2006 pH 5.4 pH-units 0 EPA 150.1 11/27/2006 Based on the results of the parameters tested,the water is suitable for drinking,but may present aesthetic problems(taste, odor, staining)due to Iron. h Approved By- __ d Direaltai) - Ue ',`fit rn CJ N n i MCL=Maximum Contaminant Level RL = Reporting Limit Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 FINE Town of Barnstable o� ,,,�,�, Board of Health 9Q "5 •� 200 Main Street, Hyannis MA 02601 'pA S rED MA'S A Office: 508-862-4644 FAX: 508-790-6304 January 31, 2002 Mr. Julius Morin 75 Salt Rock Road Barnstable, MA 02630 Re: 75 Mountain Ash Road CANCELLATION OF SHOW-CAUSE HEARING After a site visit was held on January 30, 2002, and information was received regarding the location of the original leaching pit, it was determined by Susan Rask, Chairman of the Board of Health,that a show-cause hearing will not be held regarding 75 Mountain Ash Road. If you should have any questions regarding this matter,please contact Thomas McKean at 862-4644. Sincerely yours, omas Mc ean cc: homeowner JAN-23-02 03 :53 PM DOWN CAPE ENGINEERING 508 362 9880 P. 03 + 125.00' 7 LED) INSTALLED 1� 2/98 CHES PER AS 6UIL CARD n • J �Az V SEPTIC TAN EXIST. WELL 125.00' od cx �6 Town of Barnstable BAMMBM ; Board of Health 9q, '� ��� 200 Main Street, Hyannis MA 02601 RFD MA'S A Office: 508-862-4644 FAX: 508-790-6304 January 24, 2002 Mr. Julius Morin 75 Salt Rock Road Barnstable, MA 02630 Re: 75 Mountain Ash Road NOTICE OF SHOW-CAUSE HEARING You will be given an opportunity to be heard at 7:00 PM. on Tuesday February 19, 2002, at the Barnstable Town Hall, second floor Hearing Room,to show-cause why your disposal works installers permit should not be suspended. On January 23, 2002, during a public meeting of the Board of Health regarding an adjacent property, it was discovered that you installed a leaching facility too close to a private well at 75 Mountain Ash Road, Marstons Mills. However, prior to obtaining a permit,you signed a document indicating that"there are no private wells located within 150 feet of the proposed septic system." The signed form was dated January 8, 1998 and was attached to a disposal works construction permit application. The health inspector then approved the disposal works construction permit application that day based upon the information which you submitted. Then on January 12, 1998, you installed the new leaching facility less than 150 feet from the onsite private well. During the hearing, you will be given an opportunity to be heard,present witnesses, and to present documentary evidence to show-cause why your disposal works installers permit should not be suspended or revoked. Z ;earl:T GD PER ORDER OF THE BOARD OF HEALTH cc: homeowner a No. 4 ,f" d Fee—lam "•'� C� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Misspogal *pgtem Cow9truction Permit Application for a Permit to Construct( )Repair(_V, Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's e,Address and Tel.No. Assessor's Map/Parcel -p 3 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 2 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 Repairs or Alter tions(Answer when applicable) ����� _ G� � ZZ 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 f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this oard of He Signed ter•— Date Application Approved by Date,-"L- 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( )Repaired Upgraded( ) Abandoned( )by - C/ at has been constructed ill, accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer_____5 c.- -�--- The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 C Insp-eeyctor No. — —-------- ------------------Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miooeal *pgtem ttConaruction Permit Permission is hereby granted to Construct( -);,Repair pgrade( )Abandon System located at �'j�st;e!°� ��. 6�✓. e'�C `� . : 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 t. F( Date: r- Approvedy NOTI CE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTI FICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITIIOUT ENGINEERED PLANS) I, 1 hereby certify that the application for disposal works construction permit signed by me dated t �`I' ,concerning the meets all of the property located at following criteria: c—e- There are no wetlands located within I o0 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system 1-9�llere is no increase in now and/or change in use proposed e lure are no variances requested or needed. �f life proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the less than fourteen(14) feet above the maximum adjusted proposed leaching facility will nW be located groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) g@_ DATE: 9 SIGNED: LICENSED SEPTIC TEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certined plot pion. this plan should be submitted). q:health folder:cert ,n�_ 1' ' TOWN OF BARNSTABLE _ LOCATION SEWAGE # VILLAGE-- / ` • ASSESSOR'S MAP& LOT Ia Y- O A 3 <.INSTALLER'S NAME&PHONE NO. SEPTIC.TANK CAPACITY ti�.� l-. lr x�x� --.-LEACHING FACILn Y,• (type) size) -NO.OF BEDROOMS $1 ALDER OR OWNER <PEItMTTDATE ^J _ 9— COMPLIANCE DATE: .'Stparation Distance Between.the: <:Iviaumum Adjusted Groundwater Table and Bottom of Leaching Facility Feet -Private 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(If any wetlands exist d>��..{� Feet within 300 feet of leaching facility) Furnished by �. L s L}- - d OL _ 1 StN(,tt. FAMtt-N' _ 3 BEORooM pefml ►JO 6AQ5A(,E 69J?JDER. p�a►Ly FLoW .: ItUx 3 = 330G.Pv, SEPTtG TA►.�K = 330x15o% = �9%G.Ro _ / s.00 __ _ ot5Po5AL PIT v5E tvoo Gam. I ,(pT/p 5 t DGh/At_t_ 15o 5.r-. x 2.5 = 3?5 G.pa /a5�•/ ti. 50T TOM A QF-A- .. �0 5 F•- 5a S.F x I• o 5 o G.P o D.sT -7oTAt- pESIGN = .�}•25 G.P. D. � �j0 �x Q -ToTAt_ DAt>_Y 'Ft_ot� = 33oG.Po. V "1ST /o/ / 9 © S PE2GoLAT►otJ RATE : I''IN 2MtN i 4 �*SIN OF k � AlCHARD ALAN s ` O ) ••- A. W. qa BAXTER nr, AM E S No.2404847 7 TE`�T �'loZoiO F6• = aZ•� TOP FNO= /o3.0 Ho t.rcG�s�B3 ,. r • o.4.v16 loot/ tN�•' iGAL. :. .. SEPTIG • z t 00 :trD INS. BUX 99•G TANK i 99.0LEAGPITINV.. INJ. WIT 99- 99'�3/4i WAS% � G�wE.c.._ 9-3•o • CEtZTIFIGD Pt-07 PLAN /� i�/oW4.4 RUFII �.ac4TIoN g'7 I.10 S CA-.l E rj GALE / , ,SD. AT G�Z3�1�3 _E,N Cr- IA AT THE peoPoS MSS, SNoVYN µE, _SOW GoMPt-�(5 A►.tD 56T<a4GK �Z.6RvtR.>✓MENT� oF �µE- B,c! ZSa •f�133 1.1oT- LOGp,TED WIT 11J NE Gt-ooD LAIN pA'TEG 3 Ct gA7cTEct.e 1JYC- INC. �-r E26 D'1.A1!0 5 u my TI4IS... P��r.l 15 Nam' an5r-_ram Z>)d AN os-rE2vILI.E - ems• Iu5-rR.�M6W-r TvV-Ve -THE ot=F5ET5 SlOULD -APPLI ���,eL.4N� CO,� /^/G. ' No-T [3E .V5ED d DETERI^I►lt: L..cT t.t1-lE. GA►-�T 0 No. 19� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rppfication for Mizpozai *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(_V� Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. Owner's e,Address and Tel.No. U -7 S v c /''� f�` CrC Assessor's Map/Parcel v 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 Naturepf 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 f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this oard of He Signed Date 9— }� Application Approved by Date,---G' 4;-- ' Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certiftcate.of Compliance � THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by T P1 Cm'i.� at has been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ., . dated-_ -0 Installer Designer 15 e 4-- The-issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 f �. Inspector ,.r.— No. � ----------------------- 0• Fee 6� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi!6pozal *pgtem ctConotruction Permit Permission is hereby granted to Construct( epatr( grade( )Abandon( ) System located at 7 _ 'JcrC� f ,s �T I 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 DeMt. Date: ° r Approved , k I l tll'9N7 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 ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 1 — '� ,concerning the d at 5 �`'r��� meets all of the .property locate following criteria: c—r There are no wetlands located within 100 feet of the proposed leaching facility ty There are no private wells within 150 feet of the proposed septic system ;x--i?tere is no increase in flow and/or change in use proposed There are no variances requested or needed. --*—`if the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will nW be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: z. A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) ' (according to Heal th Division well map) _ 5 B)Observed Groundwater Table Elevation(ac g DATE: SIGNED LICENSED SEPTIC TEM INSTfIN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan or the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert r � l 1+"`,,. �' L� ' TOWN OF BARNSTABLE _ LOCATION kilt SEWAGE VILLAGE / ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. oq A . „ SEPTIC TANK CAPACITY -LEACHING FACILITY; (type) size) frl0dtrL N(7._OF BEDROOMSld�. $EIILDER OR OWNER p <PERMITDATE•. C _ 9— . OMPLIANCE DATE: Separation Distance Between,the: { Ivhazimum Adjusted Groundwater Table and Bottom of Leaching Facility Feet . .Private Water Supply Well and Leaching Facility (If any wells exist �3"� Feet i on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Within 300 feet of leaching facility) �'t"�� Feet Furnished by ;r�iGLL— F A M I BEOR0OM �)�,m "f �-3-573:z ..¢Q, G�•Q.BA6E �j21h.IDE2 gar LY F L o•W ; It O X 3 = SEPTIC TA�1K = 330K15o"/• = �9%G.P. � _ / s•od _ _ U5�- 1OOo GAL. - /oz L 015Po5AL_ PI-r v5E 1000 GAL. I qo 5%DCWALL ARGta 1JOs,F t50 6.F x 2.5 = 3?5 �.Po /oy./ ti• BoTToM 50 S.F x ►• o 5'o G.P o.. 'T oT A 1-. p S'51 ,g 2 5 G.P D. 'TOTAL DA I L�( F%-ov4 = 330 G.Po• S.T PE2CoL.AT►oW GZATE : I"IN 2MIN 0r`.L>~55 29'� J�k OF 4� PdCHARD ALAN A. W. BAXTER �°, JUNEs 1 II�Et4' No.24048 r;, 41, 77 h� EU4iV�i� -- - TE'�T �'/�Zoip ... �G• = a�•C, TOP FNP. NoLEG�s 3. �G . /oZ•�^ � 7I°P�� v 9 INV. /too.a loov lN�. G prST. 1 ,�afjsoic__ . ay (N� S£PTtC 9/•8 z ' l000 INS. Bu7c q9•G TaNK y �� 99 0 ►YITfi4cF L.EAGtA PIT I N Y.. I NQYd S • WITt1 , 99 Z 1'/314.1%Z C44CA / WAS4tGD 646A✓E4.._ 9..3.o CERTIFIED P1.oT P1..At�1 b0z ,✓o t4/,ar P R U F i 1 .� L o C 4"r►o N /!J/I�STo v'•� : 'Nf/G'GS S7. 0 SCALE SCALE / '_gip_ VATS cEQTI�Y -rH AT THE FpoPoS hF5t. 511o4YN PL-P`t`I RE�6 ZE N GE NE,REON GOMPL-`(5 1�ITN"THE S 1 o�LtIJ I= �v7— /p . Aura 56'f�.GK R.6QvIR-�MENT'� oF -tµ� 1 'To W N O gAeNSTA►3t.=rc AND t S I.lc��- S� Z SD �G, 133 i LOCp.TED WlT 11J N6 GI OOD Lb,IN 6AXT'EI'Le Wye: INC• SI EQ Tu15'PL ►.I 15 WiDIT old AN OSTEiZVILL� - s 11J�jTRuMENT SvQVE`( Er-rI4S 017-F5ET5 6uouLl) �PPL.IGA►-IY' � NoT t3E V5EDT0 DETE[�1^I►.lrc LcT t.r►-IE.S - - j 1 .�L.4.V`17 CO,/ /n/C, TOWN OF BAR/NSTABLE _ LOCATION .7 S I"� �� SEWAGE # 5 VI- AGE ASSESSOR'S MAP & LOT/ V- 6 A 3 INSTALLER'S NAME&PHONE NO. -"�`"" SEPTIC TANK CAPACITY _ LEACHING FACILITY: (type) l-• size) lst,y -Z V )ij NO.OF BEDROOMS -71 BUILDER OR OWNER PERMIT DATE: I - 9 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility "ar'' - 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 • 4 ga C 41 5- 7 _ e . R No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppliCotion for Miopogol *potem Con5truction permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's a e,Address and Tel.No. Assessor's Map/Parcel 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 Nature Repairs or Alter tions(A��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 f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this oard f He �Q Signed �`�E�, �_ Date 1 r!! Application Approved by — Date,-"'-'' Gl�-�2g Application Disapproved for the following reasons Permit No. Date Issued No. c Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Application for Digogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's s(Name,Address and Tel.No. c y�// Ass Assessor Mdp/Parcel I,/ A~ P 7/� _ �— --- -� -3 3� 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 3 :?2 eD 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 f Repairs or Alter tions(Answer when applicable) Date last inspected: f 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 f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued blv this oard f He 1 Signed Date APPlicatioi►Approved'by _ .�_ ::,-.-.. ,.,,....Date:.����"�3,�__..�h__ Application Disapproved for the following reasons T Permit No. ram' Date Issued I � ———————————=—-------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ' Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired (,�<)Upgraded ( ) Abandoned( )by— T (f 141 at �, �.r� ���_ _. Z0_,/9 has been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "' dated � .s Installer Designer c, — The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date I 0 . ?R Inspector���C""'1 --------------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS lwigpogar *pgtem Congtruction Permit Permission is hereby granted to Construct( _epair( 4-111,pgrade( )Abandon System located at � � tl 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. ° f+ Provided: Construction must be completed within three years of the date of this pe it�. y. Date: ��" ��-_ Approved � Ie',O� 1 4- 1019/97 NOTICE. This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I ,hereby certify that the application for disposal works 7 , construction permit signed by me dated i — — concerning the L meets all of the property located at following criteria: �.- There are no wetlands located within 100 feet of the proposed leaching facility �y-There are no private wells within 150 feet of the proposed septic system ;--There is no increase in now and/or change in use proposed _-_±_J1Le.re are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the d less than fourteen(14) feet above the maximum adjusted proposed leaching facility will pQt be locate groundwater table elevation. Please complete the following: A Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) _ 5 SIGNED: DATE: -./s ` LICENSED SEPTIC TEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also It the licensed Installer posesses a certined plot plan, this plan should be submitted]. q:health folder:cert III -5- L 4 No. ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS ZIppYication for �Digooal bvztem Construction Permit Application for a Permit to Construct( )Repair(_V, Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's e,Address and Tel.No. CTF?�� ✓ 7 S . - /1 ' Assessor's Map/Parcel 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 Nature Repairs or Alter tions(Answer when applicable) Z12te 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 f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this oard f'He Signed �_ Date Application Approved by Date Application Disapproved for the following reasons Permit No. �' Date Issued B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: DATE: LICENSED SEPTIC TEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan or the proposed system.Also lrthe licensed Installer posesses a certified plot plan, this plan should be submitted). q:health roller:tart i --.-t��� 7 n� ,yNo. (� •Y d Fee-1� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01 pplicatton for Miz pozal *pztem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. Owner's ress and Tel.No. e,Add ` i Assessor's Map/ParceI c�'3 3 ­7 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 :2 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 Repairs or Alter tions(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 f the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this oard f He Signed Date Application Approved by -' Date Application Disapproved for the following reasons Permit No. Date Issued .� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certif irate.of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(k)Upgraded( ) Abandoned( )by -T�p �'GCCrt.e•-v� at - has been constructed iD accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. I dated . 1. Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 b Inspector No. 04K .- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC�HEALTH DIVISION BARNSTABLE, MASSACHUSETTS Mitpozat *p$tem Con$truction permit Permission is hereby granted to Construct( epair( pgrade( )Abandon( ) System located at �7 5- r�Jc 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 t. t9, Date: 9- Approved "`� �, IW/97 r the Repair Of Failed NOTICE: This Form Is To Be Used For p Septic Systems Only. CCR TIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1 , hereby certify that the application for disposal works concerning construction permit signed by me dated -- '7 , the d at�c��L�� -- � meets all of the property locate following criteria: cue— There are no wetlands located within I oo feet of the proposed leaching facility ;may-There are no private wells within 15o feet of the proposed septic system 1-9 here is no increase in flow and/or change in use proposed e ure are no variances requested or needed. �f the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) ' B)Observed Groundwater Table Elevation(according to Health Division well map) SIG NED:: J--f]N DATE: LICENSED SEPTIC TEM INST THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan or the proposed system.Also If the licensed Installer posesses a certified plot plan. this plan should be submi(ted]. q:health folder:Bert ,�` �. ��� Ls��- _ k � -S � 4 TOWN OF BARNSTABLE _ `LOCATION 5 '" SEWAGE # ' ASSESSOR'S MAP & LOT l� O VILLAGE INS3'ALLER'S NAME&PHONE NO. • lam.�^^� SEPTIC.TANK CAPACITY Uv.v ....LEACHING FACILITY; (type) size) . :.NO.OF BEDROOMS• D $I;JII..DER OR OWNER p PERMTTDATE: COMPLIANCE DATE:' Separation Distance Between.the: :':'Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist ..on site or_within 200 feet of leaching facility) ��- Feet Edge of Wetland and Leaching Facility.(If any wetlands exist Feet. within 300 feet of leaching facility) Furnished by ;iWGLc- FAMILY - 3 BE.oczootA �) rM,f�0-53:z " .io GA.R•BA66 6QjwDE2 Sra%L.Y FL z 110 X 3 = 33a &,Pv 5EPTtG -rAQK = 330x15o'/. = -49%G.Po - - u$E- I o o o GAL. - /oz r- ot5Po5AL_ PI-r v5E 1000 GAL . 5%VG-WALL ►50 S.F X BOTTOM AZF-A— 5 a x 1• o. 5 S.F -TOTAL- pES1GN = .425 G.P0- -T'oTA%- DA 1 L "( FL-Ova( = 330 G.Po d .T, 9 PE2GOL.AT►Ou tZATE : l"iN 2Minl ot~L>~55 \ Ko ? V 9 Sr Ikk OF C,Z' RlCHARD A. a. W. �► P��' �X BAXTER ts, JUN ES te•Q Rk4� r; �c %00 L f �z�7 IW i3 Top FNo Sajj�/c_ D1ST. �N� Gay. t. p SEPTIC 99'B Z (DOO �N�. gUX 99•G TANK ` -54A,� ►YIT��F LE A G LI S/LT P1T INY.. INV. . wiTu 99-Z 99-41 S ' r 3/4-I YL � � ..�:vTJ ✓ 6Tv N E GwE.c_ 9.3.o GEwrlr-►Go PI-�T PL_AtJ • PRvF1 �� • /y� No�,ar �o c A-r i c N ,t���s•rov�..s: ��li�GS 8'7• N o• 5 ClaL.E s cp.1.E / '_<So. T)AT<✓ G��3/�3 P>r A t� REF E iZEN GE � C E aT t F�{ THAT THE Fpc e�o5t�+ MSc• 51.10 µ!N • NEREO N GOMPt_�(5 yJ►TN z HE S 1 o6t_th•t� ,�..�T /� • A►.t» 56-c�4GK Ct.6C7utR.I:MEN'r� oF 't1-t� zee ,33 LOCp.TED •WtT 1U 1•i6 Gt_oao ltx aA-r E G 3gAXT'E iZ a W`{E IN(-' f�.esv 16AW o s u 9�v rii-Y6es I "T%Ai PL&KI 15 Nam' E3�5Fp ob AN os'rE2.v1LLE - N�ASs� ~ IN5-r9-uM6WT 'SVZVE�( ,�-TNE OFF5ET5 SUauL� Nod' DE u5E1)TO C)ETE?-P I►-t Lo�r' 1HE.5 APPLIGA►�T j ,eL.4.{/� GO,� PIC• ; •' is .?. ;. - .t: TOWN OF BAR//NSTABLE _ LOCATION /'►.0 6� SEWAGE # ,;�� .3 S VILLAGE ASSESSOR'S MAP&LOT IL i- O a 3 IN$TALLER'S NAME&PHONE NO. `SEPTIC,TANK CAPACITY v C;�C-> ::LEACHING FACILITY; (type) size) NO:,OF BEDROOMS. $LTII,DER OR OWNER PERMTTDATE: ' ^ 9 —'g COMPLIANCE DATE• Z" �"Z^ Separation Distance.Beiween.the: �l Feet . Maximum Adjusted Groundwater Table and Bottom of Leaching Facility `Private Water Supply Well and Leaching Facility (If any wells exist JS Feet ? .on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility.(If any wetlands exist ��� . Feet <. within 300 feet of leaching facility)' ;. :Furnished by toC &LION . ,�� SEWAGE PERMIT NO. -r4F /D iJywfT tN VILLAGE 1144R5-ToA S M/L L 5- INSTA LLER'S NAME i ADDRESS 1E, APP I-A&u?E e U I L D E R OR OWNER C'C&AMic mil//_ DATE PERMIT ISSUED -- -' ® DATE COMPLIANCE ISSUED A10-VA11,4GiV ffS/,F / HovsF Al �9sz rood b� GIS UNIT i MR, AAP 124 SCALE IN FE 700 . .........- NOR I M748 x i. X45.9 x ODA[ ,a X43.5 M L x W' Q"M f 3.9 In X53.. 1 1 Hit --v X69. A Yf IRS t "MR, 'ZERO_ -Mw X Orm RON= RM �W pps t 24 �"d mp"(po A, %X63.7 1354 gfiffi 2,5' MA -1`511— F-4 wo �M\ A 6" 6.3 -------------