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HomeMy WebLinkAbout0087 MOUNTAIN ASH ROAD - Health 87 MOUNTAIN ASH MARSTONS MILLS A= 124 = 032 __ C /,;?�-d3,?, 83-530 vl-- LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS 4 PA/?D LA FRUTrE 8UILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ��►y irk f�i Are ff&Ap � cI I ' r �4 Z2� 22y, - �000 cW� ry�uK �GGGgL TOWN OF BARNSTABLE s LOCATION Ln LY/rt A I'l SEWAGE # A010 r VILLAGEih[ ASSESSOR'S MAP & LOT `D i 1 I INSTALLER'S NAME&PHONE NO. n'J i n c�� S� .7! c- 2 21- e6 y cf SEPTIC TANK CAPACITY LEACHING FACILITY: (tyj/'.+r�' S (size) NO.OF BEDROOMS BUMDER OR OWNER PERMTTDATE: O COMPLIANCE DATE: Sa© 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 I Furnished by i t. i r� ri I f 14, r - _ _ TOWN OF BARNSTABLE °`L' LOCATION Ark A 14/ 'cam SEWAGE # AIX VILLAGE Me MIGLSASSESSOR'S MAP & LOT 'D INSTALLER'S NAME&PHONE NO. SUS r 7-)rSS' 6 S' f SEPTIC TANK CAPACITY /rt1 c^l LEACHING FACILITY: (ty /jC7.d?isle S (size) ter S NO.OF BEDROOMS BUILDER OR OWNER Q PERMTTDATE: Q� COMPLIANCE DATE: Separation'Distance Between the: 4 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 Wedand and Leaching Facility(If any wetlands exist within,300 feet of leaching facility) _ Feet Furnished by � � � _ � .- ' � ,, -., Hl � f�l � �.� f3 2 h� 7? �. - Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Disootal *raem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System `CIndividual Components Location Address or Lot No.S?7 1• o,,1_3X%A,,) i6 o- Owner's Name,Address and Tel.No. Assessor's Map/Parcel I>A -63�>- �, S �� rV RYvS Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �A-;p--C- �� Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow '�73 3o gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 460tv A Type of S.A.S. 14 Description of Soil: A4rea 3lN6:Rn Nature of Repairs or Alterations(Answer when applicable) 1 �So%C- .�(L kkl Gc. .n, C I*a urn, 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 alth. �! Signed Date a l`� Application Approved by Date '2�- 1 T C90 Application Disapproved for the llowing reasons Permit No. — © Date Issued ----- ..' .�------------------------- No. Fee ,i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _XZ PUBLIC HEALTH DIVISION - TOWN-.O STABLES MASSACHUSETTS Yes Application for Migogaf *pgtem Cow5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System 154ndividual Components Location Address or Lot No.,75�'7 ft\o,,N\.^&j p1S t-� Owner's Name,Address and Tel.No. Assessor's Map/Parcel O ..t .. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rlr�,p�r-V,PIZ-S'C'�aC Type of Building: Dwelling No.of Bedrooms f Lot Size " sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures - Design Flow '`CJ gallops per day. Calculaied daily flow �t�l gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 4,`r C.; ( T',D2 Typ_e;of S.A.S r Description of Soil 6&n Nature of Repairs or Alterations(Answer when applicable) 1 Ub7?Sc�zcr N�c� -QLyc Tvc.`t,c� C C_A_(SA�l cry S,,rnT—r 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_issae44vp+his.B Signed /�� Date / 1' Application Approved by Date j=- tV -00 Application Disapproved for the lowi g 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 'I P--r A pt C-- at 22 Mout,<-bw I4S W 0A 06,(\4 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - O Ndated Installer Designer /, � r The issuance of this permit shall not b/e construed as a guarantee that the sly tem will function as signed 4 Date /1 ' 1 , Inspectors! ' ----------------------------- - ---------- 'r No. 90!' 2- 0 9 U Fee .�0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wigpogal *pgtem Congtruction Permit Permission is hereby granted to Construct(A'Repair( )Upgrade( andon( ) System located at /✓tl�._7 i - - 04_S/A 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: 2L Approved by '+ 1/6i99 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 PER= (WITHOUT DESIGN-ED PLANS) hereby cermy that the application for disposal works construction permit sipped by me dated `-,-R— � —UD concerning the property located at Q 7 Ao-,A�6 Ate - rkolg,+f meets all of the following criteria: I /• The failed system is tonne✓ed co a residential dwelling only. Tnere are no commercial or business /uses associated with the dwellins. '�• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 nunutes per inch. There are no wetlands within 100 fee;of the proposed septic system ere are no private wells within 1.50 fee;of the proposed septic system The-e is no increase in flow and/or change in use proposed • T here are no variances requested or needed_ The bottom of the proposed Ieaching facilin,will not be located less than five Fes;above the ma.=um adjusted groundwater table elevation. [Adjust the s--pundwater table using the Frimptor yriethcd wheat applicable] ✓• If the S.A.S. will be located wicl� 2f0 jest,of any vegetated we lands, the bottom of the proposed leaching facility will not be located less than.ouneen (14) jest, above the maximum adjusted Zroundwater table e!e'/aaorL Please complete the following: 7 A) lop of Ground Surface cieration(using GIS information) � u ' B) G.'N. Elevation 2 =the'vt�-'(. `Fligh G.W. Adjust meat .�)I Q = 36 t D T-F'"c-REN CE B ETWWEEN?.and 3 SIGNED (Sketch croeosed plan of s.ste;m on bac!c{. a:h=1Lh foldcr-c-t .. ., C� s� P;f