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HomeMy WebLinkAbout0066 MOUNTWOOD ROAD - Health 66 Mountwood ' Marstons MIlls - A= 125 —020 i i I TOWN OF BARNSTABLE LOCATION 66 Jfljq!/AT- /&T0 SEWAGE# ;TILLAGE A ; m 1 I S ASSESSO 'S MAP&PARCEL INSTALLERS NAME&PHONE NO.� ��,e.�fP SEPTIC TANK CAPACITY LEACHING FACILITY.(type) tf SuJdl'L size h ( ) NO.OF BEDROOMS OWNER —� PERMIT DATE: `mot — COMPLIANCE DATE: �. 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 leachiN-e,+� cility) Feet FURNISHED BY 1-2 r (� h 6m rt— AAA A3.2 t4�4 � �� 63, 6f7,�a1� � �bx t HJ LO_fATION SEWAGE PERMIT NO. _/ 6T'$/.2 mo u IV i' Wool) Rot �7 r 7 F 7 VILLAGE /off 430 M INSTA LLER'S NAME i ADDRESS Qc)6,e a u rc Co HAM W)cN B.0 I l D E R OR OWNER 4 s DATE PERMIT IS UED DATE COMPLIANCE ISSUED r - � v �� �� t ���,� � ,. ' � I �,� ��` ' $ �y� �� �- � �� R� . `T THE COMMONWEALTH OF MASSACHUSETTS Application is hereby made for a Permit to Constru ct �_<Or Repair an Individual Sewage Disposal Syst ........ - - _-- --- -------00�v.........d__;� ne Address A Zs Ft�a Address Dwelling—No. of Bedrooms...........3k....... ...............Expansion Attic Garbage Grinder Z Other Distribution box �,d);gin ta 7 7 _��A 9 . ........ ../...... ------" ----------------- Agreement: % The undersigned agrees to install theufore6escribed in accordance with the provisions ofIlIlE 5 of theStateSanitaryCode—Zbeumdecai.gned further agrees not to place the system in until Certificate of (Compliance has been issued by th Sig ......... ......... ' ��-_�-- ` Application Approved 8y......' -_ ------------ --- !�L=.�u�,-�"��- ' �^ um" Application Disapproved for the following reasons:............................................................................................................... --'---'''------'-------------'---------'-''-------'--------------------------'---------'--'--------'- u,te � Permit No......................................................... Date No................ Fps THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE TVi .... ...... . ----------r ......OF...... ......... .......... ........................................................ Appliration for Disposal Mirkii Toustrurtion Vvrrmit Application is hereby made for a Permit to Construct 0:1 or Repair an Individual Sewage Disposal Sys ', ......A.2.......... -I-------------- :......47 .......... . ..................... Loc effion-Address oroL t No. ........................ .............. ................................................................... Own 7'Jfj*a1 Ar-q of/ Address - L............................. ........................... ............ ............... .... . !..... -2-�t O..�...... ....... -------------------------- --------- Installer Address 07�--- Type of Building . Size Z ot117 7.........Sq. feet Dwelling—No. of Bedrooms.__..__.__ 5 ..____________________________Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ............. .................................................................................................................... Design Flow.............:67-0....................gallons per person per day. Total daily flow___________________.______..1.9 ....gallons. IY4 Septic Tank—Liquid capacity/AOt- a-56ns Length________________ Width________________ Diameter..-:..._.._:____ Depth____________..-. Disposal Trench—No. ...................7- )O)idth........... ,4.. Total Length.........e...... Total leaching area._.__ .....sq. ft. .......... 11 b '..sq. ft. Seepage Pit No E ....... Total leaching area... kOtVw. z Other Distribution box Dosing tank . Al�-- 77 Percolation Test Results Performed by........... ......... Date... ............. Test Pit No. I________________minutes per inch Depth 6f Test Pit.................... Depth to ground water_____._...________...... Gil Test Pit No. 2................minutes per inch Depth of. Test Pit___._.___.__________ Depth to ground water........................ ------------------------ ---7 ------ y——-------------- -----New ---- 0 Description of Soil..............V............... ... . ... . m------- .................... A �4 ut---------------------------------------------------------------*--------- ----------------*---------------------------------------------------------------------I....................................... ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------*----------- 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 TITLE 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. . .. ..... Sign ............. ........ ...... Z�........... Date' Application Approved By.......11-414 ..... . .................--------- .... 10 Date Application Disapproved for the following reasons:................................................................................................................ ....................................................................................................................................................................................................... Date jj��_ '000"';�� 7d�" PermitNo......................................................... Issued------ .............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF HEAL H ..... ........OF. ...................... (Infifirate of Tautpliattrit TH T he,4 IS TO CERTY Individual Sew D* sal System constructed or�Repaired by..� ... ........................ .......... ..................... . .............. .............. Ins�.......... at..... /VZ ----------- ------ 01 ..... ..... ...... ............ - - . ................................... has been installed in accordance with the provisions of Tg�*F_ E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No .._. '.$ - .. .....?_7............... ......71. -/................ dated... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEIA WIL� FUNCTION SATISFACTORY. — /iK— 71— Inspector......j!.� ........ 0-1------------------------------------------------------------------ DATE....... THE COMMONWEALTH OF MASSACHUSETTS � ''" BOARD PfHEAL'—OF...... .................... No......... ............. FEV___47............... Disposal Works T-5 `qn rrmff P e rtm- s*' �is ai .......... ls�io i'�e y granted.. ................... .... ........ ........................................ s r or Repair );^n In 'victual SemSogej;�sqo al S to Constr ( S, at No. 17"........ 0 �"X-,............ Str et //-7;7 as shown on the application for Disposal Works Construction P mit yo.........e7........ Dated..........:!�t�-' ----—----- ............................. DATE................... ......................................................... ..3 FCRm 1255 HoBBS & WM',%R�CN. INC.. PUBLISHERS - ►,to C"z !� 33o G•r-'•U. U Ste- t o OCR 6/s t✓ . r �lSPD�A.t_ PiT - USE (000 Gt�. �t---WALL. AV-EA = (50 S.P. 'IV Ss= )4 2.5 = 37S G.P.D. To-r,&L IZ�lGS16KI = 425 G•Ra. F � '►•-oTl�t_ D Q 1 t_�( F L.0\�./ = 33D 6.Ph. o DEf1GDLQTI0�.J CZIJTE (��ta,f 2/vt�u 02 LESS. 1 RAX 1 t iH- N { r., Tor rwo LOAwi PPE tuv. 97 + loon iuv ' ,. Sd 4 iw. GOL. 9G 7 l -Box 9G Sepric kuv. 10, , TANK L�H 'e M© , FIT , Wir4.t �� 'i �TGN� WASHED f�'�`_' CE.QTtF1Et� pLbT ��L./yb.�i - LbCAT1b" lV�A �TQ�,f� V,C.t� SCAt_ ,�l0 1cIA��t l CIrIZTtt=-{ Tk-!A-r TNT 1`OUIk TIoo P,--4Ili 1ZLPEIza►.ic_c-. WZA t=nl-1 Gc rlPL`!S W ITt-A T14G: Lor AWC> St=Tt'-,ACI4 V[QJICEIVcWT'; 7oW►.1 of,= $At2�1yTAr?�L �� I.{ �acaDtom. 2�I�i 2CGlS'ILiZ�.D 't�.1..tt-j 5tJ2u'�.`(�t-`> T"I-1lf-, C7t_Ak,l I,-, QOT 0" Aa.l O5?E2V11_LG o MAS-i, ItJ�r?J;✓tt_�JT' !i()t ./r_�' Tt�t__ vFI-S CE, Pik IG�ILA APPL-1 t•.k.�C' C',t-, u 5 e�� T c> to r_-__> c r;M t►,I C-- Lo-cr t_t kJ a S TOWN OF BARNSTABLE LOCATION SEWAGE# • ' VILLAGE •�l ; r r + l j S ASSESSO 'S MAP&PARCEL _ 05 INSTALLERS NAME&PHONE NO. d -e SEPTIC TANK CAPACITY 4 . j LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER ,CA PERMIT DATE: \ '`�L COMPLIANCE DATE: 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 leac7hiMd-5 lity) Feet FURNISHED BY `ea1[ Alf ri E All eK y 6fTAlm LL 0 ' P No. .t�)�e I Fee G T THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: // PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for M5po5a[ 6pgtem Conotruction Verna Application for a Permit to Construct( ) Repair( ) Upgrade ] Abandon( ) ❑Complete System ElIndividual Components Location Address or Lot NO& O ner's eame�Addres ,and el..NP. r� Mao ris M i 115 rn (�� �vlQ Assessor'sMap/parcel 25 -010 {_/_ Installer's Name,Address,and Tel.No. �U—77Y/8?g Designer's Name,Address and Tel.No.�� 3!' 7-9 1P4� &CA5 . 0 .06X 1657. Mwpi_5 1� 1-Wft1vrt6 Type of Building: 2 Dwelling No.of Bedrooms �J Lot Size 20/f/7 sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p Design Flow in.required) b3 3n gpd Design flow provided 3 "1 gpd Plan Date I/ Number of sheets r Revision Date Title Size of Septic Tank I' 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 thi Board of Health. Si Date Zm 60 Application Approved b Date Application Disapproved by: Date for the following reasons Permit No.s _`e Date Issued L �— No._ C:�3 C(96 ")50 — Fee ` !V­ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z(Ppltration for )Dtgo$al i�p.5tem Cow trurtton Permcit Application for a Permit to Construct( ) Repair( )`Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. l�,(n w Owner's Name,Address,and Tel.No. Assessor's Map/Parcel j'y,-e.— Installer's Name,Address,and Tel.No. p iiress, t "��-t•D�� Designer's Name,Ad "ani d Tel.No. r h Type of Building: Dwelling No.of Bedrooms 13 i. Lot Size 20, 117 sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures o s Design Flow�( in.required) gpd Design flow provided 3 ( gpd Plan Date e�-1,l)('j/ 41, 261)ta Number of sheets / Revision Date Title Size of Septic Tank 9,4, ( Type of S.A.S. ,�7 f r, , 71 A 1 Pya.-f d r—j t Description of Soil Nature of Repairs or Alterations(Answer when applicable) r / 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 Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign �/� } .G i Dated Application Approved by Date L Application Disapproved by: Date for the following reasons ,Permit No._ Date Issued ———————————————————————————————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comphante THIS IS TO CERTIFY,that the On-site Sewage _ ge Disposal System Constructed ( ) Repaired ( ) Upgraded (X) Abandoned( )by -V,P) �y;l)lk at 1L4 Moy-ti �t�. oa _ b M has been constructed in accordance with the provisions of Title 5 and the for Disposal S stem Construction Permit No. E;0_ dated 4 /7 Installers% /�� (ii'(/t �i Designer fl Al SA #bedrooms _ Approved design flow 33• gpd The issuance of this permit(s�hall not be co`/strued as a guarantee that the syste ( fu�ion as d7signed. Date 17 744 Inspector\ ———————//————————————————————————————————————— No. ��10 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS i0v"o5al *y5tem Cori.5truction Vermit Permission is hereby granted to Construct ( ) Re air ) Upgrade ( Y) Abandon ( ) 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 mu/st/be omp et�d within three years of the date of this pe tnit. Date �/ �71 (n Approved Town of Barnstable �GF1HETpy,O Regulatory Services Thomas F. Geiler, Director BARNSTABLE, 9�A 1639. ,0 Public Health Division 'Eo►��a Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Ze Designer: Shay Environmental Services, Inc. Installer: a �� CSC. Address:. P.O. Box 627 Address: _East Falmouth, MA 02536 On was issued a permit to install a '(Bate) (installer) septic system at /� I1S based on a design drawn by (address) Shay Environmental Services, Inc. dated � ' Z)(S-)0 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. 0! OF \fir CARMEN E. Iri"sta ' SHAY No. 1181 _ o GIST02- sANITAR�PN gner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, r,-AK-NtCr�. FS"wrl ,hereby certifythat the engineered lan si ed b e P � Y m dated /1 concerning the property located at �? �L�Q`c����� � { 1�1•t i 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. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) �- B) G.W. Elevation An+adjustment for high G.W. DIFFERENCE B EN A and B Z ,40 SIGNED DATE: UCG 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. L—�vt1 n Z4ts .,� q ASeptic\percexemp.doc