HomeMy WebLinkAbout0094 CARRIAGE LANE - Health 91 CARRIAGE LANE ° 'a
BARNSTABLE
— _ A = 298 044
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LOT NO. : ADDRESS:_n ' '
OWNERS NAME: : �cra- C�1w�-f II(1�'crwSEiQ-IQ��
SEWAGE PERMIT NO. : NEW: REPAIR:
?, DATE ISSUED: 3' ?® ® DATE INSTALLED: /
INSTALLERS NAME:
. INSTALLATION OF:c2-5m °
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WATER TABLE: - =FINAL' INSPECTION BY: ( j
DRAWING OF INSTALLATION ON REVERSE SIDE:
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No. 6��"'' Fee L5
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
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PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Digooar *patent Cottgtruction Permit
Application for a Permit to Construct( )Repair( /Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. l Owner's Name,Address and Tel.No. ,
Assessor's Map/Parcel aQ C `[
Installer's Name,Address,and Tel.No. j Ll 3;t—sltb Designer's Name,Address and Tel.No.
a �iedZ
Type of Building:
Dwelling No.of Bedrooms Lot Size 93 sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow - 33CD gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil CQo=
Nature of Repairs or Alterat�i ons(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 issued by this Board of Health.
Signed Date
Application Approved b Date-�"" -'�G=Z
Application Disapproved for the following reasons
Permit No. C2 Date Issued
No. �!/Q/''"' �' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 0
Yos
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSE-TTS_..
ZIppfication for ;Dioozal *raem Construction Permit
Application for a Permit to Construct( )Repair( /Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or/L'ot No. Q 1-7 Owner's Name,Address and Tel.No. �^
Assessor's Map/Parcel
Installer's Name,Address,and
(�T_ el.No. J Ll 570) Designer's Name,Address and Tel.No.
1 �Aaxz,
Type of Building: `
Dwelling No.of Bedrooms 3 Lot Size '3 sq. ft... Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures -
Design Flow Lj!1 gallons per day. Calculated daily flow 33CD gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
\i Description of Soil ✓)m
Nature of Repairs or Altera�ons(Answer when applicable) S�P
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 by this Board of Health.
Signed Date.
A lication A roved b C"lG , V- Date "
PP PP _
r, 3
Application Disapproved for the following reasons
Permit,No. Gd 0 ' Date Issued a-i� 2 -~r'•�'� C/
THE COMMONWEALTH OF MASSACHUSETTS z
BARNSTABLE, MASSACHUSETTS
t Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( )
Abandoned( )by ! ,
at P r- �'� '`/FlfeS -III J 2 Lj has been constructed in accordance
with the prrgv lions of Title 5 and tthe for Disposal System Construction Permit N?06;/--7 04 dated Z •;;,4G.l
Installer-r,l Designer
The issuance of this pe it h 1 not be construed as a guarantee that the syste> 1 func ' . as-,d igned.
Date �/ / Inspector J^ ` : _AA
No. a'?/"-^ r7 L Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
wigooal 6potem Con5truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon=( )
System located atlirJ
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 X-rrmit.
Date: ' / Approved
i
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{� U6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL
WORKS CONSTRUCTION PERNIIT (WITHOUT DESIGNED PLAINS)
1, , hereby certify that the application for disposal works
construction permit signed by me dated 5/o'Z l 0 , concerning the
property located at �/ � ) � meets all of the
following criteria:
J • This failed system is connected to a residential dwelling only. There are no commercial or business
/ uses associated with the dwelling.
v • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
V • 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
d•. There is no increase in flow and/or change in use proposed
�/• There are no variances requested or needed.
V 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]
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:
/ J
A) Top of Ground Surface Elevation (using GIS information)
J
B) G.W. Elevation +the MAX. High G.W. Adjustment `q _
DIFFERENCE BETWEEN A and B J'
v
SIGNED : DATE: . 5( Q
[Please Sketch proposed pan of s em on 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:cent
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LOT NO. ,-.ADDRESS.
L-A
OWNERS NAIIE:
Vv\A
SEWAGE PERMIT NO. :
NEW: REPAIR:
DATE ISSUED: DATE INSTALLED:
lmSTALLER5 NAME
INSTALLATION,: OF
AL-A
WATER .TABLE:
-FINAL INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE:
(D IN,
A 3S
r✓d4
L INSPECTION BY:
No.....iZ_71a.._.. F��...;2 ....................
THE COMMONWEALTH-OF MASSAGHUSETTS
BOARD F HE L�H
...........OF..... . .
Appliration for Ubipsal Narks Tomitrurtinn Vamil
Application is hereby made for a Permit to Constr o Re air ( ) an Individual Sewage Disposal
qsyst at -
. / .. . . �-- ....
F Location ddr V . or Lot No. /
--... .......................................
e ner - Address
...C. ------- -----------•----•- -------------------------------------------•---............-•-•-------••----•--------
Installer Address
Q Type of Buildin Size Lot.31$7"�..Sq. feet
U DwellingNo. of Bedrooms..__ ® ______________Expansion Attic ( ) Garbage Grinder ( )
U+
aOther—Type of Building -__________:!............... No. of persons______________---__--__-__• Showers ( ) — Cafeteria ( )
QOther fixtures - - --------------------------------------------------------------------------------------------------•---
W Design Flow......_ ....... ... _ ` gallons per person per day. Total daily flow...{.:.., --------------gallons.
®�9 J
g
WSeptic Tank�Liquid capacity`-•----...gallons Length................ Width ____-_.___ Diameter---------------- Depth---___--_____---
x Disposal Trench—1�To....................:"Width.__.-- .__ -ot e l Total leaching area...... ..........s . ft:
Seepage Pit No.................... Diameter__ ept e ow inlet..__._________ ..__ Total leaching a a �5�jq. ft.
Z Other Distribution box ( ) Dosing tank
aPercolation Test Results Performed by.......................................................................... Date----------------------------------------
Test Pit No. 1•_______________minutes per inch Depth of Test Pit.................... Depth to ground water_-_-___.__--__--___-__--
frA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth t ground water------------------------
------------- _ ------ ----......
O Description of Soil--------------------------t[�,�GsI .........
-
V -----------------------------------•-•-----------------•-------------------------------------------------------------------------------------------------•-•-------•-•-----------------••------••-------
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 Article XI of the State Sanitary Code— The undersig ed f rther agrees not to place the system in
operation until a Certificate of Compliance has been issu y the boar of alth.
Signed s ..: .
—
na
2APPlication Approved BY
7
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------I-----------=-'------------------------------
Date
Permit No.
- Issued---------•----- - ...-----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F M H
OF. ...................
Appliration fat Riiv saf Works. TomitrurtiOn Vrrmit.
Application is hereby made for a Permit to Constr t Re air ) an Individual Sewage Disposal
Syst at:
tee•+
. �-----_R7.7- 5 --. ......... _. §... ......... ....... .....................................
Locati0 ddr ^'" or Lot No.
°------ ------•-------•------------------
p -
W s Wner Address
a m at .....
.... . .. ... .....:................... ..............•-...................._......_............... ......-
Installer Address
UType of Bu ding ,,.,y Size Lot_# ��_.. ...Sq. feet
Dwelling No. of Bedrooms....... ..............................Expansion Attic ( ) Garbage Grinder ( )
.a
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures --------------------•-----------------------------••----•----------•-._.....-•---------------•---••-•--•••---•-....--------------•--•----•--••••--•-•
W Design Flow_,...._:-_.......__�_d.:: ______ gallons per person per day. Total daily flow_.._ .:_ ................gallons.
WSeptic Tank i—Liquid capacity/+ ...gallons Length................ Width..._ -___-.__. Diameter---------------- Deptit_._._____,__----
x Disposal Trench— o. ...................: Width..._______ o Total leaching area_.._ sq. ft.
-------
Seepage Pit No......:.............. Diameter.- e t' e ow inlet............. _._. Total leaching a _ ft.
Z Other Distribution box ( ) Dosing tank ( ) , . yam}- 1
a Percolation Test Results Performed by......................................-••----•-••-----------•-•----••---- Date------------------------------------
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.____________________-.
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................
...
O Description of Soil......................... �_....... , ----
x
U ---------------------------------------------- --------------------.........................................-..........................................................................................
W
U t 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 Article XI of the State Sanitary Code—The undersi ed f rther agrees not to place the system in
operation until a Certificate of Compliance has been issu y the boa of Ith.
,�, �' .s
Signed = :_
r f D
Application Approved By------- - -- -- r j.r.�.. ,.
...........
- ---------------
Date
Application Disapproved for the following reasons----...............................---------- ---------•-•-----------•----=--•------- ------------=---
•-------------•------......--•-----.....------------...-=------------•-----------•------- ---•---------------------------------•- ---1A0.00
- -----
Da
te
Permit No. ---------•------------- Issued... � �7
Date'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....tv. ? � .............OF..... ........ ...................
_ � �e pr#i�ir�� of Tn�plitt�re
THI IS TBY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
�00 r-1....................1. -�.Zn s aller
Y t ...'
has been installed in accordance with the provisions of Article,,Y, I of The State Sanitary as d�,scribed in the
application for Disposal Works Construction Permit No_______________ :___.___.._..._... dated_-__. : ...2.. _._._ ._ �......__....__.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D AS A GUA ANTEE THAT THE
SYSTEM FUNCTION SATISFACTORY. "
DATE �1 L4._;7 Inspector /L!% ✓
THE COMMONWEALTH OF MASS HUSETTS
BOARD F HEALT
t0 ...........of
.......&.. 44 No •---••.. ......
\..
FEE:_ __
= -- .
R,4va,ittl ' nthil (11P rurtwu ami
Permission6 t�,hereby granted ------- -----�-'..---... -�................................ ........................... .
to Construe ( y or,I epatr ) 'an Indivtdual Sewag sposal Syste .3f
at No
.as shown on the application for Disposal Works Construction, Perr rt No._ A _: �, '.,ated-
�treet ° �....
----•----• � .---..
DATE. !Board of Health
FORM 1255 HOBBS, & WARREN:"INC.. PUBLISHERS