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HomeMy WebLinkAbout0098 FLINT ROCK ROAD - Health 98 FLINTROCK ROAD, BARNSTABLE A=316-080.006 l z " b_TOWN OF BARNSTABLE 4� LOCATION (>�S LNy I264,�C- SEWAGE # - r VILLAG ASSESSOR'S MAP& LOT ,3l`. d8d.Gay• 'i INSTALLER'S NAME&PHONE NO. - � t SEPTIC TANK CAPACITY �� -i CRA C� �Gi'd�-=z �- LEACHING FACILITY: (type) : size ( ) NO.OF BEDROOMS cS•1 � P tT t� �'�-�3t BUILDER OR OWNER 'PERMIT DATE: 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) Feet Furnished by 1 e' No. Fee THE COMMONWEALTH F MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Migq aY *potem (fon6truction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `S �-Lwi rrx k.- ME Owner's Name,Address and Tel.No. Assessor's Map/Parcel �Kr Ai�� •' "�J� P'O W Y�.� �`' `�%�� �� 3 � ( b C) 066 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. A k J V I1 S ,�tS�9'D Type of uilding: Dwelling No.of Bedrooms q — of a sq.ft. Garbage Grinder( ) Other Type of BuildingPersons Showers( ) Cafeteria( ) Other Fixtures Design Flow q q O gallons per day. Calculated daily flow Lf 57 gallons. Plan Date Number of sheets Revision Date Title 0WV\ Size of Septic Tank Type of S.A.S. CC GeT i.....e� Description of Soil aNnt� Nature of Repairs or Alterations(Answer when applicable) .Z 4A t �s'iu �q cc(OG4 T -- �w 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 bee issuad by this o Signed Date Application Approved by Date (e2-2 it-of Application Disapproved for the Mlowing4easons Permit No 7` Date Issued w.. ' No. - I Fee THE COMMONWEALTH t F MASSACHUSETTS Entered p computer: ._ . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSE 4` S. Yes - i rication for i( a[ *pMem �Congtruction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 9 S I �.\fjT Y'UG\e— Owner's Name,Address and Tel.No. l —KY A�STc�1p� �1(�r 5 -o w rJ Q VN a r t C AssessordFMap�.cel\ 3,`�1� Installer's Name,-Address' d Tit.No Designer's Name,Address and Tel.No. Type of ,wilding: Dwelling No.of-Bedrooms ! j Lot Size sq.ft. Garbage Grinder( ) Other -_/Type of Building 1 -Lig ersons Showers( ) .Cafeteria( ) Other Fixtures r Design Flow, ?,' �r�4_ ' gallons per day. Calculated daily flow ✓ ' gallons. Plan Date '.'- /Number of sheets Revision Date'" Title VIN Size of Septic"Tank, 5 t- 1 COb Type of S.A.S. OQS Description of Soil Nature of Repairs or Alterations(Answer when applicable) "�--- �v-� SIDeS �! (u" yc✓ I`rx.-t (� } ( 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 bee aI Signed Date 0 '?7 - Application Approved by Date /r> -a g- Application Disapproved for the "owingQeasons Permit No. 7` 6, 16 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 g P Y ( ) P ( ) ( ✓1' Abandoned( )by ��� "Q R e e .SC e`T ( C_ at has been constructed in accordance with the provisions of Title 5 and the for Disposai System Construction Permit No. / dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date a `'T'? Inspector --------------------------------------- No. ! - L12 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mt!6pont 6potem Construction Permit Permission is hereby ranted t Construct d Repair( grade( .)Abandon( ) System located at � L ( (V t\a C 2 b Q A-R M Snq 9 L 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 permit. Date: - 2 Approved by Q 10/9/97 NOTICE: This Form Is To & Used For the Repair Of Failed Septic Systems Only. P Y Y CERTIFICATION OF;SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) l r � hereby certify that the application for disposal works � l construction permit signed by me dated ` I(�-�r`3-�i�7 , concerning the property located at 1 ��" � - ` a.Z'= �- QQ� - meets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching facility (l There are no private wells within 150 feet of the proposed septic system L..��There is no increase in flow and/or change in use proposed '-�_ 'I here are no variances requested or needed. ihe proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will=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 Divisionmap) G.I.S. p) B)Observed Groundwater Table Elevation(according to Health Division well map) a SIGNED: DATE:- ? c—>9 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]. q:health folder:cert I 6 r- f A7 ty TOWN OF BARNSTABLE LOCATION _�� T:,LN\ PLCI�- SEWAGE # / VILLAGE .��a,5t�c�IrP ASSESSOR'S MAP& LOTS' 16.d }INSTALLER'S NAME&PHONE NO, �- b��P SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS Sv've&.P I w6-Alt BUILDER OR OWNER V'Ow IJ 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 LeachingFacili If y ty( . any wetlands exist within 300 feet of leaching facility) Feet Furnished by _f l3 l� _ • � icy ©. �' U -- s L 0,C AyjT 10 N.. - b E W A G-E P E'R M I T N. �. r Q '7:1CA-- YI h ` I'MSTA (it i,S M_AIRE :8 AD»DRESS r ~ B U I L D;E`R ' OR own ER DATE PEIRMLT. ISS:WED> M z BG y DALE COIA'P'LIANCl ISSUED ip } k I 31b� -o�so --oDCn L'bCAT10N _ EYVACE PERMIT NO. ©T z ;7i ge -- /B VILLAGE o 00 INSTALLER'S WANE A ADDRESS B U I L D E R OR OWN ER. DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� �� G ' 3�- Z� -Sic - e.b i "�•�.. No..... '.tli F�a............._... :...� . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .:.Tt""'1..........OF................ .............---- ....................... ApplirFation for Bhopaii al Workii Tonotrnr#ion jkrmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ... ... ZD .��. - -- - ------------------------•--•- •...... .... S... .... ._... .... •• ----- Location- dress o. Lot No. wn _ Address ................................. ------ ---•----------•----------- . Install / Address d Type of-Building Size Lot... _Z.A ..Sq. feet V 'Dwelling—No. of Bedrooms............ ........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin No. of persons............................ Showers — Cafeteria Q' Other fixtures ------------------------------------••--••......•• . hh ��._rr�� ....... W Design Flow................:...........................gallons per person per day. Total daily flow.._..._........c.,JJ' .._..........gallons. 1:4 Septic Tank—Liquid capacity-/-07Dgallons Length................ Width................ Diameter--__-_-...__--_• Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank �� ¢ ~" Percolation Test Results Performed by---------------- ...�z ?! �4----.--__._..._..._.. Date_....!1 ....<.. -- .._. Test Pit No. 1.�r g ._minutes per inch Depth of Test Pit.................... Depth to ground water:-___-__-____-_._.-__--. Test Pit No. 2i . ......minutes per inch Depth of Test Pit.................... Depth to ground water........................ --•-•-•••-•-•--•---••-----•---•------•--•-...---•••-•-•••----•-----...--••-....-•••....................................................•----------......••... 0 Description of Soil........................................................................................................................................................................ x W ------•-•-----------------------•---•-----•--•-•-•-••-•------------•----•---••--•------•-••------------•------------------•-•••-•-----•---•-•-••--------------------------------------•.._...._....----- VNature 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 LITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the.system in oper tion until a Cert' ca.te of C pliance has been issued by t e board of eat . .......� �& Signed........................ ..... -----••----•------ - -- ------ •-� -•--f ...-•ateApplication Approved BY•-- -•---• ... _..----•---- -•.... ................•- ...----..... _ -- R,G---- at Application Disapproved for the 1lowing reasons----------------------------------------•-•--•------.....------•--•-----•-----••--•-- .... ....-...... ..............•------------..................._...----•--•---...••---.......•---------......_.....-----..._..................-•---...---•••...---...---•-------------------•--•-•• ...................... Date PermitNo......................................................... Issued....................................................... �� --- Date � vY ! i No......................... Fizz............._.. THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH ..-----...... ........OF.......... `c' ---------------- ----- Appliration for Uhgvaaal Workii Tnnitrnrtiun ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System : ��.,�.....,�...�... ..c? _ r - Locatio - ddiess ... or Lot No ....... ...... _. ... :. ......... ..... wn dy J/,/ Address W .................................... ......................f.'..'.....^ +C r. . !._,/. ..__..., .... .. ........... Installai e� /f d Type of Building Size Lot...... . -A,<_._..Sq. feet U Dwelling—No. of Bedrooms........... .......................Expansion Attic ( 4) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria. ( ) P4 Other fixtures -------------------------------• - Design Flow............... per person per day. Total daily flow__._::.__._.-_-:A 1W.._.._..._.gallons. WSeptic Tank—Liquid capacity./gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area.... ......... sq. ft, z Other Distribution box ( ) Dosing tank ( p �" Percolation Test Results Performed by.................. .... .___---"-----•----------- Date------" ? �`--- --��::?.. a Test Pit No. L. .minutes per inch Depth of Test Pit.................... Depth to ground water____................._.. Test Pit No. 24 minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ------------------------ "........ --------------------.---------------- ..--•--------:............----•---•--------------......--•--•......- -•-- 0 Description of Soil...................................................................---.........---------"------------•"-----........-------------""--------........---•--••----......"" x �., W ------ - ------------------------------------------------•--------•----"------F.--------------------------------•"-----"----------------------""-------------"-"------•------------------------ UNature of Repairs or Alterations—Answer when.applicable._...............................................:::.....:._._.................._.............. -"---------------•-----"----------------------------------"---•-•--.......---------...s...---.......................""----" -"------"""----"--""""--•--•-----"--------•----•--......................... Agreement: The undersigned agrees to installer thd"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 oper tion until a Certi to of Co pliance has been issued by t e board of ea t ' Signed................::.•.... ..... ............ -•-- "" . •. --- Date Application Approved By.... . . ..- _... .................� :. _ Dat Application Disapproved for the mellowing reasons:---- •--------•-----•--------"-•----------•------------------"-""-••---. ----•---"---. ""•"---""•-.........._ ................."--•--"-----•------------............------•--------------...........•...-•----..........-----"--------------------------"--"------"""-"""""-"-......._----------...Date•----......._ PermitNo......................................................... Issued..--------•-----•- •. Date THE COMMONWEALTH OF MASSACHUSETTS ,r- BOARD OFZ EALTH ................. . 7 (9rdif iratr of Tomphatt r THIS IS TP CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( ) by ? s? 1----------------------------•-•---------........................................................................... Ins ler at...............�2 ..-_... .. ; ---—&e /---------_----._-..--.-.---------.---_---_-.-_--------------...._-.---.- has been installed in accordance with the provisions of TITLE. 5�# LT,� � The State Sanitary Code as escribed in the application for Disposal Works Construction Permit No. ...... ___.[.............. dated_ ��? 7�._.........._._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUN ION SATjSFACTORY. DATE.........:......•-" ...........vr..------------•--•--.:.... Inspector ....._...._..............._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH 'r fr '�' No.. �.:".� ' FEE........................ - Disposal Workii Tun#rnr#ion "anvil Permission is hereb - ranted..................C� .3#^ .......................... o Construct ( ) or Repair ( ) an Individual Sewage Dispo��a,,l System at No............-"" L JJ .................•-•-- Street as shown on the application for Disposal Works Construction Permit No.. ... ... 4 Dated...._..._............... .. , -"• . . . .........- �. 4oardl.-.1-bi Health DATE. - -•-----.`.l 14 ..6 20....................... FORM 1255 A. M. SULKIN, INC., BOSTON 1 ,� :cam _ �—" .— a 4 — -- - — - ," ` i � - 3. k '.( _ N t }, •, " DPP i _I..BI-�.1�,..�.N'�,-)I�,�,%-­k:.7.'I,­_l F:~ - .. `�. , " F " i 5 � . , ,. - - X I" I. s. -+�. I ' I` o 5 h a <" �, \t \ N`. . : `� \ 11- `D T \�0 7 �X \ ° _ I. 3 ` �� - 1 - q� 5 _ I :� \ 8 r ' I . , 24 s4 ' \. C a N V Q J soy , a �� . ?.5 Z4a 7v57 0• ` " c: ` Lq t%' K i' \ ` ��b ` S3 , . 1., 4 _ �2 r . i _-, ¢ o 0 . . . . \i 0.. G. '6 �,.....0, ZUAle TI.F- 1. I , . SE7! 1 r,.� s , l L } i y a 1 a a+.r 1?. E w FiO6�jCCC�9.• �/vi� }.... 11 LEGEND East"----1,0 e I. aa �.' Y ' r„ #". qsa r l / . EXISTING ' SPOT . ELEVAI'1®N Ox0 � Fes. EXISTING .:CONTOUR ® — ��'r%� '` � �.," , CERTIFIED ..PLOT PLAN a b��l ��e4? ;8e " 1MI-SHED• SPOT ELEYAT'I ON � ,; : ' ..w _ _. _ a � a L O T 6 ':?` -//t/T /z o -K R 1 . . a ,.1IWSNED CONTOUR ® . s , . NO'1'E: .The ,location of. any existing underground' sewera.be, — --- --.- welds, or ofher utilities shown=on .this plan is approz- k-'. IN . imate only as determined-,from records and/or verbal 3 � �Wi g,f m - infoxmation.. The contractor is ,responsible for' .the i, - isc�v 3�///e� yerification.of he existing locations in the field. . SCALE, / " <-'O DATE 1 // Sb Y �.DA'E'f3G�' E'l10.GONE'E'RONt� CCxIM 6l/CFjle f ,i q�.IENT, •__�____ i CERTIFY THAT THE PROPOSED EOISTEI�IE. ° R.EGISTERF,-3 � , Joe, p_- ___ BUILDtIdp 8HOWN ON TNIS PLAN CIVIL' `LANDri II ,- �,., t CO1�9F+pIR S TO THE 20NIN0 LAWS . 712 MA1 N `STREET x , �'° CI1,�61Y� . a ANN S, .MA$3.� ` Y" _ - . SKEET' +0 .. a. DATE :REG- LAND SURVEYOR ` J .}r. ,1 Ate ; ) i .. ..... ,r -, ... " ' .w 7-, i F c/7NE,4 THE S.=PT/C 7-,4N/C 5fAC,,-i/V 6; F>/:T ARE /`10R,=- rH A9 -v /2•�BELO H/ { _:aJ � � � . . � � „iJ�IA�LL BE:-9ROUGHT .TO GgAOE:�.- !✓ .EXTRA ' C ONCRBTE G 4 //20/Y C o S L PVC P/PE i HcA✓y i9 ST lYER /�.4L DE U.SEL� /W P/TCN f j T o EL 9 S �B-•PFR FT. !. C'o1VC.e_A- CC) YER i w � ; y .. d 'q` D1fi. . 2�LAYER - v r"JIN. PITCr/' < 4 WA5HEO STONE S.FPT/C: rANK �' • • • .• • e' > '• .d a �' • ti c • e • BOX 1. �. Sds a 6 0. r..l • • .e a . . r . ' W,95HED STONE 4Dp 3 / _ D.'De' o. _� • • o • • • •` p •b p PREG45T SEEPAGE . lNirPRT ��LEd%AT/ONS P/? c�r�.4c. 7y G76' G/t[�D'`�y v, y , t ► s '• ` .• • e o G<7 OR.EQU%V /NYERT AT BU/,L!)/NG 93',� FT. G .3 1/NL:ET "iSEF�T/C,TANK. •, e F7 FT. C SEE TsIBUL 4TlON> t �OIJTLET,SEPT/C:TANK. 9Z6 FT INLET,0V5 /BUj/ON BOX 7�.4 FT, SECT/O V„OF... GROUND NIATEfr TABLE :_ Ot>7"LETD/5TR'/.�11T/ON 60X .9ZZ 'FT. /MLFT LE.4:CN./eYG, o/T 9 Z° FT S..E �4G�' 0/S'/®OaSAL .SYS��h9' . _ ` Ti4 46t✓L.ATID/V �. .. OtMENS/bN FT. SCALE 4 ., DESIGN Ct't/TERl�4 .., D/.�fE•NS/oiv 8 :. � Ft." �, , FT.`'' Nv 3ER Of BEORO o/+9S' GA RBA �,�sirE SO LOG G,�p/SPOSA UNLT � /L `. ! • TOTAL 1-.ST/MA-TED, FL 3_3 GAL.IPAy cS:01 L TeST l l SOIL 7EST#2 �; NUMBER lGF EACNING p/Ts__.,:� F[EY. ¢ J Jr FtEY, DATE OF. SO/L TEST fit:./� �c4S h S/OF CACHING GER P/T 226 SQ, PT;` le'l RESULTS 1t//.TNE55ED BY /� 5 vnrLON ' 1 8oTT0/Yf LEr1CN/NG PER;.PTT 1113 , __' $Q• PT. ,;' �,. .'Z:DA:Al F�t/�COLA.T/D/1/ RATES / 'G is /+JI/V•/I"CH . TOTAL LEftCN/!Y"G AREA 3 3 �: SQ, FT. .' 7E 1 2 TN�'N MI N.�INCH r 3.3� . . F >rCOdi4T/ON RA RES`�RYE CgI)YG ARER SQ.. FT { 2.®' h { I • x'`W q t' �(.. 'r r y., : � - .. ype�� /}��//p��po� �p► �j/gyp .. t 4 Ciu�G Tf V 7/2 MAIN.ST.� f/YA.NNl9;/NABS .� NOGI�®UNQ,.yYATEpR FAICOU/VTL�e�o C<LEwr: d't GRa UNO yti%d�TAR AT EL1� z 17 fir ,- sP tom` JOB"n/a. �v�a s�a .�T zd .:: n'. w K i ,