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HomeMy WebLinkAbout0020 GRANITE LANE - Health 20 GRANITE LN. ,BARNSTABLE A = 316072 5 tit � ,• .. .. - ., ,,...' � .. .t 'q�. r% � r� mot,'. ` - _ � - a a, � , J. [. t•ti' p .. t. t S � h. • ..'.. f N1 1. _ + •M1 � .. > L� Va' • .r. 4 a e - ; �' , ' � x � n • � , r s, A, , a. II a � c _ r x. • e� fi , _ _ - - � - .r d .g.•a, a ,. � - �t. .. - , • v t ' - y u r o v • u > • r - H r - , : n� I • d .. - 'fib J � -„ � '.. F�.. � � �" ,.I• , 'A � rV - ', - \„ r 1 -�,� -♦ . n, „,1Y' •; ,�F _ •: a , • F •" 0 u n s - n i , n , e v a R v }" c, TOWN OF BARN STABLE 1 L. LOCATION - S(2—a LAW?- s VILLAGE 01-9 95ii ASSESSOR'S MAP LOT (p�72 SEPTIC TANK CAPACITY &/I /ozm LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR UBLIC_WA BUILDER OR OWNER DA VA 4H*NeFi, es No }� TOWN OF BARNSTABLE �,•0 I CATION � ��) — �� SEWAGE # VILLAGE, ASSESSOR'S ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. /' eol ��sT SEPTIC TANK CAPACITY LEACHING FACILITY:.(type) ZVU na fy (size) NO.OF BEDROOMS 3 v (� BUILDER O OWNER 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 Leaching Facility(If any wetlands exist e/ within 300 feet of leaching facility) Feet Furnished by ,6L� Y �jn aY r 30 c O ,� / Z c No. 77, vvten} I Q Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOIWN- OF BARNSTABLE, MASSACHUSETTS ZippYication for Migpogar *pgtem Congtruction permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System &'Individual Components Location Address or Lot No. p j Owner's Name,Address and Tel.No. Assessor's Map/Parcel 40;&,P�2b�/�' k 6Z ` re�e/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7/- e9 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 /L® gallons per day. Calculated daily flow 13 1349 gallons. 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) 7-2,61f Ar /-e_,r 11- 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 is oar of Health. Signed sued t is Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued q o 7 z Q / 0 _ Fee THE COMMONWEALT-1 OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWNGF-BARNSTABLE., MASSACHUSETTS ZIppfication for Miopaal *pztem Con!5truction Permit 1 Application for a Permit to Construct Repair Upgrade Abandon ,,9�// pp' ( ) p (y')Upg ( ) ( ) �Complete System L�Trtdividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. oa% Gam, ilece- Assessor's Map/Parcel 4V' ,Q 1'457a /1C Installer's Name,Address,and Tel.No.(� �j Designer's Name,Address and Tel.No. 7 7/- ¢9 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building IGe No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Desiig Flow /L© gallons per day. Calculated daily flow 3 345) gallons. Plan Date - Number of sheets Revision Date /,.. Title Size of Septic Tank wo %S %r Type of S.A.S. _ /></`9 �4� Description of Soil Nature of Repairs or alterations(Answer when applicable) 2 l I"-1 e 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 )aro7of Health. Signed Date Application Approved by Date -2. /- Application.Disapproved for the following reasons Permit No. Date Issued --------------------------------/------- THE COMMONWEALTH OF MASSACHUSETTS '72 BARNSTABLE, MASSACHUSETTS (tertifirate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(1/fUpgraded( ) Abandoned( )by 961�Zogt�z ell1,00 , at N 57t;"61, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated ! Installer Designer ! \ „/ n n, The issuance of this pe mit shall no be co 'trued as a guarantee that the sys�tern will unction as d/./I a� yned Date /�1 Inspector .![ � No. �� '------------------�/�.,.D7� Fee [[JJ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS MiOpo0al *pgtem Cougtruction Permit Permission is hereby granted to Construct( )Repair(Vf Upgrade( )Abandon( ) System located at 10 d Iwo)Ae Z. . 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 rmit. Date: 2— �� Approved by et��` f ll6J99 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 DESIGNED PLAINS) I, ,� l�� lfl�/, hereby cemfy that the application for disposal wor.�s construction permit signed by me dated concerning the property located at ZD meets all of the following criteria: L The failed system is canner ed to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 17 fie sou is classified as CLASS i and the percolation rate is less than or equal to f minutes per inch. t/ There are no wetlands within 100 feet of the cr000sed septic system ,/There are no private wells within 10 feet of the proposed septic system 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 not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor /if meth when applicable] 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: A) Top of Ground Surface Elevation(using GIS information). S B) G.W.Elevation Z Z +the MAX High G.W. Adjustment.D , _ Z 3 DIFFERENCE BETWEEN A and B SIGNED : _ DATE: [Sketch proposed plan of system on back]. q:health folder.oat i.1� Pi 1Q �. Z r � _ L I ' 1 t� s i I // TOWN/OF BARNSTABLE LOCATION Z d blV 4l � l4, SEWAGE # �CYD VILLAGE Art.z, ��Lv ASSESSOR'S MAP & LOT .?,i� INSTALLER'S NAME&:PHONE NO. SEPTIC TANK CAPACITY r®�D ��tia s � (size) io rc ja',�1 LEACHING FACILITY: (type) .� �— NO.OF BEDROOMS _ BUILDER PERMITDATE: Z- I S—D(J COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �l Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) J'3 Feet I Edge of Wetland and`Leaching Facility(If any wetlands exist within 300 feet.of leaching facility) /y Feet Furnished by 6G2 - - _ i 0 ��L► . 6 LOCATION �hAi lr/h�f� SEWAC4E PERMIT UO. IWSTALLER 5 ► &NIE ADDRESS BUILDERS Q &ME ADDRESS DATE PERNAIT ISSUED D ATE COMPLI &KICE ISSUED : - - - /elm Ilk- NO.M...l ........ '' ram. _ FRiz / ................... THE COMMONWEALTH OF MASSACHUSETTS 9 i BOARD F HEA T Appliratiuu -fur 43iiputitt1 Works Towitrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal )-6ystem at: .......................................... on aA e ? or t o ff , yy 1 �' C--------l�.!�--- -'�. .-------•-------------------- 4`'�?�'�2--=.......... ........................... v t O -•-•.........................\:...._.. Address -----------------•-----...------------------------...----- Installer Address Q Type of BuildIn Size Lot...._.. �. �__Sq. feet U Dwelling—No. of Bedrooms---------- p ( ) g Expansion Attic Garbage Grinder pi Other—Type of Building No. of persons..............I------------ Showers ( ) — Cafeteria ( ) Q' Other fixtures d ------------------------------------------------•------------------- W Design Flow.__ ... __ . . gallons per person per day. Total dailyflow...........t�-� ___________________gallons. WSeptic Tank Y Liquid capacity-L_ _gallons Length-_______C..... Width-.-. ._.- Diameter................ Depth...._____.:.... x Disposal Trench—No. .................... Width-___-._ .__,____ otal Length.................... Total leaching area-------------.------sq. ft. ."Depth below inlet Total leaching area.. sq. ft. Seepage Pit No------I------------- Diameter z Other Distribution box ( ) Dosing tank ( ) Vh- / ;X , ' aPercolation Test Results Performed by------- ----------------•-----------•-••--------.....----------------•---• Date------------ --------- ------------ Test Pit No. 1--------------__minutes per inch Depth of "Pest Pit.................... Depth to ground water._-____.._.___.__.__. -- L14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water. _.__..__-__--____---- e ---•-�-•-p••----•---- - _. -a �pDet do of Soil---------- - - cxj -Q--- ---------------- 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed_.. Q ---- ---------- ..................................... -- ................................ Date Application Approved By-------- . � �lf!L -•Y � 6------------- !7 Date Application Disapproved for the following reasons:---•---•--------------- -------------------------------------------------------------------••------............ •--•-----•-••---•-•-----•••------•---------------------------•---------•--•-•-•-•-•---•••-••••--•-••--•-------------•-•••.....•--••••-•--......•-•--------=-------------•••••---•----------.........--- Date PermitNo......................................................... Issued........................................................ Date No..`_...1 1'........ Ftca....l. ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEA TH _. .. _.. OF........... ... .. !......... Applirtttion -for Bhipoiittt Workii Tomitrurtion Vermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .. ------------------------------------------•----------------------- Lo N Own Address U Dwelling ldinof Bedrooms..._.__.. _______________________Ex Expansion Attic SizderLot.Game Grinder feet d Type q. P ( ) g ( A) p, Other',—Type of Building __.. AN-4...:: No. of persons---------------I----------- Showers ( ) — Cafeteria ( ) dr" Other fixtures ------------------------------------------------------ ------------------------------------------------- W Design Flow.:.. _0_ . . _ ___gallons per person per day. Total dailyflow....._._._. .............................gallons. WSeptic Tank—Liquid capacitv.-!_._'.`_-.gallons Length......... .... Width----- .-.....-.. Diameter---------------- Depth.-..-------.---- x Disposal Trench—No_ ____________________ Width.-__--.--._-- __�9ta1 Length------------_------- Total leaching area--------------------sq. ft. Seepage Pit No-------I............ Diameter./ r ____ depth below inlet____ ___ _____ Total leaching area.-._..- ._.-__-_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) D h- G , — X- /S`, 74 . Percolation Test Results Performed bY.......................................................................... Date........................................ a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water-..-_--..--.---.--.----- �14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.........--._--.-----.-. Ix ------•------- r / G _ ------ A� Descnptto of Soil.---- ---- D .. -- 3 '�- - ----------------- --- --5~- ----- -�/�- �' W U .-----------'� tS��t c- - -- -� -c... ----s----- ... r•- �1---------- V 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed;.. ................................................ �i Date Application Approved By---------- -- `--- -"^ ----._.1,�....-- ---------------------- ..... ? 7 ------------- Date Application Disapproved for the following reasons:--••------ ------------•-•------•------•-------•----------------•--•--•---------..-----------..---..._---------- --------------------------•-----•-----------------------------•-•-------------------•----•-------•--------------.-.----------------•---------------------------.----------------------------------•.---- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O. . EALTH .................................... . G.... .... Tertifirttte of 0,11mViiattre T --T.D CERTIF , That the Individual Sewage Disposal System constructed ( or Repaired ( ) by......... .. ••-• --t-d---- - ...................Z............................................... -- I t er at.."". .__4fil�l r..-------`O. ---- = Y ,....� - has been installed in accordance with the provisions of .VI& e XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No1�. ..................... dated...__'`�___Z._`.7. ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS A GUARANTEE ITEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- l ------ - ------------------- -----(-f ------ ...................... THE COMMONWEALTH OF MASSACHIZ S 'b BOARD OF-) HEALTH ) ....._.....OF.............. r:: .....-'' .................... No..--. I.. •••-•-... FEE-/ --------------- i� tt tt ttrk,, L �tr rtion Prrmit Permission i eb anted. '- .._ 4`rl.'........ Yg to Con ct, r Re. tr ) an I iv' ual Sewag sposal stem � � //�� , at No. ciK ! .-- ......... -� 7�J A_ ems/ _-.._.. Street L/ as shown on the application for Disposal Works Construction Per o______________f.. ,eyd___.__7_- ------..7 _........ DATE.-------------•-------•--••--•---------•--._.._................................ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS tp Ct € f A -71 A.—,jnj -1.4- Ell 'k {. 4 t. ____�____.__�� �._.�y��..�.___.� _______.. .___SILL f..LE✓..� _ Ff�T L1f30144 �OQD 15 L OCA 7-/On/ PLAN /26 F&,2ENCE "4} ; C,!�V7'iFY 7-1-IA T TA/6 ExiST- ING FO UNDA 7'/ON I-OC4 7'ip v /s ovzem AS 3NOfW�I gNIJ_T'��e _COA1 1?//T{ o eA N ����,�,� �'j t, "� �" "''�'•" THE c�U/LD/NG SETl3.4C��'f�QUi.�'EMEic/1 y. OF 7 ' C.- 42 Id/� ,per jZ F dC GKe- E E.G• i✓AtP VE YOB 9 t�vr��o�v sr. y.4i2Mo ur�r�o�T MA.