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HomeMy WebLinkAbout0038 SLATE LANE - Health t 38 SLATE LANE BARNSTABLE j A :315 079 ro d �a a ',, ;;� _ 7� :_ .. ', n ° ,.i, � � a �_ •'. 'r r : b a :w , r Y ,r , r t. .a +. ,: a 'a' r' '� z$. "fir; k ��-� ^�• ,^r <,K�" �, � t+ '�, .�, i ' a � v '¢ ° A. � .¢� a :yi',. „ � y: L -,,,.,-:b .�.� � �i - t 4y . .1,. �� t ./ _ •r� , ' e. r �Yn .Y ..,4. ,:,-C _.' 1 ,,. ' i y ty- :'A ""1 i S. Y -r••• '• ''�.- '' r '� ,l�` " ):. s a _i ,,. 'a a. 3 r Yl. r - .. '`•r. A G '4 # '_ n .. P.'Y if 'X 'c. �•{ , it ,�:.�. ;:, w �.�,. .. 'c,. „ ,. .:;�. 'ILI Io e' � u v r x �': .r'.'!�,:o ...Cr, .:�.. v A, .: :a�"- S , ,.... ,.,, r, .,.- - •;,.. $ t - �it9 .. r?Dvy �iiYi3• F ] j i �,,.. rd� �€,� ✓✓ rl,:. 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Y ':, n•",.1. b J.' 4� Er' !� !�1: rm. ,.,; ',.� y.�_ ._. t��.Y ,i {f, -Fq �-'J �i, .. : rt�{+::1 �i} ..�' M ^>7 of, ry Ya '1 i. of ar 'At 4 t" ,.a �, . .. y.TY `,=,.ir r. , •'r 5i '' t `y:. + i.f,a f '� i.�Ir y � , G. ,a'art r: 4 , r � .. pr w • y[ �, r . .., .. ay ,. 4 } _ - x"n. � r -Y i y. � i ��a�' ~..,� t t Y ,d, ` z 'c : , r Y S TOWN 11OF BARNSTABLE �Q t LOCATION¢ s'L ,d SEWAGE # � v VILLAGE a n,a C t# ASSESSOR'S MAP&LOTI�16fj-Q�J INSTALLER'S NAME&PHONE NO. M f b'I/�S e ram /C y SEPTIC TANK CAPACITY �/a a a : LEACHING FACILITY:J / size Pe) ( ) NO.OF BEDROOMS 0 BUILDER OR OWNE CIJ PERMITDATE: 6 3COMPLIANCE DATE: Separation Distance Between the: I 1 ) 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) r Feet Edge of Wetland and Leaching Facility(If any wetlands exist, within 300 feet of leaching facility) Feet Furnished by r . ` r 13 A� 63 f� A No. —J 4 Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migogal *pgtem Con0ruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System individual Components Location Address or Lot No.349 5 AN \ok K�' Owner's Name,Address and Tel.No. iPr2t.7S�Ft.�.Q, d Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. gy Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3(D gallons per day. Calculated daily flow �C( gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank PiiAkok) Type of S.A.S. a L i T - Description of Soil rSla�n.� Nature of Repairs or Alterations(Answer when applicable) � �_ "j'_ ` d eeez ST! L acy — S4� -,I,— 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 ha o ea Si7by Date r� Application Approved Date �- 2LS%4 Application Disapproved for e fol owing reasons Permit No. ?S g? Date Issued TOWN OF BARNSTABLE LOCATION VILLAGE SEWAGE �� n �� ASSESSOR'S MAP & LO r� INSTALLER'S NAME&PHONE NO. Mi ) SEPTIC TANK CAPACITY p v LEACHING FACILITY: pe) (size) .. NO.OF BEDROOMS BUILDER OR OWNED PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: I ) Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet �+ i3 �4 I. Ll 131 Y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZlppYication for MgozAl *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System iklndividual Components Location Address or Lot No,.3,q S AN�E Owner's Name,Address and Tel.No. IA2N`a` �, o' Assessor's Map/Parcel Installer's Name,Address,and Tel.No.l Designer's Name,Address and Tel.No. !�—GcA ae IA L Type of Building: ., Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures { Design Flow 3 3 C) gallons per day. Calculated daily flow ��� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank � s-T t Occ �o Type of S.A.S. c-'%T �--- v ; Description of Soil S la�o 's.- Nature'of Repairs or Alterations(Answer when applicable) �`vt-`T W\� o t=� ` S k -c�' s ►�1 /�Ca,(.�' t �1 �C'Zt �G�LT dGi C�:1Q S c { t 5 cll.� Sk'o ?C- ` 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 ha o ea Signed Date to—r7 J-� Application Approved by Date 4- � Application Disapproved for e fol owing reasons �X Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance , � THIS IS TO CERTIFY,that the On-site l age Disposal System Constructed( )`Repaired( Upgraded(� Abandoned( )by , —C a at 3L C (J has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 4 Installer J I Designer P� The issuance of this permit shall�/ot be construed as a guarantee that the s"Y"I ill function as desi ed. 1 Date G1�l "t Inspector '��'111 .-c�1 10 JO %� 0 / No. / / - ,, Fee THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Digogal 6pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(✓)Abandon( ) System located at -NS 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: L) Approved by 'fl p�a.5. csr-i i.. 1 . � M 1 li33r-n- > >w.�i�.�cN 2.405 BLS./DAY 83,Z Suf35o/� • � Gc.�M,�ACi � � ,� -. r� pi p U0A-) 7t= tAY - �>.:: �' r Lid l`J �• 760 rco C, i � • r. 116199 NOTICE: This Form Is To Be Used For the Re Septic Systems Only, pa><r Of Failed _ 9 1.e, CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT yI'I'IOU DESIGNED PLANS hereby certify that the application for disposal works . x construction permit signed by metdated concerning the Property located at meets all of the' following criteria: � JS VA'0fV-,-5 VThefailed � system connected to a r esidential dwelling only. There are no commercial or business uses associated with the dwelling. /ZThesoil.is classified as CLASS I and the percolation rate.is less than or equal to 5 minutes per inch. . here are no wetlands within_ 100 feet of the proposed septic system ry • Y P � ere are no private wells within 150 feet of the proposed septic system , �'�ere is no increase in flow and/or change in use proposed �. •�!here are no variances requested or needed. ' .1 • The bottom of the proposed leaching facility will not be located than five'feet ~ an five feet above the ` F The w 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 groundwater table elevation, fourteen(14) feet above the maximum adjusted Please complete the following. x „ A) .Top of Ground Surface Elevation(u sing GIS information) B) G.W.Elevation c�a+the MAX. High G.W.Adjustment. DIFFERENCE BETWEEN'A and B SIGNED DATE: (Sketch.proposed plan of system on back]. q:health folder:c ert t _ s �� ,� -� ' iI V l ' i 317 LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAIVE A ADDRESS B U I L D E R 0R OWN ER '5 DATE PIRRIIT ISSUED DATE COMPLIANCE ISSUED q" zs _ p5 i'vrrovwo1 ve IOOo a�►tlo� i., ��� Q�s 30?C. � �V11C�i Nee2 wendG- 1 C NJ a"k T�c�cJS Board of Health ? Town of Barnstable No...._..-•---- P.O. Box 534 FEz.... ................ Hyannis, MgMdWft"fW16Mj'H OF MASSACHUSETTS BOAR® OF HEALTH ow143..............OF...........................% 57 ,8L ........................ Apli iratinn for Uhipus al Warks Tonstrnrtinn Vamit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at ................_.�L ........�. bo �......------................ 6C7% __.......7 '_. r r? a Loc ddress — t No .... ..�.1 .. ! �. ._._.�I� .R..t !....... .. ... V Ir Owner Addr I ------------ Installer Address Type of Building Size Lot.... ®0-_3!?�O..Sq. feet U Dwelling—No. of Bedrooms...........112...........................Expansion Attic ( ) Garbage Grinder ( ) a p,, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fix�res ---------------------------------- W Design Flow................. ................... per persont;r day. Total dai�y�flow_:._..._. Q__..._..._ _.......__..gallons. WSeptic Tank—Liquid capacity.&O..gallons Length... ........... Width...... ._._-___ Diameter---------------- Depth..... x Disposal Trench—No. .................... Width.................... Total Length...............____ Total leaching area________..-.. sq. ft. Seepage Pit No-------j............ Diameter..... ....... Depth below inlet.......6.......... Total leaching area�311 sgr4tG.p�. Z Other Distribution box (k) Dosin tankr f ) Percolation Test Results Performed by__. c --v_�.____ ��:_tt /A..... Date_.....� ..r� � Test Pit No. 1._�.?..__.minutes per inch Depth of Test Pit__.___i7 ..1�_ Depth to ground water................`,...__. (s, Test Pit No. 2..... 2-...minutes per inch Depth of Test Pit.................... Depth to ground water.__ _ �2 Descriptionof 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the syst in in operation until a Certificate of Compliance has been is d by e bo f health. Signed--... .. .- --- .... .. ... ---' ........... .....7-........ ate Ap lication Approved By / _ ........ Date A plication Disapproved for he owing reasons: ............................................. = --` ----------------......-----------••-•----------•--------------•-•------•-----•-------••-•------------------...---•--- ......------.... Date PermitNo.......................................................... Issued....................................................... Date i a � No......................... Fps........................... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.C�r�Jti�...... .....OF................4�-Z. k-isri�l/v/:-' ........... Appliration for Disposal Works Tonstrnr#iun Prrmit Application is hereby made for a Permit to Construct (, ) or Repair ( ) an Individual Sewage Disposal System at Location.Address or Lot No. Owner Address W Installer Address Type of Building Size Lot..... .%._.%Zn..Sq. feet �., Dwelling—No. of Bedrooms..........S.............................Expansion Attic ( ) Garbage Grinder ( ) 'PLI4 Other—Type of Building No. of Tersons............................ Showers — Cafeteria aI Other fixtures ---------------------------------- d es ----•--------------.------------------•••---------------------..---•-�-----------------.......--------•--------•. W Design Flow.................. ....................gallons per person per day. Total daily flow._._......:_M..._-_---.----_-_--....gallons. WSeptic Tank—Liquid capacityItfK�L_gallons Length................ Width.....q_11.... Diameter---------------- Depth.... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.:...w.......... Depth below inlet...... ........ Total leaching area. _.�-..sgrft:C P Z Other Distribution box O Dosing tank ( ) Percolation Test Results Performed by.....M_`� _ ......! . ��`:........i __:....... Date...... ...........3........ a a Test Pit No. LZ.2 ..___minutes per inch Depth of Test Pit.... ` `"f Depth to ground water_____._n-:!... 44 Test Pit No. _..minutes per inch Depth of Test Pit......`/``..... Depth to ground water..,.. .................. .................................... •----•--.......---•--------•--••-•---------.....----•-----•-............................................................ DDescription of Soil ...........f....... ..........•--•------------------------------------------------------------------------------------------.....•-•--- 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 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.. Signed -•--- --- -•--- -- ..........................----- ((��,, Date PPlication Approved B 1/ ` -` PP y......--- .. -•---- --------•--------------------••----= ..-----•.. Date `Application Disapproved for the ollowing reasons:------------------------------------------------------------------------------------------ ------------------- ...............................---..........................-----------•---------------•------------....-------•------•-•--------••--------------•----------------------------------------------.....---- Date Permit.No................................................... -. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS t � BOARD OF HEALTH j ..........................................OF..................................................................................... (9rdifiratr n$ Tumplianrr stem � THIS IS TO, CERTIFY, That the Individual Sewage Disposal S- constructed or Repaired g P �' ( ) P ( ) i 'T� Installer { 97 at........................ .............. -- ---- `----. -./-..--••---- ------------ ------------ has been installed in accordance with the provisions of TI LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No— _-v- ----- dated................................................ ? !THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE ' SYSTEM WILL FUNCTION SATISFACTORY. a DATt-------•--.-•---�y -_-.-. Inspector........ _ ` �S ...- . -- 175E �'F p-f THE COMMONWEALTH OF MASSAC USETTSDES/(,Wih c r_oj vA E F_k .S70tjic'I ��.n/y Pi BOARD OF HEALTH MOST cf R.�%,pj ZvsQ_rC wt A.j%.D ... � � S.C�IL. GJNVi"T,oa.�s, j. ..........................................QF........ .......... .......:................. --�GX No FE ........ Disposal Works Qn it rrmit Permission is hereby granted.---------_ ._.......... 1 .a> n - �� i2......._.... to Construct ( or-Repair ( ),an Individual Sewage Disposal System = ,r . Street J 4 y,... as,shown on the application for Disposal Works Construction Permit A5..'r.'`�$.__..__ Dated.........7 Z'19- �:......... DATE. ;7 .....;1.4..... _. .......................... Board of Health -._. ',+i FORM 125 A, M. SULKIN, INC., BOSTON - 7-op 00 84 i —� I— - ----------- PT 80 60. o — - 70 f —.t ( A, i' E kiL) r4LL- i4PPL /C r3�� - - _—_.--- eXrs �rn roUncl r'`orof� le _ a COVEpS T-0 —o — o— v—o — ror-o1c, t�r0u 7 Proicr le ._._—.- F L 0 i ti./ -T EQLJf=3L. 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