HomeMy WebLinkAbout0030 TALLY HO ROAD - Health 30 TALLY HO RD.,.BARNSTABLE
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TOWN OF BARNSTABLE
LOCATION 2b Z2% SEWAGE #
! VILLAGE 13w s t
r1I� ,,L;�= ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. /YID`nC 4 a c- Se p
SEPTIC TANK CAPACITY /Ds CI
LEACHING FACILITY: (type) f v ;</,L /t„r1���1 S(size) _- f�3--2
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE: C�
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
i Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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TOWN OF BARNSTABLE
�L��9-nON Z2V ,0V[1 SEWAGE #
06? _� I
VILLAGE 22/ir 5:44 P ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY O!
LEACHING FAClLrrY: (type) IAI ��`���®�.S(size)
NO.OF BEDROOMS
BUILDER OR 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
within 300 feet of leaching facility) Feet
Furnished by
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132RL
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No. s Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
- Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pplication for Miowaf 6 gtem Cow5truction Permit
Application for a Permit to Construct( )/Repair( )Upgrade )Abandon( ) O Complete System 1pndividual Components
Location Address or Lot No. p Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
5 l 01-► S i
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 gallons per day. Calculated daily flow I gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank C: C_--ry LO'Do Type of S.A.S. I/t CG,, ,kn ��--
Description of Soil
F44G
Nature of Repairs or Alterations(Answer when applicable) �` 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 '
Signe X Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. . Date Issued
----- - - --.�— — -- ----- ---------------
�•' mar ---;•�t -~
��. No.
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
• � Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
01ppYication for �Digool 6 ,stem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade )Abandon( ) El Complete System Cl-hidividual Components
Location Address or Lot No. a Ivi O Owner's Name,Address and Tel.No.
G pr►`ZttiS�"C�t.�.�
Assessor's Map/Parcel I U
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
C r t
° Type of Building: - F
Dwelling No.of'Bedrooms .,* � `�` Lot Size sq. ft. Garbage Grinder( )
Other ' Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtur s I
Design Flow °� v gallons per day. Calculated daily flow gallons.
Plan Date `s �`- Number of sheets Revision Date
Title '1%, ` \ '.
t'Size of Septic Tank `�- ` �=� �c ��� Type of S.A.S. N` C`�
Description of Soil 51n
( �7_DJF
Nature of Repairs or Alterations(Answev when applicable) xu-'< 1 \ &Y fiv72 F '�
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 beet' ed"by fhis Bo th
Signe Date, / -,
i
Application Approved by " / Date U
Application Disapproved for the following reasons
Permit No. L' 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(�
Abandoned( )by its-C.(APF: SL' 4.G
' at v —TAC� ✓�Q0JSt� h01
constructed in accordance
*,
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated /
Installer r Designer /A n ,
The issuance of this permit s'h 1 no 11e.construed as a guarantee that the system willfunction/ esi ned.
Date ��� Inspector
� ------------------------
No Fee
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THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
t-
�Giopogal *potem Con0truction Permit
Permission is hereby granted to Construct( )Wcpair( )U rade( Abandon( )
System located at 34 -T �-x �`tU V A
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.
x �i Provided: n tru20
cf s b "o eted within three ears of the date o this er ut. �-
;, Pro ded:Cos m
r " Date: r Approved by( ` l
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. 1
- - J
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I � ✓y hereby certify that the applica
tion for disposal works
construction permit signed by me dated —� � , concerning the
property located at meets all of the
following criteria:
l� This failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
(4/ The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
.4 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
(y 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 method when
applicable]
(1'• 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:
A) Top of Ground Surface Elevation(using GIS information)
_ Oro r
B) G.W.Elevation ;6' +the MAX.High G.W.Adjustment —
DIFFERENCE BETWEEN A and B
C •
SIGNED : DATE`.
[Please Sketch propos p1a system 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:cert
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4--CC, AT 10N SEWAGEPERMIT N0.
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VILLAGE
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INSTALLER'S NAME - ADDRESS
B ULDE R OR OWNER 3
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED 13 --��
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....... ...... ... ..................OF.................................................... - ........... ........
App iratiun -fur Biipuiittl Workii Tunitrurttun Punfit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
............ ......../U....................................... .................................................................................................
—� Location-Address or Lot
----------------------------------------- --- ---------
/�J��J/� ( �caner j /p_ Address
Installer Address �y" ` j 1—
U Type of Building Size Lot_.-..______'___r, Sq. feet
Dwelling—No. of Bedrooms__.:_________________________________Expansion Attic ( ) Garbage Grinder (Ud
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures -------------------------------------------------------
W Design Flow-------2__0_j?........................gallons per person per day. Total da)iy flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacitv,0.: e5allons Length-----6___.... Width-4... ...... Diameter----..---------- Depth-----.-_---_----
x Disposal Trench—No. ____________________ Width_____________-_.___- Total Length--_._____- -. Total leaching area--------------------sq. ft.
3 Seepage Pit No...... -- Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution box ( • ) Dosing tank
Percolation Test Results Performed by r���� 1�/� �
71�
a � -------------- `�1 ------------- Date--------
,_l Test Pit No. I................minutes per inch Depth of "lest Pit-------------------- Depth to ground water...____.-.-___._---.---.
fX4 Test Pit No. 2......_.........minutes per inch Depth of Test Pit.--____-__.______ - Depth to ground water...................
O Description of Soil-- - - -------
^^'� ------- ----- ---------------------
x '--------•- .--•-- -. .... ............................. --------------------------------------
U ................ r '-P �� -
-------•----- - --- ----------Pas-r- -1 eL.,;-----•---- .__--------------------------------- ------•-•----•----------------------------•-•---••----------------------------------
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 \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee -ss d byte boar4 of health.
Si ned- --------- _--� /v37-�
-----•-•-••••-----------
Date
Application Approved By--------------i------------------•••-•------•---•--•----------------------------
Date
Application Disapproved for the following reasons:............•--•--------------------•--•-----•-•-------•-.....--•--------------•-•--•-------••----....••••--:---
-----------------•-•-•-•---•-------••-•---•--.._-._._.--------•-•--•---------•--•--------•-•--•--------•-------•--•-----•--•----.._...--•-••----•-•------•-----•---------•••----------..._•------•--••--
_. // Date
PermitNo-------4/f--------------•----------------••---•- Issued........................... ............................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_. _..__...-.....OF....`................................ ...................................................
y A p irtttion -for Diq aiial Morks C onstrurtion Vrrmit
AppirLtion is hereby'made for a Permit to Construct ( ) or Repair ( an Individual Sewage "Dlsposal
Y :
System at L, ,� J .
Location-'Address or Lot
----•- / ...................................................... --- o ---- --------------------------
W caner / Address
Installer AddressL
d Type of Building Size Lot.... -------------. _ •_Sq. feet
U
Dwelling—No. of Bedrooms_____ ___________________________________"Expansion Attic ( ) Garbage Grinder
Other—Type e of Building \o. of persons
� YP g ----------------•----"------ =T P -- ------ Showers ( ) - Cafeteria ( )
d. Other fixtures ------------------------------------------------------ --------------------------------------------------------------
W Design Flow_......2__(1 p------------------------gallons per person per day. Total dai y flow------------------------------------------"-gallons.
9 Septic Tank—Liquid capacity&O�eallons 'Length_.__-�,o_______ Width___ .._-.-.._. Liameter_______ ______ Depth----------------
Disposal Trench— o_ __________________ Width-------------------- Total Length_______-________._ - Total leaching 1re1 :.____sq. ft.
Seepage Pit No._____ Diameter_________________ Depth below inlet____________.._____ Total leachiii" trea.:_.. _ "_'___sc it.
------- -- P g 1.
Z Other Distribution box (•• ) Dosing tan ) "-
~' Percolation Test Results Performed b //�1�----"-t'�-A_--"--------&DOW-1-I-•--1� Date------�I������i.
a Y - --
,..a Test Pit No. 1----------------minutes per inch Depth of 'lest Pit...----------------- Depth to ground water------------------------
44 Test Pit No. 2.....___________minutes per inch Depth of Test Pit-------------------- Depth to ground
W , it y
w_ate_r____-_____-_________________________-___-_-__.
_________
O Description of Soil j !
f -----
__
-= :
rA4--1----------------------------------- ---------- -------------------------------------- ----------------- ---------------
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 Cow—The undersigned further agrees not to place the system in
operation until a Certificate of Comp.hance has bee AV, d/iy e boaLd of health.
Slgned -------------------
Date
ApplicationApproved ----------- -- ----------•---------•----•--------------------------------------------
Date
Application Disapproved for the following reasons_.........................._-------------------------------------------------------------------------------------
y
Date
PermitNo........ 1d ..........._ ---••- Issued........................... ............................
Date
THE`COMMONWEALTH ,OF MASSACHUSETTS
BOARD OF HEALTH
............OF.......�i, ,�1141.T.. «-
• ' �rrtif irtt�� �f•f�nm�littnrp
THIS IS TO CERTIFY, That the Individual Sewage
Disposal System constructed ( -or Repaired ( )
by....-.. lA:----------- l�eC4.STr�4±C..1--•-- =-----------------------------------•----"------------._...---------------•--------•-------
Installer y�
at-...--•--...•-••-•----•-L-4 .......f l '--•---•--� a. - �u G ! E
has been installed in accordance with the provisions of 'article XI of The State Sanitary Code as described in the
application for Disposal Woks Construction Permit Flo ? ___________________ dated-.-__"---&.-.�,; ---
-------
__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
inspector
pector ------ ......................................DATE_
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THE COMMONWEALTH Of, ASSACHUSETTS
BOARD OF `HLALTH
No. -Jd..........
FEE........................
�i��n��tt� l�rk� C��tt.��r�trti�at rrtttt#
Permission is hereby granted------------- __ r_*_.............
to Construct O or Repair ( ) all Individual Sewage Disposal System
at No........... -ar.........71-• .......7 ---'-&4----•------lep.4o 9'C-----------------•t'7: ..............................
Street
as shown on the application for� sposal. WorG"Construction Permit No....Z1,1 ------ Dated___-__- --
77 Board of Health
DATE...... -
FORM 1255 HOBBS & WARREN. INC..-PUBLISHERS
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TOWN OF BARNSTABLE -, UNDERGROUND FUEL AND CHEMICAL S;rORAGE REGISTRATION
) �! ', G OWNER AND INSTALLER`INFORMATION
ADDRESS: ° ih. f �tcs "" ,- __rMAPO-Nil PARCEL NO. °
TO I
OWNER NAME: y VILLAGE: 5.`:
I NSTALLAT I ON DATE: 7 S BY:
ADDRESS: E=r _ CERT. N
TANK SINFORMATION
i
LOCATION OF TANK:
r CAPACITY -�`�' D 'E"TYPE . AGE FUEL/CHEMICAL g 0
i
TESTING CERTIFICATION C /I PASS i C ] FAIL DATE 1
LEAK DETECTION C7 CHECK IF N/A TYRE/BRAND
ZONE OF CONTRIBUTION C I YES C 7 NO DATE TO BE 'REMOVEDf�0
07
' FIRE DEPT. PERMIT ISSUED C ] YES C ]` NO DATE t
w CONSERVATION C7 CHEC IF N/A DATE .
BOARD OF HEALTH TAG NO. ]C ]C _ ]C ] DATE
PLEASE 'PROVIDE A.,SKETCH SHOWING THE .TANK. LOCATION ON. THE BACK .OF THIS CARD
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BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT
SUPERIOR COURT HOUSE
BARNSTABLE, MASSA6fUSETTS 02630
yA5 PHONE- 362-2511
EXT. 330
LAB 337
CLINIC 340
NAME John Harmon DATE TESTED 8/10/88
TANK LOCATION 30 Tally Ho Road Barnstable, MA
TANK AGE 10 TAG # 456 # CAPACITY 550
Thank you very much for participating in our program to test
underground storage tanks (UST) by soil gas analysis. The free
test was offered under a grant the Barnstable County Health &
Environmental Department received from the Environmental
Protection Agency.
Becaus (th�useof soil vapor monitoring for UST system release
t - de,tectio _ ver-y-- ecen-t and only limited information -and- - -- -
experience exists with using vapor sensors in this manner, we can
not guarantee that your tank has not leaked. However, our tests
did not indicate any problem. You should also realize that a
"good" result from our test is no indication of how long the tank
will remain sound. -If you ever decide to remove your tank , it
would help our work if you notified us so we could take a look at
it after excavation.
This method has been given an interim approval for 1988 by your
Board of Health. Depending on results of research this year,
complete approval may be given, otherwise you may be required to
pressure test your tank to keep it in service after 1988. A copy
of this letter has been sent to your Board of, Health and the
records reflect that your tank test indicated no problem.
If you have any questions, please contact Charlotte St.iefel at
362-2511 extension 334.
NOTE: To prevent possible contamination of your monitoring well
with oil or other substances , we highly recommend
1•o c k i n•g—o r cove-r--i n•g—t-h.e w
*Tag number from Health Department records. Tag was not attached to the
fill pipe as required. :, .,.