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HomeMy WebLinkAbout0030 TALLY HO ROAD - Health 30 TALLY HO RD.,.BARNSTABLE A = 316 085 a e - -- _ — ------- - ............ 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 i • ! 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 • �r •i aIlL 132RL ' A 3 /33 . i.j 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 V t �! 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 ki �� r ` 4D f 4--CC, AT 10N SEWAGEPERMIT N0. Na rm �;� -p � 49 sl l ' / VILLAGE rc�i 7 s ��3 6 �. INSTALLER'S NAME - ADDRESS B ULDE R OR OWNER 3 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 13 --�� Gr Av , i I � 3 �b 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_ r Ia ;x4 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. 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I Y - A4 Itk S' J i -hil '�1 FIh�P EE3y Cl�sT/FY -7*"M7' .7%4FA .:®v�L:a%V6► '4Y ov 7W A 44 7101"•7��siQJS/• t P: a y� ,�li"'}r' '� . �T F�' � f(.��h tt h.�1,a •1. �;�#}�f�,�G'ot✓5T�'G��.T'Et�. ,`, s w'.'�.�� �k; �� ;�Sr N4�a (G� a , .�,+ '•�`�3t�. ff, J, AW7ME � 9p, > �Eat/G/A/AP,&e'3 n r k a, '- - 1 ��wt.+�+ f i d{ a• sT',L Cel��S /t/fOC/TN�MgSS F A�A.7^E� ,. °:�. .Y ,x'.:rf ...._ , .. .-y. _ i � '.9.;. v'�;«a ,3 k?i-,.��r ier .'. s�S1e s��51 i., �� �•... t `..,. 7.;Ji♦a c-.r ♦.. •+ [r ,. .._....,r • - a ` - :a�'ie.-'i::�'.rs..zw..--sr.-- 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 E �-��.� �'"1 �57n� / r� � % f UNa��� "`�N\c ok 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. :, .,.