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HomeMy WebLinkAbout0025 ALBERTI WAY - Health r248-288 25 AlbertiWay Centerville No. 42101/3 ORA clo�t SQWK :o®a CSC � � 10%i } O © p p w ..,�,. ,.,,... -._._- .:.e.,.,.,ti•..:..L:::..�„��...:-y.,.�..:...:..,s...::...�.,....u� ,......:.................nu :.s:�....W�.._...:,,....,,.cu�<i,�;.:.a...a..:.w,..,,..:ew.atw�d.;ur�m..- .�s.�._,sue - -.^ _ .,._. _.. .,.1 —._a .__.._._..__._ Fff :� (� �� i y .� � :� •� .� .� i .; ,� ,, ,, . :- 7. t GY � 36 LOCATION TOWN OF BARNSTABLE - - VILLAGE �' ,�, �,� SEWAGE # - INSTALLER'S NAME&PHONE NO ASSESSOR'S MAP& LOT I SEPTIC TANK CAPACITY LEACHING FACILITY: (type) t NO. OF BEDROOMS C" (size) BUILDER OR OWNER 4 ��L PERMTTDATE: cy ` a �%� COMPLIANCE D Separation Distance Between the: DATE: Mum Adjusted Groundwater Table and Bottom of Leaclun F Private Water Supply Well and Leachingg Facility on site or within 200 feet of leachin Facility (If any wells-exist Feet Edge of Weiland and Leaching Facileach g facility)- within 300 feet of leaching facility) (�any wetlands exist Feet Furnished by ------------------------------------ --------------------------------- Feet No. /0 _S !J 1 } Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migool *potent Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) O Complete System ❑Individual Components Location Address or Lot No.aS PA Vk-)R Owner's Name,Address and Tel.No. Assessor's Map/Parcel C�eox-evul e 0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow -3(kE gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15rsY 5-k Ps— M)o Type of S.A.S. Description of Soil d` teL ckn: � Nature of Repairs or Alterations(Answer when applicable) 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 Fm . -,ntal Code a _ not to place the system in operation until a Certifi- cate of Compliance has been ' y this ealth. Si ed Date Application Approved by y —1562C Date Application Disapproved for the follo ing reasons Permit No. G Date Issued No. /0 — �^!-3 a L 7 Fee -7 V v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0[pprtcatioii for Miopooar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(,),Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ;6 PA � � 11�{``p `�— Owner's Name,Address and Tel.No. Assessor's Map/Parcel -eo - B _ B L -- \ E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other ,,1 Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures u nn Design Flow C �3 V gallons per day. Calculated daily flow �3u\ci gallons. Plan Date ` Number of sheets Revision Date - Title l Size of Septic Tank t<< 5 o lC 0 a Type of S.A.S. V `5- Cf,12C, Description of Soil S1A Nature of Repairs or Alterations(Answer when applicable) V`-vS� ��\ v'^ �<� ` 5-A S\<(t� 4sn . r` r✓ tics 1�-, 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 ironmental Code a d not to place the system in operation until a Certifi- cate of Compliance has been site by this ealth. Signe'ed Date Application Approved by Date Application Disapproved for the follo ing reasons Y Permit No. Date Issued 5? ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance J THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(' ) Abandoned( )by 1 S l-= _, at Ice v­\k- Chas been constructed in accordance with the provisions of Title 5 and the for Disposal System ConstructioAPermit No. dated Installer Designer The issuance of this permit shall not beconstrued as a guarantee that the system will function as designed. Date - 1 LI / Inspector --Q—fT--_G---------------------------------- No. /O / 7 Fees THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migaal *p!5tem Construction Permit Permission is hereby granted to Construct )Rep '\(_ ) p rade(7"),Abandon( ) System located at ' Y v I U-Ija 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 pe t. Date: 7 ~��-�� Approved by ,.Z' F. Xc, 9_1= 10/9/97 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 ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at a meets all of the f01,16wing criteria: ;V� • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system v There is no increase in flow and/or change in use proposed There are no variances requested or needed. '�• If the 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: 1 r A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) y ' SIGNED : DATE: —� LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER licensed installer osesses a certified lot Ian [Attach a sketch plan of the proposed system. Also if the It nse ns p p plan, this plan should be submitted]. - q:health folder:cert 1 lZ� t N �- � � . �a �, �, TOWN OF BARNSTABLE LGCATION v�►- .' ;- SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C,m LEACHING,FACILITY: (type) t Ctt L� (size) NO.OF BEDROOMS BUILDER OR OWNER r Y V, � I PERMITDATE: Lo-zj� 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 D i T f� 3b • NoJig ._...--- ' Fu .......... w TKeP,,OMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEA T p,0 � � '.....O F..... ......... ... ...°'` nr i anal s Tonotrurtivia r,�ppltrtttt�an f � rk � rnttt Application is hereby made for a Permit to Construct ()<) or Repair ( ) an Individual Sewage Disposal System at j• ..sZ ./--Z' fmaf!4.TL....Gl!91!...........i,��..................... ........6_19................................................................................. .--- Location-Ad ress or t No. ,A n ............................ - ,e�.(.1...!"�v -sr --•--•.... 'LR v .._......... Address Installer Address ` Type of Building Size Lot.1.__,3- Zt A.......Sq. feet U Dwelling—No. of Bedrooms......�3............:. Expansion Attic Garbage Grinder�i) - .............. No. of ersons._.._......_.._.__.......... Showers — Cafeteria Other—Type of Building _.- .. .._ p ( ) ( ) dOther fixtures .-----_-----------•-•--••------••---------•-•------............................................................................................... W Design Flow.................... ............gallons per person per day. Total daily flow_._..._......X ...............gallons. WSeptic Tank—Liquid capacity/,,.0 gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Widt4.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......I----------- Diameter---�j. .._..... Depth below inlet.................... Total leaching area.A .,,.7E'Dsq. ft. Z Other Distribution box (K) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ( Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ --••--------- ---------------------------------------------•---•--------- ••---- ------------------------ •---- ••-•----- •------- .••----------------------- 0 Description of Soil........................ ...........................•-•-..............................................................................................................--•---...----•----------•-•------------------------------------------.._...---•-----•••••.................•... x W .........................................................----••••------•---•--------•--•-•-•••-•--•••-•••--•---••--•-----•-•-•••---•-•-•----••---••••...•••••-••-•--•-••••--......•-••••.......--•--•••. UNature 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 iITLEE 5 of the State Sanitary Code The undersigned further agrees not to place the system in operatioA u i Certificate of C iance has been issued by the board of hea h. / Signed..�...�.�--------- -- --------------•-- .............. / 04 Ap i prov By---••• "_--- ,h � ate I isa roved for the following reasons----------------------------•----••----------------------------••------------•-------------....-••-•----•-•--.. --------------------•-------••-•---•-----------------------..............--------•---....------..........-•--••••----••.......-----•--••••-•••••......----•••-•-----•-••......----•••-•---•••-•......... �- Date PermitNo....- ..6-- -�---�-----•-------- Issued.•.•..............••------•---•-•---------------------- Date -------- No.. ............ Fss... ...... ...... THE COMMONWEALTH OF MASSACHUSETTS C/ BOARD OF HEALTH/ .. �.�L........OF......,��� .0................... Appliration for Dispotittl Works Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / 2 5S A , c 1) , f ���/ � A ................__.....-•---•--............------------•----....-------------•----•--•--------.. ...----------•-----•-•---.....----•-----••---••--•••--.....-•------••-----.....................--- , �'Location-Address or ot No. 6 X/ - ,'11•i ! -, ' - X-� i 1 Z?/ d.r , ---•---•---------- ..... -------------------------------•------------..............------........................•... a Address ... l ..`.".`_..... ........ ............... ..•-•----•--------------................-•---••---......--•-•---................................_. Installer Address dType of Building Size Lot.!._''... .......Sq. feet Dwelling—No. of Bedrooms....._.�.................................Expansion Attic (J 'r) Garbage Grinder'-(/-') Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures_ .................................. Design Flow..................... ............gallons per person per day. Total daily flow__._.........:........`............._.._..gallons. WSeptic Tank—Liquid capacity:?-.:._Ogallons Length................ Width................ Diameter________-____- Depth................ x Disposal Trench—No. .................... Width....._._....._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter---k`_-!2......... Depth below inlet.................... Total leaching area.F....Z...-. ''sq. ft. Z Other Distribution box (a() Dosing tank ( ) 1.4 Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit............ .._.---- Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•--....••------------•--•••-•.................•---•----..........----.......------._.....----•-•--•-------••--•----...-••-----•--...••.........---•-••---- 0 Description of Soil.........................................................-•-----•-•----•-----••----- •-------------...------------.....-•---•-----•-----------•--......_••--..._...... x U ----•---••--•••-••-•---••---•---•-•-...--•----------•----------•-----------•--•--•--------------•-•--•----•------•-----•---------------•-•--•--•------------._......------.....-=••--------------•----- W x •-•--•-------------------------•------•••-----•-•------••••---------•----•----•---•---•....-----•-------------•-•---••-----••-•---••-----------••-•----------------------•------•---•-------------•----. 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 C fiance has been issued by the board of health. o Duat �/ / Ap . 1 prov BY --•:::.....:....4 ,.%/_ :.. �/ - ............... r � ate i' isa roved for the following reasons:.............................................................................................................. ................•--------.---•--............---------•-•-•--••......-•--•--•-----•---------•------••-•---'---...................-•--•-----••-•---••-----•-------•----•-----••-------- .....---•--. Date Permit No..... ..(-2-- ......•----- --------_•-_ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ........................'"" ..OF..........f.......................... ...........?...:"..•...................... Trdif rate of TOntpliatta THI'ITS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (A ) or Repaired ( ) by ---------- I-------•------- ----------------------=- ) j f Installer ---4 -- �l L. - --- - t 7 ��/ at-• " - --------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The-State Sanitary Code s descri.`ed in-the application for Disposal Works Construction Permit No..... -- --^ ..--__.,.... dated_._._ ._ _ _ ._ _ _. ______.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _TA G _ DATE.......... U ........................................... Inspector........ ,gyp THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / OF........ .� /fG Nod (... `l. FEE' ) Disposal orkii TOntnution Prrm Perto Construct on is or Repair granted an -- `----= =-----------._-------- ----------_---- ....................................................... hereby ( p • ( ) Individual Sewage Disposal System ` r Street / d as shown on the application for Disposal Works Construction Permit No..�_�2_. _-i D _ated.._ f. _..-* .7_�. .- (� .........r.. r Board of Health DATE---------............ ::....... ' d . ....._. ................. FORM 1255 -A. M. SULKIN, INC., BOSTON AGESSOR'S 023 ° PARCEL l.01c T10 � SEWAGE PERMIT ; No. VILLAGE I � � -IN STALLER'S NA E a DDRESS ".8 U'll-D E R OWNER , DATE PERM4.IT ISSUED_ Z_�5- ',_,-D-Af E. C0MPl1ANCE BrSSUED -�=�� r ., .._ _ � k w s �. t ,: •�.� � � �. �.: .� i'- ,r i + ��` '�` + � - t f \ �' � , I .4 • . ., _ t. ,_ r - :. ,: ., ..�, .. .. y , . u: Y., ��:•-- DATA A. -� �'►, _ :,. .. DESIGN , J :STRUCTU RE S1 NG� •{ DESIGN FLOW 3gpczla`I NO' Gsa. �-FR. •_ � 3. aczM - 3�O f�PQ SEPTIC TANK LA 1007 Gam. LEACHING RATES, SIDE AREA Z,S GPD/SF . . LEACHING FACILITY , BO EA] aGPD/ F Cla- ASUit�/\E� Im ij j & Cb 17 7 �q; / . PSC�'f A.2 Cv2 x'(T _ 1 1 3 s• F=. 5 <150 X Z•s + c aq�'; '-cam- - y�'�'�.• . \S'T.1lVG .GiZ1aUE — -- 50 =-- PLAN REFERENCE, C� Est co Ptz0Ro6� �0. ay /. ASSESSORS LOT NO. 'MAP Z4 SINd ate. A% ` f \� \� / NOTE= I. ALL MATERIALS AND CONSTRUCTION METHODS TO CONFORM WITH COMM. OF MASS. TITLE M: 7. + - `(per• / ENVIRONMENTAL CODE • LOT Coo. ate` I! 0 _ i 13 goo}S 7� �' `a °�� �` E RT �ti o _ w,y • - P_RoQ, W T> p, rEy taT IN� OF �O� DAVID g 10 z (o J y / PLAN N. T LIN IS�. No 2997 y 29$74 o SCALE V=LAO' TEST PIT NO. 1 TEST PIT .NO. \� SO. ELEV.- y9.� ELEV. o,� G/ST c 70�GIS7E Q�JQ S AL L.A� y9.5 •� — — — -- — -- --- �oAni�� I-.oan�y SOIL 013SERVAT10N PITS P-s1(oZ 4(o^O IVIED SEaNt� .SEE R.ESL1►-T5 DATE OF TEST DEG: \985 1000 % - GQA.v OF ��sTS oN ENGINEERut_1N ��1-L\S ,'Tl�UL�11�t , 1lVG. CIS CDA1.1.• .. ;yCo:L 45.(o a; B.O.H.AGENT \ (Z tC> \.GOtJ SEP7kc_ � ; . . q (o � Ix 4 L-P. /ac-" S Tos.A K • • EXCAVATOR__- S .'DR\ C�L_t- 4S. F x 45.tI ;,;°� W� a., STONE 1-.OTS, l7� co�8S PERC RATE IN T.P. NO. AT3,SFT. C:Z MIN/IN. A Q t�lCp 5[��v 0• 4 ti 1-410 �_ C)F ,qo - 13. g'-�" off' ZO' C.- rJ= Fr �2 rw ems, FOR.: L7P•,�1 t�/�A.•L�D��E1�11+. _T� �" ELLIS & THULIN, INC. LAND SURVEYORS AND.CIVIL. ENGINEERS 13 EAST SANDWICH,G:L; 3(0•o CH, MA SS. SC,AL� O Z) 1 Fes/ ► ��i�`V- . %o' v�1z-: 1 s' SECTION THRU SEPTIC tizav: �1.1� I2•za 15 SYSTEM D , - 14 By! mac_— E tasty 85- 3