HomeMy WebLinkAbout0066 BRALEY JENKINS ROAD - Health 66 BRALEY—JENKINS RD.., CENTERVILLE
A=171-184
"00_cta�p
UPC 12534
No.2_153L_OR '�T
HASTINGS.MN
i
P-r
NO. Fee
_ �G Feed
F (�-- �L
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZippItLAtion for Mtgpo!5 .Y *p5tem Construction Permit
Application for a Permit to Construct( )Repair(/'Upgrade( )Abandon( ) O Complete System El Individual Components
Location Address or Lot No. wner's Name,Address and T o.
Assessor's Map/Parcel C LJ��`j�\`e—
t Installer's NatA
are,Address d Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder,w
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank �OC--A) Type of S.A.S.
Description of Soil
Nature of airs o lterations(Answer when appli able) f't�V MG--X 1
_X�
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 iss T-t
this d ofSigned Date a H L
4
Application Approved by - Date
Application Disapproved for the following reasons
Permit No. g a.S"'�7y Date Issued
No.`7 G a Fee -�'--
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Application for Miquar *p5tem Construction Permit
Application for a Permit to Construct( )Repair(V/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ('t_ (� �,v�.�`(�p,5 wne r's Name,Address and Tet,�I�11o. C �/
Assessor's Map/Parcel CVO
b f
Installer's Name,Address
nd 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 gallons per day.'Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature fof-Repairs o Iterations(Answer when appli able) A\V V C-\C—A i M
�� _�
Date last inspected;
a
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 d of
Signed 1� e �. Date C �ao �
Application Approved by Date
Application Disapproved for the following reasons
Permit No. C? Date Issued
——————————————————————————————-—-------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance ` /
THIS IS TO CERTIFY, that the O -site Sewage Disposal System Constructed( )Repaired(v )Upgraded( )
Abandoned( )by i c Cv-^
at r V n �c� s��\ has been constructed in accordance
with the provisions of Ti e 5 and or Disposal System Construction Permit No. ,325!:� dated
Installer Y �/` '«�� Designer
The issuance of this permit shall not be construed as a guarantee that the system wil unction as designed.
Date � � Inspector
7 V
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
lwiopooal 6p5te!��),ron5truction Permit
Permission is hereby granted to Construct( )Repair( pgrade( )Abandon( )
System located at C�2 2 t c, � .
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 completedwithin three years of the date of s permit.
Date: - �(') -7�j Approved by ,��
1 a C1 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 �_�Cl _, concerning the
property located at meets all of the
following criteria:
t here 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
There is no increase in flow and/or change in use proposed
There are no variances requested or needed.
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:
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)`J
SIGNED : 'sDATE:
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
q:health folder:cert
cy
r
nn TOWN OF BARNSTABLE
LOCATION A I t� (t°Y C}�iti GC.n,S �� SEWAGE #
VILLAGE�� I L�� cc ASSESSOR'S MAP & LOT - /
INSTALLER'S NAME&PHONE NO. J COQ I
SEPTIC TANK CAPACITY /000 r, .L QOX 012 p-,'Y
LEACHING FACILITY: (type) -X /�n S (size) &NJ
NO. OF BEDROOMS
BUILDER OR OWNER G( �e.IC I
PERMTTDATE:�SIT COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
i
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) ( v Feet
Edge of Wetland and Leaching Facility(If any wetlands exist ,{ � V
"
within 300 feet of leaching facility) LV IT � Feet
Furnished by
My � �6
Atb a (dP
:V1
�6 co t-U off' O x O �,�
OWN OF BARNSTABLE ;. ..
LOCATION `Vl SEWAGE # (OO
VILLAGE ASSESSOR'S MAP 6 LOT L
INSTALLER'S NAME 6: PHONE NO.
SEPTIC TANK CAPACITY I � IV
LEACHING PACILITY:(type
NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER
. BUILDER OR-OWNERS
DATE PERMIT ISSUED: �j x - 7=
DATE COMPLIANCE ISSUED: y`Z
VARIANCE GRANTED: Yes No
� TANK r
I
I
II !
61I !!
I �I III!! I illl ' I i ICI I' .II
it
� ill I
I'I I
�►11�� il� �� � �► li ��i
i�I I I, i I III I�II!il
if
IIII
ply
I !
Imp
l l' 'i l'I iil i! II
Hill t
Af
1'II
i �I I I I Iullill
!!il
I i !li I r
;I!
o m
i
m
!I a'l i I�IIII I
s 1 1 IIif
0
m 1 I I !
I !I
Ilii
I
o a A I i
F >
0 0 = I
� � I
m
a
� i
i
� I
� 4
I
DE
j
\\ ,%
I i
00
Ar
I
it
I
!
i
i ;
> r
---
I � - I !
o a
m 2
m
' Iulll I I
a a
> � s
E E
a m m
Z <
3
m
j I
li it
!
i
I
�� II
I
i f
F � III
! �I
I
I
I a b� II
N�
1 � i
I �
! I
CA
Itor
: C,
iF.4 F � I , _—__ya�_C7�ON (]F 2X!O ,�6 oc� II•
�• N <� i ib i � � � h�' hV 'iN I ii `t
I 17
ID II I I .
c �
3
r i �
i
i
i
1
�i
I
I
i
3
N
1,
� a
i I
ILI-
zo
f z
m
V c
3
m
� a
� C O
v
Ic
1
� q
�i
p V n� v
q o �
14
v
TOWN OF BARNSTABLE �-
LOCATION 2G SEWArE 0
VILLAGE cc ASSESSOR'S MAP & LOT - /
J 6
INSTALLER'S NAME&PHONE NO. GOQ
SEPTIC TANK CAPACITY /0®0 �'s,L D aaX 0/G/ &-t
LEACHING FACILITY: (type) /c n (size) L�J
NO.OF BEDROOMS
BUILDER OR OWNER i L I DCAA I
j PERMITDATE: /gin /Idr' COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Welland 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) /l/V" "`- Feet
Furnished by a
LO
S�
N OF BARNSTABLE -*lye.
.00ATION d 'cx SEWAQE
VILLAGE ASSESSOR'S MAPLOQT J �'
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY \O O O
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL ORCPUB WATER
BUILDER OR OWNER S
DATE PERMIT ISSUED:
DATE .COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
b
s
No. .P........�.n.` ............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH �, 4 e 7 6
�.....-.�. ... -
OF...... .. ..................._.....--•--•----
. . ...
A 1utttion for Disposal Works Tonstrnstion rent-t %
Application is hereby made for a Permit to Construct (1-1"'or Repair ( ) an Individual Sewage Disposal
System at:
W.4. 0,L L
�-- /mil e -�✓ 0'�-� .......--•-
�
�L Location-Address
No.
,�..� s.. 1.....l......�� . 1 -- ..R: .....
Owner �cQl9 V1 1/ ,p Address
?.1 ....-••-••-..........- -----------•---
Installer Address
d Type of Building Size Lot.. ®®0 Sq. feet
U Dwelling—No. of Bedrooms.............::............................Expansion Atti�(�j Garbage Grinder
a
p, Other—Type of Building /�L�...�<I_...__...... No. of persons........!�t................ Showers r(i I- Cafeteria-k---)—
a' Other fixtures . ----------
•---------------------------- ----------------------•---•-----------•----•--
W Design Flow............................� gallons per person pirr d y. Total daily flow_._..._.._.... ..............gallon.�
WSeptic Tank—Liquid capacity.-------__--gallons Length.-_9..._.__.. Width.,-._....:... Diameter................ Depth......_._
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area................ ,sq: ft.
Seepage Pit No.:------- ........ Diameter......!'_�4_. ... Depth below inlet... e--... Total leaching area... ..sq. ft.
z Other Distribution box ( Dosing tank.(�_� �-
'-' Percolation Test Results Performed b ._. J_ J _. � .............:...... Date....J. ..� ,-
Y
,.� Test Pit No. 1..,<......_..minutes per inch Depth of Test Pit____________________ Depth to ground water.... ._-:_____.._____. i
GTo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
---•••--------- ---- -- • -- •. f
O Description of Soil----------�?...�- �cr
U ---------------------------•-----------•-•-•••-•....•--.....---.........--•-•---••----------=--•---......---•--------------•-----------------•-••--•--.................................................
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
-------------------------------
gned-agreto install the aforedescribed Individual Sewage Disposal System in accordance with
P Y
the provisions of TIME 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the board of lth. q
Si ned--x-- a'Ac / 16 �-�
DApplication Approved By........ •--• '._ -----------------•---......._.-•-- . Ti-- !Y�.....
Date
Application Disapproved for the following reasons---------------•--------•----•--••---•-----•-------•----•-----•----------------------...--_-•-------•---------••-
..........................................•--•--•-------•---••---•-------------•-----------•--------•---..._....._....--••-•-----------•-----•------------......-----------------------------------------
Date
Permit No....... - ................ Issued.......................................................
—-----------
Date
No�`...........�� , Fus..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH P 4 �3 7 �
/ Z ,ass; a
..........................................OF...................! v L
f Appliration for Disposal Works &tuotxurtiun Vrrutit
Application is hereby made for a Permit to Construct (fi)or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address
r Lot No.
•--.... _..........—'��e: � z� 1.e2 vs r'......._ /..�.�.....Qc,�......1... t.3_�:...........................
Co. Owner - Address
a �y� I f .................
]et t Address
U Type of Building /.J OCJC�
� Size Lot_. __�__________________Sq. feet
1-� Dwelling—No. of Bedrooms........... .-:.`.:....................:....Expansion Attic--(�"")- Garbage Grinder
Other—Type of Building 1C'.5 t. _.___. No. of persons.._..__.L.__•_......._-_. Showers (✓)— Cafeteria-(---)-
Other fixtures ....,................... . .
•---•- ----.... •._......
...
W Design Flow............................_. ..gallons per person per day. Total daily flow__`................___3` __
Septic Tank—Liquid'capacity 2. .._.....___.gallons.
W � gallons Length._�3.._�__. Width.__`_t•._.�7. Diameter--.--.-t....___ Depth _._...8..
x Disposal Trench—No. .................... Width-------............. Total Length...............®_. Total leaching area................—sq. ft.
Seepage Pit No---------1.......... Diameter.._... Depth below inlet.._3:-....-._.. Total leaching area...2_�` ..sq. ft.
Z Other Distribution box ( 1,-)' Dosing tank - ✓ /
aPercolation Test Results Performed by.__.�._-�%� -�z..�..wy'=•_•.-_-•_--•--•-.__- Date....LQ117 -t&•.�`.. --
Test Pit No. 1..-<... __minutes per inch Depth of Test Pit-_--_�___z-.... Depth to ground water-__.L- -> J.-'.
4� Test Pit No. 2................minutes per inch Depth of Test Pit___............._... Depth to ground water-----___------------___-
a ............L..............................................' 1.....---......_...._._......_._
O Description of Soil....._....r?? � d ' �"'' �r � c ✓"01
✓ l
x ----•--•--�;--- /-------------------
U •--••------------------••--••----------•-•-----.-.-----------------•-•-------------- ------------.....
W
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
......-•------------------••-----------------------------------------------------•---------.......-----...........----•
Agreement:
The undersignedL1 g eeslto 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 'sued by the board of health.
_. Signed .�....... D ..1... ---•--
Application Approved By. . .. .. .............•-•--------------------.....----- 1D�t[__��_.:
Date
Application Disapproved for the following reasons:--------•-------------------•---------------------- :----•-------------------------..._..
..................•-•-----•--•---•-•-••---•---•-••••--•---•...-•----------•-•--------•------•-•-•------••...--------••---•-•-••-•-••------•--•-----...•---•---••--•-•----•...-------- --••••---••-•-
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..... ........OF.
......................
rrtifirFatr it outpli anrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed r Repaired ( )
by Dstaller ° L 3 �f ti \ •--"'I., l t l------- -----•-
-----------
has bee t, led ti ac orda,,rry�e routs f �`J "
t � tfrc� v Lfl 1� "I�`!' S o ate Sa ifary 6 as escri ed in'the
application for Disposal Works Construction Permit.No----------------------------------_...... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................... ..'..� 7... Inspector....: -- ......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........--'''/'^........ .......OF
....... ..
No......................... J dW r1. j f (�!1 'Fr-CS.��.............. ................. FEE...........
........
Disposal Works Tnnstrudion rrntit
to Construct ( . or Repair ( ) an Indi idua #S e IIi`poi � f �-�
�
Permission is hereby ranted.............. _ _
g p a ystem
atNo.................. ----Y = _--
as shown on the application for Disposal Works Construction Permit No:................... Dated. ........_ ......................
Board of Health
DATE..........1--�,-�------�•-Q--•- -- -
FORM 1255 HOBB & WARR N. INC., PUBLISHERS
- SOI L LOG
D ATE:
WITNESSED BY : tv,
Z- C77- ZRO
41 -10
7 z x
cc 7
A
144"
-7. z
`7-0
UANHOLES AND COVER TO sE BUILT WITHINELE V. TOP OF -- 12" OF FINISHED GRADE
FOUNDATION
F '- UIN- SLOPE
pEGKN I S H E D GRADE
4%AST I RID 4�' P V C S
7- OR C . 40 /f IIST
R�.i PVC SC H. 40 ITCH I FT. a LE VE L, MIN. LAYER
0
H 1 8 1/2 P E A S T 0 N E
o. PITCH ✓ , k f R.oo-
I N V I- R T D I ST. ( NVE RT'
'/FT. 0
C)J,5 T. 4
C3
3/4"- 1 (12"D I A
I N V E R T GALLON
INVERT Box r <
SE P71C TANK
E:):"' WASH E D STO N E
V E R T N
JE"e- amdaffili
i N V E R 7 4D 0!4 ALL AROUND
ol ol
GA R a A G E CL _j •
ELEV. 8 0 T T 0 U
MIN . G R I N D E R - ----E)
OF PIT - 44
6-0 DIA-%4'�
20' MiN ,
E L E V. 2&�
0 7- 0 7-A4 0 4 4
PROFILE OF GROUND WATER TABLE
SANITARY DISPOSAL SYSTEM
NOT TO SCALE DESIGN DATA
BEDROOKAS
* CONSTRUCTION OF SANITARY DISPOSAL DESIGN FLOW 3 ;�- O —GAL ./DAY
SYSTEM SHALL CONFORM TO MASS . LEACH RATE - $;� �� MIN./INCH
ENVIRONMENTAL CODE TITLE -V (REVISED 7- 1 - 77)
4* 11 PROPOSED LEACH CAPACITY
AND THE TOWN OF
HEALTH REGULATIONS . a
o SEPTIC TANK, DISTRIBUTION BOX AND LEACHING
PITTO BE OF REINFORCED CONCRETE -
MIN CONCRETE STRENGTH 3000 PSI --- GAL/DAY
MIN . STEEL STRENGTH 2 0,0 OOP S I
H 10 DESIGN LOADING
0 DRIVEWAYS NOT- TO BE LOCATED OVER SYSTEM
UNLESS H - 20 DESIGN LOADING IS USED.
o ALL PIPES AND FITT I NGS TO BE WATERTIGHT AND
TO BE OF CAST IRON OR SCHE D 40 P.V. C.
SITE PLAN SHOWING PROPOSED CONSTRUCTION
S H 0 FS HS
LEGEND
-)-dg2 Z "E
FLO,C
LOCATI 0 N A3 P42
Z- ":7 APPROVED 19
FOR :
SCALE:
ot DATE : BOARD OF HEALTH
f 2 —
BUILDING SETBACK REGULATIONS PER EXIST [ NG CONTOUR R E F E R E N C E: 0 v 9/8
BUILDING INSPECTOR OR BUILDtNG Z3)< 3 0 87
COMMISSIONER . Z: _e _rl, PROPOSED CONTOUR p r- DATE AGENT
MIN. FRONT SETBACK EXISTING SPOT ELEVATION 17. 6
PROPOSED WATER SERVICE —W— CRAIG
MIN. SIDE SETBACK TEST HOLE LOCATION S P.I it T
MIN. REAR SETBACK
vs
C . R . SHORT, INC .
PROFESSIONAL LAND SURVEYORS L ENGINEERS
1586 MAI N STREET (RTE. 65A) EAST DE N N I S, MASS. 02641
1.