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HomeMy WebLinkAbout0326 CAP'N LIJAH'S ROAD - Health 326 CAPTAIN LIJAHS RD CENTERVILLE A = 193 108 UPC 12134 R �r M,I►�TtItO�.IIY No. ° Fee $ 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -VZ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair Q(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3 2 6 Captain L i j a h s Own is Name,Address and Tel.No. bOb— — 3338 Road. Centerville,Mass. 02632 ark Yessin Assessor'sMap/Parcel �� �Q 326 Captain Lij ahS Road / Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Te1.'No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1 1 0 X 3 gallons per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic TankExistinq' 1 000 Type of S.A.S. 1 —1 000 LP Description of Soil Loamy 'sand to medium fine sand Nature of Repairs or Alterations(Answer when applicable) Adding 1 —Distribution box and 3-500 gallon leaching chambers- Packed in 4 ' of 1 t�_st-nn,, 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 d by thi Bo d of ealth. Signed A a Date 4/2 6/0 0 Application Approved byV&ZW)7gjDate Application Disapproved for the following reasons h Permit No. Date Issued No. Fee $ 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mi5pozat *pztem Construction Permit Application for a Permit to Construct( )Repair kXX)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3 2 6 Captain Lijahs Owner's Name,Address and Tel.No. — 5—j Road. Centerville,Mass. 09632 Mark Yessin Assessor'sMap/Parcel `�J 326 Captain Lijahs Road Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macombeer& Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 102632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1 1 0 X 3 gallons per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Existing 1 000 Type of S.A.S.. 1"=1 000 LP Description of Soil Loamy sand to medium fine sand Nature of Repairs or Alterations(Answer when applicable) Adding 1-Distribution box and 3-500 gallon leaching chambers. Packed in 4 ° of 1w" stone 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 d by thi Boyf d of Health. Signed f' 4 Q Date 4/2 6/0 0 Application Approved by l /% Date Application Disapproved for the following reasons Present septic system is in hyd ulic failure. 1 Permit No. ® y Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that ttfe On-site Sewage Disposal System Constructedj( )Repaired' XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 326 Captain Lijahs Road Centerville,Mass. h n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer J.P.Macomber & Son Inc. Designer J.P.Macomber & Son Inc. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date CSC Inspector ----- �7-- -------- ————————— No. -----Fee 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpo.ar *'pgtem ConsStruction Permit Permission is hereby granted to Construct( )Repair.�IX4Upgrade( )Abandon( ) Systemlocatedat 326 Captain Lijahs Road Centerville,Mass. 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.dust be 1 v�)ompleted within three years of the date of r Date: Approved by / i I 1/6/99 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 PERNfI'f(WftHOfT DESIGNED PLANS) r L HJoseph P.Macomb r ,Tr . hereby certify that the application for disposal works construction permit signed by me dated 4/2 6/0 0 , concenzting the property located at _ 326 Captain Li ' ahs Road Centervillemeets all of the Mass. following criteria: /The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. �..... ._ , The soil is classified as"CLASS'l and-the percolation rate is less than or-equal to 5 minutes per inch. V/ There are no wetlands within 100 feet of the proposed septic system Y There are no private wells within 150 feet of the proposed septic system There is no increase in Dow and/or change in use proposed There are no variances requested or needed. The bottom of the proposed leaching facility will n_t be located less than five feet above the maximum 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=be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: j A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation ' +the 141AX. High G.W. Adjustment. �, ' DIFFERENCE BETWEEN A and B Z/ /t •S SIGNEDW DATE: 4/2 6/0 0 (Sket proposed plan of system on back]. q:health folder cent i III ID TOWN OF BARNSTABLE �, G LOCATION 30G SEWAGE # CYJ-.31 VILLAGE ASSESSOR'S & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY A 5yX LEACHING FACILITY: (type) (size) Jd,�'„C� NO.OF BEDROOMS BUILDER OR OWNER 1>/�s7� ,�/ ��✓� i PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 fee of leac g cili Furnished b Feet . .� 1 IN, \ 4 j' 00 TOWN OF BARNSTABLE � G LOCATION CWC. �-° t `t�,s SEWAGE # 00-321 VILLA,G ASSESSOR'S & LOT./M 10Y . INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /nd 6 G A 4 S LEACHING FACILITY: (type) QLYe^S J/(- (size) ae"d . NO.OF BEDROOMS / v i BUILDER OR OWNER Ark .U�wu. PERMITDATE: V1`1!I�D� COMPLIANCE DATE: Separation Distance Between the: 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). Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee of leac g mility') Feet Furnished b r _ � , . _ ` � �. � ��� /� �. �, 3� as/ � � i � :�� 3` .� `� � , � � NN ,r No..................pyf7••" FEB........... ....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1) ..............OF.........&Pjj. t�—TAS --------------••----_._-----•--- Ty— Appliration for UhipmFal Works Tontrnr#iun Prrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Y-kitem at* 5 %....Lmza-_ !:....P,>___..e--E7AaEA Y1.VV..................... ...-•............. .1.. ._.. --.......................................... cation- ddress or Lot No. " ........................ ..... i .. •- Ow r Address Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms____.._._______________________________Expansion Attic ( ') Garbage Grinder p, Other—Type of Building ____________________________I No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ____________________________ _ W Design Flow____.____ _t_U............................gallons per person per day. Total daily flow---------.�_ ......................gallons. WSeptic Tank—Liquid capacityA.ft-gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing to ( ) r '~ Percolation Test Results Performed by.__._. r .i .. _..._._�C.Jy ________________ Date___.__ ____ _:: ............... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... •-------•-------------------------------•-••----•-••----••-•---•--..._._.....__.........•-----_. ........................................................... 0 Description of Soil---on-3.....�.IL=LIC-s- ---A— ........fx�= -� --;- n 4 w ------- U W .................................... --1_ F S f� .Ce..e... t_ .---� i 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:ITIE 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 1 alth. n �j Signed........... • .......J`1L....__.�_..•. e ••----•--•• -•-•• �y �(s `t Application Approved By•-••----•-•--•••-•-•-------•-•-•----•----- ✓•>< .......... ........... o(A... --- i Date 7 Application Disapproved for the following reasons__________________________________•____-__-_________-___--__-_______----___--__--••--•-------••-•--........._.._ ......................._................................................................................................................................................................................. Date PermitNo......................................................... Issued_....................................................... Date No.... e6::. . .... > FEs............................. s# THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH .__�Q.w Q..........OF........ .. R..i�.�w ::�..... Appliration for Diaposa1 Vorko Tonitrurtion rautit Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal Sy4tem at: ....... :P..�r~?.... s.... ��.:... 1�. :�'.U►( ........----••---•�_"O t------•----'�-�"---------------------------•-••-------••--- ocatio Address t No N-------------------------- -------------•....... :. : ::V . _ --.......------..........---- ` / o�+ Address --------•V IE�.�...R-LI-�.lm--•-•---i a=?...-•-•--•-•--•-------------- _ S T_�Pt: ... Installer Address UType of Building Size Lot............................Sq. feet I-, Dwelling—No. of Bedrooms............................................Expansion Attic , ) Garbage Grinder aOther—Type of Building ............................ No. of persons....................._------ Showers ( ) — Cafeteria ( ) 44 Other fixtures .---.......-•----•-----..•-•---••---•-----------•--•--------•-•-•----•------•---•------------------- W Design Flow........./�.0.........................gallons per person per day. Total daily flow--------��� .......................gallons. WSeptic Tank—Liquid capacity/Ago.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench=No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing t ( ) ' q '-' Percolation Test Results . Performed by .. a��_.-`� /lJ-Yc_�°�. Date q"..�s� Test Pit No. I................minutes per inch Depth of Test Pit._____............_. Depth to ground water........................ Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-__--_______----_-___. 0 ---------------------------------- -•........------------•--------•-•............................... --•---................D Description of Soil--� ._3.... It ( = r_f c --------�_�t__o-=-_��� .� IU..................................------.------•-- c.> -----••-•-•••---••-•---•---•---- Mof " -f`�'�..AL,_Aye_.... .................... . Soa_!- t C i IAA, x •-•-••-•---------------------_....��_a_......1 I vi,j ' ---Vie...-I �-�--" © .............................................pca i�v L 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 TITLE4 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--�--''..55...� ( `Y ---------------------- �- °.----••--••-- ---------•-•.... ••---..._.... Application Approved By.......................................... J ts.f/ Application Disapproved for the following reasons:....................................................... ----•............................. Date..........._ --.......-•-------------------------------------•-•------......---------...-•----•------•--•-•------•----•-•--•••-•-------------•-•-•--•----•--------•--------•-----------•-----------------•---------•- Date PermitNo................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR,D/�, OF HEALTH .........1.0to*J..0...........OF.... Trr#ifiratr of Tontlifitanre TH S IS TO CERTIFY, hat the Individual Sewage Disposal System constructed (� or Repaired ( ) i 1-��b it "I. 1 ) En ................. staller at.............................................` �. E 5 - - - ------------------------- has been installed in accordance with the provisions of TIT r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------- .` _ I........ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � OF...................•••-----•..... No.---.. .... .... FEE........................ �i��o��1 ork� �on��rion rrntii Permissionis hereby granted............................................................................................................................................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No.. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... c f . DATE ....... Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON ►IO GACL5AGE p 200� Ito Y. 3 ' �3oG•Rp r I ,A►LY F 1.O W -.a� 0 N FPTIG TA►JK - `3�® t150'/• ' �97G.P. I& v5� ►000 GAti-. « � PI Ivoo (CAI_. 1�z•a I t�►5Po5AL T log i !�t pG�Al.I_ A2L-t► a I JO S.F � � 11coP Fir -- I 15 goTiOM AQ As �� ``'tF• PD (oi:ii � T: -�• t7f — ., I X 1. 0 C 9l.¢ o ai 1.4t O I 1. -ToTA 1_ oES1�N • �425 �.P o. �. .. Ir TOTAL DA I 330 G.Po. I5* roUUDAro1.1 il 2vt" p 11 FIG 2GOLAT104 RATES 1%'iN. 2MiN o�LG55 23 22 2-I i OF ``i`Q s ✓,.�`�tH RIC A. (•tag Y 7 F.R r rG=�o ToP FNoz 10A-•9 P-32&a /0T •� "- 1�. l02 Mom"" �-o DIST. /IN%/. S6pric. C=ii ar SA :� IOVO . ( Crux IDI'L TANK GwR L GA... . II 1 . ' �„ElaGII �Mova INV. INY. / etaa.,�.c.a AAY PIT 1 o� z- 101•d VUSuirt,(tL o yJITW __ MAC-h1LiAL— I'/3Ih•�II:. . Ip' Au. A2o./r� s�'� SYSra YJA;NGD i 1IArs Io 6'T0Hs Cl r1�� — SrNTH ..{I'�•- Co --�t$ Y GE9--rIFIGO PI-cT PL.A'w ' G•e�:�` P R v F I L� L04A'TI0N Jr rzg1L4 Wo gGALE rj�ALE I",, �10 �ATrc q-G-f3� 61ZEN GE 1 CERTIFY TNAT 'I NEV �J`'�APIU1l.N��N LLB 2Z i MCI.. y111TN'[NE S I NE ctSOV4 Go `!5 AwD 5E-te.GK R.6QutQEMEN'T� X of �R21:;�S A�Jt-bAN� IS T' �L,'..� 714- �ANA$�i IC• �n"t 1T� LOG(aTEfl tNITNI THE FLoop P>LN-IN DATE Q= 1)C BAxTEv-e NYE INC. R.E.G 1 vv P-Q6T)'I.AM o S V it.Y E`(oe'S Tu15 PI-L��1 15 No'T E's >c p cb AN 06TC-9-VILLE • IN^6e'p* y,5 I .T-R.0 MENT SueVt:�`( F� -T -1e nI=FSE?1S 6WOUZ) APPL►CA►J"r' DETER��I�►�_�. F �� ! x, I� � rCd to AT oN -r /.SEW AGE PERMIT NO3 . � VILLA E A/ 1-NSTALLER'S NAME i ADDRESS S y BUILDER OR 6WNER ` DATE PERMIT ISSUED � � �jl�� 9_8j DATE COMPLIANCE ISSUED //��4; 1 • y� 41 LpCAT10N SEWAGE PERMIT NO. VILLAGE INSTAL NAME & ADDRESS b B U I'L D E R OR OWNER DATE PERMIT. ISSUED DATE COMPLIANCE ISSUED f r- 1�1 �aT� Zz �a� moo ' �� ,