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HomeMy WebLinkAbout0024 CARLETON LANE - Health 24 Carleton Way Centerville - Jan SMEAD KEF_PING YOU ORGANIZEf% NO. 12534 2-153LOR Y M I,�ra�n coluiFJur,o9c oosraNs mst Mom MAW W USA AFT ORGAWM AT SYEM.000 No. FEE COMMONWEALTH OF MASSAC14USETTS Board of Health, APPLICATION FOR DI AL SYSTEM CONSTRUCTION PE MIT Application for Permit to Construct( ) Repair( Upgrade O Abandon( ❑Complete System UTndividual Components a N _ D Location wner's Name P� Map/Parcel# Z Address . Lot# Telephone# Installer's Name C kt5IN4It, CVWGT.. Designer's Name P . Address �� Address Telephone# �� Telephone# Type of Building Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type.ofBuilding. No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow Design flow provided gpd Plait; Date Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTI N OF REPAIRS OR ALTERATIONS The undersi ed agrees to ins the above 4escribedIndividual Sewage Dip al System in accor ance with the provisions of TITLE 5 and further agrees o not to plac tem inZ"era It a Certificate of o lianW been issued by the Board of Health. Signed A Date -_ qqa- Inspections job& No. FEE COMMONWEALTH Of MASSACHUSETTS Board of Health,—~ � J ,:HA. C APPLICATION FOR DISPOSAL SYS- �ENII CONSTRUCTION PE RMI IT i Application for a Permit to Construct( Repair(V) UpgradeO AbanclonO ❑Complete System PsInn dividual Components X Location •t C?wner's Name -�0' v Map/Parcel# Address Lot# Telephone# A Installer's Name C V'�,,,� C WET- Designer's Name.. Address �e 1 Address Telephone# Telephone# Type of Building Lot Size sq.ft. 007 Dwelling-No.of Bedrooms r Garbage grinder ( )� Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures �^ Design Flow (mina required) gpd Calculated desigri flow Design flow provided a gpd Plait: Date J Number of sheets Revision Date Title Description of.Soil(s) Soil Evaluator Form No. Name of Soil Evaluator_ Date of Evaluation A DESCRIPTION OF REPAIRS OR ALTERATIONS rA I LZ'R..✓ -P*,50X �Izo Y - L,,, The undersi ed agrees to install the above described Individual Sewage D'Vo al System in actor ante with the provisions of TITLE 5 and further agrees to not to Zldie system in!�ft uNtil a Certificate of Corlplianc as been issued by the Board of Health. ' Sighed \ Date mlv Inspections t �ou .c couc0000cooc 000000c_.00C oocooconoococcooC Ccoc000cc cu oconccoc-01.00010C oc:occ ucc o cc000 Coc000000cocoobooc.:1oocoocn;cdcoc=�c..' - F No. ,rZ 6 X FEE COMMO WEALT14 OF MASSACHUSETTS 190X Board of Health, MA. CERTIFICATE Of COMPLIANCE Description of Work: I ZIndividualComponent(s) O Complete System �/' .The undeerr�signed.hereby certify that the Sewage Disposal System; Constructed ( ),Repaired (V),U� pgraded ( ),Abandoned ( 1 UY has been installed'in accordance with the provisions of 310 CMR 15.00 (Title 5) and,the,approved design plans/as-built plans relating to application No..2ols?-3/V/ dated /J 71'�/� Approved Design Flow NI/ ' (gpd) Installer Designer: _ Inspector: 7�=7=1 Date: tit The issuance of this permit shall not be construed as a guarantee that the system will function as designed. .o:r coc_..o.ec„-e cc ce 0cco0c^000 o c 0 oC o00c oc o o u"ucoc occcoCc, on_c•oo e occ..,cc o occ eoc;.:C; :o0CcP oococ ooc D e C o c o o o oo a o o C o,-,oo oo<. No. l/ FEE COMMONWEALTH OF MASSA 14US ETTS Board of Health, WlJ'"Y ..� , MA. DISPOSAL SYSTEM C� 4RUCTION PE MIT Permission is�hereby granted to; Construct( ) 'Repair(Vo Upgrade:( ) Abandon( ) an individual sewage disposal system at [ a `"'� Lj as described in the application for Disposal System Construction Permit N0.2,)t�' ���, dated /a � . ' P 1 ' rr Provided: Construction shall be completed within three years of the date of thi perm t. All llu conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Chatestown,MA Date 1 C)!///: Board of Health ! (s?s �� K J t pwN OF BARNSTABLE ' ,OCATION 2 v_ 44J. SEWAGE# � - . -: VILLAGI � ,_ASSESSOR'S MAP&PARCEL /%�' 8 1 INSTALLER'S NAME&PH:ONE NO ®!: SEPTIC TANK CAPACITY LEACHING FACILITY.(type)(`L2 ,,;(size) NO.OF BEDROOMS . OWNER AP PERMIT DATE: 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 v 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 j f24.(-K O O TOWN OF BARNSTABLE ) OCATION 24� C4r/e%Grp �/ir SEWAGE #— = � VILLAGE L' P�Cr �/� ��� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /&ry LEACHING FACILITY:(type) /p`- (size) / NO. OF BEDROOMS-_P OR PUBLIC WATER �I R OWNER l e 6 �I n DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Ye;:; No 1� JIJ i l.� izz3l.00 "i THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH a TOWN OF BARNSTABLE Appliration for Disposal Worfis Tonsttrnr#inn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair �ff an Individual Sewage Disposal System at: 24 Carlton Lane Centerville Donald McBride Location-Address or Lot No. W J.P.Macomber Jr. Owner Address Installer Address Type of Buildin Size Lot............................Sq. feet U Dwellingx No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder04 ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria 44 Other fixtures ...-•----•----- -----------------•----------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity.........._.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 tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit..........._........ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Fit.................... Depth to ground water........................ a ---------------•------------------•-----••......--------------------.---------------..........------......................................................... 0 Description of Soil_.....__ ____ x ••--------------------------------- - Band- y -----------------------------------------------------------------------------------------------------------------------------•------------------------------------------------..........._..-----••---- W ----------------------------------------------•--•-------------------------------------...--•-----•------•------------------•-•-------------------------------------••----------- ..................... U Nature of Repairs or Alterations—Answer wh bled p I1ts1�1._.Teac fit; Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code--The undersigned further agrees not to place the system in operation until a Certificate of Complia1hasee issued by the oard o ealth. j 'gned :-- ' ....0----------- 1/2 /91 ----------- / r / Da e Application Approved By ----------v///" ..--------v-- --....-i ------------ ---,� . -.�-Application Disapproved for the following reason ....................................................--- ----------------------- ---------------- ----------------------- ..----------..............................................- Date ............................. ............................ ........................... Date Permit No. ....-. ..... l �. .... . ... --- ..... Issued . �/ No.... ----,�--- Fps..............................7- THE COMMONWEALTH OF NIASSACHUSETTS -- BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Disposal Works Toustrurtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair Fx an Individual Sewage Disposal System at: 24 Carlton Lane Centerville --•-....... _..._...... •-•- - ... --• ............................................... .. ........ ----...... Location-Address or Lot No. Donald McBride W J.P.Macomber Jr. Owner Address � Installer Address Q Type of Building Size Lot----------------------------Sq. feet DwellingVNo. of 'Bedrooms......... ................................Expansion Attic ( ) Garbage Grinder ( ) � Other fixtures .----•-------------------------------------•------------•------------------I--------------.--•---------------------. -•-•....------------------- a Other—Type of Building ............................ No. of persons............................ Showers Cafeteria( ) ( ) W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------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 tank ( ) aPercolation Test Results Performed by.......................................................................... Date...................................... 14 Test Pit No. 1_:___-___-_._.minutes per inch Depth of Test Pit.................... Depth to ground water----------______---_----. 14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x 0 Description of Soil........... x Sd......an... ------------------------------- ......... ---------------------------------------..------------------------------ ------------------ v ---------•-------•--•--•----------------------•----....-------------------••-•---•-----------------------------------------•--------------------...--------•--------------------........•--------------- W VNature of Repairs or Alterations—Answer when ap �1 a Y.l®ri YE; C t----�1 t:---�=----�� ��f U The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with jthe provisions of TITLE 5 of the State Environmental Code--The undersigned further agrees not to place the y p Compliance has been issued by the board of health. { system in operation until a Certificate Sigd ...�.�±:�.t Z. --../.--��.��.�!�/��.�.---..:�11._s..�................. .1�� -�91---,,---._-.. / �� Application Approved BY ------ -1.��� !.� /t-ft�- ih-............�.. 6 2.... . - - Application Disapproved for the following reasons: .�/ :.-... ................................................. ..........................'--------'---'----......................................--'----------...........-.......-.................../......t.... ..-._._----_Date - Permit No. // ........................ Issued ---------- 7..- ---------------- L/ \ / Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARN:STABLE T.er#ifirate of C11ol,ttlaiinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by.......J.,..P..-,.Ma:c 0M.bex---- x-°------------------------------------------------------------------------------------------ -----------------------------....................................................... Installer at � :--Carlton---.Lane----C-enterville--------------------- ......----------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 'i'a The St to Environmental Code as descri' ed in the application for Disposal Works Construction Permit No. ....... f ^".-.. dated ........�.� ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B.E C�.lNSTRU D AS A GUARANTEE}THAT TIE SYSTEM WILL FUNCTION SATISFACTORY. -� Inspector �Y DATE------------P - �'`� <- .�. .................................... I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.................1 � FEE........�0..00 Disposal Works Tonstrnr#inn f rrmit Permission is hereby granted......J J P.Mac omb e r J r. ......................_...........-.. to Construct S ) or Repair (XX) an Individual Sewage Disposal System ' at No....R�...Garlton__Lane...Centerville..............._.........._.__........ ._ �.........------•------ Street / as shown on the applicatio for Disposal Works Construction ems it No�....�./w !lDated:._.�y/ .� ........ q .......... �oar d of Health DATE......... . : . ' v ,�1 r....... ............. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS ;LOCATION 5EW6,64E PERMIT UO. VILLAGE Of Y IWST&LLER'S ►JMAE ADDRESS BUILDER 5 Q / NAF- ADDRESS so v r DI.1,TE PER"IT 115SUED DATE COMPLI Art-ACE ISSUED • �� Ion" Z �� v5� 0 7` d 0 y No.' .. Fux....1....lJ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF I—IEA TH r��,,•t( ...............OF............. .L4.......... .-. ............. Apphratinn -for 4%ipviia1 Works C omitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 01 :. �' + on-Addre s or I of No. � Ow er Address a _ d _.a................................... •......••---............--..........._....-• ----•-------......-•------•--••••••-•-----. � 4 Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms_-._______�/__-_---__ . _E:cpansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons--------.-________-__--.__ Showers ( ) — Cafeteria p' Other fixtures . d ---------- ---------------------------------------------------- ---------------------------- W Design Flow... _ -•.-__gallons per person per clay. Total daily flow..............�_a:'0----------------gallons. tx Septic Tank•L Ligt d capacity./d-"-_gallons Length---------------- Width--------.------- Diameter---------------- Depth..-._-__-.___- W Disposal Trench—No. .................... Width-------------------- Total Length---_-_________----_ Total leaching area....................sq. ft. x Seepage Pit No------- 11 _.._.. Diameter_ _O."S'0. Depth belo mle ....... ........... Total leachin area......._______...sq. ft. � f•••-•- � ,�; �j g Z Other Distribution box ( ) Dosing tank ( ) abi` 1 - Al-z G-7L Percolation Test Results Performed by-------------............................................................ Date----•----------------------------------. Test Pit No. 1________________minutes per inch Depth of Tesl Pit_...--______-___-__- Depth to ground water.----------_-_--__.... fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to round water--.-_._____.___-___-.--. - - --- .-•--- -- - --------- ... r - _. — --- ------........ ----- - - O Descri ion oil---------`�j-�- -----�---- ...•--- ----------- f 7� 1dJ- U - - -----.:.... �i z- 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 Article NI of the State Sanitary Code—Thc:undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by Ze b rd of he igrie :-- Date Application Approved By.....:..... ............ .. ------- --�.. ....................... ..' �7ate 7G.. Date Application Disapproved for the following reasons------------------------•--------•------------•-•-------•---•-•--••-•------------------------•--------------•---- -----•---•------•----------------------------------•-•-...--•---•----........----•-•••-••......-•---••--••----........ ---•-----------•-•---------•--------•--•----------_----.-------------------- Date PermitNo......................................................... Issued.-• --•--------------- -----------------•--------------- Date No......................... Fes$............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _._ . . .............. OF...................... .............. ................................................... Appliratiun -fur Ditipmai Warkii Tonotrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, ati dress - r o. p / Own r Address a ------...... ---- ---- ... 4---------------------------------- ------------------------------------------------------•------------------------------------------ Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------- __ __________________Expansion Attic ( ) Garbage Grinder ( ) per..+ Other—Type of Building ---------------------------- No. of persons----------------------------- Showers ( ) — Cafeteria ( ) Qtller fi_ ur d --------------•-------------------------------.----- ---•--• W Design Flow --'`_--gallons per person pe:, day. Total daily flow--------------------------------------------gallons. Septic Tank•s-Liquid capacitv.l-d- gallons Length-------- Width................ Diameter........-------- Depth-__.-_---_-._. x T Disposal Trench—No_ _________________ __ Width--- _ _____ Total Length_._-_____.-_._.._--- Total leaching area....................sq. ft.p � Seepage Pit No________ __________ Diameter__l______--------- epth below iltlet__________ ___._.__ Total leac]ing area..__..._________.sq. ft. z Other Distribution box ( ) Dosing t ( D -�C - �- G- 7C a Percolation Test Results Performed by.. „�.�.. ----------------------------- Date_-_-. a Test Pit No. 1................minutes per inch Dept of Test I�it..._.____________-.- Depth to ground water. ___._.__...___- f� Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--------------------- x ..................... ---- - -------------- --•-- G Description of Soil-------- '_ 4--YEM- U -------------------------------------------------------------------------------------------- W UNature of Repairs or Alterations—Answer when applicablc------------------------------------------------------------------------------------------------ ------------------------------------- ---------------- -----------------------------------•-------------------------•-----------------------------•---------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued Ath oard of hem th. _ Date Application Approved By.......... . u !7 7,�------- Date Application Disapproved for the following reasons:---- •---------------------------------•---------•---.-------••-•--------------------.----•-------------------•- -----------------------•--------•--•-----------------------------------•----------------------------•--- ---------•------•--------------------------------------•-----------------------•--------.------ Date PermitNo......................................................... Issued...................... ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V_12�7- ...........OF............. �. ..... ..... `....... 01.1'rrtifiratr of (aomviiaurr THIS IS TO C R Y r R , That the Individual Sewage Disposal System constructed ( oepaired ( ) by----------- ---(.�•----- �< -'-- Instatler at ------- - - has been installed Vin accordance with the provisions of : ic� XI of The St e Sanitary Co,�1e as describe in the application for Disposal Works Construction Permit No___zi:._..._ ` `'..._-----___ dated------&_-/__7 Z�................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............-- r--- f --7 --------•--- -- -- Inspector -r�-----------�J� q- THE COMMONWEALTH OF MASSACHUSETTS BOARD,,QF .HEAL%�Hl No. ----•---'----' . FEE--t<... ......... i o or Toristrurtion Prrmit / Permission is ereby granted_._...... .._(7vj _--. �/'U"to Construc r Re. I a Inddu Sewa e ,+ ste ( g at No.- ..�1'... �.. L/� `_~ 4) __ � �G------ ---- - Street L as shown on the application for Disposal Works Construction Per it No_ ___ _ __________ Dated__.___ ..`:. .. . ��__.______. -.. -vac. -r--cam { .� Board of Health DATE-------%'------------------------=----------------��--_--.-.--------- e FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 'SOIL LOS 97,11 -1�-- // , 2'.PEASTONE - 40AM d FILL 12"MAX. o ° i ►��cfnl� 4 C.I. DIST J "IN BOX ° 5'MIN. 1000 rD, °°° 1000— GAL. GAL. 1 °° PRECAST OR ° Wr SEPTIC E 1p o BLOCK ° c °' S}ot►t TANK I'°°° SEEPAGE. PIT o' e� lot O{�{tj, 0 o 0 i 20' MINIMUM 1 — — — — — "f FOUNDATION -I' °o °° o ° << 2 �,.rD° I %¢'� WASHED STONE ° o ' ° '1 Mi 1U•hSc�d — o_° o �8"SCALE. 'l+'=. 4' LVt FQ0Z fa ELEVATfON SKETCH r= 10' PRIM ItA'� �e1 'f 0 2V SCALE: I"= 4' TEST BY • Fkky I" eitr►Q L TOWN INSPECTOR: av/ BACKHOE OPERATOR : - - ►4 as Y' TEST MADE ON p � �.t" 6 00 Fwu2E 9 9g �i X ANStpv 3 1000GA L 1p;'� Dire t3ax ' /000 64L _ 5 PT►C TA alr o.r- v ` ,y �? � R1 ST'OPLY W00©1 1-Af� ICj 20' N it ©co 57A&c RoAp G8' b p, S/,k�or>•'�11r y ;� x 99.E �I s APPROVED BY BOARD OF HEALTH C /� DATE • ��t t N OF N Of EDW►N A. R+ °2 EDWIN cy to YOUNG z A. v 9096 © CD YOUNG v i NO. 12134 ell ' ELEVATI4 SCHEDULE J ` `��;.; PROPOSED SITE PLAN I. INV. AT FOUNDATION = I'O�'r40 , p SEWAGE SYSTEM DESIGN 2. I NV. INTO SEPTIC TAN-K = 9_9, q1 IN {I 3. I NV. ^ OUT OF SEPTIC TANK • aQ NSTA R(,E, MASS 4. INV. INTO DISTRIBUTION BOX = ±s21?r SCALE : I"- + �` /aP1121 •- - 1976 ' C— • 5. 1 NV. .OUT OF DISTRIBUTION BOX _ �y,. y 6. INV. •INTO SEEPAGE PIT = l•ZS f CAPE ,COD .SURVEY -CONSULTANTS-- r _ROUTE 132 r� 7. BOTTOM OF .PIT It'• *_. g��. HYANNIS, MASS. } - - A DIVISION BOSTON SURVEY OONSUI,TANT$ �8. BOTTOM OF STONE LAYER .96 ` 4 A - , s f -` - - r ` . .4a.,,.` _ 4 / �,+' a +k, ;, `,,,> ,z,,., •,} - I'Y/i -� .f .$q - w s? • � .r s af� �. :-T"i ''� 1. �.e �, r {.. �' r #.. � -`t -.. 1� • ry , Af