HomeMy WebLinkAbout0024 COVE ISLAND ROAD - Health 24 COVE ISLAND ROAD,
A=187-059 LOT 11A j
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7)2GJ(1CG O 2 ym
UPC 12543
No. 53LOR
HASTINGS, MN
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No. f•a, Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Application for 3Di_4po!6a1 *p5tem Con6trurtion Permit
Application fora Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No Lp � __�® Ow I N e,Add re and Tel.Np.
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Assessor's Mal!P ,9�� f 0 7— S�
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 gallons per day. Calculated daily flow 7'`7 V gallons.
Plan Date Number of sheets Revision Date
Title
a
Size of Septic Tank f 64PID Type of S.A.S. 2—
Description of Soil
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 1 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue A B'ard of H .,s.
Signed , Date
Application Approved by 41 Date
Application Disapproved for the foll wing reasons
Permit No. a6 Date Issued
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TOWN OF SANDWICH i 1?7 5�
LOCATION:
VILLAGE• '
LOT # : 4PERMIT
INSTALLER' S NAME• i' l e--tla
INSTALLER' S PHONE # : 3 2 —
LEACHING FACILITY: (type) /0 k- Q (size)
NO. OF BEDROOMS :
BUILDER OR OWNER: lj
PERMIT DATE:
COMPLIANCE DATE:
DRAW DIAGRAM ON BACK
N � y
•No' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF.BARNSTABLE., MASSACHUSETTS
Application for 30i.5pozar *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Ow is N e,Add re s and Tel.NQ.
Assessor's Map/Par
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 gallons per day. Calculated daily flow �Y11f) gallons.
Plan Date t Number of sheets Revision Date
Title
Size of Septic Tank bpt7 Type of S.A.S.
Description of Soil ! I
tom.... -
Nature of Repairs or Alterations(Answer when applicable)
k /o .
Date last inspected: i
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions Tiil' 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue thi Brprd of HeFZQ. _
Signed Date S�
Application Approved by o Date
Application Disapproved for the foll wing reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO 12 !Xathe On-site Sewage Disposal System Constructed( )Repaired Upgraded( )
Abandoned( )by
at a e constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. — dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the cyst will function as designed.
Date 1 - 17 -/ Inspector
No.
— ---------------------------Fee -- .ram
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
MigPogar 6potem Construction Permit
Permission is hereby granted to onstruct( )Rep (�pgrade )Abagdon( O
System located at
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:Cons n m be co pleted within three years of the date t"s -rmit. a
Date: tio Approved by �.
f
µ 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 �`
�— meets all of the
following criteria:
• 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
• 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:
A)Top of Ground Elevation (according to the Engineering Division G.I.S. map) �v
B)Observed Groundwater Table Elevation(according to Health Division well map)
SIGNED : �— DATE:
4 _
LICENSED SEPT 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
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LOCATION SEWAGE PERMIT NO.
V I L L A G E
INSTA LLER'S NAME 4 ADDRESS -
d•UILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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CATION:
VILLAGE: '
LOT # : r, PERMIT
INSTALLER' S NAME:
INSTALLER' S PHONE # : � -
LEACHING FACILITY: (type) /D o (size)
NO. OF BEDROOMS :
BUILDER OR OWNER•
PERMIT DATE•
COMPLIANCE. DATE: / �7
DRAW DIAGRAM ON BACK
1
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No..........1..�15..... Finc.... . ...
THE COMMONWEALTH OF MASSACHUSETTS
BARD F H A TH
(ltitl+�1..............0 F...... .....................................
ApplirFa#ion for Disposal Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S stem at:
Loc ion Address or Lot
.............. ........:.. .... Ss ---------- ..5 s .
Installer Address 7 Type of Building Size Lot.:.__..�..3......O.......Sq. feet
U
Dwelling—No. of Bedrooms........ __............................Expansion Attic ( ) Garbage Grinder (04
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures .............................. . .
W
Design Flow.............?S._..................gallons per person per day. Total daily flow............3.8.o...................gallons.
WSeptic Tank�Liquid capacity./,-6Q.D.gallons Length................ Width---------------- Diameter................ Depth................
W Disposal Trench—N� .................... Width.................... Total Length.................... Total leaching area..a�.�....sq. ft.
Seepage Pit No______________ ____ Diameter-______.________._. Depth below inlet_..., ... Total leaching area..................sq. ft.
Z Other Distribution box (k_� Dosing taptkk
Percolation Test Results Performed by. �� - •.-•--••......-••---. Date.3_-.2 d..........................Test Pit No. 1................minutes per inch Depth of Test Pit----------- ....... Depth to ground water-__---_...-_____---____-
(i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_________--_____-___.
.- . -•--- . -- - --�
O Description of Soil-----------�.:_---'-�------=--- --��t_.......---c�---r�2-�----f--`��--------_ �-- --•--
x
W - i ............................- � . - .....................................................
UNature of Repairs or Alterations—Answer when dpplicable..............._____..________._______._____...,...........__.___.___._.._.._...._..............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of:i:_. y g g p y
S of the State Sanitary Code— The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has been 's ued the boar health.
Signed_. -• •. --••- -• Qom, —--------------------------
Date
Application Approved By.... --•-- ........... ......... ------------- -°21 ..............
Date
Application Disapproved for the following reasons-------------------•-----------------------------....------------------------•--•--•----•--- -----•...........--
..•-•-•---------•.............•••-----•••.....••---••--•----••--•---••-••-----•-•-----------•••••--•-•---------•--------••-•-----•••----------•---•---------------------•••----•....•••-•-•••--••-----•.
Date
PermitNo......................................................... Issued.......................................................
Date
NC--------- -----•- FEs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD H H
..............OF....... .......... ---.....----------------...--------------•---------------•-
Allptiratioat for Dippoii al Workii C =34ratrtiott rnmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sy em at:
__
7�&o� Address No.
................-.... ------------------------------------------... ........49 49-
....6* ' ..... .. ;,1z"
n ddress �
MInstaller ddre s ! rt a .
Q Type of Building Size Lot__Arig�6?;i
_ q, feet
Dwelling—No. of Bedrooms____.._..___________________________Expansion Attic ( ) nder (
p`�•I Other—Type of Building _,Z_______________________ No. of persons............................ Showers ( ) — Cafeteria (
a Other fixtur
Design Flow...::..........-t.____.._________...._._____gallons per person per day. Total daily flow............... _ gallons.
lions.
WSeptic Tank-/Liquid capacity__4#PAWallons Length................ Width---------------- Diameter................ Depth................
x Disposal Trench—No,___ _______________ Width_._.................... Total Length.................... Total leaching area___ _ sq. ft.
Seepage Pit No----------- iameter------- _.------- Depth below inlet..... ..... Total leaching area..................sq. ft.
z Other Distribution box ( Dosing t ( dcl
'~ Percolation Test Results Performed by--,. q t W.. . . ................... Date........................................
Test Pit No. 1________________minutes per inch Depth of Test it__________ ________ Depth to ground water-----------___________-.
Gz, Test Pit No. 2................minutes psi "nch, epth of Test Pit.................... Depth to ground-water____�._____.
(� .� . ....._. . j _
a0 ,. --- -- Sr fa �, utI4Ji ':
Description'"of Soil - •-----------------------••-••---•----- ••. •••• .......
x �j -----=--- -----
------------------- ----ff - --- -----------_-_------------------------------------------------------------------------------------
UNature of Repairs or Alteratigns..—,.:Answer when applicable------------------------------------------------------
.................................................... : .........•------•-•----..........-•-•••••-••--•••--•••-•••----••---••-----•--
Agreement:
The undersigned agrees to install the aforedescribed- Individual Sewage Disposal.System in accordance with
'TT
�•
the provisions of 1�: S of the State Sanifar}� Code,.� The undersigned further agrees'no°t�Tlace the system ip,,,
operation until a Certificate of Compjiance has been ' ued y the boai:ci health.' ;
S ned °
a.
Application Approved By---•----•• • •••••-•---------•-----•--•..........................................................
-•-••-- .......................................
Date
Application Disapproved for the following reasons:------•-------------.---..-•----------....--------...----------------------------------------.t ;; ----------
Date
PermitNo--------------------------------------------------------- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS �• c .,
BOARD O HEALTH
,.............OF.........................` ,.........................................
(9rrtif iratr of Toutptiattrr
CER V the Individual Sewage Disposa� System /cpnstructed ( ) or Repair ( )
/Aj ✓
at..................................... ........................................................ -• •--......................... ...................................................
has been installed in~accordance with the provisions of / _�;�he State Sanitary C -.a��}esc bfd 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.............................................._, ........... Inspector......................._&Z_4_��`__-_...............................
THE COMMONWEALTH OF MASSACHUSETTS
'7, BOARD O HEALTH
No......................... FEE........................
� on ie% rrmit
Permission i�, reby granted_.___
to Constr-Inc ) e (,� a'�i�, di 1. 1 Se a Di o yst
as shown on the application for Disposal Works Construction✓P-e �No.1___. /./*Dated______________s 1/1
.--------•-�••-----•----•---•-••-----------•----------•-- .. ................-••----•••--•_.....
Board of Health'
DATE.............. ---------- ................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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CERTIFIED PLOT PLAN
EDWARD E. KELLEY LOCATION" 4;:4
CUMMAQUID, MASS. 02637 - SCALE. .!.`�--' . . . DATA
PLAN REPERIENCF .���!`� ..; T //.q....
OF
�1. EE.
ARD �
KKELLEY H
No.23100 . . .
GISTS 0'' 1 CERTIFY.THAT THE .........
T v;� S dam., SHOWN ON THIS PLAN IS LOC.TED;ON THE GROUND
AS SHOWN HEREONENT,AN# Tiit' IT`�ONFORMS M THE
SETBACKf1 S OF THE TOWN OF
... . ...... WHEN CONSTRUCTED.
)C-19.Lk 77Z us T DATE . . ... . . .
PETITIONER: W6rs•r
REGISTERED LAND SURVEYOR
1 ,
..5,90
TOP OF FOUNDATION
CONCRETE COVER
�'• CONCRETE COVERS
PI PECAST R RON 12"MAX, 4'�ORANGEBURG(OR EQUIV.) 12•MAX. """"''"'•
EOUIV.)- MIN. PIPE- MIN. LEACH
PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT PRECAST
° LEACHING
T OR
NVERT a :.
•o EL../ 7/... INVERT DIST. NiERT `� W PIEOUIV.
,., SEPTIC TANK
EL.. ?./. .. 190X. L....�3.. .. , ;:
,.e INVERT
c c ... GAL. INVERT c�a• 0: :is 3/4"TO I Vf
e; EL...�.... INVERT d W U.w �.
► - EL!$.Z4.. W :T'� STONWASHED
s,• �- ••
PROFI LE OF GRouaD WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE nn
SOIL LOG WITNESSED BY:
DATE!`1r2. .�/99/ TIME.//:oo ! PSG C /9uizrz, BOARD OF HEALTH
'TEST HOLE I TEST HOLE 2 T,�dy, G % •P. ; ENGINEER
fLEV. /7 9,?. . . . ELEV. �L,Zo
WooaLdprj /1 WoueD�oA+7 /
DESIGN DATA.:
3o NUMBER OF BEDROOMS 3
hGrD TOTAL ESTIMATED "FLOW . . 33v GALLONS/DAY
4o7v/T . / ./o
Sip Co7v1T BOTTOM LEACHING AREA SO.FT./PIT
SRO SIDE LEACHING AREA SO.FT./ PIT
GARBAGE. DISPOSAL . AREA INCREASE)
TOTAL LEACHING AREA . .7�3: �. . SO.FT
PERCOLATION RATE ?4. ,,SOFPO;A4--r./'Y0 MIN/INCH
d warm LEACHING AREA PER PERCOLATION RATE .49a./ SO.FT.
/LZ WATER ENCOUNTERED 1 PIT Wirt/ ?ki4E 9-
NUMBER OF LEACHING PITS c..
APPROVED . .. . ... . . . . . . BOARD OF HEALTH pF.S�!v.�/E� �•✓AV- SigeS,_ /7L 7Wv5±'of
S7z7Av.—
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DATE. . . . . . TIi0Iv1AS•E.Y<EY,LEY CO:
•AGENT OR INSPECTOR ENGINEERS—SURVEYORS
346 LONG POND DRIVE
y��F NAA" 7TH YARMOUTH, S• .��DF IyAs
' p��` tiv 02664 A
. ED`NAR� �,r1 y o�3 THO G
Gd7- A s' e
�r L.LEY N
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`rs/QNALF'a�
PETITIONER : WG.srA•vtiis/oolL7" MAsS. /r � `