HomeMy WebLinkAbout0023 ELLIOTT ROAD - Health 23 ELLIOTT ROAD (l !ot Street)
Celltez Vll le (Two different parcels)
A. = 248 — 242
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SMEAC
No.H163OR
UPC 10259
smead.com • Made in USA
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No. < (9 J� r — � Fee �r
` Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Rpprtcation for 3igpoear *patent Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(berAbandon( ) ?(Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
_:�Y� oZ��
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 Ci gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. l-A,, G.ca 1^WI
Description of Soil
Nature offgepairs or Alterations(Answer when applicable) l
61
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 b ealth.
Signed Date
Application Approved by Date ?Z-J
j
Application Disapproved for the following reasons
Permit No. Date Issued
q No. / -� 3 �� I ✓ % Fee -
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
01pprication for �Bizpaal *pztem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(V(Abandon( ) [Complete System El Individual Components
Location Address or Lot No.a� �� O( Y� Owner's
Name,Address and
Tel.No.
Assessor''-s Map/Parcel - ��
aye j2� �.
Installer's Name,Address,and Tel.No. l Designer's Name,Address and Tel.No.
5-7
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 (T-7) Type of S.A.S. 1-A `4�th4/)a G, t tj
Description of Soil Agz2 g`Atct✓(r� ' �J
u
Nature of Repairs or Alterations(Answer when applicable) i
•�. e—
�L S
=r! lL« r r /A �rL
---�-car
Date last inspected:`'
t
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 b ealth.
Signed Date
Application Approved by Date ?Z?-'
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certif irate,of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(�
Abandoned( )by 1 O—'C-A � — a
at G '" V4=6-A has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9'9''ro 3 Z- dated
Installer Designer t
The issuance of this pe all not e c nsqed as a guarantee that the sys ill function as desi/ /
Date Inspector ,� A �j,m 1 �
61 J v V
---------------------------------------
No. / / _ CD- Fee J /
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mi5pogal *pztem Construction Permit
Permission is hereby granted to Construct( )Repair . )Upgr de bandon( )
System located at � � t�t d V
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 mustst be completed within three years of the date of this emut.
Date: /' 2 -/9 Approved by ZZ, '
I
�r 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 PERMIT (WITHOUT DESIGNED PLANS)
hereby certify that the application for disposal works
construction permit signed by me dated ��—`FY , concerning the
property located at �� , ,� �Q meets all of the
following criteria:
l /- 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 I and the percolation rate is less than or equal to 5 minutes per inch.
There are no wetlands within 100 feet of the proposed septic system
There are no private wells within 150 feet of the proposed septic system
L-!—�tere is no increase in flow and/or change in use proposed
J-�There are no variances requested or needed.
• /The bottom of the proposed leaching facility will not be located less than five feet above the
maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor
method when applicable]
• the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation401 V +the N AX. High G.W. Adjustment�t _ t
DIFFERENCE BETWEEN A and B
SIGNED : _ DATE: "
[Sketch proposed plan of system on back].
q:health folder:ce i
000
TOWN OF BARNSTABLE`, , ��
qq-.O"
LOCATION �,3 �'�-/� o/n a..'SEWAGE #
V.U,LAGE C'eti /i ASSESSOR'S MAP & LO '
(INSTALLER'S NAME&PHONE NO. 4-7/17 G 4-E y
SEPTIC TANK CAPACITY c)
LEACHING FACILITY: (type) /•-tf 7e:I?/a, "7aX S' (size) 51/
NO.OF BEDROOMS ,3
BUILDER OR OWNER I
LZ&4V--
PERMIT DATE: COMPLIANCE DATE:
It
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 feet of leaching facility) Feet
Furnished by
_ v
1 C
i
veer'-1
u-f°-770 of
TOWN OF BARNSTABLE n !
j LOCATION 'a. E' 7_ �11� SEWAGE #
VILLAGE C'rw 71c' ,-Ji/I ASSESSOR'S MAP*LO '
INSTALLER'S NAME&PHONE NO. /Ylib C462 S e�r-� i C' ��. U.!E 11
I.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 4 70 S (size)
i NO. OF BEDROOMS -3
BUILDER OR OWNER
t
PERMTTDATE: COMPLIANCE DATE: r�
Separation Distance Between the:
Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility
Feet
jPrivate 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
i Furnished by
. :1
A
a.
13
., 1,3
.1
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44
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No.._.6��: Fxs....... '...............
9i THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFHE LT H
LICa(0...............OF....../15.fc:. .........
Allpfiraation for Disposal Works Tomitrnr#inn ramit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at
.......cation/Address
---.c ion Address '� --.. or .t.No.
. .._�... ` .......... .........:............. � .�.....� ...---- .... ..:...
,Owner � Address
a ,k ��-�--------- ---------------------------------•----•---•-----------
Installer Address Type of Building Size Lot../dy.014....Sq. feet
U Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building No. of persons.........../R--............. Showers ( ) Cafeteria ( )
Q' Other fixtures
d
W Design Flow.................. .._____.._:..._gallons per person per day. Total daily flow...............3Q.................gallons. d/—
WSeptic Tank—Liquid'capacity,j'D'�.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 ) B
~' Percolation Test Results Performed b A �---0&0--------- -------------- ------- Date....... "-!%�!.......
� Test Pit No. 1................minutes per inch epth of Test Pit---.---.-........... Depth to ground water....Ja
f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...)V_e_X 1jL_.
O G a ...........................................................................................
xDescription of Soil..... -.. .,. ---&14 ------------- ---------•-----------•--------------------------••--.....--•--------•....
U ------------
- �. -- .......................................................................................................
UW •-•••-••••--•------•...... ........................................•---------------------------------------------------- .------ --•-----.
Nature of Repairs or Alterations—Answer when applicable........ .... . ..........
... .........•••-••. ••-••••..-----•---••---•--•-•-----••--•-•-.••.-•.•..._.......-••••---•-.....---••
Agreement:
The undersigned agrees to install the aforedescri e n ivi ua ewage Disposal System in acc with
the provisions of TITLES 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 th bo d f health.
Signed •-•-- .�.. =
Da
Application Approved BY - -----•------------------------•---•---- -•--- �'fj .------• -
Date
Application Disapproved for the following reasons:-------•----------------------•-----•-----------------•----•---------------------------••--••-•-••-------------
-•---•.......-•...............•--------•--•-------...--••-•-••••--•-.....-----••--------=-----•••.........--•...._....---••••----•-•--•---•-•-----------••••••--••--•--••-••-••••............•....._..
Date
PermitNo..............=`....................................... Issued....................................
L \,_/ Date
,% --THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..............OF....... :23. .
Appliration for Uiopo,ial Mirki Tutuitrur#ion thrutit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
- /i/ c ion Address ��� j}I� /J or t No.
•-•P----------------•---------^ •---••--•--.a»--------------..._.......................-----................................ .
Owner a � Address
•-------------- . ._.----- ------------------........----......... ...----------------------------------....... ...-----..............--------.............
Installer Address
Type of Building Size Lot../1_ .f 6....Sq. feet
Dwelling—No. of Bedrooms.............. ..............•..._...__..Expansion Attic ( ) Garbage Grinder ( )
P4 Other—Type of Building - ufc -_-._: --
No. of persons ......... ............. Showers ( ) Cafeteria ( )
Q' Other fixtures .......................
W Design Flow...................a ___________..gallons per person per day. Total daily flow...............3.3.0.................gallon
S
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 ( ) DosingitakPercolation Test Results Performed by.... ..._..__.__ .. .................................... Date.......=.. a...�5�3_____..0-� Test Pit No. 1................minutes per inchpth of Test Pit.................... Depth to ground water...._/Yu"ZIP-
LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.__A-4_KX..
-•--•-_. ........... - -
0 c Description of Soil..--D L,_�..._.h'a'4''_?_....----_ - --- - - - -...._..-
�a S
w ----••----------------------•--•-•-----••-•••---•-----•--•-•--•-•-•--------.....•.---•-•......•------•--- s
U Nature of Repairs or Alterations—Answer when applicable-------._ .... _._
..---•-----•----•---•--•-••---•--------•-------------••---•---•-------------•••••--•--...--------•-----•---••--•--------------••-•---•---------•-•--•----••-------•-------•--•.........................
Agreement:
The undersigned agrees to install the aforedesc- IF n ivi ua ewage Disposal System m ac e@�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 bee/n ' sued by th bo d f health.
Signed '=�•-- •--......`= `: `''. : .::....................
- Date
Application Approved BY -----------
Date
Application Disapproved for the following reasons______________________________________________________________________________________________________________»
.........-•---•...................•------------------......--------------•--------------•-----------•---------•-•-•--••--•-•-••-----•--•------•-•••-----••-••------------•--•••......----------•--•_....
� Date
PermitNo......................................................... y, Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........
(Inrtifiratr of Toutpliatta
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (A or Repaired ( )
bY-----------------------------------------------------------------•--------•--------- - --------•--.-..------.------------------------ ------•-----------------------•-.-------------••--
/J�/ --------In ler y
------ .........................A ----- f---/-...Q,Q-d.._._..•....:---•--•--•---------------•---------------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No... 3 �1_�............. d-
PP P S ................................................
THE ISSU N E OF THIS CERTIFICATE SHALL NOT BE CONSTRU S A GUARANTEE THAT THE
SYSTEM 1Al NCTION SATISFACTORY.
DATE. _....�......................................•----•---....._.. Inspector7 . ------................•-----------•--------....----------•-----•-••--•-••----
THE COMMONWEALTH OF ASSACHUSETTS
BOARD OF HEALTH
iL OF..
a ...........� ---- .---•-
No.........................
FEE........................
Permission is herebyranted_....__...� ork� �on�#rton l�ruttr
Dio�rostt
g ,�..------U�'""-�..---------------------------•...-------•---------------......---------..............-------••--
to ConstrtWt o; Repair �0. j ,,In iduVrage D pos system
......_..
Street f
as shown on the application r Di posal Works Construction Permit No............... ... Dated..........................................
��� - -- -------•-----------------------------------------
� Board of Health
DATE........................................•.......
�F�'�-=r---
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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LEGEND S CERTIFIED PLOT PLAN I
EXISTING SPOT ELEVATION OxO
tTH d .
EXISTING CONTOUR ----- 0 --- i '?�',-- psi or z Aiaceri 1✓v P E4,,or'
FINISHED SPOT ELEVATION
FINISHED CONTOUR 0 �''• GsMz2Vi�.L6
j'.\ ERG .sit I N
APPROVED 'BOARD OF HEALTH. T� -1.+ :j'Zo�
' + Q-vlSE0 04 �0- 83
DATE 'AGENT +" SCALE: i"=30 DATE ' i 3 1
LDREDGE ENGINEERING CD IIN cI IENT M.A0bA&ENA I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB NO. .:F���S BUILDING SHOWN ON THIS PLAN
s° .CIVIL LAND ".1 . CONFORMS TO THE ZONING LAWS
ENGINEER SURVEYOR OR..BY� , 'm OF BARNSTABLE , ASS.
712 MAIN STREET' CH 'BY'
HYANN I S, MASS '4ra '�'` of
SHKT.4-OF .� DATE R LAND SURVEYOR
NOTE /F E/TNER THE S=PTi C ?-,q,V.,`< OR
_EACHiwG PiT ,ARE ORE Ty�9.'�
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2 •B^M
4AOE/ �i 2Q O/AMETEK G'CNCRET� COVED
E SHALL ,B BROUGHT TO GRAoE . !�:. � cXT?A
- -
V A RON CO✓�.? f� ��1 J 3 'S
CO NC RCTE
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EL- 101.5. C•cYERS f9 P`eR 1 R yv Y
4D CC)
o - PC
� _ LIQIJ/O L EYEL _ 4I-
...ROK P/PE• - � 1000 t • �+,.a�,�/ �
/K/N R/TCN GAL. o e 1 • � . • . • . l l 0 •4 I �y�ShFO ST�,YE I.
SEPT/C TA/YK B X , , . « • a . . . . o . o
• e � • • D�PT/-I • 1
i a. • • •1 • • • • • P .v P.4ECS T SfE.r�AG E
150.8 x 2 s 371� v l D , •. r • • • • • . i ' s • o ?/7 OR EQL//Y,
l vVexT &L E i�.4 T/OHS I l i ,` x . E a _ I ► 3,R i o - a a EL= 88.5
lmVERT AT Qu/LD/NG q3.5 FT:
/HEFT SEOT/C TANK �• 9 3, .3 FT, : � � G f'T D/A�t. • ,t 1
EET% 1PTeA S .4 FT D/4 ON�
_ •
Q
_OCITLET SEPTIC TANK: ..`l_ _FT. x g
/NGET D/STRf9LT/ON 80X 9 •9 F7. SECT/Q%V OF GRQuNo Wf�TER TA9LE
Ot/TLETD/STR/BtIT/ON BDX �12•� .ET. :. _ ,� . ,,, , .
92 S
L
INLET tEACNfNG o/T FT. GE L7/SF��SA .SY
SEN/A � STEM
TABULAT/ON
DIMENS/ON F <:
DES/G%N C q 'r.=A1
. v/•ti.E�s/aiv: . gam—Fr
NUMBL R OF btEoROOMS 3 - D/HENS/ON .C 4 F T EM
c�Ra,vG.E oisPo �+c v /rE SO
TOTAL E37/MA'TED FLOrti/ 33o G,AL.1DAY SO/L TEST A/ SO/L 7�S-Ti*2
.' t•a. �,
,yuMBFR-oF LEACHING P/TS_ 1 ELEY. 3.a �E[l�Y. 45.�L GATE OF' SOIL TEST
S/D-L-,4CH/N6 PER P/T 0•8 S(;t• FT. RESULTS id/TNESSEp 8y JAcop-1 1 4
3oT7�OM L�ICN/NCi PER P/T ( I 3. 1 FT Q 4., LOAM PCRC0.4AT/0JV .LATE
7ROT.44a LEACNIiYG AREA S SQ. fT. TaP�o�L �
�7 AEh[OLA7'/ONRA7'E,(�2 T)4,4tJ ,"••+JN.//J1/GH
y7ESERVE LEACNING AREA .9 SQ.
H cCF a" �AM1✓ t Soil TEST 1f 1 59
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Of \ �° AOgE-en wA-.e S• ELL lOT QOA-0
t10 PHIt�1�y� 4:-LPL.
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it o. 366
r 4 ti V. EL OftEDG�ENG/NEEXlNG CO,/NG:.
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'v Rv�� ., ''. .' NG.GRQclNc? yy,4TrR ENCOUNTE.��O CL/ENT:MAbDALENA D�4TE �, of 21 83
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LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME i ADDRESS
V1
i ALE'
UILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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