Loading...
HomeMy WebLinkAbout0135 ELLIOTT ROAD - Health 135 Elliott Road, Centerville A= 248-311 ti- No. 42101/3 ORA ESSELTE 10% 0 a 0 0 r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,. MASSACHUSETTS ZIpprication for �Dioogal *pgtem Congtruction Vertnit Application for a Permit to Construct( )Repair( )Upgrade(P<Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. C �fTf2�`i TP4, l�a2mAN ;/r3"c,7* > Assessor's Map/Parcel 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0 .3 CL. rc 330 C/4th 6eles y S 7 e Coveac.3 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 issued by this Bo d of H h Signed �r /` LG�' Date - D /9i9 Application Approved by ' Date jtq A ?7 Application Disapproved for the Mowing Masons i Permit No. Date Issued TOWN OF BARNSTABLE LOCATION L, &I hO SEWAGE #9. 7- Ss VILLAGE CL tI,k ;,'1 h ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Q SEPTIC TANK CAPACITY d O LEACHING FACILITY: 1 L W (size) 3 6 u I 3 30 s NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: /`r� /c� -/922 COMPLIANCE DATE: - IL -9- Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 1�E— Ip 1 { ry) G 1n\ 1U, ku x M ` m No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Miopaar *pMem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � Owner's Name,Address and Tel.No. /�/t5/ZMA,&� '���vT/en2 Assessor's Map/Parcel 13 s-Flk r/r//0l t r,]T II/nsstaller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �v, 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 of Repairs or Alterations(Answer when applicable) !� 9 4 ' 3 C,/7f c S 3 O C 49 4;6r f.S �+�,1 �S7Z n:v cove/2c 7 C."A �/ ,57-cJ/c 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 Certify- cate'of Compliance has been issued by this Bo d of He h Signed Date, /(J / 7 Application Approved by Date I —(e:) ?7 Application Disapproved for the f owing r�asons Permit No.. — Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( ) Upgraded (�) Abandoned( )by n c. i3 o 1L!I ul at I has been 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 system will function as designed. Date r i>> C7 7 Inspector No. _ ! -------- l " �r� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migw9ar *pgtemc Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(Y')Abandon( ) System located at F U� u ("Co , Ce,-e,4 4, 1 1 r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to ~ CC comply with Title 5 and the following local provisions or special conditions. f' Provided: Construction must be completed within three years of the date of this permit. Date: Approved by �. ) 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 /Cb' /0z lz 7, concerning the property located at /3Sr F//i o��r' ��i�T meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system �r�j� • The observed groundwater table is 14 feet or,greater below the bottom of the leaching facility • There is no increase in flow and�or change in use proposed • There are no variances requested or needed. DATE: / � '�0)l(7 LICENSED 9XIC 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]. jxert \ 8 � ` E C� 330 U�6 cry n ��� 37-1 TOWN OF BARNSTABLE LOCATION L&� �ll�0� K SEWAGE # 7- VILLAGE CL Ny I r, L°D /h ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. n n,12L.Lr 4 a19`S 01 a SEPTIC TANK CAPACITY I 00 O LEACHING FACEL=: (typefi-Li �� v Id J VUw (size) 3 -G(,' Z-t- 3 3 6'r NO.OF BEDROOMS BUILDER OR OWNER I-/O,ZM Ax/ Ov71-&, .. PERMIT DATE: ,1 -1d•/(J-/g g, COMPLIANCE DATE: Z - 1l 9-7 Separation'Distance Between the: Maximum Adjusted Groundwater Table and 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 F' 11 Qd LA6 3_ 'ue`� � CvIT�s o"7/c-T as 33. Fx is/ /", ��� �'2-rcu17cc - 38 /k TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS ( !q 7 NAME Charles Buckler ADDRESS 135 Elliott Road VILLAGE Centerville LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL i 20:00 Oil new STI-P3 (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2/12/.8 6 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: 3/18/8 6 TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS ��rhC in/— bii oU Cre OF -E0r1 C. APPP. OVED Varacts%, le Conservation C� fission S. Dato `/J No................ Fps............................_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALT .D %'--.OF........................ ........... ... , ppliratiou for Disposal Work.4 Toaaotruriiou ramit Application is hereby made for a Permit to Construct (T) or Repair ( ) an Individual Sewage Disposal System at: •f oe,f ..........� r� .... _... ..................... -.•----•---..........._ Ycsu!AP.�..--- .............. L��/ L. '[.dres or No. r ... ... ..... . � ... � �(// Ltq /D caner r Add_ .. DWI ...........- ---•-----• ................ •..........----••......--••-•--•-------•- staller / Address d Type of Building Size Lot-.�_M/,. ��- .-..Sq. feet U Dwelling—No. of Bedrooms...:........... J-..............__._._Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildiu 4 _... ...._. _ No. of persons............................ Showers a YP g --- �----•---•----- --- ( ) — Cafeteria ( ) a4Other fixtures .....--•---......--•--•--•-- ----••------•--•-•---••---------••••---•••--••••....... W Design Flow............................................gallons per person per day. Total daily flow___..._..... ��....:............gallons. WSeptic Tank—Liquid capacity.20D..gallons Length................ Width................ Diameter................ Depth................. x Disposal Trench—No..................... Vidth.................... Total Length.................... Total leaching area.....r , sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet................... Total leaching area.... 4sq. ft. Z Other Distribution box ( ) Dosing to '-' Percolation Test Results Performed by........����� 1��---(6.0" eo Date..........�/����_. ,.� Test Pit No. 1._. minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2 ...'..minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ............................................... o ......................................................... Description of Soil••-•--------------•-------------- lJ7're. i! -ice.--- - ......................................................... U ------------•----------------•--------•-•-------------------•--------.............--------•-•----------...----------------•----------------------------•--••----•---.....-•-------•--••-••--•.......... W x ............................................................••••••••-•--•------•---••---------•-••--••--•---•-------•---••••--•--•----------••--••-•••-••••---------------•---•--••-•••--...---•-...... 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 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 issued by he board of he Signed ----•- ------. •.. l �.. r, ate pliced B �..... ..... .......... .............................. -••----••-� Date Application Disapproved for t e llowi reasons:---•-----•-------••---------•--••--------------------------•-----•-•-•-•--••......-•--.---• -••--••....._••-- ...............................................................:...........................................................................................---........................................... Date PermitNo....---....;............................................. Issued....................................................... Date R No................--.....-- F:ms.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' f� ------..-...�...�L ....OF....................��, _4 Allp irution fur Disp.auul Worko Tontitrurttnn ramit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at: /—eg - -...G= ----.. �-----. ...... ......................... --- .... Lgcatio...... Ad s © i o--!�--- -----------.-r Jt No. �i ip /_' _ Q Owner �J�yt - / ress W .C-,'lO�� .. .�._.. C.i--------------- ! ?�..�� ,.a Installer Address Type of Building Size Lot............................Sq. feet U�+ Dwelling—No. of Bedrooms....•. Garbage Grinder-------•-• Ex ansion Attic ( ) WOther—Type of Buildin&I" No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ................................................. ••----------------------------------------------------------------------•-•------------------------ W Design Flow............................................gallons per person per day. Total daily flow............... ...........gallons. Septic Tank—Liquid capacity./!:�g lons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....5F?6�.Y-sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area_.::;r,?.!��y..sq. ft. Z Other Distribution box ( ) Dosing tank ) Percolation Test Results Performed by......---.-- .. .. f Date...... Test Pit No. 1. �,minutes per inch Depth of Test Pit.................... Depth to ground wa er... f4 Test Pit No. 2 -_.•---•-_minutes per inch Depth of Test Pit.................... Depth to ground water------_................. P4 •-••••--'-•••--------••-----•••......................•=--.........-----.....................----'---------'----•-•---•---------..--•'--------------------•-- 0 Description of Soil........................................................................................................................................................................ W U ----------------------------------------------------------------------------------- ----------------- •--------------- •--------------------- -------------- .---------------- •-------------- ••-------------- 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 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 issued by the board of health. s Signe .......... ... ..... ..•---.. ........................ ......... 1.I -�-- pate Application Approved By............. ........ ........................... ..........1 Z---1_- - Date Application Disapproved for the llowing reasons:--•----------------------------------------------------------------------------•------------------.........._.._ ---------------------------------------•-•--------------.._..-------------•------•-------......-----•------••----•-----•--•---•--••---------••-•••--•-••---•--•----•---_....-•-•-•-•................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS /f BOARD OF HEALTH ........... .......OF........... ". ......... Tntifirair of �uut��iunr�e THIS IS TO CERTIFY That th Individu Sewage isposal System constructed ) or Repaired ( ) by �J?CJ �. , . -----------------•---------------------....-----•---.........---'--•--------- E��� s ns uer at. T- has been installed in accordance with the provisions of TIT IF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... _4I_l_-_._�....... dated........!:2'./tE�!� %.._._.._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. , DATE....................... A&............................... Inspector.................... ............................................................. THE COMMONWEALTH OF MASSACHUSETTS `�_ BOARD OF HEALTH .................,1 .�� �?......OF...-..--... 'RiS�2� No..................1 FE .... Diupnuy�tt, l nr ii Tunotrudion.. rruti# Permission is hereby granted..•--±-'`. �A� . .!'e.N/ t teCT nakv---------------------'-•-------....------.....-------•-•--. to Construct ( ) or Re air ( ) an Individ al 5 .wa a $isposal System at No.------•-•-•---�.....L+0........... ..:. .. -�.(.� "= streE£ as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ................................ • tit" {----•-•-----•--•-•--------- - Boar 16 th DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON I 7- L.o,— :3 A qj '4o T s j j i 7v 6;7 S j /oofV �o D i R �0 V LEA G7. P Box .Gk 5/ r s °� t A y / M 2.0 n, p P � �A Gf' 41ps �0 .%0oo14^L� a , .N ktt N i M St�—r3,4 C \o` LUT r� c r/aq/ TZ. Y �u �DG of to ( R(}7" ©. 19367 l °y' N N / fI RT.ZZZ SC��;Ll/ G'• F✓ls/V B//—A Gt/5 crsrQJ � 351 VIj f ALHE.ft( t A. p C () ,4 /] pU13L►e lip,' '..;• LEGEND EXISTING SWOT ELEVATION 00 CERTIFIED PLOT FLAN EXISTING CONTOUR ----_ 0 -�-F0IMI8HED SPOT ELEVATION 4.LJVT _�0 � F1 .13 HZC. CONTOUR . ® -'- � � CL-�✓TG V'/L LE NQ�'E: The location of apy existing undder8vou ld sewerage, -- - - -- --'— t wells, . or other utilities shown on this plan is approx- IN *f, rimate only, as d-termined from records and/or verbal � Anformat on. ,The contractor .is responsible for the �� , S fA,0 -1-a ,o A S* `verification of the existing locations in .the field. SCALES / "=40r DATE wQREDGE �ENG��YEr�R��IQ C� ��II CLIENT. ��._ 1 CERTIFY THAT THE PROPOSED ` % �' 901STER RE®1STEREO �k, JOB NO. S�3� BUILDING SHOWN ON THIS PLAN 4f, CIVIL ,. LAND CONFORMS TO THE ZONING LAWS t ^� E N R R DFt.,;®Y� •�' OF BARNSTAS MASS `& 712` M.At N STREET ' ' CH, By,HYANNI ' . 9NEET-L OF DATE REG. LAND SURVEYOR t � `k37 ti Q � 4t;� J WQ w 0 ` � � � tL rl IJ kn UN OWN � 0 � 0 � �ll � ocQ...Po_� .ao4aIt vc J ,' Oa(IQO K � t~ � \ v ) i a 4 , v ► ♦ e �q Q U44 W s `,Q � � } • • w �s • . . a iy a� / ` y � � �`'� c� :i� fir,.�� bi 14 ? I'. v \ Q _, e r 8 i'=• s i"- i`6` ; � 1V � \ � O ' 'rf �� : h 't x . b .It q n o 44 14 b F i J tLtL it V4. tipcul � f� e ITT 13 o � apt v, J V � � a ? � W v Q � , z � .� �• ��,^o��, :. CC M Ira r b • h 8Q v 0 V ^ rF� » �s �, W4 � ,,, Ui . o � Z � � �•� mtia 13.0 - LOCATION SEWAGE PERMIT NO. VILLAGE 6i/ L-1, IM TA LLER'S NAME f ADDRESS c4 ; 2­76 -Z B U I L D E R OR OWNER p �1 � %t>�/9- 4 �� 1 DATE PERMIT ISSUED i DATE COMPLIANCE ISSUED/ 27 Z1/ I VII i I� C r v, •,Q r4 A i r- I70 � G C IT � \_ r e - v i'