HomeMy WebLinkAbout0351 ELLIOTT ROAD - Health 351 ELLIOT RD.
CENTERVILLE
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UPC 12534
No. 2153�OR g°osr.coNS°�
HASTINGS, MN
No. / / `� Fee lop
THE COMMONWEALTH 00 MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZppYicatton for Mtgaal *pgtem Construction Vertnit
Application for a Permit to Construct(VJ'Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components
Location Address or Lot No. 3 51 1L.L 107 A v Owner's Name,Address and Tel.No.
Assessor's Map/Parcel p`1 g71 O �a
/fOLM DFi— , NJ'. 7 7/ ' `®t/,o
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
b l co :ysso C 361� - 8(3/
Type of Building: `
Dwelling No.of Bedrooms 7 Lot Size 5�t V& sq.ft. Garbage Grinder(Ala
Other Type of Building/I/LIt/aa/!'�i4,w.A- No. of Persons _2 Showers( ) Cafeteria( )
Other Fixtures
Design Flow yJ 9,rZ gallons per day. Calculated daily flow Q gallons.
Plan Date 3 _Y- T7 Number of sheets Revision Date
Title L®7: //w//!} eW4t4&- � (klt Y- j{y"� T✓l.tir 46
Size of Septic Tank /5 0Z Type of S.A.S.
Description of Soil 4-01 acw
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 of Title 5 of the Environmental C de and not to place the system in operation until a Certifi-
cate of Compliance has been iss B d of Health.
Signed Date
Application Approved by Date !�
Application Disapproved for the following reasons
Permit No. Date Issued
0 / THE COMMONWEALTH OF MASSACHUSETTS ®
BARNSTABLE, MASSACHUSETTS
Certtftcate of Compitance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( 1/) Repaired ( ) Upgraded( )
Abandoned( )by J6 F h!G'I NIO - b F-(()
at # 3.5-1 9LL.16 T �� . C 7�`i AL I/•t-F has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. • 7.2 6 dated "S 9
Installer Designer
The issuance of this t e construed as a guarantee that the sys fun don s de ed
Date Inspector
—V 49 y� +r .s `' • Fee 1
THE COMMONWE/4"�LT i'O'i MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
- Application for Miopool *pgtem Conotruction Permit
Application fora Permit to Construct(Repair Upgrade( y )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.:�5/ 4 j,,, l o—f AD Owner's Name,Address and Tel:No.
Assessor's Map/Parcel A,j�/b C 7k i A4,5 LC-
aa�/ ova NG«Pe.L N�'. 7?1 - ioyo
Installer's Name,Address,and Tel.,No.,�;:j p,4- Designer's Name,Address and Tel.No.
'�.. 55Q C
-FCC LU�"�1-�,� � � 3 6a - 8 f 3/
Type of Building:
Dwelling No.of Bedrooms_� Lot Size sq. ft. Garbage Grinder
Other Type of Buildin ��i:: 4e .a No.of Persons 2 Showers( Cafeteria( )
Other Fixtures
Design Flow yi 9, r7 gallons per day. Calculated daily flow `�/� gallons.
Plan Date Number of sheets 2- Revision Date
Title 1 0 7 11 w /l4 �r AL .� z 4,w,66
4 - _ �-
'' Size of Septic Tank Type of S.A.S.
r; Description of Soil /26 iz[2., /'-0114,
Nature•of Repairs or Alterations(Answer when applicable)
Date last inspected: P
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 Certifr-
Cate of Compliance has been issued-by-t 's Bo d of Health.
Signed Date
Application Approved by /G Date -
Application Disapproved for the following reasons
Permit No. Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS J rr ��BARNSTABLE MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ('t/)Repaired( )Upgraded( )
Abandoned( )by��b r f C m Al U - n F Q)
at 3'�/ t=11 t b h ('_r-Af7F_Jt V/LL has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. J QIR dated
Installer Designer ,
The issuance of this`perrrut shall-n be construed as a guarantee that the system�!il function as desi�nedQ � �
Date l' 17 Inspector j` .//� n r' u
-��s
No. 7 ' v'�1 p
Fe4 l ev
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
1wigpozar *p!6tem Construction Permit
Permission is hereby granted to Construct( Aepair( )Upgrade( )Abandon( )
System located at 3 5/ ELL L 107 r'e Aj if-:R ✓/c.-L C
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 must be completed within three years of the date of this permit.
Date: Approved by _ _
No.._._.... .7-� F��... (�...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O7 HE
...OF..... ... :�:........:... - -
Appliratiun -for �iuvuual urkii Cnunitrurtiun Vrrmft
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
S st at. _
o 5-4
-Address or Lot No.
-----•--------------- =•••-•- -••--•-• •---- /-...
e_ Ow'n c� Address
w f
..............Address._......._........ _
nstaller
U Type of Building Size Lot---lSq. feet
Dwelling—No. of Bedrooms-------- ..............................Expansion Attic ( ) Garbage Grinder ( )
. Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ---_--------------- -----------------
w Design Flow------------ - _________________ Mons per person per day. Total daily flow------------.----.------_ ____�'�-.-_.....gallons.
9 Septic Tank—Liquid capaci��--- llons Length................ Width---------._ .... Diameter------..-------- Depth---------___-
Disposal Trench—No- -------------- g g ��_.� q,----- W' i-------------------- Tota nth__...........-__-_-- tal hin area---- __-.. =...s ft.
Seepage Pit No....,� ................... De �ire .--- rin area------............sq. ft.
z Other Distribution box ( Dosing tank ( ) C'I� ' �L �' v �
Percolation Test Results Performed by------------_- ......................................................... Date----•-------------•--------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water______-__-_---------
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..-..-..___.___-_--.--.
(� . -------•------------
Descript�t ?f Soil---- ----®— �_ 'L 41t
_ W;
w
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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en issued by t e boaj4 of he lth
Lpe
Z„
ae
Application Approved BY - �-- -----le ' �'--;7
Date
Application Disapproved for the following reasons:----••---------•---•---•-•------•------•-------•--------------------------------------------•---•---------------
........-•-•-•----..---_--•-•---------------------------•------•---_...---------•--•-----------------•---•-----------------•--------•------------------------------------------------- ------------
Date
PermitNo......................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
7N�
BOARD OF HEA.
, ppliration -for Uiapoiittt Norko Tomitrurtion Prrotit
Application is hereby made for a Permit to Construct (--_) 6-r Repair ( ) an Individual Sewage Disposal
System at y
....................
Location-Address ,' or L71 ot No.
/ r 6�
�— Owner . Address
. r
Installer Address
Type of Building �� Size Lot... � .__�.. Sq. feet
U Dwelling No. of Bedrooms.-.--.-_---�_______________�-+ g— _______________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
A' Other fixtures =-`--_ -- _
-------------------•---.._.. •-------------------------------••--••----•------.---•-•------------------•----••---....
W Design Flow............------- .._._______..__,.:-gallons per person per day. Total daily flow.__._______________- ----......��.......gallons.
t4 Septic Tank—Liquid capacity c-_5��llons Length---------------- Width................ Diameter-----.---------- Depth................
Disposal Trench—No.___________________ Width-----------------.__ Total_Xength------------------.. Total leaching area....... ft.
Seepage Pit No
Dlamet r_'``-_-_____ Depths bel�tSw`irilet! '�' To leachin arert-------..____.._sq. tt.
��
Z Other Distribution box ( ) Dosing tank ( ) f%�- il2e
aPercolation Test Results Performed by--------- ------------------•----------•---------•-----------•----•------- Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------- ----------- Depth to ground water------------------------
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.__-__---.----_-_-_...
P4 ............................ ----- --1 ...............
........................................---
Description f Soil _ 1
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 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 by the board of health. /
Si ned/' ..`�! ...Z ----'--------- .................
i J j Date_
Application Approved By--------.--- / --
' Date
Application Disapproved for the following reasons:........................................................................................... .....-•----.
------•-•----•---------------------------------------------- ---------••----------•-•-----•----------------------.--.----------------------•--------..----------------••-------------.-------------
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
--
BOARD OF HEALTW_ _
OF...;:. ... >'...........................................----..................
Trrtifirate of 0,ontphattre
THIS IS-TO CERTIFY, That the Individual Sewage Disposal System constructede('—) or Repaired ( )
Installer +�
has been installed in accordance with the provisions of Ar iccVI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.___V / � - -•
.�i .._ .���
-- ........ dated-----. -----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE - 0 ------......2 --------- Inspector------ , --------------------------
776
THE COMMONWEALTH OF MASSAC SETTS
BOARD OF HEALTH
L7
�f 7J ./...�'�"�'.- ......OF.:..........�:..� -��.�.. �................... __.-----
No...... r -----•-- FEE.�0
%sVviial ork,i (loo trurtion Vomit ..
Permission is hereby granted____. ._Y �.`'� .._.....__.._r___t �_-- -
------------------------•-••----------
to Construct or Repair ( ) an Individual Sewage Disposal System
at No..---•-=...•••-=y..---:;?............ = •"•'r^'�-
..........t. _ �^ %� i
- Street L.I/
as shown on the application for Disposal Works Construction Permit. S�
PP P - - - - Dated..-•------! -----------------------------
------------r`{ '. :I-.-
G e -• Board of Health
DATE.... _.:-- - —
FORM 1255 HOSES & WARREN. INC.. PUBLISHERS
-41
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I.00QTION ( t�bt5EWW:CE PERMIT UO.
v►LL pCaE 2sLi L,-�.
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IWS71%LLER5 lJWE ADDRESS �
BUILDER 5 Q &MF- ADDRESS
Eywz
Dth,"TE PERKA T ISSUED
D e.-TE COMPLI W ACE ISSUED ; 'VS� `
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fi
f GJ'r�tZ�/1� TEST HOLE LOG
DATE: M4-C- 00V-5, 1q60
SOIL EVALUATOR: A, Jpoes, p�,
WITNESS: FAUJ— Nl�i
PERC RATE: <Z M 10/I tJ
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4-
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DESIGN DATA
DAILY FLOW:(41 BDRMS.z 110 GPD=4 0 GPD
G4�5 SEPTIC TANK:,40 GPD z 200%= SSa GPD
USE: 1500 GALLON PRECAST SEPTIC TANK n
LEACHING FACILITY:
(�b USE:(5) Soo 44&.,V0,(W 0"9 u 1J Er-p
K 4' of jAAt5!{C-0 s�
CAPACITY:
5 F, 1Z '� �ti ( SIDEWALL:q3 YL Zx •74-
-- BOTTOM: 13')c 35,5 x
frizz- #A.L ?. 4010 SC Act 5 9 TOTAL: 4� q 4P
-r8�(• ��. y4.,7 s9 �� sx Timis p2�,v�'r�;voc.s tio� c✓�,�-✓
-Fo
11 Of
NOTES-
I*ALL PIPE TO BE 4"DIA.SCH 40 PVC. '
2. PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION
BOX.
3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN
6"OF FINISH GRADE.
4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A
GARBAGE DISPOSAL
5. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED
ON A 6"LAYER OF STONE.
6. INSTALL GAS BAFFLE IN OUTLET TEL 2•LAYER OF YS'PEASTONE OVER
Y4*-1 1/2•WASHED STONE ALL
AROUND
TOP OF FOUND.
(g EL. Zgoo \ 10• 14, \
21•� � C �Zo.33
4 ". e 21,0o Zo 75 20.50 Zo.o0
SEPTIC SYSTEM PROFILE
SITE ^� SEWAGE PLAN GENERAL NOTES
FOR 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION
LdrS .1` 1 IDI 11..1d�'� �D, ► e-r 1t ,E OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR
TO ANY EXCAVATION OR CONSTRUCTION.
�?' r4A e 98 2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH
PREPARED FOR 310 CMR 15.00:TITLE V.
v) y � ' } 5 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE
f•� DETERMINATION.
DATE: M49 l69'7 SCALE:AS IJ�6b 4. ALL DISTURBED AREAS TO LOANED AND SEEDED.
5. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY
REQUIRED INSPECTIONS.
�1BM
A Z27 pAc's .. 82
N OF
DANIFL E 9�yG; f' ` !r fir€
BRAAAAN N �:: 3 �
V No.32686C y:
• IS7 SUR
C4 y��
WELLER & ASSOCIATES , G ,I
1645 FALMOUTH ROAD CENTERVILLE,MA. 02632
TEL: (508)7754735 FAX: (508)7754754 3 _7_ ? g•.q 7
APPROVED BY:
OF
BRAMAN yG� , ♦ -
� CIVIL
0 149.32686C y -
9
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5..s..;.xx�-,. a:.:P�Ti!,'�' �,S.tm.�,�-..:. : _. ..i .-. ;l- .. ... ."✓iC:n-HF �a5..'rti"'*t�s``3F;1, '�a'4 e:.5Y,....- an :>;s. ..'���Rk".ed�s.�' E `�+�i��' � '� .
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e
{� A_ 1 r `r.. I ��`�+�•c�yRnd'«Lsc7S.*�'�� .I �«a I ���, I� "r€r' 4 ��"",r�'"�.�� r ��,b��
A I iy
-
I A Y ? .'
G ►J'r �/E� TEST HOLE LOG
DATE: 1 'rl t✓, 1980- --Z-
SOIL EVALUATOR: A, jo?Aes p�,
WITNESS: FAUl. N
PERC RATE: C Z r11 tJ�I
Z3,5 o" ZZ,5 0"
{OAH l,o4r/
144
v ►� V'
H P&---4
DESIGN DATA
DAILY FLOW: (41 BDRNLS.z 110 GPD=44o GPD
Gm�s SEPTIC TANK:-40 GPD z 200%= 88a GPD
G�,N�,�► USE: 1500 GALLON PRECAST SEPTIC TANK
LEACHING FACILITY: !
b USE: u I I�lc*I.4
4' of UTASkc-0"sT5`
CAPACITY:
SIDEWALL:g3 X ZX
BOTTOM: 13'x 33, x •'74 = 322 3
iz
# 9 TOTAL:
4�1 ,9 4PO
."1 ti- IEI,. Z,t .1 s"q boo s�" Tiy/.S ���'Dr� %''7' ,®DC�S .CJD7" �../E� :/-✓
-For ytatefl�'- P� tJlcl2� �9i" O/S?/tOC?.., E�v2
s
NOTES:
ALL PIPE TO BE 4"DIA.SCl[40 PVC.
2. PIPE TO BE LAID LEVEL FOR V OUT OF DISTRIBUTION f
BOX.
' 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN
6"OF FINISH GRADE.
4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A
GARBAGE DISPOSAL.
5. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED
ON A 6"LAYER OF STONE.
6. INSTALL GAS BAFFLE IN OUTLET TEL 2•LAYER OF 3/8-PEASTONE OVER
NP-I V2-WASHED STONE ALL
AROUND
TOP OF FOUND.
EL 2�oo \ / ID- u-r
oo 5 Zo+50 20,oo
SEPTIC SYSTEM PROFILE
0
SITE SEWAGE PLAN GENERAL NOTES
FOR 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION
OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR
''"��I`•l TO ANY EXCAVATION OR CONSTRUCTION. N
2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH
PREPARED FOR 310 CMR 1S.00:TITLE V.
` !
� v(� + � '�` -TiZ4 H15Lo:r- DETERMINATION.
DATE: MA" 4,16M7 SCALE:AS OCEID 4. ALL DISTURBED AREAS TO LOANED AND SEEDED.
CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY •
• REQUIRED INSPECTIONS. is*
%�1 ZZ'7 7Ar�rE.L. 82 IN OF
KAMAN
p CIVIL -
t� No.32686C
SUR �p6
WELLER & ASSOCIATES
A 4-301645 FALMOUTH ROAD CENTERVII.LE, MA. 02632 _ � �1
2a�,ewed�
TEL: (508)7754735 FAX: (508)7754754 2 - 4-•fig-9 7
APPROVED BY:
OF�,J� till OF
9 cs
p� DANIEL
- BRAMAN -
r G CIVIL
0 No.32686C y
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