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HomeMy WebLinkAbout0083 ENSIGN ROAD - Health 83 Ensign Road Centerville. 147 069 I for. UPC 1253a Now '` r �MA�tINOY�YN; ° 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ves PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprtcation for �Digo!gar *pg;tem Construction Permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ©4 �Q i f Owner's Name,Address and Tel.No. „� ErV S rq rl 2 C�r� ;�-i1 i P- if Assessor's Map arcel � -v19 Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No. Z T P �oA 1� �� &� 2 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 3-3`l gallons per day. Calculated daily flow —3 3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ( 157y 6 Type of S.A.S. �`J,L � ([5.'�S �Z � �� 7 N Description of Soil Nature of Repairs or Alterations(Answer when applicable) IV �- u$,Y �-V4 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 f Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i ed by his oar H lth. Signe Date Application Approved by Date 0 Application Disapproved for the following reasons Permit No. 3 0_ Date Issued No. �W ^J 3 0,e+„r��, >' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rppfication for Digpoml *pgtem Congtruction permit Application for a Permit to Construct( Repair( )Upgrade O Abandon( ) ElComplete System ❑Individual,Components `f i Location Address or Lot No. 0-4 0 Owner's Name,Address and Tel'.No,. 9S r rv. S i S n Rd -�+�---,1�.c.LLr� n�t'n�it� b<,e ► � ,Q SIG �i✓n�J} a ., Assessor's Map/Parcel r ,pr yy�,� lq7- vs9 S r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.Nb' `7 S` -C+ f ko C�= `�.49,* �(I .� k"V / Cv u Ito l� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) t Other Type of Building No.of Persons Showers( ) Cafeteria`( Other Fixtures - Design Flow 33 gallons per day. Calculated daily flow -3 CD gallons. i Plan Date Number of sheets Revision Date Title _' Size of Septic Tank y Type of S.A.S. �-�. S 4 (0,1 S X L I r . 7 Yo Description of Soil Nature of Repairs or Alterations(Answer when applicable) / t -) Date last inspected: ~' r Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisior�s_ofjitle 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been 15SW z d by is oard o H lth. ) Signe Date Z" Application Approved by Date' �0, Application Disapproved for the following reasons , / A, Permit No. Date Issued Cii r y r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS —; Certificate of Compliance THIS IS TO CERTI�Y, that the On-site Sewage Disposal System Constructed Repaired )Upgraded g P Y (�) P ( Pg ( ) Abandoned(^. )by 'rA) at _ r ' ✓l has been constructed inr accordance ' with the provisions of Title 5 and the for Disposal System Construction Permit No. 20 - 32,u dated 6 2 ). Installer ' Designer The issuance of,thi pt/��.all ri t be construed as a guarantee that the yst m i 1 ctio as designed. Date �_ _ ''� inspector `t --=-------------------------------------- i No. @cam Fee U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1wi!9pogal *pgtem Construction permit h Permission is hereby granted to Construct( )Repair , )Upgrade )Abandon,,( ) System located, ? r - 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 da of this p�e t. Date:_ / (U Approved b Town of Barnstable IF,E Regulatory Services Thomas F. Geiler,Director • BARIVSFABLB. • . MA-5S- Public Health Division sEo Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: eFVW1VI49 Installer: /U Address: .BoX Address: �(4-- �buk On �' - -2F- 266q Mb21A) was issued a permit to install a (date) (installer) septic system at �Sj Ct11S(W based on a design drawn by (address) C1�t�/a2T� Lr• h! �y dated G�y��l,� (designer) v� I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. SH OF N4ss9 T -//(Inst ature) EDVYARD EDSP� K E. s r e) (Affix Desi tamp Here) ST PLEASE O BARNSTABLE PUBLIC HEALTII DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BARNSTABLE LOCATION Tt:-A/s L SEWAGE # O`P.`,,3dZ VILLAGE .I wI I S n ASSESSOR'S MAP & LOT `I -U6 INSTALLER'S NAME&PHONE N0. �T C SEPTIC.TANK CAPACITY fco= - LEACHING FACILITY: (type) (size)NO.OF BEDROOMS BUILDER OR OWNER K PERMTTDATE: f0—,)-9-0y COMPLIANCE DA j 7=I _�dpY 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 • I r-� v A qr. LO CATION --' S E W A G E PIR"Ml T 0• (D -�Ste` VILLAGE INSTA L ER'S NA i ADDRESS 'yam ex ► ,� in C t U I L D E R OR OWNER a DATE PERMIT ISSUED DATE COMPLIANCE ISSUED =NOR No ,�1 -7 3Fizz 3 r,.,. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........OF..........Poe&511.0&1 ApplirFation for Disposal Works Tous rur#inn rrmit Application is hereby made for a Permit to Construct _<cr Repair ( ) an Individual Sewage Disposal System at: Location,Address A �f or Lot No ................. Owner i Address Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms________________ .....................Expansion Attic (Alp Garbage Grinder (A40 04'4 Other—T e of Building ____ No. of persons____________________________ Showers — Cafeteria a' Other fixtures ____________________________ _ W Design Flow__________________________________ alions per person per day. Total daily flow........_�_t-__�.0................gallons. 05 Septic Tank—Liquid capacity (p Q�� allons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. ...............I_._. 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 ( ) � .._. Date__________________ '-' Percolation Test Results Performed b t.c.&�f�_�f :____[`.�_ ��/1 ./..l � a Y Test Pit No. 1__4__t_5_S__minutes per inch Depth of Test Pit_.___.•_=�,_ Depth to ground water____ fs, Test Pit No. 2___ th-41eminutes per inch Depth of Test Pit_'_ _____________ Depth to ground water...... �? __ �•d� 01 -------------------= b ----------- ----- ...®._.. 0 Description of Soil.......................................:-®-�='-------------..��I�'! ---�---� - ' ............................................................... -------------------•-------------•------•----------------•------------------•---------••--••----••-----------------••-------------•----------------------------------------........................... 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 iITIE 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 o ealth: Signed 5' �1 ------------------- ,p� Date Application Approved By......... d�/' ........................... ....... o��/��r� .......... Date Application Disapproved for the following reasons:-----•----------------------•-------•------------------------------------------------------------------•-•-••-- ----------------------•------------•--------••-------------------------------------------•-•------...-••----------------•-------•--------------•----•-••------•--------•-•----------=-----------•...._._ Date PermitNo......................................................... Issued....................................................... Date 3,5 FEs. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .W- V .........OF.......... ' °g 3. `✓ :�/.`:.......-•-------------------------------- ApplirFa#ion for BigVus al Works Tonstxnrtion Fautit Application is hereby made for a Permit to Construct �,er­0 r Repair ( ) an Individual Sewage Disposal System at: T-T.- I ,� - ...... •- - /' Location-Addres$ fy r� e7 or Lot No.. » A 5✓ e� i` \ f✓.W -YFi ......................».-.-. y........_........-•--••........................__...--••--•- --.. _.._...---- -1........_._...._.........42 .. ...---•---._.._........--- �--- Owner + Address �_srar S � .......--•-...-------•-- '.: ate wr ----••............•---•-.--••-- •-•--••----•......................... �.. ?... ..f .............................................. Installer Address d Type of Building ^�`� Size Lot............................Sq. feet V Dwelling—No. of Bedrooms----:..............7.....................Expansion Attic ( Garbage Grinder (,, 4C.) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ....-------•••--......••..........•.... . W Design Flow................... ......................Fallons per person per day. Total daily flow........ .f .................gallons. WSeptic Tank—Liquid capacity;L UQallons 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 (A, Dosing tank ( Percolation Test Results Performed by-----------------_.:F.�__ . 5....... Date............................ Test Pit No. 1-_4---r.5.t__minutes per inch Depth of Test Pit----- Depth to ground water.... � P P T .... P g ----- - _ _--._ Test Pit No. 2.... �,!! niinutes per inch Depth of Test Pit.................... Depth to ground water._____! �^ _± s! a'� O _.dam.�.............. L)i^i� °. 1- ...................................................... Description of Soil-------------•-•-----••-•--------------........:--•- - - x r w� ==r y r. rl �11101_") U ....•••--------••-•••-••-••---•-•-•----•-•••-•--•-••......•-----2----=-- -------------------------------------------------------------------------------------•---- 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'?TL Z S 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�liealth: sal JI i p r O � �• r,, ApplicationApproved By...................................................... . ----•-----._.......----•-----•-•. ----------•---••••-•--•------------•-•-- Date Application Disapproved for the following reasons-.............................................---................................................................ ••--------------------------••---•-•--------•--------------------------------•------------.....•--------..... ------------------ Date PermitNo------------------------•--------•-••-------------.----.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F........... OF................ :.,....... .N...... ...;� Trr ifiratr of Tomplionrr THIS IS TO CERTIFY, That the Individual �ewage Disposal System constructed ( 1�)" or Repaired ( ) by.................................... ='" ------...t 4?'' ------------........---.........-- .............�...---•--.....----------------...-- at 1 LJ eInsX ^S C�� 4J &I t --�-•----.....-••--••--•--....._---•�----------------- ----------•--------------•----......--------.....--•----•---- .,y has been installed in accordance with the provisions of 'L 1T& 5 ,State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------.---.__------___---__---_----.-•----_-_--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................1^��_ �------...._..---- Inspector......... �l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w 3S OF rt ✓ , y No......................... FEE........................ Disp lsnl Workg %Tonstrudion ranfit Permission is hereby granted............................. ;' `_ ....___._..1 !__ .s'a. . .. to Construct.(--' or Repair ( an n ividual Sewage Disposal System atNo....................................Zia- .. i; - - -- _ Street as shown on the application for Disposal Works Construction P ' f..�?....... .............................. ................................................. 7 n >DATE............................. -••---•---J•--(•% —1$2...................... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •ZO FT. M/N. /1lOTF /F E/TNER THE S'FPT/C TANK OR LEAC.w/NG PIT ARE MORE THAN /2"BEL.O K—'� , /D JsT• M/N• .rrRAOE� A 24'O/AMETER CONCRETE COYt�R' . SHALL QE aROUGIyT TO GRADE.�AN C:0NC4qE76 4~P. P0ITCH P/PE XYE.4VY CA ST /RO/Y COINER .Sf/.4LL L3E USED EL=9-7.o COVERS M/N /F/IV DR/VA=WAY- 2 q• M/N. CDNCRFTE A o: MADE co VEft CLEAN SANS .-� L/QU/O LEVEL - ' • . - •tom/ r771. _ Z LAYER ' RON PT/PE i 1000 G�1L. o v o • P c o OF /�8 --��8 ! ~'¢ MIN.P/TcN D/ST. + • • • • • ° • • ' ' 04 WA5HF0 570E %4 PER l''T $APT/C TANK ° e • • • • • • • • • • e . 1*' BOX c • t B • ° • • • � .°° i D EFFECT/✓C • • • . • • • pEpTN • • t ' • v , WASHED STONE • • • • • • • • 1 �p o . PRECAST SEEPACF.- 2 S = 4-7 I C.P. p. ► a. e • • • • . • • • p °•n P/7 OR E9U/V. l NfiBRT EL EY.4T/ONS . G.P. D. a • • • • • • • • e o -7g.� xt.o = 1g � p o a >=L = '27o 1NYERT AT OUILDING �1�.6 FT, 6 D/AM. P,rC_-nP^C(T 4R P• D. C(SEE TABU44TJON> INLET SEPT/C 7�141VK 9 3.9 FT OU71-E7>SEPTIC TANK 93•t- FT. INLET D1STR/8llT/0N BOX 93•4- FT. SEA-�aN O,�- GROUND JoV,4TE TABLE O tlTLETD/STR/BUT/ON BOX `i 3•��- FT. C" INLET LEACHIMa P/T 9�,o FT. SEWAGE O/SPOSA L SYSTEM T- J4&.AT/DAl LEACH//V6 p/T DIMENSION A FT. E DES/GN CRITERIA SCALE %I _ /= o" p/,•BENS/ON $ FT. NUMOER OF BEDROOMS 3 D/MENS/ON C 4 FT. M t ti.,, GAReAGEO/SPOSAL UNIT ® SO/L LOG SD/L TEST • TOTAL E3T/MA7-46D FLO*V 33� 0.41-1DAY SOIL 7-E5T A/ SOIL TEST**2 NUMBER OF LEACHING P/TS � f^FLEY. 94.3 �`-ELgY. >ATE OF Solt TEST cc� ' S/OE LEACHING PER RPr I SO, FT. RESULTS i'd/TNESSED BY -� 60TTOM LErgCN/NG PER P/T �� $Q. AT. O`_2 ec PERC0LA7-/0N RATE At l L=`' MJN�I/Ni C 26(0 7-4SO `- PEitCOL,AT/ON RATE> 2 'Ti TOTAL LEACH/IYG AREA SQ. FT. RESERVE LE,4CNlNG AREA 2� SQ. FT. i W OF M,� b�' ar3 /lti<t SSa� Lc)T r�2 � may\ f`�,,�., r;� �-:5[✓ o HN N\ �,��/ E P BERT s\ .p�Na29874�0 1� No. 1095i�c�� ELOREDGE ENG/NEFR/NC,r CO,//e` Q/8TE� Q` \A F.. TAP/<` 7/2 MAIN ST. �N �yo 90 E�-B'L.3 O SURD cs.c: � F`? /y0 GRO[lND LY,4TEfr ENCOUNTL�REO NYANN/3, MASS. ij GR0 U/VD YvATER AT J06 No. �stp23 SHEET?OF ?. 1 t* �9 cli ' 3•G Q 00*1 K, i y T $ F OS• F' ?o'* art O i23 3 � N OF rA4 1/ Q 15,wo sF F�a AL ER 9c�N �T `b g lco'WIDD-0 20' FS•P�. E o No.1v951 ,off"p�C S„O JA EXISTING SPOT ELIEVATION Ox0 OF Ass�`y� CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 --� c FINISHED SPOT ELEVATION LaT Etic�` ��.. Q.�o FINISHED CONTOUR 0 MAC`_ tc IN APPROVED BOARD OF HEALTH DATE AGENT SCALE, I 4-�� DATE: 12- 105?l LDREDGE ENGINEERING CO. INCCLIENT ! I CERTIFY THAT THE PROPOSED EGISTERE REGISTL�RED J08 N0. �. BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS % DR.BY . gr, 712 MAIN STREET, CH. 8Y ASS. ENGINEER U R V E YO --•---�-----� O F B A R N S TA E, � ���� ' � H Y A N N I S,. MASS. � 12 I 0•gl _--, �." ��=�--,'--�---- SHEET OF 2 DATE R G. LAND SURVEYOR s' ae m j j '�� V TOP OF FOUNDA ]ON ° � �� �iloll �.., CONCR=ic C.7V=R5 4"CAST IRON 9� - ;`. ® ':•' .�, 0 J-1 1Vlf i OR SCHEDULE 40 .. . • o `:'. 1. 1�� J I �• P_V-C. PIPE MIN. _ n 4"SCH=DULc 40 P.V.C. (ONLY) t . ` ',• r �' 1 ,,, ?ITCH I/4 PEr2� ti�rsr z 9-"MIN _ LEACHING TRENCH ( r )REO 35 MAX PIPE- MIN. o TCH 1/4"P�_.% -- ro�ccy�L I/8��- I/2� WASHED STONE �� M __tea.- 2 INVEZT GAS BAFFLE-ti L: J Fc.87.-qf EL SEPTIC TANK �— INV='T STO E� — • r - - _—' _ -- __� 8S-e INVERT - Gscisn�c Z87.�8.. Z99,Z3 - /eeo _ _ - ` B Ih1l=R; — K. S �L DIST pX y� 14 SC_�4o c9r'i4�as 3/4"-II/2'-/ 6"CRUSHED STONE 87 H-Zo WASHED STONE .....•,- N (." •;• /3' eQ�r I INFILTRATOR S o, PROF] LE 0^ � .v..v�r �teu.vrtxirp G/LL p!1 �?. c _. ��/� 1-47 ��c� t i- fi 2c� SEWAGE DISPOSAL SYSTEM GROUND wA�_� ;��L= " � r St ( . (o . SOIL LOG T1tAE _�/:oo .4r> NO SCALE TEST HOLE 2 �LV . s- 3o =LEV. . . . , .. . DESIGN DATA - / EZ• . L=�C-ING aR=A a VMSHED STONE SO.;7./7, NC'.i \ Z" cp• SiDE L=.^CHING ,^.?=A ir.=?JCH 8 GARSAG7 DISPOSAL or •(50 ro A - INCR Sc) iu-a:.. L1.CriItiG ARIA 07 p GE35 fq.v z Hi✓ r)----4.Lr% ?ERCOLATIUN A'z PER. INCH -/e,zf -- —�O Id v F1 LAC:•IING AR=-A ?_:Z P=_RCOLATION :.Tc 3 rt3 So , G.P,D 5� GROUND WATER TABLE Cp /44' Ez. B2„3d A??ROV=D . =Oa._D OF H=ALT?i vrl WITNESSED BY --c-NT OR INSPE:-TOFt GOA.=.D o= r:=.aL-Ji P=,1 a 10N E? /`�fq/ZSTD�/S MiG�s /"Jfj . o - . OV �� \ , ' •S! T�" �L�/�/ 1^/ �/��z.v.ST/�/�� L" M�9ies70nrs /kf I• � r tDw�9/et L. uey I f i -H OF kq.9 4C o Z-43 7 �R,tG CFI STETS y�� CP �N Of KELLEY '^ EVALO' No. 25100 E' IST L i i NoyC ��� vi/T7aws 1�,9sEr> �r��,✓.� /C��