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HomeMy WebLinkAbout1808 FALMOUTH ROAD/RTE 28 - Health 1808 FALMOUTH RD. CENTERVILLE A = 189 032 1 I ml u�c as3a No.2-l' 0 JIAYTINai.pN, TOWN OF BARNSTABLE LOCATION O }� WtoV p0 SEWAGE # v Q VILLAGE Cjr u itful-yc ASSESSOR'S MAP & LOT INSTALLER'SyNAME&PHONE NO. 2 6� �' SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 2x 1 a„�_ NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: ' O _COMPLIANCE DATE: 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 Feet within 300 feet of leaching facility) Furnished by. -------------- yy a - - No. 0 Fee$5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: /: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS . , 21pprication for �Ofgpogar *pgtem Cottgtruction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components •• Locati n Address or Lot No. Owner's N 'e,Addre and Te.No. 1808 Falmouth Rd.. , Centerville Pau ine wec Assessor's Map/Parcel C T 6` Q, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service PO Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 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 S and. Nature of Repairs or Alterations(Answer when applicable) j i t l P—� l P a�h ors t P m c o n s i s t i n g n f a n—hnx and 2 nnnnrete leach chambers with stone all around.. 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 t s oard of Health. Signed 1- Date Application Approved by %CdNs_ Date 7.-A de) Application Disapproved for the following reasons Permit No. ;Zam *n Date Issued (/ wit i� No. � /60 - - Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for &.spool *patent Construction Permit Application fora Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components P061T t''aTmord'd ' Rd.. , Centerville 0 wnf5jU112 gregW6C? o. Assessor's Map/Parcel ' ! Installer's Name,Add s�,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service PO Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 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. n Description of Soil Sand. 4 Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system Consisting of -a ,,D-box and. 2 concrete leach chambers with stone all around. a 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 itle 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has beenOssi'ed b s oard of Health. / Signed` '� t 1 Date �C, 6­0 Application Approved iby'f Date .4- D c) Application Disapproved for the following reasons Permit No. ;pc;n - �f 6C> Date Issued —————————————————————————-------------- THE COMMONWEALTH OF MASSACHUSETTS Sweck BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X )Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Servi . at 1808 Falmouth Rd. , Centerville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.off- VOC> dated ,Ji Installer Wm. E. Robinson S r. Designer A /�/4�. _ � The issuance of this pe ' al n t b v M11functi©n as d�si c strued as a guarantee that the te'� gned� Date �� : Inspector f t — o --- -----�-----------------------Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Sweck PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwitpooaf *potem Construction Permit Permission is hereby ranted to Construct( )Repair(X )Upgrade( )Abandon( ) Systemlocatedat 1.08 Falmouth Rd.. , Centerville 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 thi permit. Date: 7-G ` ao Approved by 1161" 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) I, W i 11 iain E. Robinson,S t%reby certify that the application for disposal works construction permit signed by me dated Z—2— 00 , concerning the property located at 1808 Falmouth Rd.. , Centerville meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. b/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. .l/(7'tere are no wetlands within 100 feet of the proposed septic system /There arc no private wells within 150 feet of the proposed septic system (./ ere is no increase in flow and/or change in use proposed ere are no variances requested or needed. • The bottom of the proposed leaching facility will t 2tjt be located less than five feet above the maximum adjusted groundwater table elevation: [Adjust the groundwater table using the Frimptor method when applicable) If 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 G1S information) B) G.W.Elevation +the MAX High G.W. adjustment DIFFERENCE BETWEEN A and B r L) � y SIGNED 4/�J >�...., DATE: [Sketch proposed plan of system on back]. y:deaM folder an i i � E + L =� TOWN OF BARNSTABLE e LOCATION 6$ PSI wtW-+1_ Qc!zAQ SEWAGE # a608v 1/60 VILLAGE CC-vU &Z_U L(e- ASSESSOR'S MAP & LOT y INSTALLER'S'NAME`&PHONE NO. SQp{1C "77S-9T 7,C, SEPTIC TANK CAPACITY .006 LEACHING FACILITY: (type) `MV LJC__(f S (size) PA 1; (P,5 NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 006 COMPLIANCE DATE: Oda 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 ��a�� o is ��� �. �� ,, , . � *,. �a, << `mod �. . , � r No....g'.....'�. . `j �` ' Fas. 0�.• THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEAT 9 ..........OF...../.../.. .... /f✓...JG.. /.. .............................. Appliration for Disposal Works Tonstrnr#ion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: n -��--....... ..............•-- ..11.�?�=Y - / '......_... .--------•---------_------__.:............... jL ti Address or Lot No. .f=! •.. ... .. ..... ..... /..... l �� --. ........................................•---•----•--- Ownez Addres (� .._... ._._.GC2GC--• .......... ..... .._......__........-•-• ................�� _-! ls"�.--L'l '�.-•--•-• 'R. 1.��.� Installer Address � Type of Building Size Lot___________________________Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ....................... No. of persons.................._........_. Showers ( ) — Cafeteria ( ) Other fixtures ??! '..............••.........._.._.. _ . W Design Flow.._........ ........................gallons per person per day. Total daily flow..........F9cU......................gallons. WSeptic Tank—Liquid capacity/-*V.-zLgallons Length................ Width...... Diameter-_-e.!?.D.Depth....-_......._.. x Disposal Trench—No. ......1........... Width........ Total Length.......'. ..... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tan4���/) �, '-' Percolation Test Results Performed b � Date..a<�,.- .Zz.....: / Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GG _ .. .-•---•--•- - ':......._. ...........................................--...---- 0 Description of Soil--------•- -- _�.^..__ ...---. �_l^P�___.._� ��__...._ W --•-------•-•--------------•---•---•----••-------•-•---••.......---•-••----•....----•--••••-•-•••••--•--•--••---•---------...•••-••-•--••-•---•---...----•-•••--••••--••-•--•--•-•-•-••••-...•--•_----- VNature of Repairs or Alterations—Answer when applicable............................................................................................... ---- --•••---•---•---•••--•-----------•---•--.....••-•--•-•----------•-.........-••••-••-•-•.............•---•-•-••-•------•••••---------------------------•-•......•----.....•••••-•........_-••_••--• Agrees t lie undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t pro i ons of i .f 5 o A112 State Sani -ry Code— The ersigned further agrees not to place the system in per on a to ompliance s b n_iss67dd by the o health. Signe ---._..... - ....... ................................................ ......... - �1 Date A li t Approved By..............•-•-........•-•-• •-•--Jr1_...... Z�._'t.- ._......-•--- ---•- -•-•--••------••------ Date ication Disapproved for the following r as ns---------------------------------------••----------------------•------------------•--•--••-=--•••--•-•-••----.._ ..............•--•---•-....-------•-•--..........___••••--......---••--•-•••• . •••••-........_.....•-•••----•-•-----•---••-•-•----•-....-•---•-----•-••-----••-•----•-•-----•---•--•---•----•..._.._. Date PermitNo......................................................... Issued....................................................... Date '+ pG No.................. .. FE ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH IV Applirtttiun for Diapuiittl Works Tonuarnr#ion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: c�t�pn _.- - ---- - _ ......or Lofb ....._.. rr y r `�C.� '- ress wrierAddress iInstaller Adre Type/of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.......... ."" Expansion Attic Garbage Grinder Other—Type e of Buildhi .............. No. of persons a yp >sg ______________ p Showers ( ) —'Cafeteria ( ) may--•-•--•-••--- dOther fixtures . --••-•--------•------•--------•....._----- ••.................•---•--•------••.....•---••••- Design Flow............ .. ^ '" � ' ....._gallons per person per day. Total daily flow.......:..._ gallons. WSeptic Tank—I_igmd capacity_.f,, gallons Length................ Width._............__ Diameter__.__ _o.�Bepth.......... 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 tank ( ) a Percolation Test Results Performed by.,-------- fider ._..f �n �... Date-.__ � l` . Test Pit No. I................mmutes per inch Depth of Test wit.._.............._.: Depth to ground water........................ (� Test Pit No. 2----------------minutes per inch Depth of Test Pit............. Depth to,ground Water.............. -------- Y O Description of Soil- - L _. 2 }� :... VNature 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 1ITt.8 5 of'the State Sanitary Code The,undersigned further agrees_not..to,place..the,system,in operation until a"Certificate of Compliance.h r>:issued by they of health. Signed: __... ;- -- ------•--------•---•--•--•-•----_---•- Date Application Approved BY -• .1. ..•• •................. -•-- Nate' Application Disapproved for the following asons:............................................................................................................... - --••-•-•---------•---•--•----••••--•-----...-•--•-••----•-•-----•-•-•----.............................................................................................................................. Date PermitNo......................................................... Issued---.--................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ . . O F ...... CIrr#if irtt#le of TortIt Ina THIS IS O CERTIFY That the Individual Sewage Disposal System construct ( ) or Repaired ( ) Lam, - ' 7� ..... ifsfalc�e, .. ;_... .../_� ........�- +-r at-------- 1/--------------------------A-%--1--....---.-------- -._.v..l....4....---C........--------- ---.....J---------.................----- 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....... :':_57_`tJ_...... dated___...__��.:.:z_H.-�........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY.. DATE........... . •• >�--•---------------------------- Inspector............ _` ....----•- ;.:... .................. i THE COMMONWEALTH OF MASSACHUSETTS u: BOARD OF HEALTH ' tF 9 1 c� OF...........:..: aG .; �.__%........... _ �i��outt u �onu�r hermit } _. Permis ' n is hereby granted................. ..., .....�..... v .::' .'.::.... :.....�.. to Constrt ( . r R it ( ) Individual Sevda e Dispo S st at No.....................................................G. .. .�`.. �v�� � c T 2 V!G G E_ ,v. °�� 5 ion Fl yrKJ 1 j, Street as shown on the application for Dis osal Works Construction Permit No..................... Dated.......................................... f1 2 - -. Boar o DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON 1 p( r.n•�.�w• --.t_��� - ....�...�_.... __..._...... /Go � Wrv7r/ . Sd-T a,1 c.KS 4 /�loTE �Q ssv M�D Go 7 Al 0Ter—p(' / �'�� ARr,l � v 6wM6 fins 7aw.� ,( y cis ws 4-14-n x-) _J O, v 9 kv �.. o F 0 ° vi ' G,q,e. +to r � Lu 7 z `( %S 'U.5'_�' W I I� 0 � q Lc- u !� NAi: II y , (N6 0 II'o 9 4C `e eCz55 Peal% J 114_ ✓� (� 2 f3 ALBERT gin\ rnr A. n o MOR.SE �, g �' i i E cn ejQA, No.1095'l O �) `�,t , Pay 1-;.:�, '`(( 4t "=LEGEND.- EXISTIN® SPOT ELEVATION Ox0 EXISTING CONTOUR --�-- 0 — -- CERTIFIED PLOT PLAN 110111INED SPOT ELEVATION _ .RI.�i,l H9.0 CONTOUR -- 0 z >f PL g/V 2-'�,-7 rU. ;3! NOTE: The location of apy. existing uunder r. oun�d sew.�rage, . wglIs, or other utilities. sbown on this plan is approx- ' -imate onlyas. determined from records and/or verbal • ;informatin. ,The contractor :is 'responsible for the SAJlh`S fA�1+Z j1JASS+ 'verification of the existing locations In the field. gCALEs DATE /0 z3/ems s> 3A-kff5-rA6 LL i; DREDGE �'NGINEERINe C� /N C�.IENT.�,._._��•v� 1 CERTIFY THAT THE PROPOSED E01$TERI: RE01'TEREO 40 tMO, 8S v BUILDING SHOWN ON THIS PLAN CIVIL 4 =' LAND CONFORMS TO THE ZONING LAWS . # B E ��, OF BARNSTABLE , MAS ` 7'12 MAI N STREET`:; . C,N,. I$Y /6 z3 s� HYANNIS' :MA9$. ``----- <- SHEET—OF DA E REG. LAND SURVEYOR ;: r �,h lk kq C U+ `:i rl tk � \to o. Qj � � � U VW v;u •av '• a' 4�� (1I 1(� � � • . r • �• 4 I � J � V I h anti w `via 174 l J kj • � ��� Q �4 t- •� WVw. • • � � � � � :Q tit) U, ItlON I W �` �1 o • a • 4 town a_• \ ( (/ _� "' 'V ,� M• ++ L1 y J N QJ � 4In 44 l< tq V h Q V O ` \ \ 44 ry VnnZ, �t ` �i �J � Il; 'R�J//�•- Irl 4tj � v h4Q t b v ;It�\ h 0 q v h �: cj :l Gi toL2. ;l► ` i r 'V 1\ 4 W l ti � O � O � ui � h q 'G 4�y - ova . SEWAGE PERMIT NON Z-07 V %T cQF VILLAGE INSTALLER'S NAME&ADDRESS azm �b BUILDER OR OWNER M DATE PERMIT ISSUED t� zY/O5 DATE COMPLIANCE ISSUED 1 L-2, I � r 1 tq©k)T �I 30 00 o .