HomeMy WebLinkAbout0090 GUILDFORD ROAD - Health 90 Guildford Road
Centerville
172 056
No. 4210 1/3 ORA
Pendaflexe
100
No. ?o V — J /,;� Fee�V
THE COMMONWEALTH OF MASSACrIIeSE'ETS Entered in computer:
:�<�
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplication for Ziq;pozal *p5tem Conotruction Permit
Application for a Permit to Construct( . Repair( )Upgrade(' )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Inst�ler's Name,Address,and Tel.No. j eZ-1/20—%7�� (1� Designer's Name,Address and Tel.No. S
vvSz p�v �-L 9,fr, O-5 66ut CID-ve 1;5 Ems'✓
/ /?'I /s S��- L�- 376 Z
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 C) gallons per day. Calculated daily flow F4 S gallons.
Plan Date ^fG- C? Number of sheets Revision Date
Title
Size of Septic Tank e—,x / OVZ9 Type of S.A.S. _ i 'dL
Description of Soil
Nature of Repairs or Alterations(Answer when ap licab ) M ove IA
C) a l
Date last inspected: ,,�
Agreement:
The undersigned agrees to ensure the construction and maintenance o age 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'ssued by this Bo d Health.
Signed Date
Application Approved by Date
Application Disapproved for the�t/ollowing reasons
Permit No. Uy Ll Date Issued ��
:j t •'�'r~' t �j •' #:i ems
No. � � • _ }���1�tFee�
t
` e
THE,COMMONWEALTH OF MASSA",,_VSETtTS Entered in computer:
N Yes
PUBLIC HEALTH DIVIS;O, WN OF BARNSTABLE., MASSACHUSETTS
ZIppricatfon for Mi5pogar,*pgtem Con!5truction Permit
Application fora Permit to Construct( w)<pair( )Upgrade( )Abandon( ) O Complete System Individual Components
y•.
Location Address or Lot No. Owner's Name,Address and Tel.No:
AL
_ Assessor's Map/Parcel aS� f /
L/t (.�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building: 1
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 {L— O y Number of sheets Revision Date
Title
Size of Septic Tank Fes/aM2 Type of S.A.S. ze&4— 4.* = —6
Description of Soil
Nature of Repairs or Alterations(Answer when ap licabl ) OV-Q T ► i.i
cam./ ) a cd,
IF, iA t _
u 1, •� yv v U \
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore- escribed-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 Board of Health.
Signed �. ,,JA Adi Date
Application Approved by �l.,. Date u t/
Application Disapproved for the Vollowing reasons
Permit No. 9,60 U '- Date Issued A L
'i -
THE COMMONWEALTH OF MASSACHUSETTS
7 L —0-r& BARNSTABLE, MASSACHUSETTS
RR [�� �� Sh T� . Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned( )by
at 90 i/d r✓ �.aa�,/ fob�,v�'//� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System`Construction Permit No. '?t 4 W- 3#,2 date
d
Installer , `Designer r f
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
-- --- -----7No. nv\/— Zf2 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
.
Migooar *pgtem Construction Permit
' Permission is hereby granted to Construct( )Repair( , )Upgrade( )Abandon( )
System located at
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.
1
Provided:Construction must be completed within three years of the date of this permit `
r
Date: I r Approved by -
� av
TOWN OF BARNSTABLE L
LOCATION 90 SEWAGE#
VILLAGE_ CFhT�!'d/l/= ASSESSOR'S MAP &LOTL79-o,5 G
INSTALLER'S NAME&PHONE NO. e/20-�7�'� �� �, / v
SEPTIC TANK CAPACITY /32dO
LEACHING FACILITY: (type) - LEl4c1� pir (size) /Do0
NO. OF BEDROOMS 3 //
BUILDER OR OWNER
PERMITDATE: G-2 2-a COMPLIANCE DATE: G ' 30- O
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 faacii ) Feet
Furnished by
O '
c
0
4
TOWN OF BARNSTABLE .
LOCATION 90 SEWAGE # _2 DO e/—
vII.LAGE �'FHrredil/- ASSESSOR'S MAP& LOT 172-031G
INSTALLER'S NAME&PHONE NO. SS 4-`12O—5P75? /oSeAg G7e i�r s
SEPTIC TANK CAPACITY lSdO" /
LEACHING FACILITY: (type) 2 - LE14c,�i eiT (size) 10099
NO. OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: G'2 2'4—COMPLIANCE DATE: G - 3e
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 faci ' ) Feet
Furnished by
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Town of Barnstable
OptHE T Regulatory Services
Thomas F. Geiler,Director
r +
+ BAMSTABM
6 9 ��g Public Health Division
Alfp '�° Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: -7113 lo q
Designer: 61ev►-61 j aerlt i Installer: Ta e..Y J .) �7G �C'P
Address: 9. Ledo. 001f L ii/ Address: C C
On was issued a permit to install a
(date) (in taller)
septic system at qO Caddkrd- Vt � based on a design drawn by
(address)
y . dated J u 1,,L 10 , "10d-t
(designer)
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.
ZH OF
GLEN oy
G
ERIC
(Installer's Signature) 4 HARRINGTON -+
No. 1070 �
0
sn�%: Gjsrt�Q�.`a
''QTAR\P
(Designer s Si a e s (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH 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
✓`No "�?r1��1..... FEs...,�D...................
THE COMMONWEALTH OF MASSACHUSETTS
��-6 _� , BOARD OF HEALTH
17,2 ..............OF......................................... ---------.....---------------------------------
,� �irtt Ilan for Diipntitti lUork,5 Tnnitrnr#inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
IAGIZO
Locatidn•Address or Lot No.
..........q ,4. ...............•-----•--.....--••--••----..... ..........-••---•--•------ �:!'n - . ...- .........
ner Address
.......................... .•---............-•-...........--_. ...................._....._.....--•••......
Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............ ............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons........................---. Showers ( ) — Cafeteria ( )
a Other fixtures ......................................................
W Design Flow........ 0..................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity. allons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
xSeepage Pit No...------/......... Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.......---...............
GT, Test Pit No. 2................minutes per inch Depth of Test Pit.--................. Depth to ground water........................
-------------------------------
•.............
-......
•.............................................................................................
0 Description of Soil........................................................................................................................................................................
x
U ----•••---•--•.........--•-------------•--•--•---....••----------••---•----•..................-----........._---••--------------•--•----••---•---•---------•---•----------••--••------•-•----•......---•
W ---------------- --------- --------------•••--••-•---------------------•---•----------------•-•............ •----•--•-----------•-•---=••--------------------------••--•---.....---•---•-••-------••...
V Nature of Repairs or Alterations—Answer when applicable-------..-A..0 .-
1...--..1�X k -; ..................
-------------------------------------------------------------------------•-•••-••-------..._.._.....----••-••------------•-------------•---------------------•-•-----•------------•----•--..__....--•--
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 beem issued by th d of al .
Si •---------------------------------------- ----1 _.._.
Application Approved By.................... ..... ....................................................................
�® L
Date
Application Disapproved for the Ifo ng reasons:..............................................................................................................
-
...
--•-----•------------------•-------.....----••------------••------------------•------••-------•......-----------------••---....------•-----•--•--------------------
Date
PermitNo......................................................... Issued.......................................................
Date
•t�rra�rr
..i to..... FEs.....�!.:
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....--- ..... ... ................ OF...........-.................
Appliration for Diopooal Workii Tomitrnrtion 11amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
q. .. �.n.. Q_...1�✓1.c.u.C...........-• ........................................... a.............................................
Locatidn-Address or Lot No.
..----6 ............� ?Cc.=-••••• n .
er� y - Address
^•-•-------------•--- --.. .................-•........................ ........---....................................__..
j Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............L-..........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures -.--•..............•--•-•-•---•--...--•--•-•--•---•-----------•-•--•-•-----•----•-------•--•.-...-•••--•-----...----•-....•--....-----._......__.....
W Design Flow........ j�.7..................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity.}`-,?Tnkallons 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 tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
14 Test Pit No. I................minutes per inch Depth of Test Pit.................___ Depth to ground water........................
4 4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •-•---••-••-••------•--•-•-••--••--•-••••-••••••--••----•.............•--._....._•-•---••--•--••--•---.....-•-••-•-•........---•---._...._••---••-...--__•••-
0 Description of Soil........................................................................................................................................................................
x
U --------------------------------------•--•-----------------------------------------------•------------•--------•-------------------•----•----•----••----•--------•-••---•-•••--•••••-•---•--•••-•-.....-
W
.....--•---------------------------------•--•-•-•-•••-•••----..-...•-••-•-•-.-.....----•----••--•-•----•---•----•-••--•-•----•-••••-•--•---•---•---•-•---•-•---•••-•-•-••••••---------••---•---••----•--
V Nature of Repairs or Alterations—Answer when applicable...........AXJQ.......--1_....... ......... .__________________
--------------••-••••---•-•-•--•-•---••••-•••-•••-•--•-••--•---•-------••--••--•-•-_._._..._....----•---_-•••--••------•••---•--•--•-•---••••-•-•---•---•••--•--•-•-•-•.........._..--••••-••-•-------•-
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 issued by the b=d of Japlth.
fir_-._
Sig �= ._..... --=-�'---..`:.:.::---•-•.......... ...
Date
Application Approved By--•---•-•-••--•.:_G'_. =_ ` ,.- --
Date
Application Disapproved for the f I o `•ng reasons:-•-•-----------------------•-•---•-•--•---•------•----..-..------•-•--------•-------•---- ••-----•--------
-•-•--•-•--•--...---••-•-•----•-•--•--•---•••••---...--•-•---•---•---------••-•---------------•-•------••••••-•-•-._........-•••---•-•---•--•-•-..__.--•••-•----------••--••••-•-...•••••----•••••_---•-
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
Y
BOARD OF HEALTH
..........................................OF......................................................................................
(9rdifiratr of Tontplianrr
THIS fS_b CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by- =-. •-••--•-•-._.......•----/t1hie
•-••- -•-•-. ..---•-----•..............................•--•••-•..__._.................-..........-••--••-•••--...-----
_ r � Installer
has been installed in accordance witrovisions of TITLE 5of/�e State Sanitary Cod as scribed in the
application.for Disposal Works Conn Permit No.-f_3......�r�?_ ______________ dated- !:,-,-::. ._.*... ..:F_.._._-.._..._____.__
THE ISSUA C OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE
SYSTEM WILV F CTION SATISFACTORY.
DATE..._ _ ________________ •----____--•••------------- ----- Inspector....... ._... .. -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
0 3�-�l .................................OF............---....-._..-.._-..._.-............-..._--....--.....-....-.....-........ �v
No............... FEE.---..............•••---
�i��o��l , ��c. on�#rttr�ion rrntit
Permission is hereby gra 'F!:=f:? ••••••
to Construct ( 0,
. a• r n Individual Sewage Disposal System
c,-/ J
at 0 �.. ----------------------•------._-._..__.._-._.-._..-...•----•-.._-............_.
' Street
as shown on the applicat n for Disposal Works Construction Permit Igo-rl�. _____ Dated. ................................
................... "G' -Zlitch --•--------••-•--------•--...--••------
— —" Board of
DATE................................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON
n
LOCA 10 SEWAGE PIT NO.
�.
VIL ACE
INS"TA LLER'S NAME i ADDRESS
• �. II
R U I L D E R R OW R
DOE ERMIT I S S U E D
DAT E COMPLIANCE ISSUED
_ �. .
t
��
SITE PLAN SITE"CENTERVILLE"
SCALE. �J
. �,= �1 20
BENCH MARK ON THRESHHOLD OF REAR O
SLIDER, ELEV.-100.00' (ASSUMED) /d
Ash/e R
O ar
O O
r �
O oo, 4c
Paved driveway t
O
at .LOCUS
NO SCALE
rr^�\V 7'
^
V
B.M.
9sB2' x 97.89,
existing
concrete patio 98.31'
a
AP
95 68' 97 1
X 97R4'
L e+,
LOT 174 GENERAL NOTES
e AREA =/ 15,254t SOFT. 97.75 1. ADDRESS: #90 GUILDFORD ROAD
PROPOSED LOCATION OF RELOCATED SEPTIC TANK 2. ASSESSORS NUMBER: MAP 172 PARCEL 056 O (INSTALL 1.500 GAL H-10 S.T. IF EXISTING S.T. IS INACCESSIBLE OR STRUCTU UNSCUND) 3. DEVELOPER'S LOT: LOT 174
O 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN
ON THE GROUND INSTRUMENT SURVEY.
5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES.
6. REFERENCE PLAN: PLAN BOOK 247 PAGE 84
ex;
7. NO WETLANDS ARE LOCATED WITHIN 200 FEET OF SAS.
SAW 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS.
7 31' 97,441
s� a 20' CONSTRUCTION NOTES
exxiis5ting 1. Contractor is responsible for Digsafe notification
97.431_ and protection of all underground utilities and pipes.
2. The septic„tcnk anq, distribution box shah oe set
level on 6 of 3/4'-11/2" stone.
3. Backfill should be clean sand or gravel with no
stones over 3" in size.
4. This system is subject to inspection during installation
G by Glen E. Harrington, R.S.
9G64' � 5. The contractor shall install this system in accordancekO � (� with Title V of the Massachusetts Environmental Code
3-2W DIAL„C=MAN OM and the Regulations of the Town of Barnstable.
� 6. Provide an Acme Precast H-10, 1,500 gal. septic tank (if necessary),
and 1 H-10 5-hole Distribution box or equal.
7. No vehicle or heavy machinery shall drive over the
" septic system unless noted as H-20 septic components.
8. Install gas baffle or equal on septic tank outlet tee end.
9. All existing inverts and site conditions shall be verified by contractor.
9G53' "'�* O 10. Existing leach pit to remain.
11. If existing septic tank is inaccessible or structurally unsound after relocation,
install new H-10, 1,500 gallon septic tank per Title V.
STEEL REINMRCED PRECAST CONCRETE
PLAN VIEW
s-W rmso AM cm�s
a• >.
T Y mh Merit!e am" �r wtr
Rev r ourLET
r. # � ;�T
l.
�•-e•mkL
• owls depth
�' aFMgss PROPOSED SEPTIC TANK RELOCATION j
•s'-o} s -o� � PREPARED FOR
CROSS SECTION END-SECTION R LINDA M. PERRY
H-10 1500 GALLON SEPTIC TANK W
NOT TO �CALE .1 0 p AT
LEGEND ��, �� #90 GUILDFORD ROAD
G
USE ACME PRECAST OR EQUAL sgIV TAft BARNSTABLE (CENTERVILLE), MA
EXISTING LEACH PR
Existing Dwelling —I 0' min. from NOTE: ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. 0 TO REMAIN
9 g house to septic tank *NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE.
took covers must be Finished grade over system-2% slope away PREPARED BY:
First Fl. EL-100.00 in e•ar RnLh.d grad. g HOLE PROPOSED 150 NKGAL. GLEN E. H AR R I N GTO N, R.S.
ce ar EXISTI (MST. Box Existing dads Elsv.-g7't O O O H-10 SEPTIC
wall D-Box cover must be Min. 2•-1/e•-1/2' PIT cover must be raised to 9 L E DA R 0 S E LANE
+ within e"of Iahed grade double washed stone within s• firishad grade •maic DENOTES EXISTING
s-•02 MIN. x104.46 SPOT GRADE MARSTONS MILLS, MA 02648
• Lawl for Y
' 23 PROPOSED S-•01
b 1.500 5lin En
III SEPTIC TANK f 10, o e o 0 95 EXISTING CONTOUR
H-10 o e e e e TEL: 508-428-3862
GAS-OR EQU B , 1
0 0 0 0 o APPROX. LOCATION
;a o 000 o FAX: 508-428-3862
EXISTING WATER LINE
e•OF 3/4•-++rl-STONE a APPROX. LOCATION SCALE: 1 "=20' DRAWN BY: GEH JUNE 10, 2004
e e o 0 0
a"OF 3/4•-11/2•STONE EXISTING GAS LINE
SYSTEM PROFILE
Not to Scale c EXISTING LEACH PIT DATUM: ASSUMED FILE: PERRY SHEET 1 OF 1