HomeMy WebLinkAbout0056 HARRISON ROAD - Health 4axm sul 2r d}
S M E A D
KEEPING YOU ORGANIZED
No. 10334
2-153L
MADE IN USA
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No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftphLation for Bisposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair(!) Upgrade( ) Abandon( ) ❑Complete System X Individuall Components
Location Address or Lot No. S(o Ho ts'�SO c+ Owner's Name,Address,and Tel.No. ( grCkAr 0. l r0ojc$6A
Assessor'sMap/Parcel CjQ•nk44-\% , o-7 s'(0 140,;50, ROO,6 (, r c(vjtw
Installer's Name,Address,and Tel.No.6 3 6 Ca�ac n Designer's Name,Address,and Tel.No.
3_+'A t 00vc, t56 SandWw4i Say q_+1.0eC 13A (Tan,%� onl
Type of Building:
Dwelling No.of Bedrooms /JM Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) AjpQ— gpd Design flow provided gpd
Plan Date 3 1 1 Ol 2.1 Number of sheets I Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
lo�n�
Nature of Repairs or Alterations(Answer when applicable) RQ,9A(XC4,'0Lnd A-bft C 1\11h in QCc,O cdAclW
�-c� 2 n a:nn a c t d d�ou►s .
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si Date `Z g
Application Approved by Date 2� z
Application Disapproved by Date
for the following reasons
Permit No. 2a t Date Issued ��
No. Fee 100
THEE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISIO<IV - TOWN OF BARNSTABLE, MASSACHUSETTS
api pliration for .Misppsal 6pstem Construction Permit
Application for a Permit to Construct(. ) Repair(X) Upgrade( ) Abandon( ) ❑Complete System ®Individual Components
Location Address or Lot No. S(0 Rc,t d;'10- .V L�, ,Owner's Name,Address,and Tel.No. �ic r L<` �f o ok �1a_
5 '
Assessor'sMap/Parcel CQt0fc('U•1LC'
'
Installer's Name,Address,and Tel.No.�?j$ (� CCavUtl6,l Designer's Name,Address,and Tel.No.
(souk 130 �jPryCtt.4 so, L1 }� bc�5 3 1�A C�c�nk rjM,
1�pe of Building: ,
Dwelling No.of Bedrooms AM Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided /Uft gpd
Plan Date 3 1 1 o l Z 1 Number of sheets 1 Revision Date
F
Title
a
Size of Septic Tank Type of S.A.S.
Description of Soil
,�
Nature of Repairs or Alterations(Answer when applicable) y n Q_9( (,c g,#Aan(A C�-boti 0 u, in ax c.0 f CA Aa, e,r
u Q nc:naoce ck ; s vg
Date last inspected: Y
'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 t&Olace the system in operation until a Certificate of
Z k.,
Compliance has been issued by this Board of Healih
Sign Date G 1(
2 8 l
Application Approved by, V Date
Application Disapproved by• Date
for the following reasons
's Permit o. /n_ Z92 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS A.
BARNSTABLE,MASSACHUSETTS
j Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X Upgraded.(, )
Abandoned( )by
�C X C avc��o (lC • i
r �j
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. - f)—?tV dated ZZ ZpZ
Installer Q l (� f 1((o.u r k k o r. k f)(• :Designer ATM S�1 c C➢k��(�r� 1_LC
#bedrooms fir. nk f1-loc?x fi c'i�to Approved design flo.("`�, 1 p@ gpd
The issuance of this pe it shallnot)be construed as a guarantee that the system will func'ti �as`designed.
J �.,� t,
Date / f Inspector t
No. ZSZ� S19 D ' t 1 V Fee 1�0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
{ __ Misposal *pstem Construction permit
Permission is hereby granted to Construct( ) Repair OC ) Upgrade( ) Abandon( )
System located at S(y NC\t c"n a n �<o a ct
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permi.
Date 22 Z► Approved by ___
RISERS ON INLET TO RISERS ON OUTLET TO BE RISERS ON D-BOX TO BE
BE BROUGHT TO BROUGHT TO GRADE WITH BROUGHT TO GRADE WITH
WITHIN 6"OF GRADE CAST IRON RING AND COVER j CAST IRON RING AND COVER
\ `'.-:��HS j •i % -� 9"MIN. COVER
36"MAX. COVERULON
PROPOSED DISTRIBUTION
BOX(H20)
t
1 18' OF 4" SCH 40 EXISTING PiPF.. IN STONE L:=kCHREI.J
ROUTE 28 ! I 1 PVC, S=0.010 MIN. PROPOSED 1,500 GAL40
r SST —:"-- REINFORCED CONCREIN. (TO REMAIN)
SEPTIC TANK(H20 _—... _______ ____
. WATERPROOFED�1r7i10" ( ) ..—III l.iE . , s �. ..............................._..........._.....__..........._._.......LQA'O INV.=99.43 MATCH EX.LU ................................................................................................VEL STABLE BASE TEE WITH GAS BAFFONSISTING OF 6"
LOCUS (CENTERED IN TANK OPENING) CRUSHED STONE '
SCALE 1"=1000' REQUESTED BOARD OF HEALTH VARIANCES
LEVEL STABLE BASE - 310 CMR 15,211 (1) - MINIMUM SETBACK DISTANCE - MINIMUM SETBACK DISTANCE FROM
LL
E 10 FEET. TANK IS LOCATED ±1.1'±
,B5 \ ._..1 Og CONSISTING
CRUSHED STONE t S \ FEET FROM PROPOSED TANK TO THEPROPERTY ROPERTY LINE.B A.VARIANCE OF ±8 9 FEET IS REQUESTED.
( SH ING OF 6 \
......
�.�.. •. __ 0� N/F (J-� � I ANKH ��RoS
E y
{ 06 ""''DONNA L. HOWARD aC,o� _ YY 6 9F 310 CMR 15,211 (1) - MINIMUM SETBACK DISTANCE - MINIMUM SETBACK DISTANCE FROM
10 --60-HARRI.SON...ROAD „� ;..�` �1 9� �IS TANK TO A WATER SUPPLY LINE SHALL BE 10 FEET. TANK IS LOCATED 33.9'3
104 _.MAP/PARCEL 229/76 '"`>;.� /i •�\�02�0`QO 0i� FEET FROM THE WATER SERVICE. A VARIANCE OF t6.1 FEET IS REQUESTED.
— _-_`- /
�B4 NX °3 _c I J / �s•Pe GENERAL NOTES:
l / FD E10Spry�;CO9C D 4 O l B 9 1. THE SUBJECT PROPERTY IS WITHIN THE LIMITS OF 'OTHER FLOOD ZONE"AS SHOWN ON PANEL NO.
S 8�'5fL 1b�-,W C 106 d9 Ndy ./', �� \�8' 25001 C0562J, EFFECTIVE DATE JULY 16, 2014.
P
E d� -,r , ('==-<-__ 1_N 1,)00 Gn.l_ON'\ 2. VERTICAL DATUM IS ASSUMED
dNK TO BE REMOVED) �' 3. ALL WORK SHALL CONFORM TO THE TOWN OF BARNSTABLE AND THE COMMONWEALTH OF MASSACHUSETTS
'4APPR(X16.ATF (,)C.v TON FXIS..4Q CONSTRUCTION STANDARDS AND REGULATIONS.
2"X2CY LEACIi FiF.,) (TO f MAIN
4. ALL UTILITIES SHOWN ON THIS PLAN ARE APPROXIMATE ONLY AND SHALL BE FIELD VERIFIED. DIGSAFE AND
uj g Z L PROPOSED DISTRIBUTION BOX (H20) LOCAL UTILITY COMPANIES SHALL BE CONTACTED PRIOR TO ANY EXCAVATION OCCURRING. EXISTING INVERT
,j 3.01' J W j•, (MATCH EXISTING INVERT ELEVATIONS) ELEVATIONS SHALL BE FIELD VERIFIED PRIOR TO INSTALLING ANY PROPOSED COMPONENTS
;F X7 Tl� !` \ /f PROPOSED 1,500 GALLON TANK 5. THE CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER 2 DAYS PRIOR TO BEGINNING INSTALLATION OF THE
`'1` \ % (H20-WATERPROOFED) SYSTEM TO ALLOW FOR SCHEDULING OF INSPECTIONS
4" SCH"40 PVC SEWER LINE TO BE SLEEVED
CB/DH II I I - t! pOM NC 6. EXISTING CONDITIONS SURVEY PERFORMED BY PAUL E SWEETSER P L S JULY 2020
l
(END) "" Ei,2 ,\ H PIPE WHERE SHOWN-ENDS TO BE
SEALED EXISTING BRIDGE ....q CRESTI IEW DRIVP
: I
z I OVER'RIV\ER EAST SANDWICH MA 02537
50' BUFFER TO BORDERING VEGETATED ? PHONE:(508)400-2365
WETLAND AND TOP OF INLAND BANK
,�1 •
o STOP OF' NLANDCo BANK., 7Q 3� %7 SITE DESIGN, LLCM
:1 I sz x s,a a1 Sic n g,' a r s
99
EDGE OF BORDER'
INb o ��• l HgRRI �`"
LE GE
• VEGETATED WETLAND 8 - ,� _ r Sp,1, �. .... ,. .._
A4 ,� 9B 97 Rp PROPERTY LINE .,,. .._.
a + _ ... J qO
rn 61 •'�._.— -= \'•� —A2 �''���` / ---104 ------ EXISTING CONTOUR OCAT/ON 56 HARRISON ROAD
` It -A3 `' `�'� `� ( ' CENTERVILLE. MA 02632
Al 104 PROPOSED CONTOUR
( 3 t CL/ENT: BARABARA BROOKSBANK
) .I •' 1 I N/F -------------OIiP�------.------ EXISTING OVERHEAD UTILITIES 1 SD AVENUE LINDB RG
DONALD & SANDRA BARTLETT E
HOLYOKE, MA 01040
52 HARRISON ROAD ------W — EXISTING WATER SERVICE
MAP/PARCEL 229/74 . DRAWING 77TLE.•
................_d...."x.............._._.....- EXISTING GAS SERVICE
%` � SEPTIC REPAIR PLAN
EDGE OF WATER
o* r EXISTING SPOT ELEVATION
u (LONG POND) ;i SCALE .. OATE'
LIMIT OF 16.5' / r UP-0 EXISTING UTILITY POLE 3/1U/2,
EASEMENT %
cl
Town of Barnstable
Inspectional Services
: Public Health Division ,r-
• 13AMSTA8t.8.
��sh Thomas McKean, Director `'
plEo ° 200 Main Street,Hyannis,MA 02601 !' '
Office: 508-862-4644 Fax: 508-7W6304
Installer& Designer Certification Form
Date: 1'/;f 121 Sewage Permit# Assessor's Map\Parcel
Designer: 41 l� 5 t� } S((�/�/ Installer: !3 XXCi0ya-Ti�/S�-
Address: 1,&grylatj 1� Address:
On a Pc AVtA IOH was issued a permit to install a
(date) (installer)
septic system at X HAR143o 4 01 E/ Z4tu I"E- based on a design drawn by
(address)
4 104 SIB �SII�(a Li-L dated 3125121 Ev 4 21.
(designer)
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. Strip out (if required) was inspected and the soils
were found satisfactory.
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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in a with the to rms of
the RA approval letters (if applicable) �N of MASS cti�
a
,M pqR I MINTZ Nt�
CIVIL
(Install is gn a No.52659
' o
�FGISTt:��c
SSIONAI.E�
( es gner's Signature) (Affix Designers 9tamp 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.
WoAdeptAHEAMNSEWER connecASEPTIMesigner Cenification Form Rev 8.14-13.DOC
TOWN OF BARNSTABLE
LOC TIO 4c.,r r i fan SEWAGE# 7-021 - ZS Z
VI ME SSOR'S MAP&PARCEL 9.�2Lq— 07��
INSTALLER'S NAME&PHONE NO. 13;, n 0653
SEPTIC TANK CAPACITY 1$00 /420 cipAcr proo4' ST
LEACHING FACILITY. (type) (size)
NO.OF BEDROOMS
OWNER !'ooKS, a►n
PERMIT DATE: • Z I 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 within
300 feet of leaching facility) Feet
FURNISHED BY
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TOWN OF BARNSTABLE
SEWAGE#
g2
LOC(TIO
SSOR'S MAP&PARCEL
VIL AGE 4II EXc �ItO �7 • pG$3
INSTALLER'S NAME&PHONE NO. B o CT ro
SEPTIC TANK CAPACITY 15�— (size)
LEACHING FACILITY: (type) .
NO.OF BEDROOMS
OWNER �
� �2, 7 � _ COMPLIANCE DATE:
PERMIT DATE: Feet
Separation Distance Between the:
ottorn of Maximum Adjusted Groundwater
hiae
to the B
Private Water Supply Well an Facility
aci ty(If any wells existon il,ty Feet
site or within 200 feet of leaching facility)a wetlands exist within Feet
Edge of Wetland and Leaching Facility( Y
300 feet of leaching facility)
FURNISHED BY
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A2 Z-1 lo, 4,,k d,,( K
30 �
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