HomeMy WebLinkAbout0031 HENRY F LORING ROAD - Health 31 HENRY F. LORING ROAD
Centerville
A = 172 - 182
Sllll _-�I �
fil�ll�G® fie11
i
llll
UPC 12534&2153LOR
NABTINOB•YN
TOWN OF BARNSTABLE r' 93-t�
�CATION�: C I ety t-0 J'a — n—oSEWAGE
�
VII, r-491M—
LAGE C �-eV y��� ASSESSOR'S MAP & LOT
y M
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY IS i CR"
LEACHING FACILITY: (type) � r/Xu
NO.OF BEDROOMS
BUILDER OR OWNER �TAvg
PERMITDATE: 9 COMPLIANCE DATE: Cl R
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
ti 1
i
eZ
No. 9s / `✓ Fee
THE COMMONWEALTH OF M ACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pprication for Mig0 ar *pgtem Construction Permit
Application for a Permit to Construct( )Repair(' )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 3� Owner's Name,Address and Tel.No.
Assessor'sMap/Parcel G�13ti 27r`VM� � {�, 0� e1��
2 2_
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
VIA -
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 O gallons per day. Calculated daily flow ��`� gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank %ti; -\ MZY'D Type of S.A.S.
Description of Soil 1M V-0 .SyLA l
Nature of Repairs or Alterations(Answer when a plicable)_—_17V"9_V I
--� C S C• it �- ec_
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 nvironmental de a of to place the system in operation until a Certifi-
cate of Compliance has.begsri o a t .
Signed Date "
Application Approved by Date
Application Disapproved for the fo owing reasons
Permit No. Date Issued
TOWN OF BARNSTABLE
:LOCATION3( 11
.eNro,, p . VAA68 SEWAGE# 9 4 - 13
ASSESSOR'S MAP&10T f
".L::INSTALLER'S NAME&PHONE'NO. 1 ' —GAP► '—S�Q �
SEPTIC TANK CAPACITY
:',:. LEACHING FACILTfY: (type)
`. NO.OF BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE: - Q
Separation Distance Between the:
Feet
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility
.Private Water Supply Welland 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
TV
0 0 �1
1 �
�� - Cs.'
No. > Fee 1
r
' THE COMMONWEALTH OF M ACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
� 1,10101p4lication for Migq at *Vmem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ` GMYa Y'�N owner's NameAddress and Tel.No.
Assessor'sMap/Parcel `�'�' 1V0�1~�.,,,. �, 'C.l1V 01
2
Installer's Name,Address,and Tel.. o. Designer's Name,Address and Tel.No.
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 0 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank �z��5 t �i1�10T7 Type of S.A.S. \ V` 41
Description of Soil YAV_� YD C.
Nature of Repairs or Alterations(Answer when a plicable)—T—WSZ o-`
O Q—`QO!c V- �Cc -e-, oy- St b• �1��it CJm,_ r�
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�ofthenvironmental de a of to place the system in operation until a Certifi-
cate of Compliance has-1issue��-ti ' o H alth.
Signed Date
Application Approved by Dates 190-11-Ae
Application Disapproved for the following reasons
i
AMI
Permit No. - Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO RT.IFY, that the On-site Sewage Disposal System Constructed( ) Repaired( )Upgraded
Abandoned( )by A ex
at h h a v o t �„ has been constructed in .. cordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated ®°' r
Installer Designer
The issuance of this permit shall not be construed,as a guarantee that the system will function as designed.
Date 3 `7 —�/ 73 Inspector_����
-- .y e �� �--- ----- — =—
------- -----------
No. Fee,6 4-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS
ligozar 4p�tem on�truction Permit
Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( )
System located at 3 l 4e�,`,- L_y Y InG C U 1
J J �
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty PP g y 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 rmit.
Date: Approved
1019197 '
Failed
NOTICE
: This Form Is To Be Used For the Repair-Of
Septic Systems Only.
' I
CERTIFICATION OF SKETCH AND APPLICATION FORA
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
it
ENGINEERED PLANS)
jI
�(( fY that the a certify application for disposal works
y Pp - i
construction permit signed by me dated <5"94 concerning the l
' d �Y meets all of the
property locate at !
following criteria:
zonere are no wetlands located within 100 feet of the proposed leaching faciliy
u There an no private wells within 150 feet of the proposed septic system
-. There is no increase in flow and/or change in use proposed
1
r
'n are no variances requested or needed.
If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the
proposed leaching facility will no be located less than fourteen(14)feet above the maximum adjusted ; 1
groundwater table elevation.
please complete the followings i
A)Top of around Elevation(according to the Engineering Division O.I.S.map)
� j
(according to Health Division well map)
B)Observed Groundwater Table Elevation j
SIGNED DATE: �-
' �
LICENSED SEPTI SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
� 1
(Aitaeh a sketch plan of the proposed eyrtem•Abe Irthe licensed installer posesses a certified plot plan,
this plan should be submitted).
Y 1
4 health folder:art
.�
� � �
�-�'
O
l �-���-
6
����
r.
���?^-1
N&
0.......... ........ ........
THE COMMONWEALTH OF'MASSACHUSETTS
BOARD =HA H
..................OF....
-- ----- --- --------------------...............
Apphration -for lliipoiial Workfi Tonstrurtiou amil
Application is hereby'made for a Permit to Const uct or Repair an Individual Sewage Disposal
Syst
-----------------------------------------
.. . .. .... ...... . ....... ... ... . ........... ........ ............. .............4
Loc * ft-A ress t No.
- ---- --------- ... . ........ .................. .. ..............................
Owhe _ ;�ddress
... .......................
.. ........... ..
Installer Address
Type of Bui ding Size Lot_/C ___Sq. feet
U ooms------3--------------------------------Expansion Attic Gay --Ie Gr�nder
Dwelling—No. of Bedrooms._.__. r(ag
Other—Type of Building ---------------------------- No. of persons___...._..........._....... Showers Cafeteria;
P4Other fixtures ..... -------------------------------------------------------------------------------------------------------------__------------------------------
Design Flow-.---__ .....-.--.gallons per person per day. Total daily flow............................................gallons.
Septic Tank—Liquid capa( t -
P4 /h_-�_ allons Length---------------- Width................ Diameter.____...-------- Depth----------_---
Disposal Trench—No No. ---------------------Width ....... Total Length------------------ Total leaching area----- --------------sq. f t.
7-------f---
Seepage Pit No../ Diameter........(_c�-------- Depth belo;, inle---------------_ Total leaching area_---------------sq. ft.
Other Distribution box Dosing tank_L( r
Percolation Test Results Performed by.� ----------- - ------------------ Date----
Test Pit No. 1----------------minutes per inch Ikpth of Test P- -------------------- Depth to ground water---------------
r3:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
P4 ---------- . ...........A-01--------I-- ---------------------
0 .... ................ -----------
Description of Soil__ A;/;��_77/A....
--------------------------------/-.d--------/,>....... .... ......%bar .....................---------------------------------------- -----------------V------------------
------------------------------------------------------------------------------------------------------ -------------------------------------------------------------- ----------------------------------
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 undersign 7further agrees not to place the system in
operation until a Certificate of Compliance has been by the b d health.
Signed. .......... ----- ... ...................................... Da.t7e J--/
Application Approved By----- ----- ........... . .. gzlel/ ..... _x-,-—"..?Y •
-
-------------------- 71
Date
Application Disapproved for the following reasons:-----------------------------------------------------------------------------------------------------..........
......................................................................................------------------------------------------------------------------------------------------------------------------
Date
PermitNo........................................................ Issued--------...... .........................................
Date
L------------—--------------------- ------------------------------___ � —___j
;y.' , ..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF
Appliratinn -for 13ttymiai Workii C owstrurtiou Vrrmit
Application is hereby'made for a Permit to Construct, ( ) or Repair ( ) an Individual Sewage Disposal
System/at:
l :...,1�-_{cam--
Location-Address 7 or Lot No.
.__.._..--•---•-•-----------•-•--------------•--•-••--------•-----._._...-...•-••-••----.-.......- ..-••••...-•-•--•---•------•••••-••---.._._-...............----••--•••••--•-••-----------......._.
Owner Address
W
Installer Address /�•�-
UType of Building Size Lot_,<._.:1...._CJ._0._..Sq. feet
Dwelling—No. of Bedrooms------- -._ _-___.----_-.Expansion Attic ( ) Garbage Grinder ( )
`4
p-, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
A' Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow------------------------------------.-------gallons.
P4 Septic T:uik—Liquid capacity------------gallons Length---------------- Width------------._.. Diameter---------------- Depth--------------_
xDisposal 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. . �. GT ,,' '
a d�� --- =' A Date---- �
Test Pit No. l................minutes per inch Mpth of Test Pi ...:._____._____. Depth to ground water...-----_--__--.-..__._-
w Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_.--.---_--_-_._----._.
zr
D Description of Soil--------� _„Zr.. A�--- '� ^`
- .z._..._._ °...........................
•--•------------- ..............--------------
W
x
V 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 \I of the State Sanitary Code—The undersign further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the lbd health.
t _
".. . Signe -----•-_-•-* �(------ -•-- --
Application Approved By.... ._.__ f, � Da '
----------------
APPlication Disapproved for the following reasons: --------•- - ---- Dace
...............•-•-------•-----------•-••-------------------••--•-----------•-•--------...---••----------•----------•-••-----------•--•--•------••-•---•-••-------------••._..------••-••••------_..............................
- F •
Date
PermitNo......................................................... Issued.............................................---=
Date
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
..........OF..........
.... t. ... .......................................
Cnrdif irtttr of TOmphaurr
THI TO Cf R"IFY i t the Individual Sewage Disposal System constructed ( 4-o-r--Repaired ( )
by-------- 1 (/ ..........
Installer e.
- --'--• -•-- -•_�'�'-• ----------�-,2--�-•' - -� _ -•--•-------------
has been installed in accordance with the provisions of .' ti e XIof*'The State Sanitar- Code as describe in the
application for Disposal Works Construction Permit No. �¢.______-. n-_.-___ dated__.__. Y_ -" , ___.__.__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector.-.-------------------------------------------•--------------
,k.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
.Z, ................ ..OF......-.. ...------.---................ ...... FEE-----------
-----
No.•-----. --•-•••-••- J
-.......
r . V
ttion Vrrmit
Permission i reby granted_.__.."`_.___ f_ `
to Constru t ( or Re ( ) aW-_nd' dual Sewage Dis al S mat No. �'
[��(/ �y� �_1fJ��I /iryT/)gj/j�lf
Str e�tt
as shown on the application for Disposal Works Construction Permit
--- ---- -_ Dated------- ----------,�.
---------•-- ----- - - - �
.Z� i 7 $ Board of HealtE
r���/.
DATE•• • --- ------•-
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
S�uGUG: P'a(.L - 3 Fst tzooM r .
1.10 GA2$AG� GRI�.Jn�k �•
L?�t�..�•(. FI.,�w 11b �+� � = '3�0. G.p•L7 � "... � ., a (� �"� {, ,t°.
-'��F?T'tG T�.t IC' = 3�O�r 1�G % ,c�q c-,,6.P t7. ,: ;`s/. � � t a # ; • �.
U S _
ISP6 'NL PIT ' 1J5E " locoo `G
r ` .. -�'ac'>,*� • ���i r� ; � _ .! y t �k i r�r Y-t� ' ` --t � ri 9 � t. I
1 Sir, '2 S = w "lam �.PD ��` I N� , . d .�� .... Qr
-��!� F.1�G.�Q S. l �� .��•t -r•�. y � i 9 t RG [ , � � t l`�i � t F :� � :
G,.,p. Sri'' •rc r 1•'.0 � *=� + Sb C-�.PD �. l � s i } � ''' ) ` f k o t �.� `� � x } ! q '`�t a s"
-1-oTA l n�11-`f E F Uu4! 33D 6.PD f ` ►`. .t ,„ 1 )1 4 i ,
a I :
i'IV
• c .I � i � is - !�,\� 1 l � k r t '' ,I { 1 i y.� > � ) �'f i t '� � ,� k �.
t Y r �fijyF�..,..F.�Sa ` t. � // [ 1 ; j ; •;..� .:{��.•��} I �r i �.� C .
�
js .ti$(
' �,
�, yy It
i 1++ ,y� rX r):,
" "LU Y`+u1r�x�,5 R,p.•�� 'i� � �^ �4d 3 'i Y t { 'z
�F
+� - •-per S );J� ..� .I i } � .{ t t _. f •� i ,•� � !
'7 1 �J. 1 = y - l ' 5 �i.,�,'9 .pf�• x T4P�F4{D
I 7
`fogM[
i 6 i -$OX [Sr�GE�TIE'• 10
-:,.,�''7 . ! t .i � GQ I,.. �7,T.A. $ .� - • � ,a t � � � i � y [ �o Fii'
�a.vtY p,T
l f,.CA.i/�L.. .VC/lT4-t } •± c e 1 n.-. .t
d5T
_ C
Ao
G Lc£/41d i 3 t - t
i 7 t'
I?9 C..�CLTtF=.1ra Pl:.c>LOCATIO
'f
I F i r
TL
1-(AT' TNT FQIIt4DAT~1�a616; 541ow4.1 ? P� .:AI-j � Qt._��1;?E`�.i4C
i TIA TNI" -51 DE..L("C— t U T
�-'! 1-G,rit.� 'GC>riclCaL�!a
_�.>'.1ta� �� r��,ac�G `�'cq�l�'�Mc.1..ITy o� T►-+€ :, �j�� ° ; _ '' +�y t ;
r; A, _1
4 IBA AT C tz 4 ����7:, #t a{c.__
f RE G f S tt=lZ�.Ll` 1-�,6JG 15U cj
i T1-{l5 C�C_A1--i s' 6�oT p-w-"cay. rJt-b /�,�.J o�TE2v►%u o �1rCAS5 4 < . �
ilIp1C'J4✓lE tali �itJe,\/l= "['siC, ii=1=51�/ 5llcrc�ts� AI?rzt IC:A.l�1T
t' � ;(" 11:�aEr['� :!T'C.i.:.�7f._l.i�C_Mt►:IL, -II�.1�:.`.. e
� rF ,
CATION EWAGE PERMIT NO.
L L A G E
INSTA LLER'S NAME & ADDRESS
B UILDE R OR OWNER
- v �
DATE PERMIT ISSUED � ����,�►
DATE COMPLIANCE ISSUED 70C
%f
.�
,.
r���.
i
� � -- -