HomeMy WebLinkAbout0049 HITCHING POST LANE - Health 49 HITCHING POST LN., CENTERVILLE k
A=173-034
I
UPC 17534
No.2_53COR
asTiaas.Me
ry `> TOWN F BARNSTABLE
LOCATION SEWAGE # , 6 L
VILLAG e V I Y i ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACl'TY -4(&2
LEACHING FACILITY: (type) , 41.'A/CIS (size)59 X/I X
NO.OF BEDROOMS
BUILDER OR OWNER-. /✓1�
PERMITDATE: -5'- COMPLIANCE DATE: /l) ! A T
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 x
within 300 feet of leaching-facility) '" `. Feet
Furnished by `f
c
No. b / Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 7
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS
ZIPPYication for Moont *proem Con.5truction Permit
Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. `7 9 %f ck^� OS� 1An4 Owner's Name,Address and Tel.No.
�U1tG/�1/c !32 t[;ACk KYI��T
Assessor's Map/Parcel
Installer's Name,Address,Ad& 4ANCO Designer's Name,Address and Tel.No.
350 Main Street
W. Yarmouth, MA 02673
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 31p s- gallons per day. Calculated daily flow 330 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1006 6x4rA7179 Type of S.A.S.
Description of Soil J'�ngPk !vAcxe—�
Nature of Repairs or Alterations(Answer when applicable) Tn rJ4(I I 4 Q�X 3
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 this Board Heat.
Signed l Date 10 •S' PS
Application Approved by d e - Date ly-3
Application Disapproved for the following reasons
Permit No. /pr Date Issued 1/0 -_I--
Jc
No. / O "Fj Fee . o
fix= THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Application for Migpo!aY *proem Construction Permit
Application for".aTermit to Construct( )Repair( )Upgrade( Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. t19 ' A�n ras t /A/l� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel ^i � V ?2�� i r�GL I"y 1.0e r
Installer's Name,AddnA&Ri. ANCO Designer's Name,Address and Tel.No.
350 Main Street
W.Yarmouth, MA 02673 It
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( )
Other Type of Building f No.'of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 20 gallons.
Plan Date Number of sheets Revision Date F
Title
Size of Septic Tank pe of S.A.S. c r
Description of Soil .f�r�cFv t l Aa-e
� I
Nature of Repairs or Alterations(Answer when applicable) 7n.r1A II r J . v,x 3
/TlAX;M i r I t G✓ Z/ J/-e L,0
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 this Board o Hea .
Signed ( Date w • S - 9
Application Approved by Date /Cy
Application Disapproved for the following reasons
�i
Permit No. 76F"1� Date Issued
F,
THE COMMONWEALTH OF MASSACHUSETTS �
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired Upgraded( )
Abandoned( )by rl--wc U
at y9 1 .3 r 1-?"7_e has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. -G 9 f dated /0 .
Installer Designer
The issuance of this permit shallot be construed as a guarantee that the system ill function as designed.
Date C> - ��`� Inspector
—------------------------------ -
No. / O '(9 l G Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
40igozar *potem Construction Permit
Permission is hereby granted to Construct( )Repair(✓SUpgrade( )Abandon
System located at t-9
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 this permit.
Date: �� J ��� Approved by i `
3
10/9/97
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
ENGINEERED PLANS)
i
hereby certify that the,application for disposal works
construction permit signed by me dated /D - r- 9 f , concerning the
property located at i&A nq Dorf A, meets all of the
following criteria:
There are no wetlands located within 100 feet of the Aproposed leaching facility
There are no private wells within 150 feet of the proposed septic sysiem
ct
There is no increase in flow and/or change in use proposed
There 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=be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to'the Engineering Division G.I.S.map)
,, I% 4
B)Observed Groundwater Table Elevation(according to Health Division well map)Cre
M.
SIGNED DATE:
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
q:health folder:cert
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IC SYS& TEM
DESIGN
FLW 99 fff-
BZDIWOA(S' AT . _ G AL/DAY/BEDR�OO-[ _ .. GAL/DAY
SI'?'IC TANK:
, ., GAL/DAY x 2 DAYS GAL
`$ USE GALLON SEPTIC TANK
LEACHING AREA:
USE 3 INFILTRATORS AXIYI ZER CH"BERS
WITH f OE STONE ALL AROUND (W x tf x Z DEEP
SIDE AREA: t3o + H)2 .x 2 = 164 SP (.74) _ . L._ Gil L/DAY
AGM AAA: W tr _ 3.WSP .74) _ GAL/DAY
CAPACJTY m365 GAL/DAY
a
Ns -- SH
i
TOWPAR/NS
F BTABLE
LOCATION ! C�- 1 j'd SEWAGE # �I(�- 7
VILLAGE (_P-Pl rP_oc V/ ASSESSOR'S MAP & LOT 47' - QA
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)5/W 10 (size) XGI.I Z�
NO. OF BEDROOMS
BUILDER OR OWNERefl/✓� 9
PERMTTDATE: rb- .S—- 9,_$�—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
LO ATION ; 5E\NaC4E PERMIT U
VILLAGE 0j;
INST ERA UWAE ADDRESS
` ill —U - - - - - -
bU LDER 5 &ME A D DRE SS
DNTE PERMIT ISSUED : = 23' - -
Ci!
D ATE COMPLI W-ACE ISSUED '.
let
1060 Q`
No. .. Fin&.., .. ..................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
' 0-t,441.L.. OF........��. nP P.-- :..............
Appliration -fur 4iipuual Vorku Tonstrurtion Van it
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
i✓/C:c Vic..fn..W.�✓ 0 G�.a._:- ��= � 111.!✓L� - = f 1 i✓1/ .
Owner Address
aW w0 :...........................................................
Installer, Address
UType of Building Size Lot...��.,_.��'r-------Sq. feet
Dwelling No._ of Bedrooms_______ ________________________________Expansion Attic (Q Garbage Grinder (X,)
Other—Type of Building* --=-------------•---•------- No. of persons___________________________ Showers
( ) — Cafeteria ( )
a' Other fixtures ......................................................
w Design Flow--r- 0.................................gallons per person per day. Total daily flow______-__3.to............... gallons.
WSeptic Tank-(-Liquid capacity.f.�DUgallons Length................ Width_----.......... Diameter---------------- Depth.__--__-__..__.
x Disposal Trench—No --
No//.................. Width.................... Total Length.................... Total leaching area-------------.------sq. ft.
Seepage Pit No--------.__......... Diameter----/00.0..-I'Depth below i let____________________ Total leaching area..---_-_--_--__-_sq. It.
Other Distribution box ( ) Dosing tank , �- 3'7f
a Percolation Test Results Performed bY-------------------------------------------------------------------------- Date---------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit.._.......__..__.... Depth to ground water...___--__---.-._---_...
fiq Test Pit No. 2................minutes per inch Depth of Test Pit.--__--__________.__ Depth to ground water-..----------__._-_--.:.
.......-- t ------- e------- ---
i
d. «� -•7---- --------------- ---------
O Description.of Soil-•-- .... RSt �
x
c, r ------------------f
---------------- --------
-------------------..........................
----------------------------------------------------*-------------------------------------------------------------
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 undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be n issued by e oa of h ith.
Sig -- - `-�-l----- _----------- • ----- -------------------------
Application Approved By --• -- - ---- ----------------- iS
S'..-.
Date
Application Disapproved for the following reasons---------------------- --------------------------------------------------------------------------
----.....•-•-•---•-•-----•-•----------------------------------•----------•-•-•-.........-----•---.....---'•-•-•--•-•-------------•--•-•----•--------•-------.....•-----------------•-----------------•---
Date
PermitNo......................................................... Issued........................................................
Date
No......................... FEm..............................
fTHE COM/M�ONWEALTHFOIF MASSACHUSETTS
04 ®P1 R DAC�/Y� 1
»`
Appliration -fear Dili ogat Morks Cnonarnrtion Vrrni t
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: 7117... -a n
,:106Location-Add ss �U��C *Lot No.
__.
rrr
S caner Address
a (�1�r- -----
Installer Address
Type of Building Size Lot-------------------_-._--Sq. feet
Dwelling—No. of Bedrooms_.._._ 3__--.___.-_-------------_....Expansion Attic ( ) Garbage Grinder (x)
aOther—Type of Building -_-._______________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ----- ----------•-------------------------------------------------------------------•----------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
1:4 Septic Tank—Liquid capacityl�Q0-gallons Length---------------- `vhidtli---__- ..___.. Diameter................ Depth................
x Disposal Trench—No..................... Width----------------6.. Total Le 11..__ _ .___ �#otaffe�
tal 1 c1 1 g a fa.._.-.--_-_-.---_--_sq. ft.
P g p .1—a 4 �trY ,.See a e Pit No_____________________ Diameter________.._.___._.__ De th bel � inlet_.:.___________._. r ii. �.r�l,_..._._.....sc 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-------_-..--..--.-__--
G4 Test Pit No. 2..........�___pimutes_ r inch D01h f Tes, Viv-----____ `� e th to.Tun water �.._
S `� ..............'� �ur./. /iuq v Ste,
ti ��
D Descrition Aoil-- -Gtr"`. r--------... �..... 9 f u.---
x _- /�j�
U ----------•-• ---•--•--•..............•------------•---..........--•---------•--•--...--------...-•----..........._..--•-•-•---•----:•-•--••----•----•-------•---.... -----
x --------------- ------------- ---------------------------------------------------••----------------------------------•------•----------••--------•------••-------------------------------•-.-----
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 NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Caliance as been ' sued by the s and of hea t.h.
4(.c w' z s/
Date
Application Approved BY -------- -------
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
• •---•-•••---••-----••-•----------------------•---------••.-------_-------------- ---
Date
PermitNo........................................................ Issued----------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
7�" BOARD
..........................................OF........._.....................................................--...................
�lertif irate of GUNImphaurr I/-'
THI I ; TO CERTIFY •hat the Individual Sewage Disposal yst constru e ( ) o epaired ( )
s/ --------
at...................................... -------------•-----•-•------•-----.--.--------• �� --
has been installed in accordance with the provisions of _ icli�""X7 o T11e State Sanitary Se ash des rued 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................................................................................ Inspector----------•----------•--•------------------------ .--------------------••-•---------
THE COMMONWEALTH OF MASSACH rSE TS
�. BOARD��
..........................................OF............................................ ---.......------------------......_...
No......................... FEE........................
%spr,itt1 rk C � tr�trti�x� ler tit
Per � i - is erebY d- -='-••-- ---... . .----•- --- -- •� -•--- ----------•-•- -•- ------••�-- --1.._._..---- --•-•---------
;i6e
to Co, u� ot7R . ' i>� G' td a .ew �Plis os
( � B�IXg� p 1%
at No.----•-----------------------------------•----- ... ----as shown on the application for Disposal Works Constr _.
------------------------------------ -----------
DATE------------------
--------------------------------------------------------------
Board of Health
FORM 1255 HOBBS & WARREN- INC.. PUBLISHERS
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
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Q� Ila
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4/1
LO-CAT ION .............. SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S NAME & ADDRESS
B U It D E R OR OWNER
DA..TE PERMIT ISSUED
DAT E C 0 M P L I A N C E ISSUED � ���
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