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HomeMy WebLinkAbout0207 HORSESHOE LANE - Health 207 HORSESHOE RD., CENTERVILLE A = F uu • UPC 12534 No.2.1 L3 OR t UlTINdle VN 9 C No. rK— 6,5,& Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for ]Bigo5af *pztem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade(Vj'Xb"andon( ) Complete System ❑Individual Components Location Address or Lot No. 20 7 Owner's Name,Address and Tel.No. Assessor's Map/Parcel C C oe b O tcl Installerr''s,Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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.gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank %-00 gjJQ71C,jAv- Type of S.A.S. tv C, L Description of Soil Vim© Nature of Repairs or Alterations(Answer when applicable) 40 C � _Ce fI 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 of the Environmental Code and not lace the system in operation until a Certifi- cate of Compliance has ssued by this 13:Eiiil eat . Signed Date — C, Application Approved by Date — Application Disapproved for the folio ' g reasons Permit No. Date Issued r _ ...tea_. No. tl6- Fee �— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 2pprication for Miopooal *pztem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade(�andon( ) `Complete System ❑Individual Components Location Address or Lot No.-_a6 (_e�C, �_�. �� Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. b 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_ ::3—Z0 gallons per day. Calculated daily flow Z�-i gallons. Plan.Date Number of sheets Revision Date Title 'Size of Septic Tank 7T/ A. Type of S.A.S. 44v G. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ,O C ti , ` h 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 Etvir mental Code and not t lace the system in operation until a Certifi- cate of Compliance has b� ' sued b�this o ea Signed Date Application Approved b pp pp y Date Application Disapproved for th follo reasons PP PP g Permit No. Date Issued ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS QCertificate of Compliance � w THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(1/) Abandoned( )by l Z-- [ S E ( aC— at i ") (�4a* � r� ,�tr t �/{l OP has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer , The issuance of this pe ' Jib not be gnstr-u d as a guarantee that the sy ill function as de igned Date Inspector 1411 rQs (; I I r ------------------------- -------- No. / Fee �J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopozar 6potem (Con0truction Permit Permission is hereby granted to Construct( )Repair( ) pgrad ( )Abandon( ) System located at 1 � 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. a Provided:Construction must be completed within three`�ears of the date of this permit. Date: -- / 1./ — 7 q Approved by 1/6/99 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) hereby certify that the application for disposal works construction permit signed b me dated ���—p p � y `� , concerning the property located at 007 1� ® VS-e-fl ea- Cor-Z 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. (�/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. /There are no wetlands within 100 feet of the proposed septic system ere are no private wells within 150 feet of the proposed septic system ZThere is no increase in flow and/or change in use proposed ,,,:,/There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the ma.�dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor m thod 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 GIS information) ` B) G.W. Elevation A+the MAX. High G.W. Adjustment. f DIFFERENCE BETWEEN A and B 30 fSIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder.cen ::� '�!. i 0 v U TOWN OF BARNSTABBLE ` LOCATION,9ol �a�f t r llp e— SEWAGE # I I� D VILLAGE (���t/ �P�t y: //.t ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Ze-49 6 iS. ®� LEACHING FACIL=: (type) (size) NO.OF BEDROOMS 4 BUELDER OR OWNER PERMTTDATE: COMPLIANCE DATE: q1fq,-g1Qq 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 Ap��©x Toys✓� ��; , -� V • ' ' r AV' � AG / r <o4AA e. 467 1 (, Q �t TOWN OF BARNSTABLE n LOCATION C9 0—) f��t/�u e— Q.--( SEWAGE # VILLAGE s rti �«y. //.r ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. , SEPTIC TANK CAPACITY LEACHING FACILITY: (type) _�i��l/ 7f ►y�h r —(size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: L � 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 Z� 119 a � r FES...................... THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOAR® Off' HEALTH 6arA Ct�nt~rvt�Oep�rtment TOWN OF BARNSTABLE Appliraft for Dispaaoul lVarkii Toutitrurnart Prrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at* S ..... rs ... L / .. - __...... . ---.- ...... ::. : --1. -..... - - ... .. Locatio 4--Address �- or Lot No. -f .... owner Add ess Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedroom Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers Cafeteria Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons 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 ( ) 1­4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water..--.................... a ---------- C Description of Soil----------- -- - ----------------------------------------•-------------------------------•-------------------------------------------------------- V ---•-•----•------------•-----------•---•- ---------------- --- -----------•--l--•-...--------•----•----------•-----------------•--•-..................................................... W --•-••-------- -- --------------••••-•••--•----------••-•----••-••••-•••-•-••------------••--•-•... --------------------------------- ..---•----••-•---••---•••-•--......._. U Natur of , epairs or Alterat' ns`An er when applicable.......- -- ��..-._--...w -------- Agree ent: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal ystem in accordance with I the provisions of TITLE 5 of the State Envir ntal Code—The undersigned further agrees not to place the system in operation until a Certificate of Co .plianc h been issued y the board of h lth. Signe t/ `^- ... .--l2 Date Application Approved By ............ . �- � L Date - .... ...............................................................-------........ Date Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------- ----------- ------- ........................................................... ---------------------------------------------------------------- ------- -- - ------- - --- -- ------ --- - ---- ----- �..^...1. ..:� Date Permit No- ---------- - --'..-ram. .............-- Issued ........�p.....^. �...�... --_------ Date No.. :�--_.5'6 Fim. THE COMMONWEALTH OF MASSACHUSETTS `I BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFation for Disposal Warks Toustrnr#iun 1hrnti# Application is hereby made for a Permit to Construct ( ) or Repair_z?< an Individual Sewage Disposal System ..... �1.... ..... ..» .. --....... s ---------------------- CD - ......r Location-Address ...»w. _.% orLt N »» _.h.... --• .. , . © ..»pe _� + Owner //�n• 1 `a 1v AddQss ......... — ,�\ .: ... Address Installer U UType of Building Size Lot-------------------- -----Sq. feet Dwelling—No. of Bedrooms--- --------------------------------------Expansion Attic ( ) Garbage Grinder ( ) a a Other—T e of Building ............... No. of ersons------.---_-------------___- Showers YP g -------------------------------------------P--�- ( ) — Cafeteria ( ) Other fixtures W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons 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----------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit-------_------------ Depth to ground water........................ f=, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water------------------------ 04 ............... - O Description of Soil--------- ` �; ; .-...... V ----------------------------- —- --- --------------------------------------------------------------------------------------•-------------------- x Natur of e airs or Alterations-Ans er when aP ---------------•--------------.........------------•--•----•---•--- . Q U e� p ' plicable---- - �``�5,:� ��--------- C - ----------•----------------;_... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co pliance has been issued}by the board of hea th.L Si ned\ Date Application Approved B ..... _ �_z ,,,:_-..___ ________ l� J Date Application Disapproved for the following reasons: _-------------- ------------------------------------------------------- ------------- ------- ----------------------------------------------- _------------------------------------------------------------------------------------------------------------------------- ----------- 2 - -- q Dale Permit No. /'----- - ------- Issued �� { ` - - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cferttftrate of (gantpliattrie by (TT IS IS TO CE' TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired��-• _ �'� `r ------------------- --` ,r C,� `�' ` ............. ' -------------------- -- -- ----------- � _ Installer f , has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._.._ e :.-___.. -.. (.... dated __....._..(a._-_1.2---..-.� \ THE ISSUANC THIS CERTIFICATE SHALL NOT BE CONSTRI�E AS- GUARANTEE THAT THE SYSTEMLL FU �Ti N SATISFACTORY. \. DATE ---- ------ t---�.---------M------ ------------------------------------------ Inspector ----------------------------------------------•--------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... FEE........................ �ts�r�a�tt�1 n � �untc����nr�uorn rrnti� Permission is hereby granted..._.........C_..`t...........................____l\_ w �+ V� to Construct ( ) or Rep air (Van •ndidual Sewage Dispo System at No.............................C) Y-S-f'. -- Q Y � r C w ---- •• -----------•-------- ----•----------------P---------•----•--_.... Street ( �` as shown on the application for Disposal Works Construction Permit No,��-_-�. L__ Dated......... `U............................. r ----�-------------------------------•------------------...» ( Board of Health DATE------------............................................ FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS - TOWN OF BARNSTABLE LOCATIONdx2tge- AL2 'c2,5" VILLA GC(, V ij t ASSESSOR'S MAP & LOT - `l INSTALLER'S NAME & PHONE NOeoai Jts . 2 �Z SEPTIC TANK CAPACITY (� ;, LEACHING FACILITY:(type) L , ` (size) L NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER to-,Yf__ DATE PERMIT ISSUED: �vias DATE COMPLIANCE ISSUED 4 ' VARIANCE GRANTED: Yes No �� y TOWN P!AIR,3 T: W e, o = C'. H G cn ---- }kr�` LIPWX A I 0 I I ox._M oil 153 s FW s� z OM UTILITY vzg NEW C4.0aeT D New .DF4 Q Cw- �g �qOr �1p�S SPACE AfC 7V Tc�00M EXIST. s. __NEW a'Im' PIELD VotlA BATHb. EXIST. IXMOVC OR R { o w vim" a 1/3'dA. Ae. y SLAB was,. (POST ° t�T LALLY COLUMN COLrI ABOVE ABOVE) I ♦'-0'! '-Id I -ar r— , EXIST,MAIN s• EXIST.D —J 7Italon Daer. L • IX16T. a�C 2.- r= Cp N CgyM� NEW WINDOW MW !'%tea' A�R/OOTING a7�0'xlo'POOTI — V`O IPY INM12 - BENCH UNDeR Nj'rW PS�SLS2vC^1 PURN. NEW EXERCISE/ UTILITY Q FAMILY ROOM .. P NEW Iq N�'i W 6U W z Q o ,E tu tl1 tL 'Zo 0.11'A { > Z p 6'w tu I -a' � IL � tt WALL KEY NEW BASEMENT FLOCK PLAN o EXISTING.WALLS �'? j WALLS TO 6E REMOVED 6 t ® PROPOSED WALLS Qj m a i �16 ruN�Law mNaavlee Na� fj! 'O.G MLEaS arNoavl e9 No '~ m � THIS BUILDING, IS DESIGNED IN ACCORDANCE WITH THE ° T����K�I��,2"e° o MASSACHUSETTS STATE BUILDING CODE Oth EDITION. 4 eaNTRoeTae eNALL veRlPr DIM 10l18 w Z ' THIS INCLUDES THE WIND LOAD FOR EXPIOSURE C AND 110 mph. PkIOR T�oTeopNenaxrproN. eam��e c�T goTo =W ` - 015 TTQITION OPI TNe SIGNER, T o fA