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HomeMy WebLinkAbout0018 LIAM LANE - Health O020 NoJ �� ... Fxs.._... ............... THE COMMONWEALTH OF MASSACHUSETTS �- BOARD OF ®L ,..... --......OF.................. .......... Appliratiou for Dispo.ial Workii Tomtrurvott Vrrmit Application is hereby made or a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ! ---•-•_.... .................................•--•-----------...........•-•-••-•-•••--••---•-•- F� �_ .. ......................... .c...� Location•Ad or Lot No. i • ......................_................................. ._� 4.�.F(e..G�,.a„�, •_�- --...-- � [.rr .. ._...... Owner � Address w .._ , . . 3:......- �i• _.....cr,�� � Installer Address Q Type of Building Size Lot____.._Z.0,_Q_4.%)..Sq. feet U Dwelling—No. of Bedrooms................ .........................Expansion Attic ( ) Garbage Grinder e^—rO '4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ............................ . W Design Flow........... ,_....5<___._..gallons per person per day. Total daily flow.............I---0-0--- �__.__._____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 ) e_ ~' Percolation Test Results Performed by_______________ "'_ __..... _•.•.. ...... Date....... 2.;V1 Test Pit No. 1.. ._..._5_5minutes per inch Depth of Test P ....... Depth to ground water_._.. . fj. Test Pit No. 2__. minutes per inch Depth of Test Pit____________________ Depth to ground water______ ._G .... .. --------------------------------------- 0 Description of Soil••-•••-••-•---•................•-•-•-•-...--•-----•----•--...---••---••L..�•1---- __._..__-__.__.- U /Z . - e ..........j--------------- VNature 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 iIli U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued-by the board of 1 ign ............... ---- ft410A"'(Application Approved BY '� Application Disapprove f or a following reasons_________________________________________________________________________________•-_.___.._:.___......_.__...__.. -••••-•••••••••••••..................•••-•-••••---___...-••-••.......•---•........-••-••....._..__..._.........._........... Date PermitNo......................................................... Issued_....................................................... Date -i, FEB.... ......... ... ... T THE COMMONWEALTH ,OF MASSACHUSETTS - BOARD OF HEAL ti ..... .OF........ ...... ... .. ............... . . . Appliratiun for Diapuiitt1 Worku Tontitrnr#inn Permit I Application is hereby made for a Permit to Construct ) or Repair an Individual Sewage Disposal System at: .........................••••-.-..�. ` ..f - .........................................................----...... f• . . Location-A ss or Lot No. ••• ---. Owner t Address .............. 5V*W..... .......... -5, P............ Installer � -. Address ' Type of Building Size Lot______ (I,A.,r?A...Sq. feet Dwelling—No. of Bedrooms......_. �� .........................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .................................................. •----------------------------------------------------------- •---------------- ----------------------- W Design Flow_-_._._-_. .5 --------gallons per person per day. Total daily flow............r_.0Q___(,�............gallons. WSeptic Tank—Ligar '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.............ice _ ty........ Date...... Test Pit No. 1.__. .-_._..- minutesper inch Depth of Test Depth to g ound water_ ,f.&A- - f=, Test Pit No. 2_____�'J minutes per inch Depth of Test Pit..... .. ::..: : De th to round water.:___�!1•.f 0 PDescription of Soil--------•----------------------•---------------------........-•---------- t..r. '�-`-.................. /-�- « V — r f°�''.i►'� l s`'"-_ ---" ........ W .,:.0 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to.place the system in operation until a Certificate of Compliance has been issued by the board of.h i r Igne •> Application Approved By.......---•• ...'�••--------•.......................•-•-------....-•---- Date Application Disapproved r t following reasons:........................................................................................... ..................... ............................ ... ... ...•• •-------•••-••••••---•-•-•••---•.......•----•...•-•-------...._....-••••••-•-•-•--••••-•-••••--..__...-•_.._ ..__-••-- •• -•-----•- Date PermitNo......................................................... Issued...................................................... "s A Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF........................... ......... d (ftifiratr of I ra THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Repaired ( ) bY•------•-•-•-••••••_--••-••------•--_-•-•---_---- -•------ ------ t----••- at............................................. -- ,,y' • • jj . ------rl�RANTEE ---- ......•.-•- •• has been Installed m accordance ay h ti p vtstons TITLE 5 h Sanitary in the application for Disposal Works C-onst2U n Permit I To____ __ __ dated..... __.-�._..._______. THE :ISSUA C OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G THAT THE SYSTEM WILffi CTION SATISFACTORY. DATE.... ---•-•-----------•--•---.._....•-•-•-----•--•-_-_... Inspector-- .............................................................................. �yaF 4, THE COMMONWEALTH OF MASSACHUSETTS BOARD.: OF HEALTH .......OF....................... f lU No.•• � � � l'y( ._.......... FEE........................ RioTiAttl Vorkg Tonotrnrtion "permit Permission is hereby grante'd................................... .. ... .......................St --t S V to Construct ( ) or Repair ( ) an Individual Sevc� prgtp@ y ep � £ at No........................ . - Street_.._ -••••-• - as shown on the a phca on for Dispol fir s Con to ermit No___________ ___ Datea.__.__ r...........:______. r .. ................ •••-•••-••-••- oard of Health DATE------- --------••-- f FORM 1255 A. M. SULKW, INC., BOSTON •� �IoTE -f73M cnu -TcyP cQ y L� t• ;� ' .(da P.;IInn PS tv �' V,� Z6. 7 7 - Tas > a Nr SN OF MNwr 57� i� 1p 3 ' N X _ E S R�Q' 4N� SU � !`� IV Win' F'. �• (3 : /� �"=\ sa,3 f �� l3 . �\ LEGEND �. EXISTING SPOT ELEVATION Ox0 � ��µoF 9 C RYIFIED PLOT PLAN EXISTING CONTOUR 0 ---- oy 7 �� li;, ,4-„sue�D .y-� FINISHED SPOT ELEVATION ° A•RT FINISHED CONTOUR 0 -- o `MORSE 4 C� /T��U'��-.t_�' No:109511,11, p I N APPROVED + BOARD OF HEALTH A;) h �-+ . w ! �► ' WA DATE AGENT SCALE, /"= 40 � DATE+.. LDREDGE ENGINEERING CO. IN � � '� CLIENTS 1 CERTIFY THAT THE PROPOSED. EGISTERE REGISTERED JOB NO. BUILDING. SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWSENGINEER R OF BARNSWW6 ASS. 712 , MAIN STREET CH: _ 8383 NYA NN I S, MASS. SHEETS OF �DATE ND SURVEYOR t l N07, : /F E/TNER THESEPTIC TAN,< OR - �0 FT. M//V. n�Ef#CHING PIT 4RE NJORF TVA."/ /2"BELOft/ /O fT MIN. 1,4AOE� 24 O/AM ETER CONCRETE COVER S,"A L L _BE B RO uG N 7- TO G RA O E. `�+,'✓ EXTRA CONCRCTE 4 PYC p/Pt tYeAVY CAS7- /rPON CO{/�R SAI,4LL 3t- U P/T I SED CDYE/GS MIN. Ctii EL..r zo ®•PF•P F/N OR/VEYVA Y 2 J• M/N. CONCRETE A ;:aC / G AOE CUYER C'L TA/V .SANG 4514 .0"CAST _ 2 L AYE R IRON P/PE o e o P OF MIN.0lTGN (2 0/6 G/IL. • • • . . a • • . D •eo SEPT/C TAAoX D/ST, • • . • e • WASHFO S70NE BOX • a, • ?�: e � � 1 � •EFFECT/✓C ° f • 34 v l�i/A o SiSIEO/STO NE • • . . • pEPTH • • ► • 7& x o — ?-7 9-- i a. 0 • • • • • • • • . p.o PRECA5 T SEEPAGE !N!/BRT CLEY.�ITIONS �rT e�t�� c/ryr S¢� 4,�tL��?�1 r II .•� • ► . . s . . • . :Q o P�T�L= uo . /NYERT AT GUILD/NG FT. INLE-T SEPTIC Ti4NK 4S•8 FT _L� F7 O/i4lrf. C SEE TABIJLATION> Ot/74ET SEPTIC TANK 48, Fr r /NLET 40/57RI400T/ON BOX ouTLETD/STR/BUT/ON BOX 48,4 _)-- GROUND C1TER TABLE SFCTiON OF FT48.' - 1,VZET LEACHING PIT 4.6,0 FT. SEWAGE AO/SPOUSAL SYSTEM • - L EACH/NG P!T TA8UL.4TlON TCAL.E %~ /=0� O/HENS 3 /ON a FT. DES/6N CRITERIA D/M.eNS/oN 8 6 Ft. NUJNJER. OF BEDROOMS 3 D/HENS/ON C_ - FT. GARQAGED/SPO.,SAL UNIT ��"��` SOIL .LOG TOTAL E37/M4TED FLOry 3 3 C7 a.4t. DAV SO/L TEST 01 So/L 71=S7-*2 SD/L TEST �. NUMBER OF tEACNtMG PITS_./ f^FtE1! 9.g /^-ELlrY, PATE GF SO/L, TEST S/DE LEACHING PER P/T �� Ski i•T. p _ / f RESULTS i�//TNESSED BY R �' �' -!-2 7� . 9oTTOM LEACHING PER'PI W. FT. PtRCOLAT/OJy RRTE,*/ ! �"-'-� M/Ny//NGK TOTAL LEACH/NG AREA SQ, FT. AENCOLAT/ON RATE/k2 RESERVEGEAC'N/N6AREA SQ.-.FT. ' /� --{> !�'/''� ��L "ice-'�'�•"i" �.1� �- � � `1- � �k OF A4,45, f 1 rG o 0 16 : ALB %'1 ^^ i U �SE in'6 •o r„ 0.10951�O Q a T� �,�`� ' ELDREDGE ENGINEERING CO,INC. O�gK�O� j�I oI ;l EL F i, 3-7. LJ 712 MAIN ST. , /'►'YANNiS, n�lAss. ell �"°r' ® ND GROUN[7 Y{/i4TER ENCOUNTERED CL/ENT;�`ze-r' ;"' DRTE 5/ G / � ' Q Gmo u vb I-vATER AT ELL�N ,j pB u TOWN OF BARNSTABLE LOCATION L{k rh SEWAGE# VILLAGE SSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY k 000 0 LEACHING FACILITY:(type) eXtS,k to 60 (size) NO.OF BEDROOMS_ AJJ�y- OWNER PERMIT DATE: I I I a I COMPLIANCE DATE: -7 I o?6 a;l 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 .) I g V4 = ys 3 o `I No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplitation for Disposal *pBtpm Construttiun joermit Application for a Permit to Construct( ) Repair(.4pgrade( ) Abandon( ) ❑Complete System �ndiidal Components Location Address or Lot No. Owner's Name,Address,and Tel.No.�p(C 0 1 1S l;,614-N L,pnQ...Assessor's Map/Parcel Installer's Nam Addres ,and Tel.No."?J O` esigner's Name,Address,and Tel.No. Type of Building: dOL Cl Dwelling No.of Bedrooms u 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 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when appilicable) O J Rk � 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. �1 _ Signed Date Application Approved by Date L Application Disapproved by Date for the following reasons Permit No. � Date Issued Z /2, LOCATION fg SEWAGE PERMIT NO. VILLAGE 1NST L R'S N E i ADDRESS BUILDER OR OWNER a DATE PERM ISSUED � DAT E COMPLIANCE ISSUED iI F � +1 .5.. �', �� 4�_ � � No. FeeA.ptiter THE COMMONWEALTH OF MASSACHUSETTS Enteredin PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4 1�A 0 2ppi cation for Disposal *pstem Construction Permit " ( Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) El Complete System [�,] n�l""dividual Components E Address or Lot No. `�m �*�^r----' Owner's Name,Address,and Tel.No. t l` , r�� IJ 's Map/Pazcel01T N1 �1 �v'�`s NameQ Addres ,and Tel.No.\ �\ f) Designer's Name,Address,and,Tel.No. Type of Building: ©cj a Cl ( 1 ` Dwelling No.of Bedrooms N A Lot Size sq.ft. Garbage Grinder( ) w ' Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided A.1 t+ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ti Nature of Repairs or Alterations(Answer when applicable)\ _ Y.� � ­4 -fir•-rc� � �� �G�"t � � G]'iS '�''�1 i�C�C'�1� Date last inspected: 1 «.4" Agreement: { Y1 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 o .. Compliance has been issued by this Board of Health. � �y Signed Date ., Application Approved by Date L1 q Application Disapproved by ls<41 Date for the following reasons 1 y ;1 Permit No. 7� Z .Date,Issued w THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS �` Certificate of Compliance b THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( w< Upgraded( ) Abandoned( )by �rt at \2) L,Cmb-N'�. c1 \..pp - 1 Q has been constructed in accordance i with the provisions of Title 5 and the for Disposal System Construction Permit No. Mil �29Ddated 7 � L Installer `�c C'!`er k -n C- - Designer ", #bedrooms N A- Approved design flo J r,A gpd The issuance of this permit sh 11 not be construed as a g uarantee that the system ill fun ion as desi red. Date — ! �► 1 Inspector ( ( 1 No. yI/t� t Fee THE COMMONWEALTH OF MASSACHUSETTS iVu PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pste onstructon Permit Permission is hereby granted to Construct( ) Repair(e Upgrade( ) Abandon System located at tit(�M"1 f9, t� Q,.� r ;� 7 / Z.,Z. 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 a completed within three years of the date of this permit. /` ! Date 2 Approved by l