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HomeMy WebLinkAbout0050 NYE ROAD - Health 50 Nye Rd., Centerville -A=146.010-007 r' f� I _ I S w r /o -7 No... _. FEE. .D......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirativit for Dia agal Wor1w Towitrurtinn ramit Application is hereby made for a Permit to Construct (L" or Repair ( } an Individual Sewage Disposal System at: � � � ......... -------•--------------------------------- ---------•---•------------------------- r.__7.......------------.--..--..•----...----- oddres or Lot No. ......................_.......4'�W.3, ►, -c------•----------------- Owner Address 1 �a -l:---•----•-•--------•--------------------- ---------------•------------------------ Installer Address UType of Building ' ?? r' Size Lot----Q,.7?©..Sq. feet ►.� Dwelling—No. of Bedrooms-------------V----•-----_-------..-.--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) p•' Other fixtures .. W Design Flow.....................6 ..............gallons per person per day. Total daily flow..............................330....gallons. WSeptic Tank—Liquid capa6ty/,0V0_.gallons Length---------------- Width................ Diameter--.............. Depth................ x Disposal Trench—No. .................... Width-----_------------ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------------- D' meter.......?...... Depth below inlet----------6...... Total leaching area......Z4...sq. ft. Z Other Distribution box ( t Dosing tank ( ) ,`(�/ /' 0-4 Percolation Test Results Performed by .4.. '"- _ 11✓�.------. Date........................................ 4 Test Pit No. I........Zminutes per inch Depth of Test Pit------I4::...... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ RS ----..... ----------- ............ O Description of Soil--------------------�.^--z--------�A-1m-- - - -- - - --- x ,S,9.W..�.---- ..........-------=-------------------------------------------------------- W --- ............................................... = UNature 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 Environment Code—The u rsigned rther agrees not to place the system in operation until a Certificate of Compliance been is ue �ch boar of health. Signe ---f - --------- ------- ------------- ......... ............................. .......------------- Application Approved B � � --.---®.... .... .......... - ....... ........................... re Application Disapproved for the following reason .............................................................................. Dace - 0 Permit No. ..._......... Issue - Dare ` TOWN OF BARNSTABLE �^ LOCATION I1 V C/h SEWAGE # VILIAGE l' �'�-/� ASSESSOR'S MAP & LOT ryG• 0/D- Oo7 INSTALLER'S NAME&PHONE NO.1L/���:,a C% v,Ci C-4 SEp•ITC TANK CAPACITY �! r (size) LEACHING FACILITY: (type) NO:OF.'BEDROOMS BUILbER OR OWNER r.&^r ''y- —i* C r COMPLIANCE DATE: 7 PE.RMPTDATE: SepaCation Distance Between the: M".AAMum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private;Water Supply Well and Leaching Facility (If any wells exist >` Qq site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet :.;.:within 300 feet of leaching facility) Fuftiishe.d by 1 A . L/C/ . . . . E . No­ q - /.Q..0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (�f TOWN OF BARNSTABLE Applirattnn for Dtti-Vnnttl Wurk.6 Tomitrnr#inn ramit Application is hereby made for a Permit to Construct ( �r Repair ( ) an Individual Sewage Disposal System at 26 �� ..Locat.on�}ddress o. Lot No. Owner Address ------------------•-------•----•--.--------- Installer Address p Type of Building Size Lot----¢ ,.�..t- ..Sq. feet Dwelling—No. of Bedrooms...-_--------113------------------------Expansion Attic ( ) Garbage Grinder ( ) pa-I Other—Type of Building .--.--.-.-.-_------------- No. of persons..-----.--------.-.--.------ Showers ( ) — Cafeteria ( ) p' Other fixtures ---- WDesign Flow......................5. ..............gallons per person per day. Total daily flow..............................�30.-..gallons. WSeptic Tank—Liquid capacity/D.U.Q-gallons Length---------------- Width....------------ Diameter---------------- Depth................ x Disposal Trench—No- -------------------- Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..............1.... Di- meter......./U------ Depth below inlet..........6...... Total leaching area.......��_.jr...sq. ft. Z Other Distribution box ( v7'� Dosing tank / „ '~ Percolation Test Results Performed b �.61_�aK. ........ . .........A. _ ........ Date........................................ ,.a Test Pit No. I.......7--minutes per inch Depth of Test Pit.-----4n------ Depth to ground water............. ........ (i, Test Pit No. 2................minutes per inch Depth of Test Pit_----------------- Depth to ground water........................ ------------------------------ --- { DDescription of Soil....................d- Z'-•••----- ..'...... .. . . .. -----------------. --.--•--••---•-•---•••-•-•---------•--.. x Nature o.. Repairs or Alterations�— 9 -- --------------------- --------------------------------------------------------------------•----------- U P —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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance,has been�issu�by�the board/fhealth. Signed ----------------------------1,--.-'+ . //� ............................... .-- /.::.....� Application Approved By . -... .. .. o, . .: i l._/✓ ... j .--. Application Disapproved for the following rearon U..................................................... - _...................... ;........ .F...- �----------------- - - - )� Dare Permit No. ..-...... �,7� 1 -/.. --'............ Issued Permit 1... . d----------------------------------..-,--,-------------------------- -----_/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C9Qr#i£iratr of CIIlnlaliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed <Or Repaired ( ) by --.....----------------------------------------------------------- - _.... - -------------------------------------------------.... -------- lasr-1 ---- at --------------------------- .%...�-.._....._------------------ ---- 6---------- -..... - ............. has been installed in accordance with the provisions of TITLE 5 o- The State Environmental Code as described in the application for Disposal Works Construction Permit No!X.. ...'''..�?� �t - " dated ------------------------.__----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................3.. 7------------T ---'----------------- --- Inspector -------- -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH gTOWN OF BARNSTABLE �!� Nog o......:..........•--- FEE._.;..:..._.... ...... r �in�n�tt1 nrkn �nn�tr�trtinn �rrmit Permissionis hereby granted............................-•-------------------••-•-------•---..-..------•-•-••--•-•----.-..-...-...-......----------------.-------..--•--- to Construct ( V)�or epair ( ) an Individual See age Disposal System atNo........... fJ.?` .,`�...... N,� = ......................---- --��''-jy�-- ��,1/'1,: ........................................ Street � /�- { -•-••--............................... as shown on the application for Disposal Works Construction Permit7N�o�i�.}� ��•J � � �-'-��'? D(tie"., Board of Health DATE......•----=�---------=------------ �... ................................. FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS f -PATA Sl�lGC FAMILY 3 '5&V9=/►.tw 84s�u5 I1O 6AZ5AGE 61ziIJDEV SE rl C TAIJV— 3'3o xi.5 =4r(S OD �T I-1000 6 A L /� STbAI L� bQA i rJ �yv�f � � � . �ooi 51DEW4LL E P �06SF' � W $OTToM AeaA = '7 g SF � — .. : 1j5 `MrAL DAILY T%�¢GaCAT7ON QA'TE iN ?-mIu/L,056 "_'3� o-A. Pao X� Pir .I DA� «� R . SU'LI""Pa I N a SAL E '` iL o9 13�•o o. �t-Z2 �'F-`t�'� 5✓�vu. 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P'E24 V(-ATI oN FATE j'1 ,N. ►u l /, -- 4l4 // i1 PRO 0 OAXTli• �� PITcRSULI At tc IL oq 13�.o D. ��4 2 Ft,0(;E- 3Wg5 F�=44, TF • 5✓c.�,o� p v c rl (000 I�VPrsT iN✓ 6AL lN✓ tcxxoA.GAL. TANr_�4' rz — .• MLI7• WiuiFIF3� �t�� ALL 5t7tLcTuRES 6>r.T SA Np ST01JE MoP.G T1WPJ 4!'Dte? Z -- 6. --� QqA14 ti(AP 1 R-L 10=� ZOnJC Z yF1.op UFI�-- C Fir pt d7- PLd N scd LF-- Lc)dATIoNBCD 15 SNowN NE,ZEoCv\( TdT TI{E�wazc PLAN QJC� _ M��Y S w1rts� �6 s(p,UQ, �= °fi T��E- rMWN of -aAeAN T-4, ; A+tD 15 {,I -- L o�4.(�.� u✓lt!IIU THE TlxoD r�ol ,h n Pz- Bil- pAfE — - G I�c ice" DA 71K FLAW IS NOT- r / i _.._. P 55roNdr_ �AtJ� Sue 3A.�J AN 4T�'vti4irUT /W 5 Su2vEy AiJv rN o'1 OFFSETS ' �4ouQD L ��1 E�1Gr N EEzS uSC-1� T'p �i7"A�LISri Ptza�Etz.Ty U�1 S �� 0 5T'z-1zv I L L - 1v(A4l, APPLICANT; ALAiA SMAI�- I CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508) 790-2380/FAXa(508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F,A,* cS-,l LOCATION: ADDRESS OF RELEASE: AL DATE OF RELEASE: PRODUCT'RELEASED: :a, ,!.r, „ ' c ESTIMATED QUANTITY: CORRECTIVE ACTION TAKEN BY RtSPONSIBLE PARTY: ,� -7 1 ,f ] ] X% 7 7 w NOTIFICATIONS: FIRE DEPARTMENT: YES(,4) NO( ) DATE: - ,�` �TIME g/ NATIONAL RESPONSE CENTER YES( ) 140()) DATE: TIME: DEPT. OF ENVIRONMENTAL PROTECTION YES( ) NO(x) DATE: TIME: OIL SPILL COORDINATOR: YES( ) NO( ) DATE: TIME: TOWN BOARD OF HEALTH: YES( ) NO( DATE: A,,tr yTIME: TOWN HARBORMASTER: YES( ) NO(.,,,) DATE: TIME: OTHER AGENCIES: COMMENTS:-- ✓/ t.r'l4]i'T^7'T,b !3' 0/'1 1 I ,yl'! (4f f�,�1�r1 • 17"7 1-r�i i I^R, 'J +'1f y-0: T{1 I"1"t 1 4: 1LI><if�-Tf �( REPORTED BY:_1"t gr-�, r=--( � DATE;_r- ]✓f-r—y1� � WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E,P, PINK COPY-BOARD OF HEALTH C-O-MM FORM *58 UU A"daCl C/ TOWN OF BAARRNSTAB E LOCATION A a r 7 c_G/ff y c IV SEWAGE # a VILLAGE &.0 i r'L/,,r t G CIO ASSESSOR'S MAP& LOTIE • l f 0b7 INSTALLER'S NAME&PHONE NO. ��/y C •at c'i SsJ=d So SEPTIC TANK CAPACITY Z//��� LEACHING FACILITY: (type) tip! (size) NO.OF BEDROOMS BUILDER OR OWNER rA.•i PERMIT DATE: P'.IInL dg /PA 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 OL y6