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HomeMy WebLinkAbout0378 NYE ROAD - Health eo 378 NYE ROAD, CENTERVILLE A-148-1.03 t e No. (/ Fee $5 0 .0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for �Digpozaf *p6tem Con!truction Permit Application for a Permit to Construct( )Repair(xyj Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. 378 Nye Road Owner's Name,Address and Tel.No. 4 2 0—4 0 0 2 Assessor'sMap/Parcel Centerville, MA Elizabeth Merritt 378 Nye Rd 632 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service P O Box 1089 Centerville 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Install Title 5 Leaching consisting of D-Box, and two 500g precast leaching chambers. 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 iss ed b is Of and of Hea Signed Date Application Approved by e Date 7P�� Application Disapproved for the following reasons Permit No. Date Issued No. 61d7 - Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: C-10/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Yes 01pplication for �Digool *pgtem (Construction Permit Application for a Permit to Construct( )Repair(X)O Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 378 Nye Road Owner's Name,Address and Tel.No. 4 2 0—4 0 0 2 Assessor's Map/Parcel et Centerville, MA Elizabeth Merritt 378 Nye Rd Centerville 0 632 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service P 0 B.ox- 1089, Centerville 02632 Type of Building: Dwelling No. of Bedrooms 3 of4. fe-r-torA ' e r- sq. ft., ', Garbage Grinder(no) Other Type of Building _0V Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Install Title 5 Leaching consisting of D—Box, and two 500g precast eac ing chambers. Date last inspected: Agreement: h 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 iss ed b ks B/ard of Health. Signed "� ` Date )�7_zr Application Approved by rr, Date 7"Z =p c Application Disapproved for the following reasons Permit No. Date Issued THE CQMMONWEti A TH�O:F'MASSACHUSETTS Merritt BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired (XX)Upgraded( ) Abandoned( )by at 378 Nye Road Centerville has been constructed in acco dance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9�—1 dated . 7 2�` �r . Installer W E Robinson Septic Service Designer , The issuance of this permit shalI not.be construed as a guarantee that the system will function as designed. 1 Date Inspector No. ��' ----------------=---=-----Fee $50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Merritt 0*05al *p! tem (Construction Permit Permission is hereby granted to Construct( )Repair(X)Upgrade( )-Abandon( ) System located at 378 Nye Road Cen ervi e Installer: W E Robinson Septic Service 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 it. Date: 7 ��' Approved by r , 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, William E. Robinson,Sr. ,hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 378 Nye Road, Centerville, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * 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 with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S.map) . B)Observed Groundwater Table Evaluation(according to Health Division well map),7 SIGNED: �Z I�-C�i G DATE ?`^ LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). O µ r �� , .i ' �'n 6 � � I I � l�.,._ I ' l � � l �-�-.� TOWN OF BARNSTABLE _C g✓ LO'CATIONJ 7 7 J SEWAGE # � I� Vi LLAGE ASSESSOR'S MAP & LOT f INSTALLER'S NAME&PHONE NO. '7 ? � SEPTIC TANK CAPACITY" LEACHING FACILITY: (type)o4"A.0 S l"e 16 size):S—.X6 NO.OF BEDROOMS BUILDER OR OWNER ,Zf PERMIT DATE: COMPLIANCE DATE: "' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Fa 'lity 'Feet Private Water Supply Well and Leaching Facility (If any wells st on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands a st within 300 feet of leaching facility) Feet Furnished by r � B � i ��� a �n��'� � -� may., ��o �z ��f �� � ' No. !..� 7 .. a Fss... ............. t. TFaE COMMONWEALTH OF MASSACHUSETTS a BOAR® OF HEALTH ............. ..........................OF......................................................................................... Appliratiun for BiupuuFal Works Tunitrnrtiun frrutit Application is hereby made for a Permit to Construct ( Vj'or Repair ( ) an Individual Sewage Disposal System at: Location-Address or t o. ........ ?4 .._ ,: �.. .c.. .......•------------------- ----------- �� ��k..................... ................ Owner Agr a � .....e.�c ..... .........� P � ,H ..... . a Installer Address Type of Building Size Lot-----._ff:.:.... ........Sq. feet �. Dwelling—No. of Bedrooms....._.�................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' 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-.-.-.--.----.----.-.... fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------•---------......-•-•--------------.......---._....................................................................... 0 6escription of Soil........................................................................................................................................................................ x c., w --------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- 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 TITU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued board of health. ed....... !'...... ....--- ---- ---- -------------- ......................... �� f D to Application Approved By... .. ...... .... .. Date Application Disapproved r tl following reasons--------------------------------•----•--------------.....-------------------•-----------•------------------_..... --------•-----------------------•....---------------•------------•-----.......--------------------•--_--- Date PermitNo......................................................... Issued....................................................... Date �. Fxs.............................. TAE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F.................... ..-........_.... Appliration for Disposal Ifork.6 Tons rnrtion runfit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: *) ,�. C Location-Address lG l� or�t�No. Jd • !r!-4?� — ..... �.. lA-t,......... .........j...J-^......... ............................... ............ ........ Owner .............. Installer Address .: it 9 U Type of Building Size Lot..... ...._ ........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............................................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. I................minutes per inch Depth of Test Pit.................... Depth to ground water..... ...___._........._. 0s4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 O ------------------------------ '.... 6escription of Soil........................................................................................................................................................................ x U ••••••-•--•-•-•--------•••••••-'•---•••-----•-•-.....•---••-•-•-•--•-......---•........................•-•-...••--••••-'--••••-•....-------•--•-•---•-•-••••••-••---•••-•-•....----•---••••••-- W 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has teen issued t board of health. ed. ... ��h _.....................................................----•------ . -� 3� r 7 Date Application Approved BY---Itollowing ••• .... -----....".................•----•--•---.......--------'---•---'•-- ........................................ Date Application Disapproved r reasons:.................................... ..•. .....--•-----------------•-------------•------------------------------••--- Date PermitNo......................................................... Hate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.Qom?-..................OF......�.�..w. T ;1..t .......................................... Tatifirate of Tuntplianre THIS �$ TO CERT�FYyThat tihe Individual Sewage Disposal System constructed or Repaired ( ) d G {,�cau�l cC �, -0s testa't 'Vxo&-.- bY -•-------•---•-'...----•'--------••-------•----"•---•--•--'---....---'......:..............••------•'-----"--'-•-..........-'---- ................................ Installer at........ ---'-qr-� •... •--•- ........................ has been installed i ccordance with the provisions of T F r f T State Sanitary_ derma e c *bed in the °? , ,r, 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. / ` f . Inspector DATE_`....._... ............................. ..!..'. - -•----•--'••••••-•-'--.............--•---•-------•--•_... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH fl............................` . OF.... �.,..�...1s1ew No................••....... FEE........................ Rspo I Works onstrudion "permit Permissionis hereby granted.........---------------•-•--•--- T----------------'--•---------------...-•-•-------•----------------------••------•----....---•-••---•---.. to Construct pr Rep it ( ).an ndividu l Sewage Disposal System at No.... 3 ••-•-_• o f C. Cu�akl •...............•--•........--- Street �/ as shown on the application for Disposal Works Construction Permit �do._. .._..._..... Dated.......................................... ................ ..... -•'••••-•-•-...•---•-••••----------•--••-•••-•-••-•............•-----'•---...... �y / L��/rsJ� DATE.............................. -,( ---- l/f Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON - LOCATION SEWAGE PERMIT NO Z::oT a3 .f/,�� �'y 74 -VILLAGE i I N S T A LLER'S NAME A ADDRESS I! U I L D E R OR OWNER 1 �j DATE PERMIT ISSUED /G 2- DATE COMPLIANCE ISSUED �T � IL 4 soil LOG CD T E PLAN N0. 1 NO 2 2 - . e; TOP OF FOUNDATION El.: - — 6 --- D 8 _----1 ° Y e • =-----� 9 -----� 10 IN EL. _ _ _ -- - 2 COVER 1/8 3/8 WASHED STONE •.•�,.cl _._�?-' Z_ '___ -_ •.• L D i N.E L L. I . 6 D o • n �'✓ 'eJ,Ni' '' • O/B W/ 6'� SUMP I" E! ' `" °� FOT ° ° ° --- 3/4 1 1/2 WASHED STONE 13 �- • 4' LIQUID LEVEL • i ° � v ° e� , o ° ° ° -- 14 n . ° d p u e o ° o ° •� b00L�0ov� °` 6"EfF. OEPTH'•l ° - - 15 - -__ `-' o ovb • boba � PERC TEST RESULTS PRECAST SEPTIC TANK WITH oD°oo o� ° i o ov° PRECAST LEACHING PITS PERC RATE : Z.�1/,Ca7,//r'•V _______ CAST IN PLACE INLET AND EL. �_ tea° NO.: -_ s_ SIZE : _ - = -_ -� WHITNESSED BY: -. �? s '__ i OUTLET T 'S PER TITLE �t __- ---_-____-- .:� � . BOARD OF HEALTH DIA + 0 45: SIZE : /®c.�c} a .v`' ,..,� D ATE : __ cVAx1_ `C".[ ca. -;'oc> ••�.-<c c yc. yes' , . �� �' -- __ D I A . / \ � i PROFILE OF PROPOSED SEWAGE SYSTEM %= w• ��`� -� SYSTEM DESIGNED BY THE TOWN Of REGULATIONS AND A6 STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4"-- 1 ' 0 I . ALL PIPES SHALL HL SCHEDULE 40 P.V.C. SEWER PIPE J- f 2. ALL PIPES SHAU BE SLOPED 1/4 '** PER FOOT EXCEPT FOR ,��'7 • �' `� `��' � � ;fig THE FIRST 2 FEET OUT OF THE O / B WHICH SHALL. BE LEVEL `' I°kr 3. DESIGN FLOW W BEDROOM T PER S 11 GA A 0 DAY L R BR. �. GAUDY A � D �► .� SEPTIC TANK SIZE -- ._ X -sZ�GAL. / USE/__ r_4_�_ GAL. W/v�,— GARBAGE DISPOSAL V L EACH I N G SYSTEM : USE - t ,. - ,-,� ,� ,. W.1114 �� � �. - plc �1 EFFECTIVE AREA : SIDE �xCX 5 x z' �f77 BOITOMOA TOTAL FLOW---_ tip__ __ ____ W/__ GARBAGE DISPOSAL TOTAL REQ 'D FLOWs _ X N RESERVE FLOW.����� �--��_ GAL/ DAY_ 5 1 REFERENI' E PLANS z � - APPROVED BY : 04 L� 80ARD OF HEALTH DATE : .__ ___._---------- F_S' ITE PROPERTY OWNER . - ---_ AND SEWAGE PLAN FOR : X BEDROOM SINGLE FAMILY DWELLING y���A LOT so�v 1 , DATE . �7" DOYLE ASSOCIATES FALMOUTH a MASS .