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HomeMy WebLinkAbout0264 OAK STREET (CENT./W.BARN) - Health 264 OAK STREET, -'CENTERVILLE' . --A= 194-001 . 001 t No. 42101/3 ORA ESSELTE 10% (a O O O O THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Application is hereby made for a Permit to Construct or Repair Oc:�) an Individual Sewage Disposal System at: Location-Address or Lot No. 0, Address Installer Address Z Other Distribution box Dosing tank Nature of Repairs or Alteratio 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 h bee issued b th oard of health. ---'------------'-----------------'--------------'------ ....................----- Da° � Permit No. --'����—'��---163.5----' Issued ----------------------' THE COMMONWEALTH OF MASSACHUSETTS l�� DQ�• d�� BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Comptia ice THIS IS TO CERTIFY Th ,the Individual Sewage Dis osal System const>;ucted ( ) or Repaired -------------------C--------.S G.,'�V-n�---- -------------------- ---------------------.................... at . -�:6P..`'. ... U 1 C- -5%`rt �c -"--- -------- --- ---------�--F/1'U��-L'4-- ----------------- has been installed in accordance with the provisions of TITLE 5 cif The State Environmental Code as described irv. the application for Disposal Works Construction Permit No. ...._ _�j`.r--_� �}�._. ... dated .........'------ .�f..�.f7l3— THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......._ ---- �..................... Inspect r-y..... `.. .. - -... ----- - - ----- -- r--l- --THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH // TOWN OF BARNSTABLE No.. �..'.(.6 .� FEE....:-�U..f Permission is hereby granted...................... ---------C fJ�`�S'�2VC.�-7G►J to Construct ( ) or Repair (ram) an Individual Sewage Disposal System at No.................................. --•------- ed.-----••---....0 -..... 'L��.7-......- C- ����t�-E --------------- `� -------- - street qq _ as shown on the application for Disposal Works Construction Permit No.L�^16�-� Dated.----_-�.�-.�1,(....-JJ ----------------------- ----------------------------- i Board of Health DATE CAS ------------ FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS r r "t • EC"��rlGl - 411)% . � aWwm ^i• wrr...�✓� NoJ ... , Fim.......�....6............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ., TOWN OF BARNSTABLE Appliratiutt for Di!ipnuul Wnrkii Tomitrurtion rerutit Application is hereby made for a Permit to Construct ( ) or Repair (>,/—) an Individual Sewage Disposal System at: ...��. C� /C_vitt L ......... {......•---••-••-...-------• -••--•-••----------•----•......•--••--•--•--------••-----------•-•-------•---•------...... Location-Address or Lot No. �. O��:ner Address W D✓�./t.�0'7T7 C..A NsT`/L.►ci !.. i-••-•-.-7L.o 1_. ..J! PlLU:(........ ...."....A.....(..- T ,..J..s ✓v. I V..1 - 1 Installer Address Type of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms------------ ----------------------__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other !�xture ._.--.-.Design Flow_____________ _...._..__.___gallons per person per day. Total daily flow-__........................................- gallons. W WSeptic Tank—Liquid capacit}( o-----gallo;,s Length----_e.�__. Width.�.(_...__ Diameter________________ Depth..... x Disposal Trench—No. ....................'Width____._-_---________ Total Length_-_--___-___�--___- Total leaching area_...................sq. ft. Seepage Pit No----------/--....... Diameter._ -__o._._. Depth below inlet...... .. .._..._. Total leaching area..................sq. ft. z Other Distribution box (�) �, Dosing tank-( ) Percolation Test Results , Performed by-------------------------------•----••-------••......-•-•--•--•--...__... Date........................................ aTest Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ GX4 Test Pit No. 2................minutes per inch, Depth of Test Pit-------------------- Depth to ground water........................ W .....................t........t t__.....----•-••----............----•-------•---......................................................................._. 0 Description of Soil................................... l' J ........................................................................................................................................ W --- ------- ------- .......------------------------------ .......--,,--'--�-----••..-•-•--------------•-----------------------••--------•-------- --•-•-•-••----•--•-•-•---------•---------- ,. U Nature of Repairs or Alteration. —Answer when applicable._.:�_Q..._.. �__-_./O.P U� (� �f�: W 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 ha/beep issued b th oard of health. Signed,. l . - ... r �--- .......... --------- Application. .. ....... ..:....... Dace Approved By --------- ----------- � ------ -_eZ- Application Disapproved for the following rearons- ------------------------------ ------------------..._..... ......_...... ....... .. ......................... ------------------------------------------------------------------------------------ ---------------------- ----------- ------------------ ---------------- ---------- --------------------- --------------------------------- �. Date PermitNo. ........ ......... Issued --------------------------------------....._--------------------- Date i CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) 7 hereby certify that the application for disposal works construction permit signed by me dated -7z��ylq6' concerning the property located at V 0A-g- -s �i t e€ meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed • There are no variances requested or needed. 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]. f r �r pyti��ar� ® EY ` � b Gr�J'TF1Lu L�� I No........ ..._....._ -. FEs........�............... . l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ....... .�1....................OF......... Q1.�j H........ . Appl ration for Diipuuttl arks Tonstrudiun rrrmit Application is hereby made for a Permit to Construct (,4,) or Repair ( ) an� Individual Sewage Disposal System at . ©A.kC..�T- .............. -.1.._c� c ST.......................................... ....... - . Location-Address o�r, t No. -`••- -.......... ........•-.........1- - ...�.. ................... r-. Owner Address .....` 1� .�.._.. - � � ..... Installer �- Address Type of Building Size Lot.._ 3: �P1 '®_..Sq. fe t 0-4 Dwelling—No. of Bedrooms...... ._-._-----------------------Expansion Attic (p/j Ga bage Grinder ( A) ` Other—Type of Building a yp g ....�(1.,E}............... No. of persons...--N/. k_.......__..... Showers (A� — Cafeteria Other fixtures ._._... Design Flow..............:............5.5........gallons per person per day. Total daily flow........ ©_.-._...__......_....gallons. u Septic Tank—Liquid capac' y.ij ®_.gallons L ngth Q'(__..__. Width. ..�.... Diameter__ _.. Depth_�__�. _.... Disposal Trench—N p._.t g� !/I_ ` x ff._.___. Width_... .__ ,E�.... Total Len ....... .......Total leaching area----- .......sq. ft. Seepage Pit No..... DiameterIQ- __ . ..... Depth/ below inlet.... :. z. Total leaching area.--, ` q. Z Other Distribution b x ( �' Do ng tank (Mlilj Percolation Test Results Performed by.......!-fag./.'.. L/£0 Date.:..... a Test Pit No. 1._42--.__._minutes per inch Depth of Test Pit....k ......... Depth to ground water.- ...____. _1✓/�_---------. rZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...........................................................:........................................................................ -------------------- 0 Description of Soil............. Af .. W ` m8d, �a---•----•y`-��- ----. ----� ------------ V Nature of Repairs or Alterations—Answer when applicable..........4ff.::......:................................................................ -•--------•----------------------••-•---------•---•-•--------•----•---•---.........................................-................... -----------...--=.................................... 'Agreement: The id signed agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the pro-' ion f SIT " the to Sanitary Code— The undersigned further agrees not to place the ystem in o erat' n u 11 f liance has been is d by the b d of health. Signed.......... Applicati n ved BY = * ---- ------ ..............•-•-- ,� �lt�e /------ dace Appliea io Disapproved for the following reasons:--•--- •••---•--•-•••........----•-------•-------••--......--•-•-•• -••-----•--•-•............................ .........................••...----•-•--•-...---------••••----...•••-•------•-•..................._._......---:.......•--•----------••--------......_.....-----•....------•-•-•-----•----..........._..... Permit No._ _ -----------•-----•--- Issued....-� Date," - " = -au -j ��/ LO Z AT ION SEWAGE PERMIT NO. VILLAGE `lNSTA LLER'S NAME A ADDRESS f D uA a U I L D E R OR OWNER 2>9 C DATE PERMIT ISSUED --I1- �' - DATE COMPLIANCE ISSUED �� l��C i-C ,/ b . �� � �9 �o � �� I , �, .. FEz......... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD-1 OF HEALTH ' ................OF........ -....►�'pr�1 Appliratiun for Disposal Works Tontrurtiou Frrmit Application is hereby made for a Permit to Construct (VQ or Repair ( ) an Individual Sewage Disposal System at: .... - rr,, Location-Address .......................................... ..-- ....- -. ..... ._..._ ........................... Owner Address W a �.a R.:... = .... � '---- ....................................... --•-...--••-•--••••---...---•-•--•---•---....---........--••....Y--•-••-•........--•-......._..... pp Installer Address av Type of Building Size Lot...43:-l- ...Sq. feet a Dwelling—No. of Bedrooms. ---•---_-_----------Expansion Attic ( yam)'" Garbage Grinder (�k) aOther—Type of Building ....,� �!_______________ No. of persons._._. _._...___....._ Showers (� — Cafeteria ( ��)�- d Other fixtures ----•••••---.....-------------�--.....-••••--------•---•••--•--•--•-•.._...........••••....-•-•......... / W� Design Flow............. ........gallons per person per day. Total daily flow.............. ©....................._gallons. Septic Tank—Liquid capacityltP�P..gallons Length._�{__�"! �.... Width_4 r�! �� Diameter:_ .... Depth. ...... ... x Disposal Trench—No. ....W ...... Width.....A._ �... Total Length.._: !.____._ Total leaching area......_M��......sq. ft. Seepage Pit No...... � __�_.. Diameter.1�`_ ".._ Deptlf below inlet.... "Total leaching area...vt#*_._.....sq. ft. Z Other Distribution box ( h)° Dosing tank (Yh) Percolation Test Results Performed by........ -_ ...MGeCo� Date._...... •...............•. Test Pit No. 1-_44 _•_•minutes per inch- Depth°of Test Pit....?:......... Depth to ground water.....----------- G� Test Pit No. 2................minutes per inch Depth of-Test Pit.................... Depth to ground water._-..................... O Description of Soil....................... 1 "�, t... � � ----•---------------------------•-•-•--.....------------•-••--•---•-- r � •-••-•-----•-••---•---•-•.................. -------.................................................................................... x - ' r u a�. . 50M F_` �inl - /A ir_ V ................. ............. f I ,� y ...... ......................... .:._ ._-i ?'"t ll1M rvl-acX?.........................----...............---•--••--•-•---------------•-----•••-••---•--•-•---•-....-•-------- V Nature of Repairs or Alterations—Answer when applicable............�` ---------_---------------------------------------------------------------- -----------------------------------------------------------------------------------------•--•-•--•----------...--•------.......-•---------•-------•---.....---....:...--------.......•-----......•-•-•- Agreement: The unsigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the pro�sions�of TIT�1 5qf-'th��tate 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 health. Signed......... '��►" ' ,ti �? --------------------•--•----------•-----••---....... -._--- .-_ ------- A lication A_ roved B ���/ D�t� Date Application Disapproved for the following reasons: .....-.`' _•...............•----............----....----•-------........------......_.......-------- s �. f:...._.F...4 ----------------'--••............_..........•..... •-Da......--..._.... te Permit No._ :-.i��- --.... Issued.. . -�?_I-• ,4=................. D THE COMMONWEALTH OF MASSACHUSETTS ;a BOARD OF HEALTH `S .....................OF............... Tprtifirate of Tomb hatta THIS IS T_0-CERTIF ,, That the Individual Sewage Disposal System constructed or Repaired r by. it /i � /(i' ..�........................•--...•----•..........---••-••-- .......... ( ) / �/�J� �j per^• /� Installer ----•-- at._..:. -•---•----•-- ---- AI/ ./1/� ,f . • y . - - ------...-•----••••-•-••-----...••----.....---•---•..............•--•-_.............---- .............. - .- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..........R.. ..'. .. . ...... dated......... _ :.!j-__s-s. ............... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT ON SATISFACTORY. ~ .............................................. Inspector...... I ..--- :_ ................................ DATE..........._ QOG THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 5°c/—li'1�� ..........................................OF........... No.. .................. FEE.... ............. 11ispoottl Works Tonotrurtion 11rrmit Permission is hereby granted...._ ................................. to Construct (LI) or Repair ( ) an Individual Sewage Disposal,System at No..........................r.�. /r�/l - ------------- Street t _ as shown on the application for Disposal Works Construction Permit No. ...I!..L3Dated.._. ` ........... '� .............. .................................................................... ' �DATE..----.. , °iloard of Health �---�------�-•-•-•=----------•-•---------•-•------•--•----------•-•-- �o T 3 - e J vAc-AN14 v. L 07 A R rt fr . . r 38 OF tf4 r � 0 3 y -- o _r 3Z r++ o tORSE .off 9<p��J ��v���• ►� ' L O T �� � �� — � � o s7 c� '`� `\ `L t V FFSS/ONAL�a� y,�; 6, o 2,1 0 "ROBERT sa __ z +FtDRED A o•M . G LEGEND `' 9 l. OISTING SPOT ELEVATION Ox �oN� . CERTIFIED PLOT PLAN EXISTING CONTOUR --- p - - 4-'FIN1`SHED SPOT ELEVATIONCO] '1305450—sor 5T/'�Z--: 7 FINISN.ED CONTOUR 0IN � ��.2oKrHGE /�/7`,E�'1✓s� 2. APPROVED BOARD OF HEALTH AGENT.. .. SCALE l k=-410 W DATE COREDGE ,ENGINEERING CO IN OLIENT,y�k�oiy 1 CERTIFY THAT THE PROPOSED EGISTERE . REGISTERED JOB G N0 y6G BUILDING. SHOWN ON THIS PLAN CIVIL LAND �+.. Cn�.v CONFORMS TO THE ZONING LAWS, { ' 't• ENGINEER SURVEYOR DR.BY F - 0 BARNSTA®LE MA MAIN STREET CH. BY= HYANN I S, MASS. SHEET 'Of-,, 4 TES, .REG. LAND SURVEYOR"R Z k, ..v l S,'y '�tR' a...� .�`Y.+{ '""�`J�a�• �e<'y'r 4 A 's.•�Y. ®�, --- /YO?"4Er /F E/7 SFPT/G 7-AIJ,l< OR LeE',4CH1,,re7 F>/T 4.Rre MORE 7'I4A.,V /Z"E,W40fit/ to /W/,V. . ;,RADE�, ?'!V'WA'/AMET.=R° CONCRF_ 7'�- COP.—ER SWAL[ VF OR0116N r 710 C,dgA®Z.CAN .E;X7-RA coovc.me e , pI®z tiE.4 V y CA S f /RO/Y C©j/Ar4 r S6J.4 L L @.E USDA /miliAt. PITCH C0 6'E•/P CLEAN .SANG .C O i F ® a o/TtN i f o l9 CsAL. D/ST, ` > aa� ��y ASHEO SM)Ve S,,6P7r/C 7AzVX • e e o o . . • . e•n . = . t9oX o � ® s • mm � . e� e l^J vim- SHovv� v vp v o e r �ECT®VL' s . ! - J I2 ,E '_�' ���3 • A PT1I v O WASXFA .ST®/r . :,� :: • v e o o s a eeo i � o , � SC-035drerc.c Av e PR.-CAS 7- .SE.LtPr4GE y,q y s �o a o s • s s o o D si P/7 OR EVVIV, IAIV,"97 eL RVA7/ON S l?�T Cs�Pry e. y . S� "'°¢ t� p c, e • a e. a m . e ea e IIVYZRT AT OVILDIM6 ! 3 3,o FT _ !/1lLET ,,SEPTIC T.4)VK j- z� Fr /D .FT ®b41W- C;�SesL�7.�1hLAT/0/V� 404174 ET S PT/C TANH //1/!„ T ABSPR>�lJYI®lit BOX 1.3 2-4 FT GROIJAfD Ws4TElf 7 6V-,E ovne7A>5-rm0®t/T/ON PX 3, Z7-FT. /114-=-r.LXACHIM ®» 1,a fr, 7- &V LATIOM dCv P/7-' L C� DIMEN.SlQl�O DE'�'16M CRITE-P:/� . Jc�aLE �.•w / m OleglE/�SION:. �-- '•. J�U/►lb�ER ®F 3 DlI�ENSlC1IV �o' F ;`�r.v%. 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