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HomeMy WebLinkAbout0047 PRISCILLA STREET - Health 47 Priscilla Street Centerville A = 246 061 u 6 n II *PondmfW a aE WOO B 1521/3 ORA 100/. P2 0 TOWN OF BARNSTABLE LOCATION / R 15 lL 1 5 r SEWAGE # VILLAGE ASSESSOR'S MAP & LOT , INSTALLER'S NAME&PHONE NO. J` it? ,oq C Q�44 tj eir. S oA l SEPTIC TANK CAPACITY /, So D F _ �' �. LEACHING FACILITY: (typg) L. (size) 3 6/ NO.OF BEDROOMS BUILDER O OWNE PERMTTDATE: 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 � � �.� "� 1 ® C� � V�l��Z" '' ` W f � f- _ � i i �� �� �..� '� No. Fee to .� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Migool bpztem Construction Permit Application for a Permit to Construct( )Repair( IO Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.1+1 eel 1 k0. Owner's Name,Addr&ss and Tel.No. ►,�, Assessor's Map/Parcel q'j Pr,;6C: 4 O Installer's,�Name,Address,and Tel.No. `�'3334� Designer's Name Address and Tel.No. $Oj Z, J 1'�wuct�Y�4�lC`AY1G� n 1�a r_)- ZJr' ©. e D q01 6cu Type of Building: Dwelling No.of Bedrooms � Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 4 gallons per day. Calculated daily flow gallons. gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank f SO O Type of S.A.S. 30 X 15 )cZStidn1'Ms_00,11 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 issued by t 's Bo4 of H. lth. Signe Date S Application Approved by Date Application Disapproved for the following reaso s Permit No. Date Issued Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes,' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS placation for Migpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( 7O Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.41 -1"1 l 'r Owner's Name,Address and Tel.No. ' Assessor'sMap/Parcel �q(a D�p� �7 1�r�1 SC t�CRAOXAZ (Ye�1. , 0 0., Installer's Name,Address,and Tel.No. � Designer's Nam ddress and Tel.No. 9 PDX CA 1�RK`c1,�i4�1 �yl � � eYl7 t1�.. Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type,of Building No.of Persons Showers(. ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3;3 gallons. Plan Diie Number of sheets Revision Date Title Size of Septic Tank 1 0 Type of S.A.S. 30 x IMOAaM Description of Soil Nature of Repairs or Alterations(Answer when applicable) }w 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 issued by this Board of Health. Signe �/j. " /? pn Date OS Application Approved by `� it_. Date Application Disapproved for the following reaso s t` I' j > r Permit No. Date Issued / �l THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( ) Abandoned�r): by J,? . 07A(b . if' Q�1 J 3' at q :GG 1 I(-tk tq.+ has,been constructed in accordance with the provisions of 1T"itle 5 and the for Disposal System Construction Permit Nw _1 g a t e d Installer 4 ��6R_'`T pmA",i Designer D0',rKVP dL(' The issuance of this pe t al n t be construed as a guarantee that the yste it u io as designe . Date �:, /�' Inspector --- -- --------------- _—� No. �V t/`J ~ —————————-Fee ��•-�v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wigpogal *pgtemc Congtruction. Permit Permission is hereby granted to Construct( )Repair(x )Upgrade( )Abandon( ) System located at U 7 (cal ,c,��ls�, D� 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:Constru id mus b6 completed within three years of the date of this �j f. Date:_ /Il �� Approved by TOWN OF 9ARNSTABLE ,c� ZI� ` R / l LOCATION L 1 5 7 SEWAGE # J J' VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. eX S o,v SEPTIC TANK CAPACITY . /I i / p♦ LEACHING FACILITY: ) L. (size) "��S L• { NO.OF BEDROOMS ° BUILDER O OWNE ' PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) ' Furbished by LN Cq ` o Town of Barnstable '"E rti Regulatory Services o Thomas F.Geiler,Director snxrrscaeLE. Public Health Division ATFpA Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: t �S Designer. l�t/�' M Installer: r o� Address: psi/ q�S� Address: On `1 ! Q Lg,- -f,�,�-i'eIV� , was issued a permit to install a (date) (installer) ' septic system at -4 7 Z"cA S I . &I'Itt based on a design drawn by (address) dated (designer) certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local lions. Plan revision or ertified as-, by designer to follow. �N of M DARREN cy� ' rJ M. i1 Y R � (Installer's Signature) /� 1 G/STE�� O t \ J 8,�NItAR1PN A kM koav_ (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BA STABLE PUBLIC HEALTH DIVISION. .CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT-CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. O Q:Health/Septic/Designer Certification Form :aM. -. -mod•�4OL�vus��` L�t a��� �- . A�R `� --5 pa ASSESSORS MAP : Zp tna TEST HOLE LOGS NOTES: $LOMAX PARCEL : ®4 iI. 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH SO I L EVALUATOR : �� R�'` 5 THIS PLAN, 1995 MASSACHUSETTS TITLE: V & TOWN OF ,�' TOWiy FLOOD ZONE : f,IUNf� � B =I �� "IL WITNESS : Do c,N _6A9I�I,S�fY LC OARD OF HEALTH REGULATIONS. y ��� C. REFERENCE : �� Ot 2_ DATE : f ' U 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, LA IEgDq „� v` ` ° PERCOLATION RATE : '� Mt INGl A SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO TtER0 j F o � DR AV A 2 � UL- S .� �.,� POI Y � � G ,..,�1�...� L�-1-�'.1Q ;C�,�� INSTALLATION. RR PEHA A oR tl `" R0 ff y� s TH- I LC �' . r � TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ONLY, AND . SHALL NOT BE USED FOR PROPERTY LINE LA DETERMINATION. q 4) ,ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS Tu N l !. _ SPECIFIED OTHERWISE) LOCATION MAP CV -_r.5 37" pj� 19 +1 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A � M GARBAGE DISPOSAL. qI '1 6 SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON 1 � 17> � A BASE OF 6"OF CRUSHED STONE. 32;1) ftOT, Grp a I NoI�tN �1�1v T W w'I l ph SEPTIC 'SYSTEM DES I G N . Ala w i L .! ' w�t�I ! ' o r PAP Iv Yf: PPEPT­11.�`:_ I S NOT . (,DC Alex /rJ 2aN ._oe. , Irk AD RENA 2oNs C FLOW EST I MATE _ v _ _L. � _... _. _. ._.._._.. ._. . ..._. _ ' 1 VNUE BENCH MARK � 3 BEDROOMS AT It(-) GAL/DAY/BEDROOM - ;3Q GAL/DA -�• E "5 Y TOP OF CONC BOUND a A-T-Tv es t 24 22 _� ELEVATION = 20.02 SEPTIC TANK ft 20 USGS DATUM ASSUMED ( f C) ``?8/66 _3 G'!L/DAY x 2 DAYS - GAL -USE / �00 GALLON SEPT I C TANK A) I lLl \ LOT 28 a/ W 501L ABSORPT;ON SYSTEM AREA = 11930 sf +- � \ I a 30 L_ Y_ 15 X (o 3 LA iE� � CL 0 SIDE AREA: 'm I ✓ ` Z.10o 0� I Z I E,?TTOM aAREA: x (� x a "1`� - 6PD 0 J 1 I I 24 � � � W W o � �-- >33a G @ D i 3 H O GA S X m W �!--- GATE Z o W o SEPTIC SYSTEM SECTION \fP-wr I co co L I Mtn I �j, �,' 1 2211 v ► 1 , 12 fr l — ! \ — � `' -3/a'' ou►to wa l I ` • \ 15-0 \ 1 �• q f 2 4UT'p� C - If/ , D BOX I b / U1 . �dU GAL ��.� l�.►� .�R�d�e�I ' V x o \ SEPTIC TANK l _ ' L t 5'\,\) 100.00 {t 22 y : ter D R N G M_ R SITE AND SEWAGE PLAN No. 1140 PLAN _ ���ISTER�° LOCATION : �{? �'f�l CI�.L 4 I , SgNiTAR N _C N T r2ViL(. — - PREPARED FOR : guoHy O K a SCALE : w DARREN M. MEYER, R.S. P.O. BOX 981 DATE : -( -OS Z EAST SANDWICH, MA 02537 w DATE HEALTH AGENT Ph: (508) 362-2922 w Z