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HomeMy WebLinkAbout0015 SCOTTSDALE ROAD - Health 15 Scottsdale Road Centerville A = 229 063 No.42101/3 ORA `N f IM 1o°r D © a fTOWN OF BARNSTABLE LOCATION C �c"6�%SU"��C SEWAGE #-?-09a_ /s VILLAGE CF �� c 2 v r<��� ASSESSOR'S MAP & LOT ��°� 'Gl�3 INSTALLER'S NAME& PHONE N0.92 c is ('.✓.s T SEPTIC TANK CAPACITY S/``' ����a-✓S LEACHING FACILITY: (type) /O,F X NO. OF BEDROOMS 3 BUILDER OR OWNER ���i -✓ PERMITDATE: ' a-2 COMPLIANCE DATE: s d� 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 . $ A �Qo1C j SboS% �F.� Z� FF_3o L41=y�a k No. Fee �- 1�—I � 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppIication for &,9; o Y Opotem Conotrurtfon Permit Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot N . Owner's Namg,Address and Tel.No. _ I� S�vr�:s�A/C � �//�/ Assessor's Map/Parcel /S 5Ce, 7% Installer's Name,Address,and Tel.No. Designer's Nne,Address and Tel.No. -2 G i`/ G"G r✓,'% G !�' C�i4 v ��/ /mot ./# S`'-',"/ Type of Building: , Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(A Other Type of Building &b- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 gallons per day. Calculated daily flow 3 -2— gallons. Plan Date ��/ ,�� Number of sheets Revision Date Title Size of Septic Tank /��� // : Type of S.A.S. `71 /-1. 66u- �L�2 t%-o' 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 this Bo Health. Signe ard Date Application Approved by Q L Date Application Disapproved for the following reasons Permit No. �' 1 Se► Date Issued 6f�— No. �� s•. t� 4 r7 - Fee THE COMMO14WE'ALTH'OF kA§SACHUSETTS Entered in computer: ' - 6�e ,PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Mi Y 6petem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot NA. n Owner's Name,Address and Tel.No. Assessor's Map/Parcel /_ SCo 77-7 Installer's Name,Address,and Tel.No. Designer's N e,Address and Tel.No. Type of'Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(14 Other Type of Building 0,b . No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -3 3 d gallons per day. Calculated daily flow -- gallons. Plan Date / Number of sheets Revision Date Title Size of Septic Tank /��� dry Type of S.A.S. /-�, lAG' '" �'�%�'3/d cS 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\ as been issued by this Board f Health. igned G 7 Date Application Approve by Date �L Ica Application Disappro ed for the following reasons Permit No. -U�c ' �c 1 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the OO-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by 2 e h' C� I 5,7 c at"-, S a 7-i S 020,a X A67c /C 4///./-has been constructe. in a/9cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 'I AQ C U� Installer Designer. 449 v i The issua�n�c�of thi permit shall not be construed as a guarantee that the sys tn will utictio n as sitned. Date �� �V Inspector � , ------------ ------------------ No. �g 4S 01 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE1 MASSACHUSETTS 1wigpozaf 6potem Conztruction Permit Permission is hereby granted to Construct( )Repair pU grade, )Abandon( ) System located at / 5� 7 -5 /` d 19 1:1 C iE,2ve 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:ConstructiP,n must be completed within three years of the date of this permit. Lk Date: �� !��D'(1�-- Approved by A C• _ y l�.l-�_�.., QTOWN OF BARNSTABLE E`. LOCATION C S Sri 7s�A�� SEWAGE # ® -f-l VILLAGE �� �/�t 2 v rC ASSESSOR'S MAP-& LOT 221 " 3 . INSTALLER'S NAME& PHONE NO.,�92 c/­`,' ("--,✓-c r 7 _2's SEPTIC TANK CAPACITY S,``�' glla^iS LEACHING FACILITY: (type) '�i9 P%9/t' / �To/ 'e)3 1>( /O,FS X NO. OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: ' 6 -2 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 Feet within 300 feet of leaching facility) Furnished by I A(f z • �QoK �SaaS% f3F� �/� ASSESSORS MAP :,- -,-, ` ��� T S � , EST HOLE_ LOGS �_FT11�6 . PARCEL : SO I L EVALUATOR : I Rj M C I 1 1 FLOOD ZONE : �/�� �/=>�G/C�BC I V I TN E S S : N� b l..(� Cirt,• / y� l�-I J�,,u ��'Q O��A c3ti REFERENCE : -/ 1� �'�-' �1�/Zz/ DATE : �11�(�I O� _ - �`. �� v "7�✓f�;�o� f�� PERCOLATION RAT!-- : �j I�, I TH I TH-2 LOCATION MAP�hC,TS), � 5 � CXD ,� F, ,.�, ~ ,.\ (� I�/��{N/�',1� �/�1/�.T11'l/� .V/l+C✓� �����(/C/�^f1..n1,(*��J V da_f� ; Murvf�I k,(q / o Q3 SEPT I C SYSTEM DESIGN 1 I FLOW ESTIMATE rAju BEW-OOMS AT �� GAL/DAY/BEDROOM - GAL/DAY I a � SEPTIC i ANK aGX../DAY x 2 DAYS - "OC6AL USE 15(�)GALLON SEPTIC TANK DT SOIL ABSORPTION SYSTEM SIDE AREA: 2X\ -SI 10,0 ' Z'>X( G` I,, - —` G � � _.__.. ►o MiW f L' BOTTOM AREA: 1 ' �O�S �c , - P1, �^ -�^�� o I iu E J-I C SYSTEM SECT I ON ,'-r---•--- `..7,. _ -BOX Z,Z / r A �J ._ .- _.. --- � �1 s /ADD 2 �`. r SEPTIC TANK � \V ,,,/' � 'i �,, / 2,(� `, �„'u bJ� : ��Z ��'gl �f� l�A�•�C� �J'�'Olr]((, o I ,r 0 - SITE AND SEWAGE PLAN LOCATION : PREPARED F 0 R SCALE : / "- De;� _ __ -------�` " _ DAV I D B . MASON, DATE : �Z DBC ENVIRONMENTAL DES I GNS W EAST SANDWICH . MA 3 DATE HEALTH AGENT ( jQ$ ) 833- 2 1 77 W Z