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HomeMy WebLinkAbout0080 WOODVALE LANE - Health 80 WOODVALE LANE Centerville A= 190 - 181 s M EAD® KEEPING YOU ORGANIZED No. 12534 2-10WR Own W ® WMIR 4 GETORGAMATSYEAD:COY No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS 4pf ration for Vspo8af *pBtrm Construction pertnit Application for a Permit to Construct( ) Repair ' Upgrade( ) Abandon( ) ❑Complete System Ff Individual Components Location Address or Lot No.igo Qx 4 t(C�l� �- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 6 f m m Qy1w�1 In ller's�at Address,and Tel.Nol Q Designer's Name,Address, T 1.No. C(S . �L�'R �c-,,C�,/�VL �� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder 1 V 9 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures -� Design Flow(min.required) `S2 gpd Design flow provided �j® , b L-( gpd Plan Date —)I((o �� Number of sheets Revision Date Title Size of Septic Tank ��(��\ O(Z� �§%L Type of S.A.S. MO (75A�. `t) C\ bcsS Description of Soil pr�r ,.+�SG.r`t� 1,•, Nko 5- a(( k T X �e Q Nature of Repairs or Alterations(Answer when applicable) 9'r L-%&IM,. 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 Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by 77 ( f 5 Date Application Disapproved by Date for the.following reasons Permit No. ( Date Issued No. .. Fee V t✓ �r " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes r ks 2pplication for -Misposal *pstrm Construction 3pPrmit Application for a Permit to Construct( ) Repair!( L4pgrad'e( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. `{CA-JZ �-CInC Owner's Name,Address,and Tel.No. ?` Assessor's Map/Parcel C v,,-� cr�►�r� Installer's Name,Address,and Tel.No. Designer's Name,Address,and T I.No. ki"��t c u� t,TS Csev c1u Ck , r o Type of.Building: Dwelling No.of Bedrooms Lot Size s kC"� sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) r gpd Design flow provided [' , 0�..( gpd Plan Date ! {to ! i Number of sheets Revision Date Title Size of Septic Tank P k C-,NVk n Ci C)6t f,wt—Type of S.A.S. C�,c ,,.,S Description of Soil `,,a Cj k S' 1K Nature of Repairs or Alterations(Answer when applicable) «��, c C ; f• e t-,A 0-%, Date last inspecfed: Agreement: , (4. t d3 f 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 systemr-n operation until a Certificate of Compliance has been issued by this Board of Health. s Signed /1 F' ,.+ t• Ex: Date Application Approved by (�a✓"ir Date "~ - _ - Application Disapproved by Date for the following reasons Permit No: �1"� �''/ r Date Issued r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V� Upgraded( ) Abandoned( )by c y,�q at X_n ��`'�t�tt�1J t�'li� Lc," C u:k 1<_ has been constructed-in accordancewith the provisions of Title 5 and the for Disposal System Construction Permit No. ®� dated �. Installer �rh 1-� !� *_h Designer btU f co yi � q^ow r. #bedrooms Approved design flow �,I 0. C god The issuance of this permit shalllmot be construed as a guarantee that the system w(ill funpltion as Date �Tc� 0 ( � Inspector -- - -- No. p UI FeeTHE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(t,4 Upgrade( ) `` Abandon( ) System located at l/r. �r� (, e.pa�+L L V"t,A, C G� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title-.5 and the following local provisions or special conditions. Provided:Construction must be coo pleted within three years of the date of this permit. Date . '�"��'Pb Approved by Town of Barnstable a��f` ►�+�, Regulatory Services Riclu rd V.Scali,Interitu I3irector i . BARN STAB E IA 'Public Elealth Division A'fo �a Thomas McKe.trr, Dire:ctor- 200 Main Str•c�t, Ky,itinnis,MA 02601 Office: 508-862-644 Fax. 508_79016304 Irtstttller&Detiign.er Certification: 1 orn! Fite:: Scmage Perwit'# o�� \ scs�rtr,;< 11'IalAParcel -O 161 Designer, t 1 �u 11 l f1Wf Ittst.illcr° c�C o e F Address: l� � � r Address. �l�- v Cj . z Oil J ['�G��v��;tti iss �t d tr � itu�it:tip irtsial(.tt.. (date' (installer) s.e ttic:systc it At qO imL,V',GC ole based on a desiart drawn by 0dd re,s ) Id D -60- c)4- tW4 OW f desigite.r). I certify that the septic system ref'ereneed above was installed substantially according o the design, which.may include minor approved changes such as lateral rJocati n of the distribution.box and/or septic tank. Strip out of regttired) was it spectedl and:the sails.. Nvere;found:Satisfactory. I certify that the �septle system rcfcrenced above w-a installed with nlajur cliallig is (i.c:. ureater than. I0' lat;ra! reloCation of the, SAS or arty vertical relocation of:any,coiitponent of the septic systertt} but in accordance with State c :Local regulations: flan rev.isio t_or certified as-built ley designer to follow. Strip:out (if rc=cluirc d was inspected and the soils were 1pund satisfactory;. I certify that the system referenced above %Vas.consir ICted in rand:4vith the terrns of the Aix- approval letters tifapplieablc � t nstallcr's Sig Itr. t 093 f f.sTIE:S� (Designer's Signature} (AMx- Here) i PLE,,i ; IZEITUI2N TO BA"RNSTABL1} PUBLIC HEALTH DIVISION. CEJII IFICATF.; OF CQiyTITIANCE WILL NOT BE ISSUED UNTIL IBC TI-I TFUS Ft)I2lVI .AAD AS- BUrI,'I CAItI):ARE RECEIVED BY THE BA NS`t'ABI-E PUB[it C HEIALITUDIVISION. THANK YOU. t11S�151�c1t)rsi�trer C=ertie:t+9t�t`urm itcc fiia-1:+,citr� I mks y o 3 4 Ij off Elf .a .l ;a Was . Ns- t �" e d XjAMASS h" S d, ", °�, '�' ,u; 1 �"} o� ;,a4 "?€a `"a;'', ac9 .. .-p. .•�n; '' "'" s „�' reg '•.� a .,.aY,p;Ya.�n" `r ".. ,�" x yx Y '"' r :.. k�' a'` •'"'r ''�' ,a,; .',.. T"-n, _.� � ' l n'�-'��'B"""ya#r�l,nw��j,�i, ,��3�. c� i"a��bs. z«w- _� ��n` r�.� "�as��+j'r'�'� ''�� +�` �"� � �� `�.-�•� I..L 'f m •r � � r e* 1 x� a�'1 "ray*��a ''�".w.,�.,.y wed; tt�^` �\'\� � � :i. w�� t�" ' �§'�rv�+';t� .,_%�;s .� �''e[.__�'"," 5.�* M,�� �m`'� qcr'. M� y� �y� du X � ?• „a y��0�'h k e�r6l,, �e ,�c,y 7�. ;Y. +C _�,r� r W V) tx" rr Z ,.e �. Cj} s t y° S3S3 r 4 M - ttiw>..r.Wrr Y p 4 rn � yap _ a i t ,�'K pigI'J''1 ' r 0 3Ybi� + ro } �- 9 AVtw+'rn-++ ! y»�„v, .wk S x a� �'� �a+� ;�',.�ri. t u e a ' ) ,,.„„a 3 , i :.:'a �i�'k ,•n, jy*a`{.7�4. { .+ ,ice`v"3';`" u �.�.,,.,y n.� v, u;,t'tiv:�,#,.�iFl. ....�,E, ..,,, ,. ., .. .. ... ..,.,.,,�..,.. l'• r• i From: Skipdumas skipdumas@comcast.net Subject: Fwd: Floor plan Date: Jul 24, 2018 at 4:40:42 PM To Scott Frank scottfrankl@hotmaii.com Signed copy of Joe Floor Plan Sent from my iPhone Begin forwarded message: From: JAR F <waterwings80@hotmail.com> Date: July 24, 2018 at 3:58:24 PM EDT To: Skip Dumas <skipdumas@comcast.net> Subject: Floor plan NOrES INSTALLER MAY MOVE SOIL ABSORPTION ` SEPT0C INFO AT SYSTEM UP TO FIVE (5) FEET LATERALLY EC®-TECH'US P IN ANY DIRECTION. ELEVATIONS SPECIFIED ON FLOW PROFILE MUST BE MAINTAINED. TREE REMOVAL AT INSTALLERS DISCRETION. EXISTING!LEACH PIT TO BE PUMPED AND FILLED OR REMOVED. 83 i 1 � PROPOSED SOIL ABSORPTION �. SYSTEM -SEE DETAIL ON BACK i s41 z' p�cl12 Oq ins 3 I ® s%, f12 P/NEn 01? m P 10 P e O z � in i p O AK t � \ f I'I O � d MINIMAL O GRADING • \ PROPOSED I G 5 LINE A L Oo U l 7 AREA = 1580 sf+- PLAN BOOK 246 P GE 145 53 i THIS IS A 1 Q ASSR MAP 190 P L 181 COL PR 1 X205 ft PLAN i -^ USE COLOR PLAN ONLY j�C� M� FOR INSTALLATION SQ o BpPN�01 CisDAT � FULL DETAIL IS BEST LEGEND � EL VA TION � VIEWED IN SEPTIC COMPONENTS FULL COLOR / 53.8� p9. Y Q UEXISTING �FL� 1000 GAL SEPTIC TANK SCALE: I in = 20 f t EXISTING % - I 0 20 40 • LEACH PIT/ --- - --___ GARB p CESSPOOL INSTALLER TO G q III ��. O 10 20 VERIFY LOCATIONS OT DISTRIBUTION BOX® OF ALL UNDERGROUND' PRI N T O N 8—I/2 X I4 I n ® UTILITIES-BEFORE A OWED P rEsr PIT EXCAVATING FOR PA FOR PROPER SCALE - SYSTEM. � THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING ------- ----- - ---� - PLACEMENT OF ADDITIONS. SHEDS..FENCES OR SWIMMING POOLS. OWNER Q0 -SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR { ,a �tN OF OF OF o� F SEWAGE DISPOSAL N o 14 - s9�� �P�t� ssq� �� 5 SYSTEM PLAN m doCOUGHANOWR oo DAOVID yG� ;s -TO SERVE EXISTING (DWELLING V GREAT No. 1093 COUGHANOWR J O S E P H & J O A N N E MARSH RD II �F O NP v�l p •• �� OWNER[S1 OF E R R�R O._ N NOT ° RDI SA 1 �P s0/�P �° — P�� 80 WOODVA.LE LANE TO a SCALE E P _ RES CENTERVILLE! MA 1 1 , MA Ryder Rd S PROPERTY ADDRESS_( CENTERVILLE, MA Chatham - DATE. 6. 2018 L O C U S M A P 508� 364 t 08( 0 nEi C:'DE p //te��aa DATE: JULY 16 2018 c O�16. TEST LOG PERC# 15725 25 v � S SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE #461 I WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD it SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT NO GROUNDWATER ENCOUNTERED I USE EXISTING 1000 GALLON SEPTIC TANK IF IN� PERC AT 50 In - 2 MIN/INCH IN C SOILS SOUND STRUCTURAL CONDITION. IF NOT. INSTAILL ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER NEW 1500 GALLON SEP INCHES HORIZON TEXTURE (MUNSELL) MOTTLES TIC TANK• it 53.15 0-6 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 51.15 6-24 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE SOiL ABSORBTION SYSTEM: �! 24-138 C MEDIUM SAND 10 YR 5l4 NONE LOOSE 41.65 THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES { TEST PIT 2 NO GROUNDWATER ENCOUNTERED PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. 2 MIN/INCH IN C SOILS THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ' DEPICTED BELOW CAN LEACH: 'I INCHES HORIZON TEXTURE (MUNSELL) MOTTLES 53.35 0-8 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE BOTTOM AREA = (24 x 12.5) = 300 sq. ft. 51.18 2-26 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 s ft. 26-132 C MEDIUM SAND 10 YR 5l4 NONE LOOSE TOTAL AREA - 446 s ft. 42.35 , q FLOW CAPACITY = 0.74 x 446 = 330.04 goI/doy INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED ��0 GALLON SEPTIC TANK BELOW. FLOW CAPACITY = 330.04 gal/day WHICH EXCEEDS- THE 330 goI/doy REQUIRED FOR A THREE BEDROOM DESIGN.' EXISTING UNIT • i I i TANK TO BE PUMPED DRY AT TIME OF INSTALLATION SOIL A B S O R P T I O N ! AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. SYSTEM • ' - REPLACE WITH A NEW •• •• • r I in 1500 GALLON TANK TAPER ".. IF CRACKED. ROTTED DRYWELL 24.0 ft <,,.-.. OR OTHERWISE UNIT COMPROMISED. m ° �. M co ° NOT j N TO - Ie SCALE I c (` T• t S ONE^ 0 3.5 ft 8.5 ft 8.5 ft 3.5 ft 8 ft- µE 6 i n A INLET OUTLET 500 GALLON DRYWELL COVER COVER DIMENSIONS & DETAIL i INSTALL ONE INSPECTION k I I RISER TO WITHIN THREE INCHES OF FINAL GRADE 3 IN DROP H 10 & INDICATE LOCATION -► FLOW LINE UNIT ON AS-BUILT FROM 10, in - BUILDING - 14 TO i '^ 33 D-BOX DQUID GAS � LEVEL BAFFLE g$ I 102 in b /n STONE BASE /F NEW I' CROSS SECTION SEPARATION BETWEEN INLET & OUTLET N 0 VIEW TEES NO LESS THAN LIQUID DEPTH —INSTALL FABRIC AN AP BONED GEOTEXTILE CROSS SECTION VIEW i .u. ,■ 24 in ■ - -, rt. ©1ST ■ O O r n TO USE • 1 �B 1-1/2/�e GR�EL EFFECTIVE■ 1-1/2 in ORA EL r • ► BO • RUN LEVELM DEPTH AND 1 • BEFORE 1• 46 in 58 in 46 in 150 in 12 /n C MIN -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE —► N STARTING WORK. Lq S e -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM FROM � I OM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC N •TANK ' � TO b r ... CODE (310 CM IS). p ^ SAS -IN ! a -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND O T UTILITIES BEFORE EXCAVATING FOR SYSTEM. i � ro�ooC� -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION \� 6 In STONE BASE E OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC PUMPING OF THE SEPTIC TANK. I 21 ;n 2� CROSS SECTION VIEW S -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR ,LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. - I I CC ,• j TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE 4 in SCH. 40 PVC EL = 53.80 +- 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN '. 53.50 3' t r USE H-20 M A X EMISTING 50.50 EXISTING 1000 GALLON 000ao�o 0 o PRECAST 11 � 50.70 oo$�g.o��°g°° DRYWELL iCEP��C� �TA�I� 49.88 EXISTING 6 in r REFER TO DETAIL BOX 50.05 STONE r ML ABSORPTION EXISTING w BASE 49.75 SYSTEM Y S fc M REFER TO Q lip 49 ft 5-12 ft DETAIL BOX NO GROUNDWATER V,,I BELOW i 47.75 MOTTLING OBSERVED _ 41.65 SEWAGE DISPOSAL SYSTEM PLAN��80 WOODVALE LANE CENTERVILLE MA 11 JULY 16, 2018 ETE-4300,PG 2/2 I ,.v TOWN OF BARNSTABLE` LOCATION aQ �(p��(9//� SEWAGE# a�� 1 z�f VILLAGE VI/le ASSESSOR'S �CMAP&PARCEL INSTALLER'S NAME&PHONE N�Oj.� Sco 77 SEPTIC TANK CAPACITY {U�" LEACHING FACILITY: (type) size) NO.OF BEDROOMS .3 . .OWNER (,-7 �`✓oG/7/�e �P./r eeo `r- s �;vPERMIT DATE: COMPLIANCE DATE: �-7 f / / '-,-,.'Separation Distance Between the: . Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility /V/� Feet K'Pri a-te Water Supply Welland Leaching Facility(If any wells exist on k "site or within'200 feet of leaching facility). /'� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leach ing facility,) .FURNISHED BY ".3 f�` ,3_-N 3i 8`S 46 r; Cl— yl 13 Lt o 5 � S 13 yr _ ``; Town of Barnstable Department of Regulatory Services I ruuwarABLA t Public Health Division Date 7 1"��- 2� MGM v639 200 Main Street,Hyannis MA 02601 NJ . lF(1 Mitt� � J Date Scheduled c/-� 1/ / G1)d,p D�a Time Fee Pd._ ;:C:: bvrf • Pm.! Soil Suitability Assessment for Se a Disposal �w �..w. . Performed By:zo v t(4 D U U'tI 6i!n a�✓ Wltncssed By: LOCATION&.GENERAL INFORMATION Location Address W 04�Vp��� �h Owner's Name Opp t�rrel/ Address r5O W 1�9d Ikl�C L C2114erv,lte► t*A 026"3Z Assessor's Map/Parcel: '��� 6 ��� Baginocr's Name avl4 65 of h tYoL r NEW CONS(TR,U,, IR CrION / REPA Telephone# �� fig 64�1 Land Use ��- 5 f fil f T' Slopes Surface Stones 1 t'✓ Distances from: Opon Water Body d ft Possible Wet•Area 80 t ft Drinking Water Well �0© ft Draihage Way + ft Property Line ft Other {t SIMTCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locato wetlands'1'n proximity to holes) V3.f --------------------- $` I -[P-i VV W 0 04V �Ie LA Parent material(geologic)+rO1§1"t nrYf`" "f Depth to Bedrock V� V. �5 y L Depth to Groundwater- Standing Water in Hole: 6 o vI` _ Weeping frotrl Pit Rea �1[g n e stlmated Seasonal High Oroundwater ��'Ir'P1r +-11C7/I �T n + Z' — DETERMINATION FOR SEASONALMGH WATER TABLE ethod Used: M6 4 1 i kcr Depth Observed standing in obs.hole: In. Depth to still mottlasl la,' Dcilth to weeping from aide of obs,hole: In, Groundwater Adjustment fr. Index Welt-# Reading Detx _ ln&x Well 1mvel Adj.-feetar, , Adj..Croup 6watdr.Lavrl PERCOLATION TEST Data t /j Tama 0 R M Observation 1 L 9 Hole# Tlmo at 9 Depth of Pero l ® Time at 6" � Start Pro-soak Time @ , O -00 Tima(9"4") I G 8nd Pro-soak q_0" Rate Min./lach 2DIP I. Site Suitability Assessment: Site Passed Sitp Failed: Additional Testing Needed(YIN) 1�/ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. F Q:\SEPTlWERCF6RM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soli Horizon Soil Texture Still Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stoned;Boulders. Consistency,%'Drivel) -7 WO 24 G �kp S6)44 to PI DEEP OBSERVATION HOLE LOG Hole# 7 Depth from Soil Horizon, Soil Texture Soil Color Soil 'Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ors? en y lfg F ; b 2C -13Z. C' Loy C-,o DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency. DEEP OBSERVATION HOLE LOG- Hole# Depth from Soil Horizon Soil Texture Soil Color 5011 Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency. 0mvill) � I i Flood Insurance Rate Maa: t / Above 500 year flood boundary No— Yes Within 500 year boundary No t/f Yes Within 100 year flood boundary No. _ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious tntiterlal exist in all areas observed thrpughout the area proposed for the soil absorption system? L(e 5 If not,what is the depth of naturally occurring pervious material? Certification �\` e I certify that on 1voJ • 9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise nd experience described in;I 10 CMR 15.017. �� iH OF 4%c' Signature Date l G l �o DAVID oy�� o D. " COUGHANOWR N S Q:WHPTIC%PBR F CPORM.DOC �O f 3 Q O • � VAt.VP� TOWN OF BARNSTABLE LOCATION��J�i�r\� L44• SEWAGE # VILLAGE ( �("� �, ASSESSOR'S MAP ST LOT C) — �P INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �5Oo(size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER o��►C BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t � \ t `Q COv,-E for No•Z••---1........ Fimim �................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.�IuAn.................O F....... ......................... Appliratinn for Biipnoal Workii Tonstrnrtion Vrrnfit Application is hereby made for a Permit t Construct ( ) or Repair ( ) an Individual Sewage Disposal Syste�at: If V U L ti r or Lot No. a Owner Address W Installer Address _S Type of Building r�=�� Size Lot.-���.__._._._. q. feet .-� Dwelling—No.-"of Bedrooms____________________________________________Expansion Attic ( ) Garl1age Grinder ( ) per-, Other—Type of Building ____________________________ No. of persons-------._................... Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------- •-•-' - W Design Flow................ ________ gallons per person per day. Total daily flow________.____._g�____ 7??7_._._--.__gallons. P4 'Septic Tank—Liquid capacit/jMgallons Length................ Width---------------- Diameter................ Depth---------------- W Disposal Trench—No ____________�__ -___ Wi th_______ .__ _ Total Length p _ gt __________.____._-_ Total leaching area....................sq., ft. y" Seepage Pit No _ Diameter_ p g q._�________________ ��_________ 'Depth below inlet_____ . _________. Total leaching area__Q_Zs ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date_------•-------------------------------- Test Pit No. 1........I......minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ - ------------------------------------------------------------------------------------------- 0 Description of Soil____________ W ••--•'•-•--•-------------•-•---------------'------••-•-••-•••••••••••----•-••-•-•----•-•-•------•--•---•-------•••-•---•--------•--------•-•---••'--••-•-•--------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: •-----•-•----------------------••-•-"-----------------"---________--•---•---•----------------------------------•-----••-•-------------•-------------"-"-•---------___---------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code ,The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b i ue Vy the I ealth. Si d... - .44 ------- g ----------- -------------------------------- ate Application Approved BY r- - ••-••-•---_•••-- ....... .7 Date Application Disapproved for the following reasons----------------------•-'----'----•-•--------••---•---•------------------------------------••••-••----•---••---- 4 Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF..... . ' ,'? �e:�,. j:_ :_ ��`�................... Turrr#if irutr of Toutphattrr THIS IS TO RTIFY, That the In •'v ual Sewage Disposal System constructed ( ) or Repaired ( ) r by . ------------------------- w mstaller e g S� at y r...............F c J`"/�f a -C 7s -F{•— G..rw 1...!t .. .l has )een installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. s - DATI - 7 Inspector ------•-`° THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j f . OF........ .ti ..fy'' .'::...a� :� '" .................. No. . -- --__--. FEE---- Uinpwi4,1 rk ��a�' fratri>a - rr�ti# Permission is hereby granted....._r_ _r____:. Ys to Construct ( or Repair ( ) Indivis�,ual Sewage DjSposal v a r at No._-; ... :9 ca-. �Ase :,� .._.... � r. . ` tr.. Street ' as shown on the application for Disposal Works Construction Pe;nlit N ...... Dated.__ € t j ---_._. .. rY�- - --•-------•-------- Board of Health DATE............................................... ------------•----•--••-•-------- r/ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS No.,TA/.....---- F��.. . ................. THE COMMONWEALTH OF MASSACHUSETTS 00ARD QF HEALTH I ..........OF....... f... Appliration for Miivaoat Worko Tnnfitrurtion Pumil Application is hereby made for a Permit t Construct ( ) or Repair ( ) an•.Individual Sewage Disposal Systex at Y ' f ..................................................... Locatii• drs, or Lot No. 6+�'-------------------r k Address Inst"a er Address UType of Building Size Lot. _,�_�_.(.617d...Sq. feet �-, Dwelling—No. of Bedrooms-----------_w ............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ........................................................................ W Design Flow.......................$;.-_(1............ allons per person per day. Total daily flow------_.__--_--? 9.-."rf------------- W Septic Tank—Liquid capacit�'_ ' gallons Length................ Width..... ---------- Diameter---------....... Depth--.----_---_--- ... x Disposal Trench—No..................... Width....._._.__. Total Length._........._.•...... Total leaching area--------------------sq. ft. Seepage Pit No.. ................ Diameter _ ! ... .e°° Depth below inlet.... -----_-__-_ Total leaching area_,��_ _ , _sq. fi. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date----------------•-_-------------------- Test Pit No. 1........I------minutes per inch Depth of Test Pit-------------------- Depth to ground water.--.-----------------_- 1:14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.---__-__________-.-.-. _..._ .................... l------------ "r 1-~-''d O Description of Soil ---------------------------------------------------------- U --------•-•- ----•-----------------•--------•-----•--•---•-------------------------------------•---•-------------------------------- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the bbqard of health. tiopng, p,. at Application Approved By...... _ j�� /P, I- �. e---------- ,. .�+5+ - i'..---• � -- -�--••----••--------- -- -•�`� ate LApplication Disapproved for the following reasons:..........................----------•--••--•-•---•-•-•-•-•-•-•---------•-•-------------------------------------- ---•------....--•---•••••--•----------------------•--••-•-----•'-----••---•-----------•----••--•------------...•-•••-••-•--•••-•---•-------------•••----------....---------•-.--•••------------ Date PermitNo......................................................... Issued..............-•-----------•-•--•----'------------•-•-- - Date