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HomeMy WebLinkAbout0127 POINT OF PINES AVENUE - Health 115 Juniper Road Centerville A=230 - 057 IN UPC 12534 ' .2-153L I t No. r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Ziopo!ml *pftem Con6truction Permit Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. - Owner's Name,Address and Tel.No. ssessor's Mao/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms `� Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildings No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow S—t O gallons. Plan Date ,P —?— Number of sheets l Revision Date Title Size of Septic Tank �Xi�'7�,-g Type of S.A.S. 5:d'*1X '�-S�1 X Z 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 t 's Board of Health. Signed �� Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued • q -;No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes f PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for MigPogal *pgtem Con!9truction Vermit Application for a Permit to Construct( )Repair( )Upgrade(>iAbandon( ) ❑Complete System ❑Individual Components l , Location Address or Lot No. Owner's Name,Address and Tel.No. I155 �PFe a� 'c�.�Tc�POiLG� f3.�t�,,y .�l•,•d�ie✓'m�v ' Assessor's. ap/Parcel f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �;�.. 17i � �lraBoCdf �7.��+�O) 43A�.0 vitt,,4 Q. /�j,�,r'i•� �l".l' Type of Building: Dwelling No.of Bedrooms '3 Lot Size "M sq.ft. Garbage Grinder( ) C Other Type of Building 44'tw-' No.of Persons Showers( ) Cafeteria( ) Other Fixtures f Design Flow gallons per day. Calculated daily flow CJ gallons. Plan Date Number of sheets I Revision Date Title J Size of Septic Tank y000 gt�i �Xi,�'�Jy�:c3 Type of S.A.S. ` X ��X-� �ca<c,�iir9 Description of Soil I Nature of Repairs or Alterations(Answer when applicable) i Date last inspected- j 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 AlsBoardof Health. Signed i Date A—'7 —vr , Application Approved by A Q �V < 1 Date Application Disapproved for the following reasons 'E Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(� Abandoned( )by (.T/is. !//c' at �-� 4°���T v,e° /�-c�y' GF✓T' h been constructed in acc 9 rdance with the provisions of Title 5 and the for Disposal System Construction Permit No.D� ated F � . I Installer \7," �C����y/� Designer�.l`'�O .® iA1lD�✓ The issuance of t pe t shall not be construed as a guarantee that the systan will function as des g,. - Date 17 � I u�' Inspector 4-v --- ----------------------------------�—\—� j No. f-/�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS mtoaal *pgtem con5tructton Vermit Permission is hereby granted toa onstruct( )Repair( )Upgrade Abandon System located at ` -_� �T C�R yk" k"J f V t`t 4 i i 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 ust be c mpleted within three years of the date of this pe wit. (� Date: Approved by t QO 4--) ' 1 1/5- �vw,Per r-0- TOWN OF BA.RNSTABLE LOCATION SEWAGE # �aQ't - ts�z VILLAGE ASSESSOR'S MAP& LOT a3a -0'ra j INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: —o`"'� COMPLIANCE DATE: Separation Distance Between the: i 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) —T Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by CT� '`► � '�` `�/` RIP V pvff T D - - ' 0.......�d...Z..... Fizz. 6e(:................... THE COMMONWEALTH OF MASSACHUSETTS ;136 - 1064 BOARD PF HEA - ... 17OF...... ...... _ - . #5_1 for Mivoiial Works Tonstrudion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: p kY7i.;;;­_ .07 •--•------•---•-•..........................•-- Location- ........ :-a ld....0 _9 _��!c ter ... . . =; -•••-------- ---------�...�����tr a�....�.�7`...�.. Ow er � � Address �fr'p�1�l JE�—D''-`=f-a'yi .._ -----•................................ _.._. . -- q Installer Address dType of Building Size Lot...f 0...........S feet aDwelling—No. of Bedrooms..................3.......................Expansion Attic ( ) Garbage Grinder (i p-, Other—Type of Building -_._--'................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ----------------•----------•------ W Design Flow.............dC�......._._.._...__gallons per person per day. Total daily flow............�.�............._.gallons. WSeptic Tank-�—Liquid capacity.19W._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.........I.......... Width.._....-P-------- Total Length.....a.V...... Total leaching area...1/&0........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.—Rd...Z'4e-e- __._—_ ? �!�. �r l \ Test Pit No. 1................minutes per inch Depth of Test Pit.. ._..... Depth to ground water........................ f� Test Pit No. 2................minutes_pe} inch epth of Test Pit.................... Depth to round water........................ Rr' fGC! --- ---- xDescription of Soil...................X-....3... . - -a•-•-•-•..� 7 ----•-- .•--------------•.•----•.....-••-•-.-•----•----••......_.----•-----•--•--••._..........•......; - - ----- ............................. ` 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 be issue y the boa of health. Si Date Application Approved By--•_-.... --- •---= •--•-••--•••---•-- 0 /Da/ Application Disapproved for the following reasons:----•-•-------------------------------------------------------------------------------------•-•----------•------ ..............................••--•-------•-•-•--••------•----•••._.....••----............_...--•-•---------------•--------•--••--••----------•-••----------------------------------- •------•----_._.. -Date PermitNo......................................................... Issued........................................................ I,-- - � - - -------y--- - --- - -_•-�•__._�����.__�_--_•-_�___--��____._--•_________________Date -----'------------------------- Igo.. ..� ..... FEE.., `.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................................OF.........:..............................-----------------------•........................ Applira#ion for 43hipwial Works Towitrurtion rratit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �`-n !" ice,a:.. ,hrf./ R' ..r+,�.�--�. r -. •x.A.�... - t�F f _ Location Address ..y.�- or Lot No. t^.".�.......`..."....'� .�:'t L:... .......... ......._.... ..........' ;;`•.:.. f=.::.L".. .'..........................� I�7�ty;+r n!'::.L `` .. O `ner ' IL t- Address "► --•------," ...........a f%. y � . . Installer Address Q Type of Building Size Lot.,,1 ...........Sq. feet U Dwelling—No. of Bedrooms..................w'.......................Expansion Attic ( ) Garbage Grinder ( ' Other—Type of Building ---= ..... No. of persons............................ Showers — Cafeteria a Other fixtures ...................................................... W Design Flow................ "" ..................gallons per person per day. Total daily flow.............. .A ---"".......gallons. P� Septic Tank!Liquid capacity.4i3f'A_.gallons Length................ Width................ Diameter................ Depth.............._. Disposal Trench—No.........+.......... Width.......�..p....... Total Length......2........... Total leaching area...,9-4e�......_.sq. it. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. 'a Z Other Distribution box ( ) Dosing tank '-' Percolation Test Results Performed by._.,,,:t.___, ,_e_;__x.___.... Date "' Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ c Test Pit No. 2................minutes per inch, Depth of Test Pit---................. Depth to ground water........................ [" n Description of Soil < -................ ft -- r f I ��- U -.........................................................•.....................-----•---•-Fs yr <r .t� W � -J--p-----------........................................................... UNature 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 issued by the board of health. f ,rr Slgne £ ✓ r*s Date Application Approved By....... """ i �f�- 1 ...- ., ate Application Application Disapproved for the following reasons------------------- ------------------------•---------------------------------------------- ---------••-•-•---. ....-•----•--••-•-------------•--•••--------•-----•---•----------------------------------•---•-•-----------------------•-------------••---------....----•------•----•-----------------------•------••--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEALT . s. ...........OF.... f a :•�,, .... �e .............. uv . TI rrtifiratr of Toutphaurr T�I�IS IS TOM -RTIFY, That jthnd1vj',jaual Sew ge Dis 'oral System constructed ( Repairedby . �' -° a. - (/ 1. ........ . ... .= . ... .. ............................ .-- . .. .Insta erat�* �r�!_Ha °', .. r�:a !�... y "'.a'rf+ t- ------------- � . has been installed in accordance iith the provisions of Article of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. _f_ .� ............ dated--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s- 1 ........... ............ .... y ....................... FEE.. No...s - ---•----...... Dispolla1 y kil Tountrurfion Mit Permission is hereby granted =" ° �`' r ' _ -- to Construct( or Repair ( ) an I div d al Se age Distlp-osal }'ste�m / ..... •• . r y -at .... Y-�......_ .. �5treet as shown on the application for Disposal Works Construction Perm�No......p...... ........ Da/ted.. ��.` �*... ....✓. ' ' t_Board lofHealth DATE__17...'.2 ..— ....................................• FORM 1255 HOBBS & WARREN, INC., PUBLISHERS j °P� Al, 4 v� j I — A=V- i 4 . c:✓r!� 2E-C'o2.DZF /n/ ,.GJLs� .Z f/G'�EBY CE,O"7'/FY 7-NX:77- T//E BcJ/LD/c/G �/-J0611.t/ Ot/ T/�/S OL.4V /S LOC.gTEr-> O.V THE :�1N Or ,,`. �rL3'OC yL/D f7.�i SNO WN HC-ef'od/ q.v D 7'NF?T /T �` ff' za''�s c o 7-o rs�E- �—O,v/.t/6- y`\ .dY-.f.ASV.� ©� 7'�✓E- 7bwiv of ,/ : �.-. t c y.';x ARNC OJAl A Ln11 f oc�n ca � en in�erir� ti � a��i a- 1,9��CI,,TE L,q.t/a sci.eVs Yo aS �`�f I� �(i(/c't,l `�''�• Y� LF A.1,b' .su.?V�-ro.� //S �vuv�eP Padq TOWN OF BARNSTABLE ° LOCATION SEWAGE # ZpQoZ — -,6 VILLAGE ASSESSOR'S MAP& LOT A 00 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Ae, LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: 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 AO LA ,4 ­7 C I ' '` -- ,tea v ASSESSORS MAP : TEST HOLE OGS $t ��.lf✓ - PARCEL : 1057. �� ���.��C��`��JC.,�� SOIL EVALUATOR :��;� �2. FLOOD ZONE : 1'�IIA , 1 I l 11' � �._��_��C�• �I �� WITNESS :, REFERENCE: �W ;/ t J"J�� ? � � 1 PERCOLATDATE: VON ATE : L, �1U-1 ?4. i ell TH- 1 TH-2 tL�„)�f / l� V l/}2A �N • 0.J _ l���Z�,'�'rJ_ _� �'�1.. �1��1Q __ ___�' ��` / `I`� �b r�� �� �5�..�`�n(r.-(c� ( .,����- �iT � �,.,�,, ..� I'`�- �(�•�uP�c.� � LOCATION MAPL�ItFl/2) ,, .... '� G�� Z W, ��j .:_ h-t w, kJ-�4 _ .._ r5) F11 W, _ . --� - �`} ?�.1C.� ► -� �,�._ . r FAG p SEPT I C 3YSTENI DES I GN ' ��'� •\ �IJ /' ---. (� '".-�l 1Z _._�L�1�J7��� � � C�C�ICI,�C.�l�.t 1��r-'.�J' CCU �V� ESTIMATEi 1'L ' _ T�L r BEDRQS)MS AT GAL/DAY/BEDROOM GAL/DAY CIO S.--�- H ,_ � G2 / �� - ERA I C TANK ' �5 D GAL/:)AY x 2 DAYS - &' GAL r `O / i10 USE I DJ('GALLON SEPTIC TANK Q; � OIL ABSORPTION SYSTEM YN S I Ui: AREA 1 vc ` 9 y BOTTOM AREA: >r'G , -S:E ?T I C . Y S T E M SECT 1 ON nAa 57 i V\ /C:;00 GAL JqI 3� /^ SEPTIC TANK ''1-U�Y ^�'��j _ 7� ll . V I "�OT!b�Jj cr- A(�( HVJ SITE AND SEWAGE PLAN LOCAT I ON : M P R E P A R E D F 0 R . SCALE: 1 r DAV I D B . MASON TZ DATE: 8 DZ DBC ENVIRONMENTAL DESIGNS w DATE HEALTH AGENT EAST SANDWICH . MA 3 ( 508 ) 833- 2I77 W Z