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HomeMy WebLinkAbout0024 MARK LANE - Health 24 Mark Lane 289-151 Hyannis o I! q 1 we / e. �- 1 { I Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Mi5po5al *pgtem Cou.5truction 3permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. U iu �_ -,4D"vcy Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 75— gallons per day. Calculated daily flow 3 gallons. Plan Date .Number of sheets Revision Date Title Description of Soil ,44-e.� 5 /'",�7 Nature of Repairs or Alterations(Answer when applicable) 151-4. T rCNGAS 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 lace the system in operation until a Certifi- cate of Compliance has been issued by this Board of H Signed � Date Application Approved by Application Disapproved for the following reasons Permit No. 96 � �� Date Issued 5 �� No. 9 Fee ` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BAR�NSTABLE, MASSACHUSETTS Mie;po.4ar *pgtem Cortgtrurtiort Permit Permission is hereby granted a V`y� to construct( )repair n On-site Sewage System located at I '--k c'. 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. All construction must be compl ted within two years of the'date below. �� Date: s ^ .G Approved by 2— ' l No Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplication for Mi.5paal *p5tem Con.5truction'Vermit Application is hereby made for a Permit to Construct or Repair(t,<an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. i4-t C_tl U Al !�_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. y, Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder Other Type of Building No. of Persons Showers Cafeteria( Other Fixtures Design Flow 7S _S17- gallons per day. Calculated daily flow —3_31 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) gx_ 15 T- a.(( /50x _7_11UQ _rrCA.16 ?2 y a -e X 5,-r, t0 cAv 9 -t-Aa Date last inspected: Agreement: I 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 I­lph Signed Date — Application Approved by ApPiation Disapproved for the following reasons Permit No. Date Issued o��0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION m BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTr ,that the 0 1 Sewage Disposal System installed or repairedfieplaced V-)"on 7-f/a by h for C_,/ 4 vP-C­ as L�4i o-c— has been constructsfil in a9cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9(v —dated Use of this system is conditioned on compliance with the provisions set forth below: 91x 4007;4�4 4-.4 f f CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated -� 7' S,6 , concerning the property located at / (M v k-- 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. I SIGNED . DATE: — 7`S LICENSED SEPTIC SYSTEM INSTALLER IN TI-M 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]. P >`\ © O Vv \ �� c � � � L0-iA,• 10N SEWAGE PE IT NO. VI L LAG E &All--I� INSTA LLER' NAME & ADDRESS , Y 11,47C--GJ A_1 BUILDER OR OWNER DATE PERMIT ISSUED � � � � 7 DAT E COMPLIANCE ISSUED V � � J - J v 0�, f1k 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... . ......... ..-....OF.....................................I............................. - Appliratiurt -fur Uiipuutt1 Worku Towitrurtiutt Vrruift Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systzin at: ej J----•----------•-------------------------- •---- L Add ress . .................. - '�en . -•--------- ess ......... .............•••. ..'............... ... ° ----•------•------------------------------•------------------------•------ AddressInstaller d Type of Building Size Lot_1-.r_(�s:9P_-----------Sq. feet U Dwelling—No. of Bedrooms__._.�-----------------------------------Expansion Attic (Ar) Garbage Grinder ri, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ __ w Design Flow------- ______________________________gallons per person per day. Total daily flow..2.0. ------------------------------- WSeptic Tank—Liquid capacity_10PP._gallons Length---------------- Width.-----------.... Diameter-----........... Depth---------- x Disposal Trench—No-____________________ Width......-............. Total Length------------------_ Total leaching area--------------------sq. ft. Seepage Pit No.................. Diameter.................... Depth below inlet.................... Total leaching area._-_.._.__-___,___sq. ft. Z Other Distribution box O Dosing tank ( ) /-'/L-G�- /!OG ,SST' Ada �'' �G�C�✓e ~" Percolation Test Results Performed by:---------------- ........................................................ Date----_------- .......------------------ ,� Test Pit No. 1................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-----------.__--____.___ 9 •------ ------------ --------------------------•--------•---•-------•............._-------------•----------....----------•-•--•----._..._....------------. . 0 Description of Soil--------------------------- -------------------- -------------------------- •-•-------•-._.......--••-•----------------------..._._... ---------- w 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 NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b9eft-lilNued by the bgRq of ealth. �_ - � Signed --•--_ •�-------------- - ------------•-•-•--._.....---•--- � --------- ate Application Approved By__________ ___1��____°_ `�' a� Date Application Disapproved for the following reasons: ..........----------------•---------------------------------•--------------------------------------------••----•------•----------------------------•----------------------------------------------.----- Date PermitNo-------- 2 7........................................ Issued........................................................ Date / TOWN OF BARNSTABLE ;rOC>_'` ^�1_ l3,a; /� SEWAGE # II III.L�kG ` LA ASSESSOR'S MAP&LOT2$ff I�f INSTALLER'S NAME&PHONE NO. 1 1 Ci�QZ go k la_k l S SEPTIC TANK CAPACITY E 1,4%✓1!j 1 000 6n s n n k LEACHING FACILITY: (type) TW 0 liz(J V1 'Q_ �eS (size) 30 > A NO.OF BEDROOMS BUILDER OR OWNER Ck L� PERMTTDATE: Z6 96— COMPLIANCE DATE: ,Separation Distance Between the: Maximum t_djusted Groundwater Table and Bottom of Leaching Facility Feet 1 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 .�- ti r © a 0 -Ti � I r a . �r ru 37 ' . r r-- i o.----- N f F�> ......:.......:..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.. .. ... ... ----- OF...... .......................... . �' ,���lirtt#ins •fnr �i����ttl �r�.� Cnl�at�#r�tr#tuYt ermt# Application is hereby'made for a Permit to Construct ( ) or .Repair ( } an Individual 5ewabe Disposal Sys at ! •� .......... fYf� �> L -on..Address or N . - owner / A ress p Installer Address UType of Building Size Lot..AQ-6+00--__-_--_-Sq. feet Dwelling—No. of Bedrooms. ._..". ________________T___-.-. _--_.Expansion Attic (N) Garbage Grinder (mil `-4 Other—Type of Building ---------------------------- No. of persons.......................... . Showers ,, Cafeteria QOther fixtures --------------- ---•---•-----------------------------------. -------------------------------------------------------- ----------- .................. Design Flow------ ________________________ ___gallons per person per day. Total daily flow_-2Q9-------------------------------gallons. W Septic Tank—Liquid capacity 066-.gallons Length---------------- Width---------------- Diameter---------------- Depth------------- x Disposal Trench—No- -------------------- Width-------------------- Total Length-------------------- Total leaching area------------.-------sq. ft. Seepage Pit No___________ __ __ Diameter............-------- Depth below inlet.................... Total leaching area__. _-_.____ _sq. ft. Z Other Distribution box ( X) Dosing tank ( ) � � °+ lo4 ¢' ✓ ' " ' � Percolation e Performed by------------------------------••-------•----------------------•--•--.--- - Date.........------- .....---- ----.._._... a Test Pit N Results oi minutes per inch Depth of Test Pit.................... Depth to ground water...-=--.--_-..__-------- w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.------._------_.__.. •--•-------------•-----------------------•--•----------•--------•--•--•------------------------------------•-•-----------------•---•----- --------------- - O Description of Soil------- --=-= ------ -• . ----- -------------- -----•---------------- -- -- -- ---- •------ vs. _. - . U Nature of Repairs or Alterations—Answer when applicable----------- --- _ - -_ --_---_ ----_.. --- -. ----_. _-_ .___ ._ ...._ . __. --. . _. ---•-•--••------------------•-- -------------------------•--•-------------------------------------------------------- -----------------------------------------.......... ---••- ------•---------:..-. Agreement The undersigned agrees toSnstall the aforedescribed Individual Sewage Disposal System in accordance with . the provisions of Article XI of the,State rSanttary:Code—The undersigned further agrees not to place the system in operation until a Certificate..;of Compliance has li '' i ued by tI*J5 . of"e�Ith;= t , - SignedC.A._ ------- •------.•-------------------------- 7" -------- Application Approved By............ .A----- ��a-- - -- Date--•--•-• . Application Disapproved for the following reasons:.-:.........................................:.................-_____ _ __ _ ; ............................•---•----_____._-____________---------_--_______--____•------_--•--_----------------•--••--•----------••---------------------•----••-------------------------------------- Date P r�, � Issued.--------•---------------------- •-------------......Permit No.... Date �-a r JTHIF"'C6MMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... . ........OF...... .. �. sr , t. .........:............. . Trr#ilirtt#.e of OUumplitture HIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bya±F' -------------------- {-------- ------------------•-•------------------------- 5 Installer ••- at ......... ...4- 7'---••- 7' --------- ------` ---------------------------------------------- -----------•--•--•---=•---•-- •-------- ---- has been installed in accordance with theprow.tsiionsHof Article XI of The State Sanitary Code as described in the application for Disposal Works Co structlon Permit No '____ ' _ ------------------ dated----------- ,• ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT TIME SYSTEM WILL FUNC 1 N SATISFACTORY. DATE._ tF f f�_ __� Inspector-- G d� ��uL . --- -- x Ft ^w 4 ,vai BSc THE COMMONWEALTH OF MASSACHUSETTS y BOARD OF HEALTH ,�F.fr4k � '" .. / ...........................; -O F.... '.- *a ?'.?'?�i'i Al.. ................................ No.------• ... FEE ...----• X.�� Permission is hereby granted....----... °4..... .GvJ = v.' to Construct ( or Repair ( ) an Individual Sewage Disposal System .a at No.•--•---------• --- ' Street • ------- ---------------------------------- h t# y s, -y as shown on the applicatio for Disposal Works Gonstruction,PYermit .No ; 7_.___ D1ted__,__ _.. f x yrlsj t... Y ..................... a• DATE_ 7 �, ... so FORM I255 •HOBBS & WARREN. AC.. PUBLISHERS .:. a '.... �• ,ka y-_;`},tJ �- �` r , .. i xaaS' .s t h�'�s Y y a ,ai., �wxr ii:. $ ,•PN ' '. "y ,a •h' � d, .. a'�^' „ { i* �" �K C�� fi 1 # ci ,. j� x �X ', JAI.9/ 5 r r 3,4A" sad j. °spl y r..:, ,� _ ►Y w xs+ �, 1:ks. I In � K 4n, a " 1 pqopol oq Kixi 3 %OOO bTgp�JtFL.,WEST r r AL at MOW. _ . 69 I is r;•. a � U/.S, Hf�ST./lllGs fir, UX. .. _. �< LEGEND � . r _ EXISTING: SPOT ELEVATION _ Ox0 tKo � CERTIFIED PLOT P'tA s EXISTING. CONTOUR -- 0 'r :I:aAIiSHED SPOT ELEVATION 0.0 �� ti � o aoe�R�.; LoT 7, PLAN BK 257, PG.11 a y 1UISHED• CONTOUR 0 • . eRUCE.: p � «. ELDREDGE H r '"APPROVED BOARD OF HEALTH a, ` ` v "`i 'DATE AGENT Nv svey SCALE: =30 DATE= ; / DREDGE ENGINEERING CO. IN CLIENT PoosKi' ' CERTIFY THAT THE PROPOSE!h� f Et iSTERE REGISTERED JOB NO.Z �06 ' BUILDING SHOWN ON THIS' PLAN'5 6 $t ` CIVIL LAND CONFORMS TO THE ZONING . L�41�S EhiGINEER SURVEYOR DR 8Y5 Ra��, OF BARNST ABLE ASS. 33' N0:R4AIiY ST, 712 MAIN ST. CH. 8Y=`� � .:� �soollj 17 - °_ S( YARMOUTH, MAS& HYANNIS, MASS. ' % 2 D LAND, SWRVEY+ R 1 _ SHEET OF � '� � '',��'y��s�df'wyiTM� � �. t,.I�, '-c' Ya?�• is`3�y ,°raf��'C'+F"�Y. '"`,'r4..' A! 9�^kt.�"a4i:� �`.F'S•" �,} ,�'�}s�v r'�t{, ♦ .�^ `-� ..; �i,jj?�. Y`f*°' Yam. 'Y.:,,_. 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'�4� k w. .x. �`..•. `�k. ,�.s Fl y sv`r - ,.�T,r.c:R ..': �]1 .. .; ..._ .._ �.:.; '.a x.•'x- �""°-w.-,.-�= r ''�'t� 4.2_K<.+ L ..,Fn '.,e e •.• e,.' +f"s'"� ..t ^'y, .d.::',.. #.y J-, -. ..�i♦ ••.�� _:'. `: �Ry^. ti" 1�': :a _ 5 -...F�¢Ya _ Y d. x,'- �^�,Y.vr .._�y �A.•Y' "4S 2"4 °i .5 ?z� - _f;., '•:d_ .y to4. w��•a� • MINCONDRE.TE Pl1'CH OfltlE` _ i r'. t�/ RS i/8 PER FT< "a PERFORATES �- 2PVC P.iPE A ' .. - _LIQUID LEVEL .{ - -. _ •' � ` �, � CLEAN � r 4„ ,t.=s'T SAND s's �• IRON T t N PIPE k / IN PITCH- . O 1/4 PER FT, SEPTIC ::TANK DISxT - 4 / k O •O O • �^ �r •• C, C 60 C (SEA le , 6 TABU A LEACHING FIELD 4 SECTION OF GROUND WATER TABLE e SEWAGE ' DISPOS,4L ' SYS�'EM '~ 3FT. 6 F'1: OC , d y SCALE' $d`L ILA � n: ELE. _ T LAY R " .. 43:_.DOUBLE ` � 4 F ; VA IOf11` ti OF Jf 318 ° ,PE1 I:ORATED �,. StIL VEST "`t _ /Q` WASHED STCi+I_E ` PVC - PIPE „ ; DATE _ iL. TEST ` r- #•' _ '�. - - -- :�•'( Z '•�^•!T� ,Y3 C�.^F YYC. -'�' :'.4'f„ .t ':� t .y.*yc' ♦ CLfAN : = RESULTS.,.::WITIIESSED BY N! R. �.. z 'SAND . „ _ _ RCOLATION;+� ss�-�s-.a,�, --�.. •�c�4�;.ac..�,;•-• `�'�,� '� - k 6� ORR S� f.1 GRRVE 4'`�ouBLE DESIGN GRITERI PERF..Oi ATED 3/4 - I l/2 WOOD STAKES3L` t PVC PIPE WASHED STONE NUMBER , ' OF. BEDROOMS ` s SET. 8 FT. ON CENTER GARBAGE DISPOSAL, UNIT ate[- (WAr _n9(3tE ESTIMATED FLaW. o GAL./DAY y , LEACHING Al~tEA SECTION X— X' -0. FT p3 .. - - 5 •• •• gESERVE AREA_ 111 SO. FT.' TASULAT10k a' .SCALE _ . //4 = / - O � INVERT ELEVATIONS DIMENStOfiI" .t 3 DIMENSION- AT' a INWRT ` i3UILblNG 9Z_.FT. ., :. � � INLET 9'1=P'I TANK ,`S ,: '' `� 0#JT�. _ #: ,�. 4F e�7 a�t ti���.' ...s+_�.. �. ,.x8f����jy',r: ..d 't$ ,%tl saf��s�.f,# 7•+tq - °-.� � ,� uq,a x ,. .. _,.A, :�•,��.,.. q°"�w +'� -. ..-.::. ..♦ .�.. �we'd! �� ' t31STtIB1�"J♦tOW 7 I (® , ET f3ISTKIBU Its 1:. ..FT _EI.flRE63GE -71 �,, . . OF LEACHIN .O a< Y: PIELE �T.' f3 ` 33 lit :: IlPIAIN`'ST 7 pak fat }� �h�t 9f •'lI�'�P�Ils. � -4•r#aY. SO. YARMOUT. �!({Q['� '°``�,{�}/ S y� i iF;aY/ iij f741�+iV y7` ,iFPtA��+7 �♦�4� «�:a,:; rt g,s � � .: a { � _ --•. n� �s�f, ` s � ke-�,•r��- �a i��? �'����`' r� -�„�, � ;.ems ta7=:�`x'-,p:����_ .. -•. :.,. 'a- -,,.. : .+ .�" .�. } -.. ., +4�.�. � ...r� »�''.'*}-`w�p"�:•�-;�iC: ,?'.,.'ex.Y�y" t Y'•� -,a7�'V!.� ,�.y S'��L �,.R"`9M'C.'1F+... �a�';