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HomeMy WebLinkAbout0109 OLD TOWN ROAD - Health 109-0Id Town Road Hyannis A = 268 073 � 1 �I i i TOWN OF BARNSTABLE Q q LOCATION/Q® 0110 �0�� Ad SEWAGE#Zdd/.-- 7 VILLAGE /7/%/4AAj ASSESSOR'S MAP&PARCEL 6 Y- 7 INSTALLER'S NAME&PHONE N(C�e�®J�1J�� SEPTIC TANK CAPACITY �QlI6,1 LEACHING FACILITY:(type) size) NO.OF BEDROOMS . OWNER 76 d TiQ46tl �✓� . PERMIT DATE:l0 7/j:p COMPLIANCE DATE: A t `� 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 ' ter.-` ti".. "` ... � ,..•SY!f /. .. �3 ..����N' N' � .�� ' i y _- �+ 7.-'. s :i � G �3 � :�� �,i, O - -- { +' � '" "`. �-� �i� -;�?., cn `� �: ,7'VJ'�f'�,.�ry'�n'`'. � .� �jy7� t' � No. o - 3`� �' FEE COMMONWEALTH Of MASSACHUSETTS Z- - 1 Board 4f Health, k �, MA. APPLICATIONYOR DISPOSAL SYSH 'I CONSTRICTION PERMIT Application fora Permit to Construct(, Repair. <gmdeO Abandon( } D Complete.System 6 individual Components 'Location 54r lQ (D1..-D DnANOwner's Name 1-7-0 Map/Parcel# Z ?J ... vllti Address l QL� Lox# Telephone# Instaliei's Name C1�(L�l� ��� Designer`s'Name ' Address Address Telephone# - GO --3 t 1 Z- Telephone# �C> Type of Building; Lot Size sq.ft. Dwelling-No.of Bedrooms Garbage grinder Other-Type of Building No:of persons Showers ( :),Cafeteria ( ): Other.Fixtures Design Flow(min.re lire ) d gpd Calci.6ted.design flow Design flow pro-6 ed gpd II Plan: :Date; Z0 Number of sheets_ Revlsion.Date... Title Desciiption:of Soil(§) 1!51C A Soil Evaluator Form No. S Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR AI.TERkTIONS )U-IE�D U __ .. The!undersign agrees to install1he abovejdejscribed Individual Sewage;Disposal ystem in accordance with the provisions of TITLE 5 and further ee not t lace th : to in ration until a Certificate of: omp iance has been issued by the:Board of Health.. Signed, Date u J Inspections �+ No. ! FEE CO g t•' Board t f Health, , MA. :w APPLICATION F,OR DISP SAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to.Construct( Re air ) UPgrade( Abandon( U;Com lete System dIndual Components 4 w, I:ocati.on ® �- „ Owner's Name Map/Parcel# /c fl �1/1✓tI f Address I Del O 7 ����1 .J Lot# ,.� Telephone# Installer's Name Designer's-Name 1 Address i I Address Telephone# Type of Building' �1 ��t,� Lot.Size sq,ft: t Dwelling.-.NO.,Of Bedrooms:. Garbage grinder Other.-Type of Building No.of persons Showers (: '),Cafeteria.( ): Other Fixfttres o Design Flaw(min.rejquirei) '(F"T gpd Calculated.desiT flow f U Design flow prto.� etd� (455 .gpd Plan:' Date , ! ,� cif T l Number of sheets_ _ Rev`sion Date. ' 1-'�``1 Title c 4 1 +_AA ,,t Descripuon:of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator <:1/•"�'1 -�� Date of Evaluation DESCRIPTION OF REPAIRS ORAIXERATIONS s The undersign d agrees to mstalf a above escribed Individual Sewage. isposal�System in accordance with the provisions.of TITLE 5:and further agrees o not to�place the l to in o Aeration until a Certificate of; ompliance'has been issued by the Board of Health. Si ned � Date V � t Inspections'.. a FEE d C, COMMONWEALTH OF MASSAC14USETTS Board o f Health;4W �C...�! MA. CERTIFICATE OF COMPLIANCE. Description:of Work: LU Individual Components) ❑Complete System The Lind ersi ned h by.certi -that the Sewage by: C -ram►�a�. Disposal System; Constricted Repaired U raded /)�AbandQned ) has been install-d in acco 11ce with the provisi ns o0l.0 CMR 15.00 (Title 5) and the.approved:design plans/as-built plans.relating to application,No.�`,JJ� �j l, dated, °f/t���y�� Approved Design Flow (gpd). Installer "`t�-r�/��-f �.. t✓1� «. � �~ r`r Designer: Inspector-: I .�rd'_ �� if z Date.:. 6-1 !1 A The issuance of tWpermit shall not be construed as a guarantee that the system,will function as designed. t - T., . .No. 0 t 3 ( 1 FEE`: � � G COMMONMTEALT14 Of MASSACHUS ETTS i Board ofHealth, NIA• DISPOSAL SYSTEM CONSTRUCTION HERMIT y g P' � Permission is:hereb ranted'to Construct( ) Re a'r �) Upgrade'(,-�) Abandon( ) an indiizdualaewage disposal system at � / � l l�J � � 1`''V �.t !'T�f "C'"l!�` �t 7 as deschbed in the application for Disposal System Construction Permit No,?,(�`3", dated 1 G/t-7h Provided: Construction shall`be completed wit h/i^n�three:years of the date of .is>:p..e t. All_local conditions.must be met: Form'1255 Rev.5/96 A`.K.Sulkln Co.Chid6town MA: Date (? ! 1�1 I Board.of Health i�_/ o,/ .��� v ?s Town of Barnstable Regulatory Services Thomas F. Geiler, Director BARNSTABLE, Public Health Division Thomas McKean, Director fD MA'S 200 Main Street, Hyannis,MA 02601 Office: 508 862-4 44 Fax: 508-790-6304 Date: 1011Z1ZPt9 Sewage Permit#/ P � Assessor's Map/Parcel le) Installer &Designer Certification Form Designer: Installer: Cq1WmWk_., Address: �� C��`'�IJG�G "� Address: �� On /U !? / as issued a permit to install a (da e) (installer) II septic system at DUD MOLI-1 W. q 6� based on a design drawn by (address) ��Q'1>���• �"1� ,� 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. Stripout (if required) was inspected and the soils were,'found.satisfactory. 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 syste ).but in accordance with State & Local R- '-Lions. Plan revision or cert feed as-buil designer to follow. Stripout (if rP cted and the soils we e found sa 'sf ctory. N FF/iq,�S� v DAVID q`\1v b B. C_ n to 1 r a re) MASON 9 No.1066 r;r� /sTd esi er s Signature) PLEASE RETURN TO BARNSTABLE PUBL., OF COMPLIANCE WILL NOT BE ISSUED U'N i iL asu i ri t ni6 r URA/1 AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonnMesio ercertitication fonn.doc TOWN OF BARNSTABLE LOCATION J1L _���.1 �w� ��%/ SEWAGE # 20o 3 'VILLAGE ASSESSOR'S MAP & LOT 2G 8 -72, INSTALLER'S NAME&PHONE NO. SDS-920-47?0 12e-0^-"5 SEPTIC TANK CAPACITY /5',00 LEACHING FACILITY: (type) .�-d OL' (size) 32/ A 11 NO.OF BEDROOMS S' BUILDER OR OWNER PERMTTDATE: S- 6,d3 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 leachi�n'g/facility) Feet Furnished by b 246�/ U� -Oy' F !© J V V ` S ' � a 0•' No. �. Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS application for iwo ogaY * otem Construction Permit Application for a Permit to Construct(Okepair( e)Jdprrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. /a q D1 TD�!/� owner's Name,Address and Tel.No. YyO,qy1s Assessor's Map/Parcel 2 9/- g /O 9 Ol� /d�y yvI!f Installer's Npne Adq4e ss,and Tel.No.,S'O`r-4/44o—�1758 Designer's Name,Ad#ress and Tel.No. .//s' Type of Building: Dwelling No.of Bedrooms `7' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) `/ /Sdd is .�i� f"i C 'T�Gi k 'Jraw:" #em,h 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. Sign 'v Date Application Approved by Date Application Disapproved for the following reasons Permit No. 3 2� Date Issued i' No. , C -- Y,..���t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compute—r: y Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS.! Zipprication for Zigpaal *pgtetn Construction Permit Application for a Permit to Construct(Repair( ade( )Abandon( ) ❑Complete System O Individual Components - i Location Address or Lot No. 1 a w", Owff��er's N ddress and Tel.No. 7; tfuydJH/5 IOZY Assessor's Map/Parcel O/ ,may n� i v ; IValler's N�v n�ep Ad ss,and Tel.No.fl y'y Designer's Dame,AdEre�s�and Tel. o �CtS��y !/1 CJ�Ns�oO �AKA Ls��IG� J/!^VIC�5 8/ C�����1' �, �I,%/s /� .svtis%> ,pp� ✓/" yorofvvrci Type of Building: Dwelling No.of Bedrooms `7� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title - Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) sT�` /sa�Aw/ Sl�ri Ty ` c � 1C Date last inspefted: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system s 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 issue by thisBoard of�H(alth,. Signe Date Application Approved by Date Application Disapproved for the following reasons y � Permit No. ��3 Date Issued — ———————————————————---——— —— —————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed J05cpaired ( graded( ) Abandoned( )by jl se14 V-4 at /09 0 owl ha been constructe i-Jaccordance with the prov' ions of Title 5 a d the for Disposal System Construction Permi oc bO 3 y dated ��t Installer ✓OS�t'L/ �-� �/ya5 Designer �� ��✓�C/-S The issuance oft is permit shall not be construed as a guarantee that the syste i fut} i as g�n 0 Date �� t) Inspector t^^'f ;�A L 1� -- — !�——————————————————————— ——— j ii-�� 0 No. /fp= 3 !�G—I Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Zitpogar tem 5truction Permit Permission is hereby granted to Construct( epair( Upgrade(-` Abandon( ) System located at /O 9 r� ~15 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:Construc9on pustt be completed within three years of the date f this pe Date:_ Approved by --- J TOWN OF BARN$TABLE LOCATION _/ C �1� l�A f - ® SEWAGE # A VILLAGE AYA,K N 1 ASSESSOR'S MAP & LOTbe INSTALLER'S NAME&PHONE NO. - 'S`+r - `O P �A eds SEPTIC TANK CAPACITY O LEACHING FACILITY: (type) `� ° . ' � (size) 34 ks NO.OF BEDROOMS 4= �- BUILDER OR OWNER '� f'" 1- PERMITDATE: 1- /s 1`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 within 300 feet of leaching facility) Feet Furnished by '� a' f 010 i G�C ,ram cfa a MAP: ;. ASSESSORS TEST HOLE LOGS comply Pto � �_... ._.___ 1} The installation shall com i with the State Environmental Code Title V and Town of Vh5 PARCEL: Board of Health Regulations. SOIL EVALUATOR �, FLOOD ZONE: `fie- ,IL-V �4 `fie 2} The septic system as proposed on this plan shall not be installed until a licensed town installer ' w ..- _ .._. . .. ._,. . WITNESS: � ''�I �_ ^ ,,; �,,,� .��° receives approval and an installation permit from the applicable town. REFERENCE DATE: `` 3 Prior to installation the installer shall verifythe location of utilities,sewer inverts,sewer tines �° } PERCOLATION RATE ;. 1► l and existing septic components prior to installation, �� . The first 2 4 All gravity sewer piping is to be 4 inch schedule 40 PVC at 1/l3 per foot h firs feet out of ) g y p p g 'TH- l TH-2 the distribution box shall be level. All piping connections to be glued. 5) This septic design plan is not to be utilized for property line determination or for any other purpose other than the proposed septic system installation. 6) All Title V components are to meet Title V specifications, 7) Parking shall be prohibited over Title V components unless components are H2O loaded. `N i existing r cesspools shall be pumped and filled with material per Title V LOCATION MAP � � s} The sti g leaching o c p p p abandonment procedures. Leaching and cesspool(s)and contaminated soils within the proposed SAS shall be removed and replaced with clean sand per Title V specifications. 9) Septic components are to be 10'from a water service line.Sewer lines crossing a water line shall t _ 1 be sleeved with an appropriately sized schedule 40 PVC with ends grouted. The water service line or the septic line can be sleeved with the sleeve being a distance of 10 on both sides of E ti i crossing the line. c4D 'P 10 If a garbage grinder exists in the structure, it is to be removed if the septic s stem is not designed to accommodate agarbage grinder, 11) The installer is responsible for care of excavation around all utilities on the property and 1 g SEPTIC S Y S T E DES `I protecting the structural integrity of all structures during the Installation process of the septic EX B lab , )_ system. Corte y FLOW ESTIMATE a 12) This plan only represents that a septic system can be installed on the property meeting Title V TOP�oa,�lo`) � � requirements. C " AT GAL/DAY/BEDRgOM - .,;r LBEDROOMSGAL/DAB' 13) The property owner shall review design criteria to approve the total number of bedrooms and a r � t I. ... design flow.installation of the septic system as proposed and receipt of payment for the design �^ :,! SEPTIC TANK f shall be deemed approval of the design criteria by the property owner or agent of. 4 The validity of this plan shall expire with the expiration of the town installation permit issued for "3 ( GAL/DAY x 2 DAYS - GAL 1 ) y p p p i �� lrti this plan or the validity of this plan shall expire on the expiration of the Certificate of Compliance ::1 USE � GALLON SEPTIC TANK =- - __ 1 .,1 al t issued for the installation of the proposed system on this plan. 'RP YSTE ws-o u " ll- SIDE AREA; 2, o . BOTTOM AREA: / r i Cat-77 " . ._ Tank. Ca� S- \U SEPTIC SYSTEM SECTlC3 gL w _ T �M �� t+ 139 p C �, I `: �' �, . i ► ,�r lip G I Ivl 9 t9 4 GAI;. ,7, w � SEPTIC TANKFlo , y vjtO l I ' S I TE AND SEWAGE PLAN MASCI�i rrr R ... > LtJ AT 1 TO , , �. • OL - - SCALE.: DAV I Q B . MASON R SATE: [ l u QBc ENV ! RONMENYAL DESIGNS DATE HEALTH AGENT _ ,,