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HomeMy WebLinkAbout0221 OLD TOWN ROAD - Health FPO7V22�1 OId Town Roadnis --,. A = 268 190 i L_ TOWN OF BARNSTABLE LOCATION 0'-a 1 O SEWAGE # -'00y'33 0 VILLAGE (V-ISd1- h J Ay-fd ASSESSOR'S MAP & LOT Ake I TQ INS' ALLER'S NAME&PHONE NO. t<<� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) fly✓-t'�.ZZQAa 12S (size) /O NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 2: ? lob COMPLIANCE DATE: 2 3 c 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 C'� M M 7ZI- `�bl 41I 3 a i _ /y TOWN OF BARNSTABLE LOCATIONA*I,) Q I f) To,,t /Lcel.Cl SEWAGE #tp-004-3.3® VILLA,QE V,eV— W4,ft ,.1J254t ASSESSOR'S MAP & LOT d-6 &-!SO ToFr 3 0? 0.23) INSTALLER'S NAME & PHONE NO.1_-(I IS d3soT;vrS CO„S}. C SEPTIC TANK CAPACITY J 5O Q L`, aCHING F ACILITY:(type) 4 �+n.�'� try he r T (size) l G X 3 NO. OF BEDROOMS J PRIVATE WELL OR PUBLIC WATER BUILDER O L•1ye/G DATE PERMIT ISSUED: 13/0U DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No E. kl • cf,, 0"I � a t .. No. Q Y — -3 71i_-) 1 Fee i- T1jE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZppYication for Mi5po aY bpotem Construction Permit Application for a Permit to Construct( tepair(, Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. aa-� G !V wV l Owner's Name,Address and Tel.No. aC0>A Assessor's a /Part as — l i ,_P�j`r Installer's Name,Address,and Tel.No. l*rj G p Designer's Name,Address and Tel.No. 2 ` I ter. O Jc Qa c��►,S` u i,Tt��' S r�il�c�r 33 Type of Building: i Dwelling No.of Bedrooms 3 Lot Size 1 Ai.ft. Garbage Grinder( ) Other Type of Building <' 5 No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Y►'1 gallons per day. Calculated daily flow 'J gallons. Plan Date �y�C.a� Number of sheets 1 Revision Date `— Title 1 Size of Septic Tank Type of S.A.S. Description of Soil S-e_l Soi Nature of Repairs or Alterations(Answer when applicable) �- !� h CV, ti C �.�, ram_ Date last inspected: Agreement: R 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 iss y this Board of He Signe Date "—d Application Approved by Date �a Application Disapproved for the following reasons Permit No. rQD0-4 3 30 Date Issued &I j at, d-q No. 0"0d ✓�� 1� .,..w„_ -_ a ; , 'Fee X'` Entered in computer: TOTE COMMONW9ALTHOMASSACHUSETfS P Yes PUBLIC HEALTH`DIVISION - TOWN OE-BARNSTA1.LE., MASSACHUSETTS Application for Permit Application for a Permit to Construct( Repair( �)Upgrade(° -)Abandon( . .) Complete System El Individual Components Location Address or Lot No. �� 0 Owner's Name,Address and Tel.No. Assessor's 0 1 Map/Parcz - �O �iS�- ' ,-I r ,S^y,•-� P Installer's Name,Address,and Tel.No. 7& Designer's Name,Address and Tel.No. a I!t t-ke�f CC-01 S GG _7� _k S U l/�t�i)�/ 33 '7 " Type of Building: U 1� Dwelling No.of Bedrooms 3 Lot Size 3sq.ft. Garbage Grinder( ) �* Other Type of Building r`Q 5 No.of Persons Showers( ) Cafeteria( ) ° Other Fixtures Design Flow V►'1 gallons per day. Calculated daily flow 3 gallons. Plan Date 11'74.0 a!1,A&C 4 Number of sheets Revision Date `r Title 0 F v �/ Size of Septic Tank Type of S.A.S. Description of Soil Se-e S e_-I l Lc f Nature of Repairs or Alterations(Answer when applicable) �SO C /ia cJ z°%�f: C_ )-.-y �< 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 thi oard of He t . jj Signe Date ( _ Application Approved by Date �oZ Application Disapproved for the following reasons r Permit No. cpbo 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 ) I 1+ S G3fe-1 J-711 41-1 (alh Sc,11- at c9- 1 0 11) 60c4, h nG`7 d, has be-en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoO'/"_�te..JU dated Installer r 1!S /3roJ2,P4 CC,,IJ DesigneF c1 U/v i� The issuance of this a hhit s�hal not be construed as a guarantee that t e system will ,cti n as designed. Date f � d"?J Inspector D --------------------------------------- 41 330 No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mgo5ar *pgtem Construction Permit Permission is herebyf.granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at a 1. 0 1 a Tawh dtoa k/t°Sd 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:Consttructio must be completed within three years of the date of this p Date:_ g 3 C/ � ? / Approved by Town of Barnstable `"E' Regulatory Sei vices oY Thomas F. Geiler,Director q�A 6!9 a�0g Pulblic Health Division rFn Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: . ' Designer: (-A GL C Installer: Address: 2 &I-A Address: 3 L i E G�'g K(SC- P ly ��M/1��1��r�✓'� �/�-1l•(MC/V t � � �/,ASS On was issued a permit to install a r (installer) sephc,system at k�s7 r�Y•9,�:•�r� ���9v based on a design drawn by" _. _w._...(address) _ (designer) V I 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_ 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 system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. " a A. (Installer's Si gnature) Q H^A a (Desi 'er's Signature} _ _. ? _ :(Affix Desxgffe0tamp Here) _ • .;+r1�1`.�ts t.w. _�.+.� t4>; "_ .Wyk .." `^ 1 .� PLEASE RETURN TO BARNSTABLE PUBLIC HSALTH DIVISION CERTIFICATE OF COMPLIANCE WILL NOT=BE-ASSUED UNTIL BOTH THIS FORM' AND AS- BUI LT CARD ARE RECEIVED-BYTHE-BARNSTABLE PUBLIC HEALTH-DMSION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BARNSTABLE 7^C� �� SEWAGE #p-004'33O LOCATION © Q �" . �4` ASSESSOR'S MAP & LOT �16 fr19® VILLAGE til/�S� ( jo.,�,�S s�&-3 INSTALLER'S NAME & PHONE N0.1�11 SEPTIC TANK CAPACITY SD (t (size) l G 3 CF LEACHING FACILITY_ : YPe NO. OF.BEDROOMS— PRIVATE WELL OR PUBLIC WATER BUILDER O DATE PERMIT ISSUED: 131 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes. No z � -- cy ^t M CJ c� r cC tl M • f- 12 _ aoomeoollAV rn { � <Ti YC��ii� T 1 f K GARY A. ELLIS ` w t ;t NORTHSID BUILDING X CONSULTANTS, INC. + FINE HOME BUILDING & RENOVATION. '€ 141 MAIN STREET •YARMOUTHPORT • MA 02675 (508) 362-2210 • (508) 362-9802 • Fax: (508) 362-5269 r '� rail �� • ���� :�:-�- -.. -�., _ � :; ..`- I • • i — � �► Ii it car 1 � I ell I. 4. ell �- ? X1f3 �c�tf" oV1 +1 v GVaw� � l A pv O I ARY A. ELLIS� g G reoloo�� NORTHSIDE, ���� �� Vlal BUILDING V , CONSULTANTS, INC.r G l FINE HOME BUILDING & RENOVATION 141 MAIN STREET -YARMOUTHPORT - MA 02675 /) (508) 362-2210 - (508) 362-9802 - Fax: (508) 362-5269 ,1,04 Iq ", z -vtv"*,?1,1� I iv Z itS 6 I A BUIL ��ACC CiCo 17H N D W: 'DESIGN LO I �`h'A' N� t$�FORJE DE$16N�'AND :0ONSTRUM R$T 2' D 0 N VER T,'I N, K .,P D. PER T'J 10 6 SEPT I C TA IV 3 'BEDROOMS, F,,,THE SPOSAL, N 0 SERAdtib�i:* �,SYSTkm �ONLY!, 9 9 INV R T-lk 2. �`,' VER ICA '12 D I A S -5 �,,BED#OOM EOUAL S, 330'G. 1,N VER T OUT SEP T1 C�.,IAWK 9 BE LEVEL M OF,� 61 T�� BOX. 7�, 7, 4 14 . 'rviv or-IV M '25 DOUBLE WASHED S TO iSE o;SEE $I TE I L IV 7- 00.�2 .'; . 0,� /6 1,� 99. 330 N -ALL METHODS,AND':kA TmAtS A D .5 INVER '07 Rr OUT'D117 -'GARgAGE, I A(DER t CDAI C NO, OR NE INVE A 060, 96; REOUIRED: r IN�LA CH tHAMBER'4 -:33 SEPTIe,TANK: ��4�HIGH CAPACITY I NF I L TRA TOR -G� D'. _X4 0 660 GAL TL P 0 N CHAM E $ WIJ. STONE.�AROUND ADJUS rED 6POUND W4 tER.:':.� NIA SEP T I C TANK PROVIDED�. . 1500 GAL'.: MIN. `�EPTIC 'SYSTEV `SHALL I TENA NCE t :;0 E _AA OBSER VED'GROUND, WA TER CONFORM.rO,.M4 SS 'D'E P�� 11 TLE /A. L 2 x IO'd N �ABSORPTION S 463ULA T I 6N�, T. NK i�'CRUSHtD 'STONE OR �BOTTOM OF, TEST HOLE 90 0 SOIL :'BOARD OF HEALTH YStEk REOUIRED' DES ION PER "RA COMPACTED,BASE 'TE.:? �5�WN AfCH-:�JEXTURAL� CL SS I -S -'SOIL 4. L AL EfTle S YS TEM COMPONENS 1 OCA T D ,UNDER, A r, To UB I CUL A R TRAFF C QR L NG RA TE O�`74 I:GPDI$F PROF L NO T, TO._,SCALE AC VEN, UENT, OAD�/' EFFL N"DEPTH '74 BHAN,3 HALL CAPABLE,�OF,W1 330:OPD'I 6POSF 44 F., MOORED , A -2 STANDING H 0. WHEELAO DS �� PROVIDED: 4 % CAPACI TY;1NFI R Hf 6H L'TRA TO E 0 P.rp 5 AL� SEW R E," L BE SCHEDUL 4 CHAMBERS W1 .5 TONE,AROUND, �SF. 340 SPD APPROVED E-ObAi'. 460 S F.'� 0­74 &PTIC rAMK AND 3D BOX'�'%S ALL - H 8 RE'INFORCE6 -6 SE PRECAST'CONCRETE'AN01M ER rl 4 C) TE 5 T P 17 DA 00,� :SO L CK E INDICA rES �BE -NATER . S TEED TO CHE FOR TES I D I CA y D 0 N-ONE, ETI'�, '4S MO ,OOTL TES T -= ' 08$ER E PERCOLA T I N 0 GROUNDWATER'z�. T 7 'BEFORE.roN�TRUCTION CALL M 723± 'S.:F TER, J-888-DIG-�AFEAND THE- L 0 CA L, WA DEP T' 'ITIES. EROROUND­UT,f L FOR LOCATION. OF�UND OR ZON, TEXTURE COLOR 0 Oo.,O LOAMY IOYR 10. SEPTIC SYSTEM,:INSTALLER SHAU� NOTIFYi SAND 313 DES 16W 'ENGINEER TWO'DAYS 9 5 6 L L OW,� Ok-SCHED L ING OF�THE "SYS EM, TO�A F my, LOA SAND 416 ON CONS rR UC T I ON I SPECTI S '97.5 30, ................ 9. EXJST1NG',CE$sPooL'_'TO "1OYR P60PED DR Y�A MEDIUM , '618 o BACKPILLE0:'�� AND 6RA VEL, To 0. :NO DE TERk I NA t ON HA$;BEEN MADE,ASi� TH DEED 'R $TR 1,C REGULATIONS. IT SkA L& REAM N ,THE CL 1 ENTS tA COMPL./A N'CE W TiONS OR 50 12-64 RESPONSJBILj TY., CESSPOOL _TO� OBTAIN, ALL PERU I TS. `SPECIAL FOR 'TH I S PE,RM TS. VARIANCES ETC. LLON 00 GA SEPtIc TANK T.:SHALL "RENA N THE CLIENT'S,'RESPONSIBILIrY-�-,.�,,.�:- Ok. C6RNER SH O�ED`BOILD'ING F 6 1JNDA T I ON NO WA TER, T 12'OAK 0,HA VE' THE PROP 120' 90.0 0* K D -OAK UNr F6i.z'Tk E�)'STING VA : DESIGNED Tb�':ACC6' trION 'OF, DA TE: APRIL 15. �004 ANDIOIL CONDITIONS r�:THE LOcA-r1ON 'OF... 16 AK -PROPOSED BUIL DING TEST BY:, STEPHEN HAAS ,�' , 6H CAPACI T 2 MINIINCH �PERC RA TE LEACH I NO CHAMBERS W/J 3 STONE AROL 0 C" 1wd 4 00 13 14*0AK At .94 0.WIV 0 7 R 0,4 ��5 AfA'P '�2 e 43 WA_ YA R E-PARE-D 0 R A 0, 0 45 0;�­ M6 R �5 A 4�1,E "A 4 000' �2 0, S CA E 4 LOCUS Sr U FR,V: E,Y �:'N N o U" e � RO. a r7 rno u t 6 7 RA 16V1L E t 5 0 8 5 Z�3,_3 DR s 87] F EL CA C�. �o �SA ICF M 10 JOB'NO -CF EK L WIE -OF 0