Loading...
HomeMy WebLinkAbout0285 OLD TOWN ROAD - Health 285 OLD TOWN RD. HYANNIS A = 247201 0 it TOWN OF BA_RRNSTABLE !� LOCATION 1��"�—�/��e ram` SEWAGE # ?Z Z� VILLAGE /1 y �/91��,OC�/`l ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N0. GL� % SEPTIC TANK CAPACITY LEACHING FACII.ITY: (size) /0 X 3d x� NO. OF BEDROOMS J BUILDER O Z!!!R PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility t Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) i1�� Feet Furnished by �4 r Ol- 1*� S�� TOWN OF BARNSTABLE �L0C1�`TON Z—K5 L VV T(�411 /^� SEWAGE # __F ��� d , �1VILLAGE ASSESSOR'S MAP & LOTS 7 & INSTALLER'S NAME&PHONE NO. �'ZV� %� �� y 81.17l2( SEPTIC TANK CAPACITY 6_4 L f' LEACHING FACILITY: (type)Z"w�A,,zf —(size) /'a x 3d`�" ` F NO.OF BEDROOMS :3 BUILDER O O RrLC PERMIT DATE: " 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) Z � Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � _ . � . ;�,a.,e:,..,,:� 'ter i J � � O.r+ �� , �q, t� k y O}� iY. � !l �� O� .�� �. �P� a No. l �� -Zq G ylil/ / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: e Yess PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yication for Zi ogai 6potem Construction Permit Application for a Permit to Construct( )Repair(1/)Upgrade( )Abandon( ) ❑Complete System Ems, t ividual Components Location Address or Lot No. g'� Owner's Nam ,Add�TelNo Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7/-� Type of Building: Dwelling No.of Bedrooms Lot Sizi� sq.ft. Garbage Grinder(_t�e Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /A® gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title JI Size of Septic Tank © 5 Jd! Type of S.A.S. 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 by�thioq�ar [eajth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. g —Z f!y Date Issued Z 3- ..-. r �.,. _ - .. _r .-. _� ,.. .,-.:,,.�, s'?.v ...*" ,.. . .�-..,�"vZa..R...r.d'�,rw..,y,.,,.-:-»n.-r,� ,. . ...-.,,. •-••- �..sv.v..�.. .. .. l Fee No. ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS y 0[ppYtcation for �Dtgpaat &p.5tem Congtruction Permit Application for a Permit to Construct( )Repair( 4pgrade( )Abandon( ) El Complete System L4J'6ividual Components Location Address or Lot No. '] gS" O f �r� Owner's Nam ,Address and Tel Nose /` Assessor's Map/Parcel y� �,. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel:No. 8or�oGo� C©�sr _ 7 7/`e. Type of Building: ` Dwelling No.of Bedrooms Lot Size — sq. ft. Garbage Grinder(_9�d Other - Type of Building d1GC ._No:of Persons Showers( : ) Cafeteria( ) Other Fixtures % ? Design Flow ��0 gallons per day. Calculated daily,;flow gallons. Plan Date Number of sheets Revision Date w Title Size of Septic Tank /44' O 1W Type of S.A.S. ? 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 by this oar L: ea Signed �.�''� Date Application Approved by A Date `7,"Z? Application Disapproved for the following reasons Y Permit No. 91 _Z /Y Date Issued _ —————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance. - / THIS IS TO CERTI Y,that the On-s'te Sew t,a Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by I ®� L4i �d1vr at 2 K 5-4 e r 71-;W11 Jw'/ Ir has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 99—2 dated Installer P Designer ,, s r The issuance of this pe jj41�j of bd .o.strued as a guarantee that the syst '�+':1�1'functio/n�as designeg. � + /�Date �l r,t� Inspector i �Vd 1/�/t /Y��.f - No. �7 `—Z—y------------------ ��� / Fee ✓ " .'/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 1 Mie;pozaf *p.5temC on5truction Permit Permission is herebyanted to Construct Repair !�) , rade Abandon� ( ) P ( Pg ( ) ( ) System located at Z g �f rdWh 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 must be completed within three years of the date of this pe t. Date: 2 3- 4,7 Approved by c • 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, 1t�l�if T QO���f/ , hereby certify that the application for disposal works construction permit signed by me dated �1 5 4Y , concerning the property located at 2g5— 01,e �DGI,t� �pl ^� meets all of the following criteria: }O The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. Y There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system /There is no increase in flow and/or change in use proposed ✓ There are no variances requested or needed. Y The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] / i� If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) -/ �- B) G.W. Elevation W +the MAX.High G.W. Adjustment. 2• = Z Z- r DIFFERENCE BETWEEN A and B 2 t^1, SIGNED : - DATE: [Sketch proposed plan of system on back]. q:health folder:cert r LrI� � I Q ;z Ab t- ,;LOCH ION SEWAGE ePERMIT NO. 'VILLAGE ` INSTALLER'S NAME f ADDRESS wt���i:7 c �t�1 �•�S S U I L D E R OR OWNER � YStc�N � y� ldi 6 Co, �ti44,. 0 � ' DATE PERMIT ISSUED ® DAT E COMPLIANCE ISSUED 4 'S �. C�L .� No'.Q.:.:....4... Fmc.....4f..�............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •.............oF....... /�.......................................... Appliratiun for Biiipusttl arks C�unitrnrtiun �exrit Application is hereby made for a Permit to Construct (VI ,-,or Repair ( ) an Individual Sewage Disposal System at: kixt ......... .u...T. ca----La i . � �► � -<F `Location- des '--•-•--or Lo o.•-•.............••--•---••-----••---•--.. 0 n Address .. ...�.(t.ssS `'-- ..................................:.... ..........................O..j.--------.........-•-•--••----.............----........------ Installer Address Type of Building Size Lot....-1 �. 5------- U DwellingNo. of Bedrooms_..._.__ a — ..........Expansion Attic (d!D) Garbage Grinde (�) p, Other—Type of Building ..10ocg... .._..... No. of persons_........---------------- Showers (,�) — Cafeteria a' Other fixtures ................ ................ . w Design Flow.........S.57-.........................gallons per person per day. Total daily flow-----------3 �-�----...-----•-----gall ons. . WSeptic Tank—Liquid capacity.1t�*gallons Length.....(.Q...... Width---L......... Diameter... Depth..... ......... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.__,44{.....sq. ft. Seepage Pit No.................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing t a Percolation Test Results Performed by.__.. 1 d� C..... ............ Date..._...S l .. a Test Pit No. 1....4.) ---minutes per inch Depth of est Pit_..__l X......... Depth to ground water.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit...............:.... Depth to ground water........................ t... t............... f---..---- O Description of Soil �'.�.�� ....�,..A6t �4 -:. r�?..P.:� , :.4�-----------------� -----.tom. _.. U •••••-••••-••••--••-••••-••--•-•••--••-•-----••-------•---•-•-•-----...•--------------•-•--•••--••---...--------............-•••-----•-•...-••-•---•••----•---------------•••-......._..-•-•------------ w U Nature of Repairs or Alterations—Answer when applicalale............................. ---------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'l U 5 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. ned....... .... .. ---•-• . ..... .D Application Approved ere S ,1 Date Application Disapproveing reasons---------------•----........... ----------•----------.------ ...-_-------- ............................ � ------....----------•---...-•------•--•-----------.....-•••••----••-------•••...-••-•---•----•------ ---- Permit No.._.__ �J......7_.2--� J — -•----.._ Issued_ .. Date NO-V....... ....... Fsa... ..._........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `.�..............oF........ zw :T. . � - ....-..---......................... AVV ira ftou for BiiivniiFal Workii Ton.ltrnrtivat rnmit Application is hereby made for a Permit to Construct (`') or Repair ( )'an Individual Sewage Disposal System at: - .....................•--.....-•-•••-•-••-• 4 Location_4 dressy or Lot No. �,� +. j�t.d`l�_ ....Cex ...1. t c. ..........................�C°°'"�=.........K t.-- ... Own Address .................%% " ._. ..................... �.:r._p •--•'-..................._....... .............__. Installer Address dType of Building Size Lot_._._{ ,...............Sq" e U Dwelling—No. of Bedrooms........ .. __________________Expansion Attic (�lIl Garbage Grinde O p,l Other—Type of Building __lOCuD+ ...______ No. of persons________ ________________ Showers (^�) — Cafeteria a Other fixtures ..._...................................______ W Design Flow......... __________________________gallons per person per day. Total daily flow........... _3_ ...................gallons. WSeptic Tank—Liquid capacity._ l gallons Length.....11.0...... Width__-(4.......... Diameter--- --------- Depth....Co........ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....Q� _�.....sq. ft. Seepage Pit No___________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( DosinVac ( ) Percolation Test Results Performed b �__.�_ ..__..� f1�1_�'gr°•____________ `� �� y....... .. .. Date i'- �dde�r Test Pit No. I._..G_� minutes per inch Depth o est Pit._._.}a�?......___ Depth to ground water__ f{`_ ._.____- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ..... f . ---------4-------- -•I................•.. t t D Description of Soil.....�'--- - .. ?. :.`��3 1 _ �� '`1•` 42 Lt t# x W VNature 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 T ITL E 5 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. .Signed....._. �1�. .. ....................................... '... �.. Dat Application Approved By c- .!L _ __, ',�' ..... Date Application Disapproved ors" a following reasons_________________________________________________________________________________________________________________ --'-'-'...._...--•--•.......--•-•-"-'----'- "-•---- ••-•------- ----------------------•---•..__...--•--'----•-•----•---'------------------•-------•----•----'---------•--....---•----•--- Date Permit No............ ��----- - ..-..------- Issued... _�� .. Date _.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��� 4rdifiratr of Tnmpliatta THIS IS Q CURT �j That t Individual Sewage Disposal System constructed )'o R paired ( ) by-•................. . .... 8.4.f: .t... `1 ........... -Installer------•-----•----------•---.......*-_----•-••'-P ...................... ----------- has been installed in accordance with the provisions of TIk37f: 5 of T State Sanita as rr}ed in the application for Disposal Works Construction Permit No.__ -, - ---_---. dated_- .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............!_._... __..... Inspector....... . THE COMMONWEALTH OF MASSA HUSETTS BOARD OF HEALTH 7z� OF. ✓c�?. ta fit .._. G.e FEE........................ �t tt1Bork �si mitrt ion hermit Permission is he gran d---•--..'..! " �--�----•- --- ------tom. ............................................................. to Construct ( ) or Re, r ( ) an ndlvl al e Tag posal Sys t -� f jStreetr.� as shown on the application for Disposal `Forks Construction Permit No...........✓..__ Dated .........___ 'Iil w . S � . A � /r Board of ealth DATE..--:':. /fl _ f + FORM 1255 A. M. SULKIN, INC., BOSTON l • 7 S;o a ' 0 7" z' - T /oov 0 T\ a r� raj d/'i 0 2-3 I jj Irk of @ � L3 SUR�� LEGEND PLA ,EXISTING SPOT ELEVATION . ®x0 " ��I" UF;y�s C z ��� -Tvw✓ T ERTIFIED PLO. N EXISTING' CONTOUR :__'C _� ?�,� s� /oT C� " �cuw7> r FINISHED SPOT ELEVATION �], A� Y /yy�/V/V/S/�o. T FINISHED CONTOUR 0 R RSE IN APPROVED , BOARD: OF HEALTH No roger p ' FSSIONA:L AGE NT SCAL'Ei. 3 b DATE t S & 3 LDFREDGE ENG/NEER/NG CO-L 13�y� �a CLIENT w I CERTIFY THAT THE PROPOSED 02 Fri 0 BUILDING SHOWN ON THIS PLAN REGISTERED) REGISTE-REO JOB p` LCIVIL LAND CONFORMS TO THE ZONING LAWS �tGINEER URVEY R OR:BYt t1 .r? OF`SARNSTAS E , . ASS. 712 M:A1 N STREET CH ®Y� J. 7 HYA► NN I S, WASS. SHEET—L 2 OF A E t3. LAND :SURVEYOR /V07F K f�R 240 FT. MIN. FACHr/vG ?/T A Ae /yOR E 7-14 A `J /2 r BEL O JcV /O Jep M/N. rRAOE, A 24'17/AJiJ ETER "L'ONC.PE�'� C•OYE/P S/,IALL BE B.PDuGNT TO c;mAOE. -AA. ' GO/VCJ?C'TE 4'PYC O/PE /yE,4{!y C/� ST /RON CO{/ER Sh/ALL... DE lJSFO P/TCN LF/A' 17R1 VE-WA y. COYERS �® PF�P t T •'. C'ONCRL� E...: `/ T 2?• MIN. GJ<<4oE c0VER' CLE.4/V. .SAND f _ 2 LAYER j 4't:AST .�e e AF %8 -T/,9 r MJJV.PJTCN GAL. • 0 • • . •.. • • • • > •e WASHFD 57vNE i P��aJ�' .S.EPT/C TANfC DJsT. •'s • , . . • • ,� ®OJT o • • $ • • • • • t . e s. `'' • .EjpfECTivc • • t • • OBPTH • • • t o WA5N .STdXE I 479 PREG45T'SEEPAGE. INY�vtT eLEY.a4T1oeS/s. T'/T CA-11AC/77 54.8 6ALIOAI s r • go • �10 -78 o P/T OR EPU/i/. . ELF=V g z o o /^T ^. 6 JaT PIAM. IJVYZRT AT AVILD/JYG 9, _ SEE TABL/L.4TJON _J/1rLfT SEPT/C TANK `18.� FT- , . _ !� FT. Oli4/►rf, _ C( • � - Ot/TLET SEPTIC 7*ANK /NLET D/S7PItl4sar N BOX -9e•` GROUND JY�ITE�+C TAIL E , Ot/TLL`TD/3TR/BtJT/ON BOX - ' INLET I-EACRIAW PIT g D FT. .SE�Ni4G� O®S�IO�S'i�4 L SY.ST�M TAe(ILATIONt. LEACH/N� .P/T 3 _ZT D/MENS/ON . A DES14TV CR/TRRIJ4 StA.LF : fs" = I�:o"• O/MIENS NUMBER OF®EDJ�O®/►1S `~ ,.' r,ARatGE®/sPOSAj- UNIT nro�E SO/L LOG TaT.4e EsricTEo J=LON/ 33o G.4c./GsAY 50/L TEST J / SOILST,oOt� : SD/L TEST /. VUM8ZV QF Z.-ACRIMG P/n_l t=cE✓. 99.9 ELei! DATE OF' S0,14 TEsz ' S S/DE LE.4CH/NG PER P/T .SC•t sT f 1 ; RESULTS lt/%TNESSED dY'c�R " cJfl c� 7 Q -/ PERGOLAT/OIv HATE. 9OTTOM LFACHING PER P/T S®. JCT L p ft /�'� # LL-5S MJNtI/IVChf TOTAL LE.ACN/NG AREA SQ, fT. j p/LSD>L AERCOLA'rl0JV R.4TF Ik2 MJJV.�/JNCf+I:,. ,QESERI/E GEACN/N6 ARE/4� DF /'IUDIU/� �0T .28 (�t-D ?`v.L+✓%L FcO. Of� s90 ��y�N Mgss ��sD ' �/'/A //A/ S I�C�!x . SgR� ' rni ; o v, ORSE No.10951 o ELOREDGE'ENG/NEfR/NG:GO,lNG- `t �FGISjtiP�r``� e7.-9 712 MA/IV ST. No suR�yo FFs�ONAI�� Na Grob JNl7 yv.4;r&M ENCOuni7- "eEo L'L/ENT:a.a yiI d D/QTE S &3 i _GRDUN�.LvA7"ER:AT'ELEI/ Nd• 3 p-b Z. ,$ SET