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HomeMy WebLinkAbout0060 DOGWOOD LANE - Health 60 DOGWOOD LANE COTUIT A = 025 059 TOWN OF BARNSTABLE Z(, LOCATION �D� c�?errJ-� Imo( SEWAGE # A401-J-01 '-VILLAGE ('��c� '� ASSESSOR'S MAP & LOT OJn5 CS4 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEAC1MgG-FACILITY: (type) (size) 14:7'i 5Ad e.2 NO.OF-BEDROOMS 3 / ,T3UII.:DER O �n�R ' PERMITDATE: 4- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted,Groundwater Table and 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 hG� _ _ -�� rrL*rJf' � G� � e i�� - �— Gars r. f �6` �--� ��� F - ��,� ;� O ��� � -, .. Vic: � 6 KI�'icfi��/ - �pr, - .. LOCATION SEWAGE PERMIT NO. Clot 10 Dogwood Lane rlaQSE ti $4-152 VILLAGE Cotuit I N S T A LLER'S NAME i ADDRESS Robert B Our Co. inc. Great Western Rd. North Harwich \o a UILDE R OR OWNER Michael Hayes DATE PERMIT ISSUED Zfe- ifV DATE COMPLIANCE ISSUED - ��� rko)i-r �s�u as-r No. ,W L I f/� / + Fee 1V// THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppfication for Miouar *patent Congtruction permit Application for a Permit to Construct( )Repair(✓ )Upgrade( )Abandon( ) ❑Complete System LJ Individual Components Location Address or Lot No. /� q Owner's Name,Address and Tel.No. Assessor's Map/Parcel Gamy ap Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ael- D ,cegrV5�r W Type of Building: Dwelling No.of Bedrooms s? Lot Size sq.ft. Garbage Grinder(//0 Other Type of Building .�C' .511' i� No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated.daily flow 33® gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 12"310X 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 this o of Bealth. Signed Date ! ®� Application Approved by Date Application Disapproved for the following reason Permit No. "(— Date Issued y — ,y No:k-;°± Fee , ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pplication for Di.5poal *pttem Contructiou Permit Application for a Permit to Construct( )Repair(✓).Upgrade( )Abandon( ) ❑Complete System l Individual Components Location Address or Lot No. /D A0 74/wo /, Owner's Name,Address and Tel.No. - Assessor's Map/Parcel (! /r D CO�rIOr Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. - 939�' Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( � Other Type of Building ef No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33D 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) Date last insp cted: z` 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 b this Bo of • alth. Signed Date Application Approved by Date ZV d Application Disapproved for the following reason Permit No. ZOZ(`Zd Date Issued 4 � --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS Q Z-J _©�9 BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( V/ Upgraded( ) Abandoned( )b 07/_ ! /J at 6 �O Gr/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.-iVy/— 7-0 dated "U Installer Designer The issuance of J pe t shall not be construed as a guarantee that the syste ill f do designed.' Date /)PC, l Inspector --------------------------- ------------- No.. c�L/c'J l ' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS x1h6pogal bp6tem Cougtructiou Permit Permission is hereby granted to Construct( )Repair( V�Upgrade( Abandon( ) System located at �� rdO�'�UOD CJ �rl. D G// 7- 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 ynus be completed within three years of the date of this pe it. Date: Approved by s i --www M x; t TOWN OF BARNSTABLE S' LOCATION SEWAGE # .1661 -J-4f)l VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Qav GL j LEACHING FACILITY: (type)�it�`�. ' s � (size) �_. NO.OF BEDROOMS .3 r BUILDER O OV 'NER . PERMITDATE: 4- -o COMPLIANCE DATE: L4 Separation Distance Between the: Maximum.Adjusted Groundwater Table and Bottom of Leaching Facility t Feet Private Water Supply Well and Leaching Facility (If any wells exist r ! //3 Feet on site or within 200 feet of leaching facility) J" Edge of Wetland and Leaching Facility (If any wetlands exist n within 300 feet of leaching facility)' 1 Feet Furnished by /SGL I N PS f � • i by �\ W l f' � { DESIGN/APPLICAUON 3 OF BEDROOMS=,equired designed gpd: © . .SIDEWALL: length Z,Q X width ZZ _ X no. sides Z _ `'�� sq.ft. ' lengTdh-30_ X width--2 _X.no. sides Z = f z j sq.ft. S'idewaU area 6 BOTTOM: y width /0 X length_ ,?10. =sq.ft. Bottom area 3�® =total area y� sq.ft X 7 Gl = 3 L��. � designed (application rate) gallons/day ire" NOTICE: This Form Is To Be'Used For the Repair Of Failed Septictic Systems.Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS /ar/'0-/10/0^hereby cerffy that the application for disposal works construction permit sinned b y me dated y/ �O/ concernin the _ property located.at lr�©D�.//� 3 . /� meets all of the Al followinz citeria:. /7- hef-ailed system is connected to a residential dweiizng oniv. There e at r no comme:c21 or�uin�. 1 uses ass=ated with the dw + *+g. ae sail is classified as aASS I and the^P oiation ate is ieys:hart or--auai :o,5 minutes Vie: mc.L /7:'ie=are no wetlands within 100 fe_;of:he ;r000s=s=Mc 3"stem �'-e:e are no piivare weds wil"hin.1=0 fe_t of the propcsed sczdc.nmem. i ve nc:e s ao tact-..,se m flaw and/or c au,_ inasexcowed 7-here are no varances.=uesed or needed. 1 ae bottom of the proposed leaching faciity will not be located less than five feet above the marmum adjusted,gcoundwate:able etc ration..(Adjust the�*oundwater taoie.rsin;the Fnmrtor method when applicable]. Xf-rhe S.4.S.will be located with 250 feet of any vectmted wetlands. the bonom of tiie se o propo leaching facility will not be located less than fourteen(14)feet above the ttsa�mum adiusted groundwater table elevation, Please complete the foilowinb A) Top of Ground Surface EIevation(",sing GIS information) B) G.W.Elevation the MAX 11igh G.W. Adjustment. . D17—ERENat BETWEEN A and 3 . ll k SIGNED DATE: (Sketch proposed plan.of system on back]: ¢Ica k1da-cat ....................._. THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH ..................OF...... ... ...A�- 1.5 .. Appfiration for Moliviitt1 ar"onstrurtion rruti# Application is hereby made for a Permit to Construct ( ) orRepair ( ) an Individual Sewage Disposal System at: , I.... .. .. ............................. .. DO .. C .�L.f..T_.......:.. r .................................... Location-Addre or Lot No. ....................... IAA'-{ ...-f -- ---------.............-- wner Address a ............................................ "...... s- »------ ...-----............. Installer Address Type of Building Size Lot....4-41 5_..Sq. feet Dwelling—No. of Bedrooms___......................•.._...._..._.Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers Pa YP g -------------•-•---.._..._.. p ( ) — Cafeteria ( ) Q' Other fixtures ................................. . - .0 ------- W Design Flow.................. .. ....._..----gallons per person per day. Total daily flow..................... ?-0........gallons. WSeptic Tank—Liquid capacit —.gallons Length................ Width................ Diameter................ Depth................. x Disposal Trench—No..................... Width................... Total Length................---- Total leaching area...... ..___.._ sq. ft. Seepage Pit No.........J._-------- Diameter.......R>------- Depth below inlet.......6........ Total leaching ft. Z Other Distribution box ( Vir, Dosin tank ) � / Percolation Test Results Performed by _f' �vYl ...(�'_�! �)_. Date_._z"�� E' a Test Pit No. 1.......^j�-.minutes per inch Depth of Test Pit......1-2 ..... Depth to ground water________________________ Pz Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •---••••••••----------------•--••••••--•••••••••-••-•-••-•..........••-•-----.......---•--..._...--•.......................................................... 0 Description of Soil.................. r .................................. ...--------------------------------------------------------------------------................. W ---•--•--•-------------•--•--------•--•--••-- +�1 ?!.t?YV..---.......-��- ---------•---•----•---•-----------••-------------------------- 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 provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in er io n ' rtificate of Compliance has been issued by the board of health. S ..................................................................................... ••• ••. . Aation APPro . ... ............................................................ ------ -----------------------------•--....--••----------•---------•--•-•------------........--........---•--....---------------•-----------------------•------------------------•----••----------•-••-••-•----- Date PermitNo......................................................... Issued....................................................... Date �� THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IMFA- I DATA No....................... THECOMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . . O .v �.............. ........ A ............... ....... ................................. Appliration for Disposal Works Tonstrurtion Uptrutif Application is hereby made for a Permit to Construct O or Repair an Individual Sewage Disposal System at: .................................... -) -L.......... .. ........... .......................... .......!..aL..................................... --------- ............ ..... Location-Address or Lot 40.-- L .....i .................................................. � Owner 7'............................................ ----*--------Address '7 -----........ ........... ................................................... 14 ............................................... M installer Address d Type of Building Size Lot.... feet U Dwelling—No. of Bedrooms............Z�;.7............................Expansion Attic Garbage Grinder a Other—Type of Building ............................ No. of persons___..............._..__._... Showers Cafeteria Otherfixtures ............................................................................. Design Flow................. ............:.....gallons per person per day. Total daily flow.._.........._...._.'_:7'Z—)........gallons. P4 Septic Tank—Liquid capacit}.._.­gallons Length................ Width.__..........._. Diameter__-____......... Depth............._. Disposal Trench—No. .................... Width....__...._..__.__.. Total Length_................... Total leaching area....................sq. f t. Seepage Pit No......... ----------- Diameter.......�4��....... Depth below inlet....... ......... Total leaching area._ I p ....sq. f t, Z Other Distribution box Dosing tank 0-4 - I 1� .. . .... Date...:Z�.� Percolation Test Results Performed by. J_ f'. /_ - . !, Z_ ...... ..... .t � 7 �- '.­.... ......................... ................ Test Pit No. 1..... .minutes per inch Depth of Test Pit------1.. ...... Depth to ground water......x_............ ....if 44 Test Pit No. 2.................minutes per inch Depth of Test Pit...___.............. Depth to ground water........................ 04 .......................................................... 0 Description of Soil....................................................................................... UW ............................. .0 A L-- ......................7A ON � W . �7 ;;--r----- ------------------------------------------------------------------------------------------ M. ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ,,t provisions of'I'1Z 1 � - 5 of the State Sanitary Code— The undersigned further agrees not to place the system in e a,io tit a rtificate of Compliance has been issued by the board of health. ...................................................................................... ...... ........ Ation Appr ed ................................................................................... ... -------- Date pplication Disapprov f the following reasons:................................................................................................................. ........................................................................................................................................................................................................ Date- PermitNo........................................................ Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ,.OF HEALTH o 1 ........................... ............OF....... i...... ..........1;....... Trrtifiratr of Tompliaurr IWIS TO CERTIFY, That the dividual Sewage Disposal System constructed<--) or Repaired by .......... ------------------------------------------------------------------ ------------------------------------------ Installer r ate................................... & ......................................................................................................... . ...... _�A ii has been installed in 'ordance with the provisions of .T LE 5 of The State Sanitary Co a's application for Dis' osal Works Construction Permit No... ....V�. ............ date( ----------------------- --- 6;1Z 9� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................ ................. Inspector.....--------41"te-.6............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ell LU '­.................OF....... A. ......................... ry- ....................... F4.2................... to orkg Tvainstnution :permit Permission ereby gra e ........ f, .....................0. ...........I............................................................................................... to Construct kReFair n Individual Mage Disposal System atNo....-AIZI."W. .......................... ...... ............................................................. Street -------------------- as shown on the application for Di o Works Construction Pe"rmito Dated__________________________________________ a ................. .... ............................................................................... DATE.............. ..... ogAl Board of Health ............................ ........... .......... FORM 1255 A. M. SULKIN, INC., BOSTON -1'l'K•� a¢BAGE �jW NDER. � �/s, �. 1 � 1 �� k� D/1.1I..Y FLOW s ItO X 3 Z30GP1?+ �. } • , , SEPTIG TA►JK 3 330x;' co,,., q0� " �' • ' . # V5 GAL. V o15PoSnL PIT ' VrSE I 000 6At_./3'np - �� �• $raz BOTTOM .AIZEq s . I�3 Si F•- SZ- R' 'IOTA i- p6.SIGN G`R (,.P. D. 'ToTA%- DA►t-Y PER.coLATtoN RATE ' s t t OF R �P`SH OF MA,� -•�'L,i 1 r'6$ 1. I is DAVID. RI CHAFRD c�N s U1UUNA. No. 29976 ZI ' BAXTER g .y G/✓/ <,0 No.24D48Q - rO�O ��irsT ' I r f N A • ` i' 4 s s sulN 3og5 ' I a TOP F W D 1-iQl'F i fG1r 'SS '�;^5 �r IJV $� i i 7 1L ' e►ta+ r lsoo IW IRZ Sv4wl4 y ` 0uT INS. 2 loco INV. INV. INV. WIT" S3•Z9� c } , WAS • � is a.�1*',`,;*�� .-..a. .'t ZY ' � ..)I � G E R.T 1 F 1 G O P�.ATE P L A►.� F a 41 PR,pFILG L044-T ►oN I"vl"t"M • �. { No SGP•LE. SCALE #`VATS 0s pL P. 626NGE i �R.EMEN7 l of= -CND . , . AWP SETl5AC-K R.6Qv $ I , -To W N O F-P3 xrz.A oirAr-�Lt3 ANv 15 I_OCp.TE0 •WI'j-NI� ,T S GLoao LAIN L• G. :.{ DATE BA-ATSIZt NYE INC. RLEG 1'S7 f��6►U't.A►1 o S u Q.Y EYoiZS t TurS PLo.N 1'5 KlUT Bt'5c p o►d A.N OSTE2.VILt.� • 'SS• IuS-t-R.uM6NT 5V2vey a -THE o1=FSF-75 Suou1,,U � NOT DEUSEDTO DETEEZI�I►�•IE L•�T �-INE-�j APPLICA►-�'r