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HomeMy WebLinkAbout0139 FOX DEN BLUFF ROAD - Health 1391 FOX DEN J FF RV AJ) COTUIT ` 1 TOWN OF BARNSTABLE � ,`• hr- Lvk /z/ f:!�,X DLL/ SEWAGE # ! 7 LOCATION vIIiLAGE_�,1L � 7 ASSESSOR'S MAP &LOT 4`f L-Vi1 INSTALLER'S NAME&PHONE NO. SEP 'IC`TANK CAPACITY P � ,5 o o 1) �y A-ellT size ING CII.ITY: (ty (size) LEACH FA NO>At BEDROOMS: 3 BUILDER OR OWNER •c r < PERI+IITDATE: , r COMPLIANCE DATE: Se0s06n Distance.Between the: Maxtmum Adjusted Groundwater Table and Bottom of Leaching Facility Feet i Private:Water Supply Well and Leaching Facility (If any wells exist ;:oriaifc`.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 t -ryyft`Y.1 J TOWN OF BARNSTABLE /2- SEWAGE # 1 7 -Z.415- LOCATI�N VILLAGE e D��, i � ASSESSOR'S MAP & LOT 0 Y/.0a9' INSTALLER'S NAME&PHONE NO. ',k-a SEPTIC TANK CAPACITY SSG U LEACHING FACILITY: (typ43��5—o o /Q ry wells (size) Sd 0 G.�1 NO.OF BEDROOMS 3 BUILDER OR OWNER A os✓ /I S V 4N PERMITDATE: L —COMPLIANCE DATE: 1-8 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 �-� tic s r, 3� c h TOWN OF BARNSTABLEo LOCATION �d� f6X L-h SEWAGE # 7'z�lS VILLAGE C6 ` ASSESSOR'S MAP & LOT 1 a INSTALLER'S NAME&PHONE NO. f4l 7 SEPTIC TANK CAPACITY l-SO y LEACHING FACILITY: (type) Qrg/ize) NO.OF.BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 3.00 feet of leaching facility) Feet Furnished by 36 v . o . No. c ✓ Feeed Z� :A THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migogar *Vztem Congtruction Permit Application for a Permit to Construct(,�,Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. %3-1 fb�., vw- 'RX7. Owner's Name,Address and Tel.No. Assessor's Map/Parcel p V Alr�� 35 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ` V e—K 4-t7 f-A Ar Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow +4-o gallons per day. Calculated daily flow er gallons. Plan Date O'y i41 (-'C7 Number of sheets Revision Date Title - S Size of Septic Tank t5oo Type of S.A.S. 5'b1*% 44L• Dg W0_a Description of Soil See l` 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 Board of Health. Signed Date 1 Application Approved b - Date ' f�! . 7 Application Disapproved for the following reasons Permit No. Date Issued �. �` fir!•' ,i No. ! / � .,/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Oigool *pgtem Construction Permit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. %-3c? fbx 0e*1 $-Vff 1ZX;1_ Owner's Name,Address and Tel.No., C.C*-pI ` Assessor'sMap/Parcels4ex- F Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r.15—K 4\7 G��Y(��c✓�� f r-t G� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. t Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 44 -o gallons per day. Calculated daily flow �M. p gallons. Plan Date LIM 14l 15S') Number of sheets 'L Revision Date Title - Size of Septic Tank 1500 4At-, Type of S.A.S. m 4r L• t uh2a w I o f-ffb ti Description of Soil � 10 Nature of Repairs or Alterations`(Answer`when applicable) Date last inspected: Agreement: s 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 ace-the-system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. z Signed, Date ) ! - Applicatioa Approved `Date - Application Disapproved for the following reasons• }: k ! Permit No. Date Issued - ——————————————————————————————————————— R THEeCOMMONWEALTH OF MASSACHUSETTS - BARNSTABLE, MASSACHUSETTS -� Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )b at 52 xv has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated •��r�� Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste ill function as designed. f Date Inspector� - } No ��/--------------------------------------- Fee,/M_4-v­ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lizpool *pg;tem Construction Permit Permission is hereby granted to Co truct( �-))--R--ee�pair( )Upgrade( )Abandon ) System located at � � D,�l.✓ 12 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 t Date: 1.1 //,�C/ Approved by I NO. CCATION = I LI,,AGE DATE P.PI,ICANT FEE DDRESS ' TELEPHONE NO. (Non-refundable) J:NEER Baxter & Nye,Inc. Peter Sullivan TELEPHONE NO. 428-9131' I'Iw 5 IiEDULED glo (Applicant' s signature) [ 'JJ •VOo '$e�l L1P.& LET N�� . G..... . i' 0 C C C . .-. . . . O . . . . . . . . . . . . Y O dY . . . . . . . Y.. V. . . O Y . V . . . . . . (�' lJ SOIL LOG ' J3- DIV.ISION NAME_ }-c--•t3 27 Ige DATE ��2 gj�T TIME X PANSION AREA: YES_NO c- -iywvt9, jc `� �w�c� ENGINEER:'N' NN WATER_&PRIVATE WELL BOARD` OF HEALTH Ali- TLO EXCAVATOR _71]'CIi: (Street name,etc. ,ciimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES:- t� C5 �Lo \k 67 C ZCOLATION RATE: 4ZVA100ypez_� 1�� ''1 HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: Z A � t� 2 ' 3 !` 4 4 5 5 �tZC 7 o+.w 9 9 �{ 10 10 11 11 12 ,2 12 13 13 14 1 �© A Z 14 15 15 1.6 16 1' 1BLE FOR SUB-SURFACE SEWAGE: . LEACHING FIELDS LEACHING PITS LEACHING TRENCHES_ /N. UrTABLE FOR SUB-SURFACE SEWAGE. REASONS: E : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED -ON PERC TEST APPLICATION G _NAL: COMPLETED IN ENTIRETY BY P . E ANJ2 RETURNED TO BOARD OF HEALTH Y : RETAINED BY APPLICANT �s' ' . TEST HOLE LOG DATE: Q► WITNESS:—�-.,4uN..cJi ✓C� _.__ --- _ - ._- PERC RATE: c Z 3 ` � 4 • .� LoA� t Y .vleA.— H m -------- ' 1 1 11 I DESIGN DATA i DAILY FLOW:(y)BDRMS z 110 GPD-y//O GPD SEPTIC TANK:.4/ /a GPD z 200%- 88•a GPD USE:/Sc o GALLON PRECAST SEPTIC TANK N ' LEACHING FACILITY: N USE: CAPACITY: LA RP SIDEWALLf__c__.J-S�-=-/�3r�•:: BOTTOM:.-_:«` .'�, S�Xa TOTAL:___�___ _ .• v�G L �S /20� /5.'v'D T/•v`�,?/�ER G� ` ._:... 1 OF .' SfEVEN W. r `r9O NOTES: RUMBA C4 :T DANIEL E: .Zr' 1. ALL PIPE TO BE 4"DIA.SCH 40 PVC. 35791. 'f s AM crnt V 2. PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION BOX. E S v No.32686C y 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN s RVE*"a 5�9� A �F g Grs1� 6"OF FINISH GRADE �� � 4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL S. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED ON A 6"LAYER OF STONE. 6. INSTALL GAS BAFFLE IN OUTLET TEL 2•LAYER OF 3A•PEASTONE OVER U4•-1 1/2'WASHED STONE ALL AROUND TOP OF FOUND. EL. ;7O, DO 10• 14• G6.Za GG.o7 6�.c�o GSSo ' SEPTIC SYSTEM PROFILE v stS: SITE ^r SEWAGE PLAN GENERAL NOTES FOR 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR [-'� DATZ: . TO ANY EXCAVATION OR CONSTRUCTION. L SEPTIC SYSTEM TO BE INSTALLED IN COMPLUNCE WITS PREPARED FOR 310 CMR IL W.TITLE V. I THIS PLAN 3 NOT TO U USED FOR PROMTY LiN$ _' DETERMINATION. ` 4.ALL D AND /Jy/� G.� �j^/ ���},� ///��� �(� ISTURBEDAREASTOLOANED SE®BQ=....L� !____I �_.I—// S�rAL/L/'.J�-I�-Y-V_re�_. _ 7_ L CONTRACTOR TO 24$bUB NOTICE FORANY. REQUIRED NS.'� . � s1•.r 63`3�"V�'7-le j 5��*' - .. 0 `` i t { Yti'.r:s`.c' �y`s�jE' ,.e•�:w'T..^r E zy �" ' y a� i� Y,!„S^H _Y G f y. - to 4 -&s y$' i@`" :`•. 7pr = �"ksko?Cx •,;..,, .. ...._t,�t ` 5 . .x t 3.Y''S" 'fy '��,� w�nr��'c'�ir 4. I A z t t 3> x WELLER & ASSOCIATES 160 FALMOUTH ROAD aNTERVILLA MA. 02632 ". p isr.' -...TEL:• (508)77S•0735 FAX (508)77S•0754 ' "Aq' APPROVED BY: k{R.n�+.` N '1. 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