HomeMy WebLinkAbout0108 FURLONG WAY - Health 108 FURLONG:WAY 1
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t�
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZippYitation for 30isposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No_-A Owner's Name,Address,and Tel.No.
Assessor'sllap/Parc�l Y ] a �l�8� Al / / C�G 6
Installer's Name Address,and Tel.No. - Designer's Name,Address,and Tel.No.
jv
Type of Building:
Dwelling No.of Bedrooms ID116 701Z Lot Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Z, Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required)��tR I'&�►y gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title /
Size of Septic Tank 40M gyion Type of S.A.S.0 i 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 Certificate of
Compliance has been issued by this Board o e h.
Si d Date
Application Approved by Date .b j
rz—
Application Disapproved b Date
for the following reasons
Permit No.2 0(Z 33 1 Date Issued _la�/�Z e t z
TOWN OF BARNSTABLE 2
LOCATION'/(2 6 Foel o-,!g: WIN/ SEWAGE# 2-0 `�3
VIILLAGE C6.1-1 y ASS SSOR'S AP
&PARCEL
(INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /
LEACHING FACILITY:(type)/00. d//,O► 4, /°(size) .
NO.OF BEDROOMS
OWNER
PERMIT DATEIG f Z 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
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No. ?d Q Z3 I Fee*/ao w
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
implication for Vsposal *pstrm Construction Permit'
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.Z& Ib Owner's Name,Address,and Tel.No.
Assessor's Zal p& y -(f�� AAPI
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 0 16 ZO�Z Lot Size sq.ft. Garbage Grinder( )
i
Other Type of Building No.of Persons L Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) i j NiIb�rz, gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank j/)/2i7 a,tj/f p vl j Type of S.A.S.
r
Description of Soil _
T '2
Nature of Repairs or Alterations(Answer h n applicable)
Date last inspected:
Agreement:
,. The undersigned agrees to ensuLthe ,,,t ii1tion 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 Certificate of ?.
Compliance has been issued by this Board o ea ith.
Si ned Date
Application Approved by Date t7�J/2
T ,--in rZ
Application Disapproved by ��; Date
for the following reasons r_
Permit No. Z Q 1-7 '�'�� l ` ---� Date Issued l a�/�017
- - ------------ ----•------------------------------------------- _----,-.-.
THE COMMONWEALTH OF MASSACHUSETTS
} BARNSTABLE,MASSACHUSETTS .
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(I,,< Upgraded( )
Abandoned( )by
at �, /�,y� /.f1A t/ t� ir has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.7-017,-�31 dated It L 1 7
Installer p N► rj Designer
#bedrooms _ `►� l. -r. 161/ 0 r 1 t, Approved design fl iv` 1,/r�;/� gpd
The issuance of this permit shall not be construed as a guarantee that the system wirll fu�ion as desig ed.
Date /��/�/�_r�/ Inspector ,: '�ll/ h r-,l
Q v y
No. 7D(7 Fe
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal ,*pstem Construction 'ermit
Permission is hereby granted to Construct( ) Repair(1.41 Upgrade( ) Abandon( )
System located at S( 4-6,Qldeoq 1174 .
and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 permi .
Date Approved "`�
� LOf7
to CAT
ON c'r� S E W A G E PERMIT NO.
Lt 5 CC7
1 VILLAGE
INSTA LLER'S NAME ADDRESS
f U I L D E R 0
DATE P ERMIT' ISSUED' -z.l=
DATE COMPLIANCE ISSUEQ '/ �`
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... (Al
Appliration for BhiraaFal Works Tumiuur#iun ami#
Application is hereby made for a Permit to Construct (i/f or Repair ( ) an Individual Sewage Disposal
System at:
- i2Co•v G Ise'... .......�-a7..�{_% / ..... ..... •----....
Location Address ---or Lot No.
ddr
Owner -••--•-•Address
W ...............fka ••----.--•-••----...----•---•------•-•--•-•....... .........................•.... ...._.........._._.......---.......................
Installer Address
UType of Building Size Lot___ZZ ......Sq. feet
�. Dwelling—No. of Bedrooms.......... ;_______________________________Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of ersons____________________________ Showers
a YP g --------•------•--•-------•• P ( ) — Cafeteria ( )
Otherfixtures ••---•• •••••••-•••-•---------------•---•--------•••-••------•-•-•-•••••-•--•-------------••••••-••-•••-•----------••----•---... '-_...........
W Design Flow................. .........................gallons per person per day. Total daily flow.............. .....................gallons.
WSeptic Tank—Liquid capacity./Se4__gallons Length__ __'6'.___ Width__. Diameter________________ Depth__s.
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area.....................sq. ft.
Seepage Pit No..........Z-------- Diameter.........lq...... Depth below inlet...... _........._. Total leaching area....._-'`�.I-._sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by..__4`Pk! �__.._. :.._ !4 y._____..... Date__�T_-3o /j8J'
�------•---------
,..a Test Pit No. I..... _Z_.minutes per inch Depth of Test Pit...../�_:'_____ Depth to ground water...... "¢_ .__....
f14 Test Pit No. 2..__.L7—
._minutes per inch Depth of Test.Pit__._.e� p__.. Depth to ground water______........................
P4 •---•-•-----------------------------------••-------------__--___---------•---•-----------•------ --------•----............---•--........_........_-----•----
0 Description of Soil.....o Zl� 1 /00 Lo/� sv3-s�{C_--- z¢..= C2i�✓GsZ
x ---- ...........................................
x •-••-•---9 .,,=---i.s�G-- .`' ,/--�.q-zs ..__.5 �---------------------------------------------------------------------..................................
U Nature 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 iITA U 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n ' ue y the and of health.
e ---- --------.................................................... -...---•-- .-._.-.._..._....
Date
Application Approved ••..---••- ............................... ..............J..
Date
Application Disapproved for the following reasons:................................
----------------------•------................................................ -
--------------------•-•--.......------•----...-•--------.._...---------------------......_._...------------•----..........---------------•-----...------------•---------•---••--••--•••••••---•---•----
Date
PermitNo....................... -•• Issued.......................................................
Date
No.. .
THE COMMONWEALTH OF MASSACHUSETTS '
BOARD OF HEALTH
a+��n ............OF......
Appliration for Disposal Works Tonstrixrtion Vprrmit
Application is hereby made for a Permit to Construct (vT or Repair ( ) an Individual Sewage Disposal
System at:
G._...!w ........C�7v�.%............................ .......................................... S------------................................
--. ocation-Address or Lot No.
.............................................- ir...----.........
---........._.........._....
' Owner Address
Installer Address
Type of Building Size Lot......Z:. —SL_..Sq. feet
Dwelling—No. of Bedrooms..........�.............................Expansion Attic ( ) Garbage Grinder ( )
1.4 Other—Type T e of Building No. of persons.. Showers
a, YP g .........-•----•----•---•-•- P ( ) — Cafeteria ( )
alOther fixtures .................................0...----•-••••d ------------------------•--..-----... -- -•----.-- ------..--------...........
W Design Flow.................. ........................gallons per person per day. Total daily flow.............. ...................gallons.
WSeptic Tank—Liquid capacity..ls<_,d..gallons Length... Width... !__.. Diameter................ Depth...s.
x Disposal Trench—No....................... Width.................... Total Length.................... Total leaching area...................sq. ft.
Seepage Pit No........-:7......... Diameter.......... Depth below inlet...... ........... Total leaching area........:........sq. ft.
Z Other Distribution box ( ) Dosing tank
Percolation Test Results Performed by.... (�! �N� �Z �Y.......... Date...�T...:3..
a -------------
Test Pit No. I.....4!..Z..minutes per inch Depth of Test Pit....../..? ...... Depth to ground water........." .........
44 Test Pit No. 2..... .` -minutes per inch Depth of Test Pit....! .a: Depth to ground water........................
a •................................•••••-•••.......................................O Description of Soil......U- ` Z H/00,7 10A- -7 V S,0-Svi(.
--------••-- . .: -•...•-•---•.....-••-•••.•...._-.....'.•�.-.•.-;-••••--4.-.•.-.1•:•--.'.-.-•G••'--2••-•••••.i..�...2•-•.•.....0...........
.......
.._..
.._........G........- / r .......__ .....................................................
............. .. ......
.........................................7C-D.I................0....................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
..........................................................--...............................................................................................................................0............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation un_til.a Certificate of Compliance has b issued,by thePbard of health.
-----Si ... ... ..._....
....
ate
Application Approved ,-;:.._:: -.^.�.....l....... .
..... .. .:-
!!. - �y _... �.�--��_D
--•-•-�- •-� Date
Application Disapproved for the following reasons:.......................................................................................0.........._....____
............................................-........................................................................................................................................................
._
Date
PermitNo......................................... Issued...........................................-.........
...
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............. .........OF......... 7 mac:�`''�G ....................
(Irrtif iratr of (Complittnrr
THIS IS 0 CE TIFY, That the Individual Sewage Disposal System constructed (-,.<or Repaired ( ) ~
by.................... .. ............................-..............................................................-........--••-•---.......................-............. ._...._
,•-y Instal er
at•-......• `( .�.51. •... (�.o E3 _(........................••--•-•-----•-----.........--•----- -......
has been instal ._din accordance ' h t ns of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.- x_._.-.�f,,, .... dated..... _2..j-/.4 -/,?G . .............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE Tt THE
SYSTEM WILL FINCTION SATISFACTORY.
DATE.................... ... ....----.......... Inspector. ............................................................
THE COMMONWEALTH OF MASSACHUSE77S
11 BOARD OF HEALTH
N67ZS1�.� ............... 1^..( `f........'OF...........,./��... ...................... .
-misposal arks Tonstrudiorc rrrmit
Permission is hereby granted................_. .
( ( ) ._...... ... ......._......
to Construct or Re air an Individual S wa a Di osal System
..
atNo........j. ..... r_..1 �t trees........................................... .............
as shown on the applicati�osal �____Orsonstruction Permit a4d....JZJ&o ........
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Board of Health
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FORM 1255 A. M. SU KIN. INC.. BOSTON
DATE........••-•--• -��
�Z6Y 70p of
CavC. BouNa s
41
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Z,07-&/¢ zo-�` o 0
Goaua � �
P.r
\ RG3EaZVt
30- pir
11 /30,
LOCATION Byeni.57BGE;, ,�Coru i 7>
SCALE . /��`30' DATE
z�v a,vs G' v�✓ FLAN REFERENCE
No�— E .977 4s� . . ... ..... .
i45SuHt7� D�-rvH. ,S�IOWiV pAl PL.l�.�•, Z
. . . . . . . . . . . . . .
OF
.� EDVVARD .`
L EY N I CERTIFY THAT THENo. 26100 ... .....
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
ovn, �EGISTER���� AS SHOWN HEREON AND THAT IT CONFORMS TO THE
L UMg� SETBACK REQUIREMENTS OF THE TOWN OF
. . . . . . . . . : . .. WHEN CONSTRUCTED.
DATE . . . . . . . . . .. .
REGISTERED LAND SURVEYOR
I
i+
ZL,a o
TOP OF FOUNDATION
e CONCRETE COVER
CONCRETE COVERS
T -
Z.SZ .�0 4"CAST IRON 1I2"MAX.71*7777
� � '
OR SCHEDULE 40 4"SCHEDULE 40 PV.C.(ONLY) 12 MAX. F3/4"
P.V.C. PIPE 1
PITCH 1/4"PER. PIPE- MIN. LEACHPITCH I/4'PER.FT. PIT TINVERT e aGEL..A3:'8SEPTIC TANK INVERT INVERT p ST. � w INVERT EL. Z3.oz BIOXEL�z.�B �_ : .EL..23: 7. GAL. INVER ;• oa 0 I/2�
. BS INVERT w w 0•f EL.??:?.. :.' �� \:w E2./L,Lo
/o' DIA.
9¢
PROFI LE OF -GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM NaTz � �L
NO SCALE /o
a4,y0ND TD �3 E
2t��-ruVb'D A►�D
C(.tAn� Ss}xin,
SOIL LOG WITNESSED BY :
DATE �T. 3o!yP�S. TIME. ./0:3o . . . . f >Ge5 8. � BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 ENGINEER
ELEV. .!8.60. . . . ELEV. . Z3:2 >
s„B_s «- 7 DESIGN DATA :
et.1•¢_co 48of Cagvrz
�9 zd NUMBER OF BEDROOMS . . . . . . . . .
c COA72.fir
e"
c2, ia.G0 �0�� �
Sao TOTAL ESTIMATED FLOW . . � . . . GALLONS/DAY
Pemc, w,?
00A-,sE y0„ �� tz BOTTOM LEACHws ING AREA �B''-°. . SO.FT. /PIT�C./?t7.
.SAN D
ro 4" wanx,
SIDE LEACHING AREA . . . SO.FT. PIT/47iC.PD.
GARBAGE DISPOSAL AREA INCREASE)
m6-PI
Cogwsr TOTAL LEACHING AREA . S3¢ . . SO.FT
SL,q-P,/DCo PERCOLATION RATE . L&ss. MIN/INCH
LEACHING AREA PER PERCOLATION RATE .e/OO� .. SO.FT./C,P.D,
. .WATER ENCOUNTERED
NUMBER OF LEACHING PITS . 7Wq
APPROVED . . . . . . . . . . . . . BOARD OF HEALTH � •6�•`� N�. oN .91-L Si� S,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DATE . . . . . . . . .
AGENT OR INSPECTOR
OF
yAPV�N
ED R
v
LD T ' /�� ;K LLEY L4 Q 5T. u H
i` No. 26100 sat
. . . . . . . �, gLlsiRDah�
si L ISTEA
GOT!//T ��SS• SANRAA���
PETITIONER : e prve-• DE S/CN
r
Completed by
NIGH GROUND-WATER LEVEL COMPUTATION
Site Location: Fv/2 Lnn/G �/ CaTiu/ 7— Lot No. /S
Owners Address:
Contractor: C Address: 77'7 F�t�io�rt/ �� , 'yy �✓�s
Notes:
STEP ) Measure depth to water table 7
to nearest 1/10 ft. .. . . . . . . . . . • • _
date
STEP 2 Using Water-Level Range Zone
and Index Well Hap locate .
site and• determine:
.
4 i Iit/ .
A) Appropriate index w ell . . . . . . . .
Zo/veB) Water-level range zone . . . . .... . . . . . Z�3'
STEP 3 Using monthly report"Current
' Water Resources Conditions"
determine current depth to Z¢,/
water level for index well
mo yr
STEP 4 ' Using Table of Water-level
Adjustments for index well
STEP 2A , current depth to
water level for index well
(STEP 3) , and water-level
zone (STEP 26) determine Z
water-level adjustment . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '
STEP 5 Estinate depth to high water
by subtracting the water-
level adjustment (STEP 4)
from measured depth to water
level at site (STEP 1) . .
Figure 3
1