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HomeMy WebLinkAbout0015 RALYN ROAD - Health 151zA]LYN ROAD Cotuit �-- - ----- -- ---- A = 022 — 066 N Fee 7,� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plitation for IN DBAY *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. /`1_4�"Z0✓ O Owner's Name,Address,and Tel.No. � Assessor's Map/Parcel 4P e;L Insta er's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building c No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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) -v �ce'�/'�C f1 .0�✓���� 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 alth. Signed Date •�6 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. LpDate Issued l t At i No ) 0 Fee THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS 01pplication for 11 oBal*pstewConstruction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ElComplete System Individual Components Location Address or Lot No. ✓S y/✓ 1P4o Owner's Name,Address,and Tel.No. r G'or-rT Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building e!5? No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A& Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintedan Wf the afore described on-site sewage disposal system in, accordance with the provisions of Title 5 of the Environmental-Code_—aan to place the system in operation until a Certificate of Compliance has been issued by this Board o alth. i Signed Date 1 /6 Application Approved by Date Application Disapproved by Date for the following reasons j i! ! Permit No. 0�(9 t J 1(J Date Issued ------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �I THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by�//7'J G Gr�''O �/s'� �'®l/C ✓�VC at --"Jr— 4�e,4 C J//✓ j0C/� oP�/% has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No� 3/(O dated �� Installer �i/?7 �"�O� (✓/f Designer /Yf i #bedrooms 3 Approved design flow ??0 gpd The issuance of this permit shall not be construed as a guarantee that the system will function as-designed. Date f �� Inspector ---------------- --------- ----------------- No. �'i Vij Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction 'ermit Permission is hereby granted to Construct( ) Repair(6� Upgrade( ) Abandon( ) System located at 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 in be comp eted within three years of the date of this permit. Date In Approved by TOWN OF BARNSTABLE LOCATION SEWAGE # Z/J319 VILLAGE e 2 6' 'IZ- _ ASSESSOR'S MAP & LOT4r2 .-0.4Z INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY h LEACHING FACILITY:(type) � ) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER � der DATE PERMIT ISSUED: Z DATE COMPLIANCE ISSUED:' !" . VARIANCE GRANTED: Yes No L� 'WN)SE CDek6,r,, C� No.Y/X_ — Fus.....`......._..._ ....._ THE COMMONWEALTH OF MASSACHUSETT j 1 BOAR® OF HEALTH 1 .✓ 2.J S'7- .. ............ ...... ......OF........e ...... ................ � ............................. Allp iration for Bispvii al Marks Tomiirnrtion runfit Application is hereby made for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal System at: / .J o r�O C m u T `� cJ apt` Vs�JV�Y� •................... G/-=^ .. Lot No- - .... Q_. . ,___. ............ -------... --- ....•.... ......----- -- Installer � Address 2 UType of Building Size Lot...__..,�..................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( o '_l Other—Type of Building No. of persons............................ Showers a YP g -------------•--•-••-------• P ( ) — Cafeteria ( ) Other fixtures ................................... . d � cr»9�LQrir Design Flow----••--------- (� CU W g ._ .......... _gallons per p I�e� day. Total daily flow__________________'�1.__3.._._.__._....gal�nst� tx Septic Tank—Liquid capacity._......•...gallons Length..---....46-... Width.`......_._..--. Diameter......... ...... Depth..r�._..X. Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..__._____ iameter......... _. Depth below inlet............ ..... Total leachingarea.._ . . . .s . ft. Z Other Distribution box (ie Dosing to �� '-' Percolation Test Results Performed by......___ y .F- ,1 2/ q.__---__y,. �� �GeC X -T�°� Date..._.. .. _-J< •./ 14 Test Pit No. I.._.��.minutes per inch Depth of Test Pit......�V_-.. . Depth to ground water.... ' 4K. 44 Test Pit No. 2.....-•--•---•-_minutesper inch Depth of Test Pit..... Depth to ground water.__ / �....__. a rr......_._..-•-•-... ... --•----•-------...-•...............v--•---------77A-•--------•-------------- O Description} of Soil © - e-- ..T�. ..�....Ffo C'OrZ f�.. ".D... W -•---•---------------------------------•--------•------•----------------------...-•---------......-------------•---------------------...-•-•---•--•------•-•----I--------- 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 iITLE, 5 of the State Sanitary Code The undersigned further agrees not to place the syst m in operation until a Certificate of Compliance has be is d by the boaroof h It Signed.. ... --- -- -•--•- ---- ---- ....................... ... •f•-• -•-- --e Application Approved By....._ ._ -- --- ----- ...... .............. -- ......... ----•-•------------- --•----------- Date Application Disapproved for the following reasons:................................................................................................................ ........................................ ..... -- Permit No. .. •---• •-•-•--u� ...--- Issued...... .. .*------nau------ / Do No.......................... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . OF......4.0 7�2...)S i!9/�e-G_r ..................................._._...... ApplirFa#iaan for Dispm al Works Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal ............ . ........................................ .......... .•••.......................... -•••••----------------------------•--•...... _•---------------------------------------------- ....__ //- or Lot No. �y •---------.... •--•. .............. ..... ...•----•-----✓Y............... -a----•-------.......-----•-^--...y�. ....-•----........................-_--------- / Ow 1� 1�-/ �jddr ss A� A �.��� Installer Address 4 c Q Type of Building Size Lot...... .................... Sq. feet Dwelling—No. of Bedrooms________________________________ _____Expansion Attic ( ) Garbage Grinder a Other—T e of Building No. of persons____________________________ Showers — Cafeteria Pa Other fixtures .................................. � » . Design Flow.............. _________________________gallons pe �e Zn er day. Total daily,flow----•---_---•-------•-------__.__......._.__gallons,. W Septic Tank—Liquid'capacityj��__gallons Length"_ .._.. Width ._ ......... r________________ Depth.�___'�... x Disposal Trench—No_____________________ Width.................... Total Length_:.................. Total leaching area....................sq. ft. Seepage Pit No._.___._/._._.._.__. Diameter....... �-__.. Depth below inlet.......... Total leaching area.....-63__sq. ft. Z Other Distribution box ( Dosing t�o ( ) y— Z Percolation Test Results. Performed by_________.............................................___ ______________ Date----.....__....---_--------_______._�.. aTest Pit No. 1..__�:___.____minutes per inch Depth of Test Pit.... _%_I..______ Depth to ground water...%. .v�.�... (i Test Pit No. 2..e. L'___minutes per inch Depth of Test Pit___f>........... Depth to ground water.. ............... •---------------•-•---- •= Descr>ptipn of Soil.. .._.... _ :.. ;-_-----______-•--' 6- /y G �," _ x - -'.-�•---._._��r------�..:f��.f5.-aG !�i....�-.'---——/==� ....__�__)_.?.::'-•=--�---•-•--.'!-�fJ .-. .��•--------•--- U � � _.z_.z VW _______________________________________________________________________________________________________________________________________________________________�_.%.?._�.:__..�......... 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 TITI.1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b i ed by th board o .health. Signed_ l/ � .c_.�. `- Date Application Approved By.... ......_.. '' L.........................r Date Application Disapproved for the following reasons------------------------•------------•------------------------- ---------•--•---............................. Date Permit No._-L -•-•+---== t .... Issued_.-- ° t Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trrtifirttte of Tuntpliatta THIS IS TO .CERTIFY,_)That the-Individual Sewage Disposal System constructed ( ) or Repaired ( ) ' by..............( 0 !�iV�1/.._. ...f< ' / �, --•••=------•---•---• - .........•--•----...--•-----•--•-•--•-••-•---- has been installed in accordance with the provisions of TITLE j5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No -_� ``_._'� _��. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................... ._... .. Inspector.-------• ••-•---••--- `---------------- -.......... ..... . THE COMMONWEALTH OF MASSACHUSETTS {, n.wj\4.... BOARD OF HEALTH,.; No......................... FEE.....--••-----•-........ Disposal. nrk,5 Tnns#r ion anti# Permission is hereby granted.......... �' r ___�.k T •� --•----...----------••-•--•--•-•--•--•------•-........•......................•••---- to Construct ( ).or,-Repair ' an ndividual• Sewage Disposal,System— at No........ � hV•1P C1Z- Street , as shown on the application for Disposal Works Construction Permit No�� �� Dated______________________ __ -----•.....:..'/' �-•-•-•-•---=---•---'------------- --------------------- -•-•---••-•--•--.._ /Jrl DATE -r._..•--- Board of Health ...---•••--•••-•---------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r T P" S 'SOIL, T 20 Ft�:,MINIMUW "TOP f OUNDAMON 'DATE OF SOL TEST ' 1 0 FT. :MINIiAU - AND ED -:8 W11NE y 6: CLEAN ss COVERS 'M N CONCRETE ON ERCOLATI RATE 4*':SCHEDULE 40 PVC PIPE 013 s H -E 26p LAYER OF 1/8"r TO 1/20 MIN -PER FT. ER�ATION ' OLE PITCH 1/8" OBSER VATION "CONCRE 'ELEV 0 ELEV STONE OP AND 20 MAX. T 'WASHED COVERS 4*' CAST IRO N,,:PIPE SUBSOIL UM (OR EQUAL) 'MINIM PITCH- 1/4* PER FT.,- FLOWLLINE 10 ELEV. 0 —TIvIIN. 19 ELEV. 2*0 ELEV. LEVEL 1E LEV. .3 915 ELEV. Uj 'WATER AT �AT EL 0. EL W TER .......................6- 0 0 ELEV. DISTRIBUTION T 0 0 TO 1 2- 3/4 1 D ESI G N CALCU LA 1.0 N S 'NUMBER OF.' BEDROOMS 00 0 0 TO BE WATER STED 0 TE 1 000 , G ALL ON 0 DISPOSAL UNIT 0 BOX ELEV. � I F MORE THAN ONE OUTLET TOTAL ESTIM AED,��FLOW y SEPTIC, TANK A L/4A 2 B R rx—> (;A L/B R D A Y TIC PRECAST LEAr REQUIRED SEP ANK CAPACITY GAL.", SI WELL 'ACTUAL' ZE �OF-SEPTI TAN K 'GAL BASIN 'OR EQUIV. TS ZONE LEACHING AREA RE MEN /S F. INDEX SIDEWALL AREA GAL. /S.F.L AD JU ST_ -G E DISPOSAL BOTTOM AREA GAL. SEWA PROFILE WALEACHING CAPACiT GAL/DAY' NOT10 SCALE Y,fBOTTOM + 'SIDE GAL./DAY"�� RESERVE LEACHING CAPA CITY BOTTOM OF TEST HOLE O13--USGS-490BABLE—WATER—TABLE ELEV. OBSERVED WATER TABLE ELEV. 'N 0 TE SHALL FORM JO' D.E ATERIALS 1 ku RUL TI TLE 5 AND THE TOWN _E L or: �-AN -FOR THE SUBSURFACE-DISPOSAL -,REGULATIONS -SEWAGE. TI N G SPOT. ELEVATION 00 x EXIS 0 "COVER S A 1., ALL O SANIT RY UNITS SHALL BE,�BROUGHT O EXISTING —00 FINISHED WIT 141N 12* OF GRADE TION 00.0 FINAL SPOT'tLEVA X THE :SAM 3. E tSlINO AND FIN AL GRbts sHALL'L ES E� LL, rwALCONTOUR BE-'CAPAB N Lt OF" 4 - F,THE 'A ITARY 'SYSTEM SOIL LOCATION -H 10 'UNLESS-THEY AREUNDM 0 TH I N WITHSTANDING UTILITY POLE 13 10 .FT. ,OF,-DRIVES`OR PARKING H-20,�LOADING' SHALI_,� E-�' .OR TOM WATER W­Fg�w N 10, FT. DF DRIVES OR AREAS.:, ............ 13ASIN 5. ANY�MASONAkY. UNITS USED .TO BRING COVER 0 SHALL, M*y? BE ORTARED PLACE. p -COMPLIAN TH 6.'NO.DETERMINATION HAS, BEEN MADE AS''TO R DEEDED OR ZONING REGULATIONS.L OWNE APPLICANT.1s 10 1 Ty._L OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHOR 0 !zo APPROVED:, BOARD HEAU H jil 40 D ATE t�A SED -PLAN PROPO LOT: % FOR PROXCT LOCA'nON Z 29 S iff C, E TSER ff STANLEY, R 7 SEkSTREET- S 0 MASS.-�� —3922 026 Sq DEN I P RTi F!_ AIE DATE L SM R REVI ON �R� JOB NO LOCATI M A SH EET, OF