HomeMy WebLinkAbout0076 TROUT BROOK ROAD - Health 76 TROUt
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TOWN OF BARNSTABLE7
L ATION'-7o l�rtj
& t4ik lie SEWAGE #
VILLAGE C p t'� ASSESSOR'S MAP 6z LOTj`Z'Z
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
-SEPTIC TANK CAPACITY
Mf w trek to b P
LEACHING FACILITY:(type)3 WI-Vejr�' N<_ (size)
NO. OF BEDROOMS'3 PRIVATE WEL"L OR PUBLIC WATER
BUILDER OR OWNER
as .'
DATE PERMIT,'-ISSUED: -7 S' -7 7
"DATE COMPLIANCE ISSUED: �1 7
VARIANCE GRANTED: Yes No
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No.977 D 7 Fee V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppricatfon for Migozal *p.5tem Cott.5truction i3ermit
Application for a Permit to Construct( )Repair(.Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 7(o Owner�Pe�+ r��c �a 's Name,Address and Tel.No.
��3 (-
Assessor's Map/Parcel Cwtu t,+ dA4 e" ^fr® _z
�a� 07 CrAl"ef
Installer's Name,Addres*&S VANCO Designer's Name,Address and Tel.No.
350 Main Street
W.Yarmouth, MA 02673
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building Res No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow ® gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /000 Type of S.A.S. /YJ&Xi,jji ZP
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) !/4SJfE I( � — C'cc�
r l wn,bQ.rS Lv y 3 Ah!L1� tat 4i�te9 `-) • D)Z
VU
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 eal .
Signed Date 7'
Application Approved by - Date 1
Application Disapproved for the o wing reasons
Permit No. Date Issued
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`No-q77Ll V Fee� � r
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
01pprication for Construction Permit
Application for a Permit to Construct( )Repair(./f Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /
otc 12c�
Owner's Name,Address and Tel.No.
aro • e. ��s¢�a
Assessor'sMap/Parcel :+ Cd` O�a
d cSiA�>°
Installer's Name,Address,an f'e" CANGO Designer's Name,Address and Tel.No.
350 Main Street
W.Yarmouth, MA 02673
Type of Building:
Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( )
Other Type of Building d&5 No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow (�5` gallons per day. Calculated daily flow me) gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank A004) (o leL a f; 4 1 Type of S.A.S. 002,4 r�4 i ze r
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 7-A54 41( a _ lyiA x i nn i 2 e r 1 e cc c k
is�c
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 unlit Certifi-
cate of Compliance has been issued by this BoardM
C
l
Signed Date 7
Application Approved by - Date l
Application Disapproved for the ing reasons
Permit No. Date Issued
—————— ————— — -------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired Upgraded( )
Abandoned( )by 4r,-9,JGy
at r' has been constructed in accordance
' with the provisions of Title 5 and the for Disposal System Construction Permit No. V8 7 dated
Installer Designer
i
The issuance of this�ermit shall not be construed as a guarantee that the system�willl function as designed.
Date Z1 ) �f r 7 Inspector �3 J
— — ——— — —-————— — —————————————
No. s
/ �� / A Fee Sc�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mioozar *pgtem Con!truction Permit
Permission is hereby granted to Construct( )Repair( oTOpgrade( )Abandon( )
System located at
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:Constructifn mVst be completed within three years of the date of this permit.
Date: -7 q Approved by
7
y, CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
i , ' , hereby certify that the application for disposal works
construction permit signed by me dated c.)8 --3 , concerning the
i
property located at 76 lTcx�r� Brame 1,< Rk• C.of-ud f meets all of the
following criteria: "
There are no wetlands within 300 feet of the proposed septic system
There are no private wells within 150 feet of the proposed septic system
The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
/• There is no increase in flow and/or change in use proposed
�• There are no variances requested or needed.
SIGNED : DATE:
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
lAttach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].
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SEPTIC -SYSTEM DESIGN
MW. BZDJWOA(s . G /DAY/BEnROO�r = , . GAL/DAY
SEPTIC TANK:
. GAL/DAB' x 2 DAYS GAL
USE
to-oo GALLON SKPTIC TANK
IEACHING AREA.'
USE 3 I NFI LT RAT ORS (MAXIMIZER CHAMBRRs
WITH 4 OF STONE ALL AMUND (W x if x Z DZZP)
SI DB AREA: ..(: 0 + ?1)2 x 2 = 164 SP (.74) GAL/DAY
EOM AREA: W x rr = 330 sP (.74) _ 244 GAL/DAY
CAPACITY = 365 GAL/DAY
' L0 CA-T-ION
VILLNOE
INSTALLER'S NAME '`& , AD..DRESS
B U I'L D E R OR OWNER
Ina
DATE PERMIT ISSUED i
DAT E COAPLIANCE. : ISSUED _77
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THE COMMONWEALTH OF MASSACHUSETTS
BC OF HEALTH
Town OF Barnstable
Appliration -for Bi,ipoiittl Works To'aafitrurtion Vrruift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Trout Brook Lahe-"HILLCRFSI'" in Cotuit Lot 3A
....-•••--•••----'-••--•-'--------•---•----•••--•---••----------•-•-'•--•....--•--•---••-......... ••••-'__....-'-........•--••'•-•'•"•--•'-•'••-•......-•...-•••---•..............................
Sea-Lake Corporatf&V-Address Route 6A & T�me Lod.. Sandwidi Ma
................................................................................................. ..`'.._`.... ..... l___._ ..l ...S
W Paul Bousfield Owner Route 6 East Sandwrlch
Installer Address 22,860
Q Type of Building Size Lot.............................Sq. feet
Dwelling—No. of Bedrooms..._ ..................................Expansion Attic ( X) Garbage Grinder
o. of ersoils____________________________ hoovers — Cafeteria
Other—Type of Building 131 StO .-CZPeN p S ( ) ( )
dOther fixtures -----One bath
Other Design Flow......................:'... �,��,_�..-/gallons per person per day. Total daily flow____�1`y.....�-_____------.....gallons.
WSeptic Tank-7Liquid capacityrU.:P..e.gallons Length................ Width................ Diameter---------------- Depth..._----_-----
x Disposal Trench—No. .................... Width____.__...._ ,_� Total Length.................... Total leaching area..---.-._--_----___-sq. ft.
Seepage Pit No........i-.-_-__---- Diameter.. ' --Depth below in et____________________ Total leacliiteg -----------------sq. ft.
z Other Distribution box ( v) Dosing tank ( ) 04 - 3 A /' 7 � "
~" Percolation Test Results _ Performed by-----A-atl__Jenes..............- -------------------------- Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water....-___---_._-.._.--_-
fs Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water-.....---_--_--.----.__.
a ----------------------------------------•--......-'------•••'---'•-'•-------------------•"......••..........................................................
O DescriptiWRepairs
S..- .' --••'' --`r-�....• ....---
x e -_
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x ---------------U Nature olterations—Answer when applicable._..............................................................................................
---------------------------------••-......------........------...------.........----"........•---------•-----------------------------'-..._..---------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescri d Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary CO Th d gned f aer agrees not to place the system in
operation until a Certificate of Compliance has bee is ed he b rd_ ealth.
gned.... . .. ---- ----------- .......................................... --------------------------------
Date
Application Approved By------------ .............. ................ ... . . '!�'./""7- ------------
Date
Application Disapproved for the following reasons:................................................................................................................
.............•--------------'----•---------------------------•-•-•----'•--•------•-••_.......•----•...........--•---_........----..........•-------------'•------------------.--------------------------
Date
Permit No.................. Issued.
Date
7y �
No.... sI'". �. ..
THE COMMONWEALTH OF MASSACHUSETTS
aOA v D OF HEALTH
... Town. ..................OF........narwq.tab.le------------------...............................
Appliratinn -fur Di,spnsttl Works Tonstrurtinn. Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair .( ) an Individual Sewage Disposal
System at:
Trout Brook Lane—"HILLCREST" in Cotuit Lot 3A
•-------•-••------------------------------------•--....------------.._..•-••••-••---••-••--•••-••- •-•••••••••••---------------------••--•-•-•-••--------•--.....---..............__.._....---•••_..
L cation-Address or 1\o.
Sea_Lake- Corporation Route 6A & Tupper } . ,_Sandwich, Ma.
W Paul Bousfield Owner Route 6, East Sanc�'wicfi, Ma.
Installer Address 22 860
Q Type of Building Size Lot...........................Sq. feet
U Dwelling;" No. of Bedrooms---__-��--_____-_•____________________Expansion Attic (X ) Garbage Grinder/00 )
`4 Other—Type of Buildin l StA Ca e
p., 4 g.- ----------rY____--.P-- No. of persons............................ Showers ( ---)---- -Cafeteria-(•---)-
Other fixtures 011-- bath-----•----------------------------------------------------------------•------- -.-
• rr
W Design Flow........... __..._.__..gallons per person per day. Total daily flow__v-tr�..__:......................gallons.
WSeptic T:.nk Liquid capacit gallons Length---------------- Width------- ........ Diameter__-- -.-_-_ Depth---------------
Disposal Trefich—No. ..................... Width..._..._.... _. __ Total Length.................... Total leaching area__-._----___--.__-.-sq. ft.
Seepage Pit No______ ___ _______ Diameter._/_�.�JJ pth below inlet-------------------- Total leaching area-_-.._ ..........sq. ft.
Z Other Distribution box (�►) !Dosing tank ( ) J -f- 7 7
a Percolation Test Results Performed by.... ._aS s............. Date----•-•-----.--------.-----._-__----_--
Test Pit No. 1-----------_....minutes per inch, .Depth.of Test Pit..................... Depth Wo,ground water...__-___.__--_--._-_---
(•� Test Pit No. 2................minutes per inch Depth of Test. Pit.................... Depth to ground water.....................
Pa •----•-••-••----•--••- --------------------------------
Description of Soil._._.. See
G` --- ----• ........ . -• ---- -----------------/ --------------
xi - 11�1N"! f _ ................................... ......._..._
----••-----
UJ, Nature o .epairs oor�Alterations—Answer when applicable.-._____
----••-•------ --------------------------------------- --------------------------------------------------- •----------------•--•----•---------------- ............................................
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance wit!`.x^'
the provisions of Article XI of the State Sanitary Codd� Th under igned lier agrees not to place the system in
operation until a Certificate of Compliance has bee I is ed b the.bo rd ofihealth.
gned .
Date
Application Approved B
PP PP Y---..._.. ----
r D
Application Disapproved for the following reasons.............................................._______________.....................................................
•...............•-••-----••-•---•----.....---•-----------------...-•-•------•------•-----. •------•------•-----•-•---•--------•--=--•-------••---•-----------------------------•---•---------------_--
Date
PermitNo.......................................................... Issued....................... -------------------=---=-------.I
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r ............OF....... .. .. ..................•
Trrtifirate of Cimptinna
TH;�R7 TO, W�� IFY, That e I d' idual Sewage Disposal System constructed ( 44ror Repairedfb ••Y -----------......................... --- ----
staller
at.. ---- .. dr. ------------------------------------------•--•-••--•.
ha. been installed in accordance.'with the,provisions,.ofr fi le XI of.The State Sanitary Code as described in the
application for Disposal Works-Construction Permit No - ----/1_40................. dated-.-. ....................
THE ISSUANCE OF»,THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL"FUNCTION ,SATISFACTORY.
DATE...............---•----•-•-•==== _- :y:------------•-----------••---•-----•_. Inspector..................................................................................
ati
' THE COMMONWEALTH OF MASSACHUSETTS
BOARD-BOARD - 9 HEAL H '
A
&... ....... .. .OF..... : •............. O�
No. . FEE .......
Permission is hereby granted_-"".` -- i
6�`
to Constr t Repair ) an Individual ewage posaI yste
at Nox- �:_.�. r � � �4r�ec -------------------------------
as shown on the application ftir Disposal Works.Construction mit N Dzted___; Al-- .1,...7_-_
G�
DATE------.. =----------------------- -----
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FORM 1255 HOBBS &"WARREN. INC.. PUBLISHERS - - ,
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