HomeMy WebLinkAbout0170 ACORN DRIVE - Health 17d ACORN OSTF,RVECL-"E
A = 144 016 JQ,,N E
t
0
it
T .
TOWN OF BARNSTABLE
LOCATION ID A C(I RAI D R SEWAGE #
VILLAGE sl"eR y///a ASSESSOR'S MAP & LOT' l�
INSTALLER'S NAME-&PHONE NO. �� AAA t Q 14eiP t Sei�l1
SEPTIC TANK CAPACITY /Q 6 0 r /�'0 2
LEACHING FACILITY: (type) r'O'L U W CAM A4i if e (size) f6 6 G A L-
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 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 Wedand and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
0�
i
No. r Fee 5 0 f 0�/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Z(ppricatiou. for Oigoml *pgtem Cow6truction 3dermit
Application for a Permit to Construct( )Repair(X)o Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 5 0 8—4 2 8—5 8 5 3 Owner's Name,Address and Tel.No. 5 0 8-4 2 8—5 8 5 3
170 Acorn Drive Osterville ,Mass . Patrick Walsh
Assessor'sMap/Parcel /a &) 14� 02655 170 Acorn Drive Osterville,Mass . 026 5
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc . J.P.Macomber & Son Inc .
Box 66 Centerville ,Mass . 02632 Box 66 Centerville ,Mass . 02632
Type of Building:
Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 355 gallons per day. Calculated daily flow 3 x 1 10=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Existing 1000 Type of S.A.S. 2-50n gallon 6hamh@rs
Description of Soil Loamy sand to clean sand,
Nature of Repairs or Alterations(Answer when applicable)_A d d; n R two 900 gallon Gh a m b e r s
packed in 41 of stone .
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 an not to place the system in operation until a Certifi-
cate of Compliance has been issue by this B f H lth.
Signed Date 4/2 2/9 9
Application Approved by Date�,� - / V- ?5P
Application Disapproved for the klowing reasons
Permit No. 7 Date Issued
VFW. " a .1
+�
Fee$ 50. 00/
No.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
N — Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
0(ppYtcation for 30f 6pogal *pgtem Congtruction Vermit
Application for a Permit to Construct( )Repair(X)o Upgrade( )Abandon( ) O Complete System El Individual Components
Location Address or Lot No. 5 0 8—4 2 8—5 8 5 3 Owner's Name,Address and Tel.No. 5 0 8—4 2 8—5 8 5 3
170 Acorn Drive Osterville,Mass. Patrick Walsh
Assessor'sMap/Parcel 02655 170 Acorn Drive Osterville,Mass .026 5
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber & Son Inc .
Box 66 Centerville ,Mass. 02632 Box 66 Centerville,Mass . 02632
Type of Building:
Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
A
Other Fixtures
Design Flow 355 gallons per day. Calculated daily flow 3 x 110=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Ex 1000 T e of S.A.S. 2-900 oa
P g YP � 1 lsa n c he m lie 2 .
Description of Soil Loamy sand to clean sand.
Nature of Repairs or Alterations(Answer when applicable) Adding t w n 5 Q 0 o a 1 l on c h a mber s
packed in, 4 ' of stone.
Dite_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 an not to place the system in operation until a Certifi-
cate of Compliance has been issue by this B ardiff Health.
Signed Date 4/2 2/9 9
Application Approved by Date -5: ! V— 109
Application Disapproved for the lowing reasons
Permit No. — 7 Date Issued
- --- R;- ---------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
�'N
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(XX)Upgraded( )
,Abandoned( )by J.P.Macomber & Son Inc .
at 17 0 Acorn Drive O s t e r y i 11 e r M a s s. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 7�'-2 74 dated
Installer J.P.Macomber & Son Inc. Designer J./ Macomber & Son
The issuance of this permit shall aot be-/eons ued as a guarantee that thus lst ,�w/,ill function .s d /gned
Date I Inspector
1,`
---------------------------------------
No. �9"a7 Fee$ 50.00
THE COMMONWEALTH-OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mioogar *proem Comaruction Vermit
Permission is hereby granted to Construct( )Repair4XX)Upgrade( )Abandon( )
Systemlocatedat 170 Acorn Drive Osterville,Mass .
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 this permit.
Date: !f-9,� Approved by
!4
r �
•A
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. -
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, Joseph P.Macomber J r . hereby certify that the application for disposal works
construction permit signed by me dated 4/2 2/9 9 concerning the
property located at 170 Acorn Drive Osterville ,Mass . meets all of the
following criteria:
i
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will not be located less than five feet above the
maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor
method when applicable)
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) a°{
B) G.W. Elevation +the MAX. High G.W. Adjustment. 7e l = � ►
DiF'FERENCE BETWEEN A and B / L7
SIGNED : DATE: 4/2 2/9 9
(Sketch posed plan of system on back).
q:health folder.Bert
r
_< '���
® �-O Q
6 l � o.
� �
�'1
a
No. - --.f'7 Fas... .. .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........OF.. �� Vie.......... ......................
Appliratioo -for 13iiiVogat Worko Tomitrortion Vrru it
Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal
System at:
.,Location•Address or Lot No.
- Owner
. -----------•----•-••---•-•................................ r Ad r s
a dt� to/� �s s', '/
� Installer � Address
UType of Building Size Lot.l�,.?- e ---------Sq. feet
Dwelling—No. of Bedrooms---�....................................Expansion Attic (to Garbage Grinder (IW)4C--
aOther—Other fixt�trestn... s4'�3.��-e/�------•--No...of---el-sons........------•---•--•----•._.hoovers------------- --------------•---(--•--�
a, Type g P S ( ) Cafeteria ,W
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacityl_00_0_gallons Length................ Width._._........... Diameter-.--- .......... Depth----------------
x Disposal Trench—No. .................... Width.................... Total Length.................. Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below_ inlet---.______...... tal leachin area4__�.5_' _�'._.sq. ft.
Z Other Distribution box (/u�,<e Dosing tank ( +G� D,� /�• "2(/
Percolation Test Results Performed by.__PA..:..��!/ +`�`�.................................... Date-__--_____--_-_------.--. ___--_--....
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...---_----.--__-.__..
f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............_,----------
a ------ ----------- ---------- .............. ............... ---
O Description of Soil. --------- 1 e -• .� � - - ---------------------
x
U --------------------------------------------............................................................................................................................................................
w
x ---------------------------------------------------------------------------------------------------------------------------------------------------------------_ -- ------ -----------------------------
U Nature of Repairs or Alterations Answer when applicable..-44�3 -. -.�0.-ieSf/ f!4.. '___._.....
-••-•----------------- r--f ir•-
---------
Agreement:
The. undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the board of health.
' a
551d gned= w - .��--
D e
Application Approved By.............
Application Disapproved for the following reasons_____________________________________ ____ ______---------------------------•------- Date---------•----
-------•---•-----------------------------•-----------------------------------------------------•----------------------••-....._..-----•••------------------------------------•--•-------------------•---
QQ ,-7 Date
Permit No. Issued. .............................................../(
Date
� P
.� /Gi v✓
No. �..�`r Fsa..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... .............. OF.....................................
...........................................--------
Appliration -fur 4%ipoiial Workii Towitrurtion Prrotit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
�. Location.Address or Lot o.
��� - ---- ._ ''. ram,1.�f-----------------------------
/�j� _Owner /r ddress�
Installer Address
UType of Building Size Lot./�g4 .:Z3.._�--------Sq. feet
Dwelling—No. of Bedrooms.-......................................Expansion Attic ( llarbage Grinder ( jics
44 Other—Type of Building AXW*.11...... No. of persons---------------------------- Showers ( ) — Cafeteria
p' Other fixtures
W Design Flow____________________________________________gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity/_'60 J_gallons Length................ Width................ Diameter----............ Depth--..-_.---.--.-.
x Disposal Trench—No.-------------------- Width-------------------- Total Length--_-----_-_______--- Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter..._................ Depth below_inlet.................... Total leaching area.----.___--._.---sq. ft.
Z Other Distribution box .(.Y01111� Dosing tank vM1�• l-.2v _96
'-' Percolation Test Results Performed b s�' _ ..._�!�✓g -------------------
W Y ....... Date.......................................
Test Pit No. 1................minutes per inch EKepth of "lest Pit-------------------- Depth to ground water..-.-_-----..--.----_._.
(� Test Pit No. 2_-_--_--__--••--minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
----------------------------------
--•------------ --------------
- -----.....
O Description of Soil.----------Q l s�' - --. -- /---.....lr aD-- .._..
x
W
UNature of Repairs or Alterations—Answer when applicable---j ✓..... 4ic'?!� ----------------------------
�'�ZFtAl----- .!' r� �r/ '------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has.been issued by the board 9f health. � �
Signc� 1 /. �.._
ate
Application Approved BY �i� =LL � 1� (�
ate
Application Disapproved for the following reasons---------------------------------------------------------------------------------------------•-------------------
--------------------------------------------------------------------------------•----------------------------------------•-----------------------------------------------------------------------------
Date
PermitNo........................................................ Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........•.. !.'Z y .........OF...............:::..... ��e.�- ... ...................................
�rrtif iratr of "I'outpliaurr v-
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
b ' ill ,!h. �: (iL/G?�1 lG� '
nstaller
— /'
at----•-•. `/ f �I �c 3 - � G `: 1_=1 `�-:.....!-- ..............................
bas been installed in accordance with the provisions of Article XI of The State Sanitary Code as described n the
application for Disposal Works Construction Permit No------._1:--_.`---._-----------_.-.-. dated------- --
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE® AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE � -- - Inspector- ---- THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 1% '7 OF &'.� N .. ........................•. r
...................
No.-------- ----- FEE..............................
MnVaiial Workq C110uitrurtion Prrutit
Permission is hereby granted------- l/------------------- ;=
to Construct ( �r Repair (. ) an Individual Sewage Disposal System/ I f", J�
/
at No ••� . =) l-• . �� if.. / _'� �'��`' -`=`� f ~+••--- --•--------•.. .............................
Street f
as shown on the application for Disposal Works Construction Permit No--__-%------------- Dated...._.. .f_..`..._._......✓.......
-tl=''- ------- f..!i'
B t
DATE. Board of Health--
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
i
4�-\
/oo.00
`-'
M
- M
?So s
Ce
1 so
10,
72,4-
De vc-
CF2 r.�=r o AZo7 PL.QA✓
LOCATOR/ OS7911Z-044c,,
sC94E /'=30' DW& 400vs7-9, /976
Pl.9N ,2Er= ,e NCB 407
SNo WN oN A P1,9" F z oS E,-H .7
sic ✓I.9 ux AND ,PECo1Z DEO iN
je AN 014, 187 PG, 93
? CERT Gy 7;19T THE
✓'F on/ Ti4E G eo✓ND AS sNo v/^/
r '{ .NEi2Con/ 4WZ) ?*PAT it 'Con/j='oI4MS
r To Ti�/�£ SE�'g,9Cit �Ev�r,�'iyEni'TS oG
zl�:. -
�9uGusT 9, i9�6
45Cr. 61A1050AV6"
�Goyc T. S�G v/,► - ferlT/oNE2
�#,-3 72
LOC TION ' 5EW&C-xE PERMIT MO.
-o
VILLAGE
INSTALLER 5 ►J ME ADDRESS.
BUILDER 'S Q &MF— �- , ADDRESS
DATE PERKA T ISSUED '
s
� p ATE COMPLI QKKE ISSUED :
cgzr—
�)e
J