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Home My WebLink About0111 EBENEZER ROAD - Health 111 EBENEZER RDQ OSTERVILLE 4,A`k3058'�.tx +►r -t� #aI]r�:' _.10., E fR t: o u y N .-!._>� FEB....�IJ�,..:::-�L d�✓... �/ THE COMMONWEALTH OF MASSACHUt5TTS BOAR® Qf HEAL App iratiou for Disposal Works Toustrurtion Prrmit .Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SysW at: - - -_... ..... ..-- ---••-•-•- •--• --• ---------------------------------- -Location- ess - A.Ce�fi,1 ... ----- -- ( ...:��1..� A%c� rl� ........................ Owner Address ---------------•••...............0 ..............IV 1.,?....__.-- -••--------•-•-•--.....-•-•---•-------..... Installer Address UType of Building .� Size Lot..�Z!/_P......Sq. feet Dwelling—No. of Bedrooms......... ...............................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building . No. of persons............................ Showers — Cafeteria P4 Other Ixtures ............... -•-----•----... . W Design Flow........ .. .........................gallons per person per day. Total daily flow........1. ......................gallons. WSeptic Tank—Liquid capacityZOPq.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 (A ) Dosing tank ( ) D / 0-4Percolation Test Results Performed by--..... �r � , _C.=. �1.......................... Date....il-411-_--1�........ Test Pit No. I krJ-------minutes per inch Depth of Test Pit---. o..---. Depth to ground water.-A:�-- -- (s, Test Pit No. 2 __d.-minutes per inch Depth of Test Pit.-/e............ Depth to ground water.--ell! ! ----------- ---------- --f--------------------- • - Description of Soil----.). � ��?? ... .f �f�l . o -----�t%dl�f � - - �`� .............. x •••••••----••-•---------•-••--•-•••••••--•••---.._._. .--••---••••••-•-•-•. ......•- ----•-•--••---••••-•-••-•-----•--•-•-•••----••-•....•--....................... �� x --------------------------------------------------- -/ r � .....1'� -----------------------------------------------------------•-------------------------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------- ,w ......................................... Agreement: Soi The under f r '• —d Sewage Disposal System in accordance with the provisions of i I':1,;. 5 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 rd of healt Si ned•..... ••---• •....... Date O Application Approved By By. ��- ------•------------------ �•( � �Date Application Disapproved for the following reasons--------------------------•-••• -----------------------------••----------------•----.................----_....._ -----------------••••-••-•--•--••-----••--•---•-•------•••••-••----•-••----•----•-•..._..--------•-•-----•-••-••=----•••--•--•-•-••-•--•-•••-•-•-•-•-••-•••----••=-•-•---•----•--------•---••••••-•----- Date PermitNo......................................................... Issued....................................................... Date ~ ' THE COMMONWEALTH OF MASSACHUSETTS. BOA R® O HEALTH "-. ApplirFation for Disposal Works Tonotratrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal ..--. ... ......... ---........ Y d,em at• ...J� � >'�'�4,Lr'��--�1�� f�fil• (�� ^sue�� 'r'�r�� . ... .................. Location- dress .,r'" �'^or Lot No ...:... __..»............................... ......._...........__ ...... .............................................. ..�.................................. may... ......._. owners Address K 7 ! Installer Address " / / 0 d Type of Building Size Lot_._____ _.........._......Sq. feet U Dwelling—No. of Bedrooms........' ..............................Expansion Attic Garbage Grinder )( Other—Type T e of Building No. of persons............................ Showers a YP g ---------------••-------•--• P ( ) — Cafeteria ( ) 0.1 Other xtures .........................•-------••--•-----------. ..... W Design Flow..... to..........................gallons per person per day. Total daily flow........11_Q.........._....._..._..gallons. GL Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ ` 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 ( ) Dosing tank Percolation Test Results Performed by.....± . ✓i"' '. .. :��..�........................ Date...:�--{�.:! ._P�_.`.......... ,_l Test Pit No. 14''M.......minutes per inch Depth of Test Pit..._.. __,±....... Depth to ground water.:: +?-l......._;.-- Gi, Test Pit No. 2' .a''....minutesper inch Depth of Test Pit. ........._.. Depth to ground water_. ''yl'G :�-.!<'rlt��' 0 --------- ..................f..... J.y.. ......... --------- Description of Soil %" �c _1 t -..... ti`c�l° ►� i' `t'' .............. - - -----•-----------------•--------------------•---......------------. ------------- ----•-------------------------------•-••-•---•........--�-�.....--------,..... !_. ..:�aJ?1v1`......------------------------------------•----....-•-------------•-----•--•-------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... 7 ..r. ......-•----------'-- . . ' ..-••-•-•••-•-----••-•-••----•-•--•••--•----•-•-••-----•--•--•-•••---••-•--•-••---'Aeenent. / The undersigned_agrees to install the aforescribed�rtdividcral Sewage Disposal System in accordance with the provisions of TIT L= 5 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 theboard of health.�l y - �../' -••f Y.t. �_ - /Date Application Approved By.............=/ ~ -.• . ....= ......................••--------.. ...........................-�...... �/ Date Application Disapproved for the following reasons:..................................................... ..................................................... ------•--------------•---•-----•-----••-......_........--------••-.....--•...••-------•-••-•--••-•------"...............-•-••---•--------•-••--•--•--••--•-•------••-••-••-••--•-•-- ..........._..-- Date PermitNo...................-•••-•.......................•--•-... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS .� BOARD OF HEALTH �y ..........................................OF..... .,_S.-ef.5 ?........................................... (9rdifirair of Toutph anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed r(4 ) or Repaired ( ) by �' a '-J r,�>r: !r �' .... 71 .. .. . ......................... ....................•---- ., _ ..-------•-----------•--- Installer ' ,/ � r at.................... �� - / 'rl� _s tL /-�•-------- -----------'---- 4 has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .................. dated----------------------.......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................. /�LB/-----•--- Inspector ! --------•-----.....-•-------••---••-•--------- THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH t �..............OF..---- ` . � Ja-•...............s N�� `/ S FEL........................ Disposal orhfi Tono#r ion amit Permission is hereby granted......_.r' __.__. .:': to Construct ('')or Repair ( ) an Individual Sewage,Disposal- stem - f at No..................`.........--��--- . s t`'fL: '� t..............................- j l ----------- s r x v Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... — _..,,... .--•--•---- - - / i Boa f Health DATE------ /.._/ � / FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4 .. _ . ' ...........vi _- 74 rA /01 h' y `` V ` v ci P. r, p 8uNIKIS .` No.22162 zl Ir . LEGEND CERTIFIED PLOT PLAN "EXISTING SPOT ELEVATION OAO " EXISTING CONTOUR --- 0 -— — LO r 3 C S 'F r fez v;! ;Q FINISHED SPOT ELEVATION CC/Lr ,C- FINISHED CONTOUR 0 I a APPROVED BOARD- OF HEALTH RSIA LgoM ASS* DATE AGENT SCALE, DATE LOREDGE ENGINEER ,co IiV Gr�� ni8�«r CLIENT I CERTIFY THAT THE PROPOSED; EGISTE'R FREGISTLqVED JOB N0. g/ v Z-1 BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ' �' ENGINEER URVEYOR IDR.Byt/� OF BARNS TABLE MAS ? 12, i? /3: r 712 MAIN ST. CH. BY HYANNIS, MASS. SHEET__�L OF. 2 DATE : REG. LAND SURVEYOR .. .,-. .. �€ �Ya ... .,. .•3:_. 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'�S, ,.., .. .._ �: �. � � s�'" .� -..�f" ✓.ytSF' � an.ab= .,. � .,,,:,.. .. � h i�: '.`�:a :. �. -; ": `'F - ••� `^a' n' _:' ,.;,•. ,K. ,F� '.:3...�. ..: �.., x� q .. n,., ._ 1, � .. �f ,�j"& � 7.. .. ,... .a,d`, >*, ,�, r;..,,..-dS� .,.. ._ �� ..�.' � .r,,,(✓y�';1�iT �,-j i � -�R`'r., � � Az's a'S'Y•t� t;"3 .J.. ,..� �d'y�-�, d.�7w, .�-Y,xr#},. p .:xA y�� - rr.,S.. � %tio. �•+R'r:,.f LO CAT I0 SEWAGE EAMIT N0• VILLAGE 13 3,8, INSTALL 'S NAME i DRESS �T , 11111d4Z-&-,, BUILDER OR NEIt i DATE PERMIT ISSUED 6112Al DAT E COMPLIANCE ISSUED /�� C. U .T L ZG �f J 0 AeA TOWN OF BARNSTABLE LOCATION h I I E ��1��aor SEWAGE # VILLAGE ASSESSOR'S MAP & LOT _ C1 g INSTALLER'S NAME&PHONE NO.W iF. A1A,-rVX S.o±;c 171-137'7 L SEPTIC TANK CAPACITY i0Q0 LEACHING FACILITY: (type) /13ax;"h i 2 e-.s (size) _vL F+ NO. OF BEDROOMS_ q BUILDER OR OWNER W;LL" A03S PERMPTDATE: 3-I6-93 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 No. S Fee '5 0 . 0 0 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mi5pooal *pMem Construction Permit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 1 1 1 Ebenezer Rd Owner's Name,Address and Tel.No. 4 2 8—41 6 6 Assessor'sMap/Parcel Osterville, MA Thomas Williams Jr 111 Ebenezer Rd, Osterville, MA Installer's Name,Address,and 775-8776 Tel.No. Designer's Name,Address and Tel.No. .. W E Robinson Septic Service PO Box 1089, Centerville, MA 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( n6 Other Type of Building 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 Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic repair consisting of four stonepacked maximizers. 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 oar Health. / Signed Date Y�C4 Application Approved by _499,1� Date 3 19 —g e Application Disapproved for the following reasons Permit No. 0�� Date Issued 3 1K'f� ———— ——-----. ----------------— .�J No. .� Fee 5 0.0 0 ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Digpogar *pgtem Construction Vermit Application for a Permit to Construct( )Repair( X)Upgrade.( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 111 Ebenezer Rd Owner's Name,Address and Tel.No. 4 2 8—41 6 6 ! Osterville, MA Thomas Williams Jr Assessor'sMap/Pazcel 111 Ebenezer Rd, Osterville, MA Installer's Name,Address,and Tel.No. 7 7 5_8 7 7 6 Designer's Name,Address and Tel.No. W E Rob&ison Septic Service PO Box 1089, Centerville--,- MA 02632 Type of Building: " Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( n6 Other Type of Building No. of Persons 1 Showers( ) Cafeteria( ) Other Fixtures s Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic repair consisting of four stonepacked maximizers. wZ $° 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 tYj3oaro,4THealth. n Signed Date Application Approved by Date 3_410' 59 j Application Disapproved for the following reasons Permit No. �l 7 Date Issued 3 /G �� ' ,,./TH.EACOMMONW�E'ALTH OF MASSACHUSETTS Willi is � V— T��LE, MASSACHUSETTS Z Certificate of Compliance "�•"�su�THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (xx)Upgraded( ) Abandoned( )by at 111 Ebenezer Rd, Osterville has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 9'=/-5 7 dated 3 A(` Installer W E Robinson Septic Service Designer The issuance of this permits all not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- No. / ` -� Fee $5 0_00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTAB LE, MASSACHUSETTS Williams mizpozal *pgtem Congtruition 3permit Permission is hereby granted to Construct( )Repair(X4 Upgrade( )Abandon( ) System located at 111 Ebenezer Rd Osterville, MA Installer: WE Robinson Septic Sry 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 p t. D Date: 3 —��- �� Approved by '/�L / 4Q TOWN OF BARNSTABLE LOCATION / Ej�jnaier 9 SEWAGE # /57' VILLAGE_ ASSESSOR'S MAP & LOT - Z9 !I INSTALLER'S NAME&PHONE NO. 5,-+;c. SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) I XAx i eh z e rs (size) a�-1- �-NO.OF BEDROOMS 3 `f BUILDER OR OWNER W i LC i maS PERMTTDATE: 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 nyi � r ®CY�° .may , . s . i. NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed b me dated �� "' concerning the p g Y g property located at 111 Ebenezer Road, Osterville, MA, meets all of the following criteria:. * There are no wetlands within 100 feet of the proposed leaching facility. * 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. * If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. y Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) �! B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: mot/ G DATE �!(� LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). � .. 1 J t� F ��,� s� ��r