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HomeMy WebLinkAbout0611 GRAND ISLAND DRIVE - Health 611 GRAND ISLAND',��OSTERVILLE� A=070-008-005 \ I I TOWN OF BARNSTABLE. ©� LOCATION LA ** ``' G��rr �..IH , �r SEWAGE# s✓ VILLAGEC3u F2r r �7r 5 'ASSESSOR'S MAP&LOT�'J9 —k=- INSTALLER'S NAME&PHONE NO. q7 1- TZaA SEPTIC TANK CAPACITY f5(�n 00 /i j a LEACHING FACILITY: (type) (one-41e 1 (size) Y _ NO.OF BEDROOMS DIX) BUILDER OR OWNER PERMTTDATE: A COMPLIANCE J 5A' TE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 n THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --------------IDW4...........OF.. .A.-". 1 �-- Appliration for Uhipvii al Works Tnnstrnrtion rams ff Application is hereby made for a Permit to Construct ( �or Repair an Individual Sewage Disposal System at ......G1.1.__. ! .... se i ..... q ya....----p bii tS------------------- --- !-1` ............. ocat' r or Lot No. O f ................................Address Installe Address dType of Building -- Size Lot....-� ......1_`1.I...Sq. feet V Dwelling—No. of Bedrooms...................4Q...................Expansion Attic ( ) Garbage Grinder ( ) '04 4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ...-•--••----•--•-------•------------------------- -- W Design Flow..................... �....__.�.....gallons per person per day. Total daily flow...........................(P..!.P....gallons. WSeptic Tank—Liquid'capacity..V=.gallons ,Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No.-----_..`a_......... Width....a............ Total Length.....�'z'S... Total leaching area....L7.Z?.5 --.sq. ft. Seepage Pit No-----------_------- D' eter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) `�' Percolation Test Results Performed by.--BlVTca'Z.._._14......t IW...'1+�............. Date............. �j Test Pit No. 1....v...minutes per inch Depth of Test Pit....... ... Depth to ground water........................ (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -•-------------------/- - t . -----•- --------------........--•-•--•------•-----------•-•------:..----•-•---•-•--------•--•.._....-- O Description of Soil �?.'" -�S _l. JA._ ....... c9�S CQ� -------------------------------------------------•-----•------------------- W ---------------•--•----•--•--------------------•-- ----------- k3� ��aA./�i�---------------------------------------..................................... x ...........-...................................................................................---•---------------- =............................................................................ 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli e e i b t d of health. Signed ------- - -- - ------ - - -- .......................... .. ....--- -- --- Application Approved By . ... -. --- - ----- e Application Disapproved or the following reasons- ..............................- -- ---------------------------- .--....---.....---- ----....-- --- ------------------ -------------------------- ...............----.=.----------------......---..... ..... . -... .. ------------------ -- --- Permit No. -....... Issued ----- G/ -------....rh a------ M � No................--....... F:m$..........................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH IoLON OI -t )7- , �_ -............... -- ----------- -..... ............................-�--- ------.......................... Appliratiun for Diupuual 19orkii Tunitrurtiun rrntit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: � ............... - ^G � ...................................:............................................................ .......................... ---t-N-.....o.....•.•.....•.-. Location-Address or Loo. .........._..._. dd •..............•----...........................Owner A....---•----••-•......•..............0.... ••-•---••-----•---............................ •••ress...........--•-••......•••••............:....... W Installer Address Type of Building / Size Lot.......:....................Sq. feet U Dwelling—No. of Bedrooms..................!t_O._..... .Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria G I Other fixtures -----------------•......---.._..- . - W Design Flow.................... ............_._.gallons per person per day. Total daily flow........................... ....gallons. WSeptic Tank—Liquid capacity...`kA?_gallons ,Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. ......... Width.......Z............ Total Length-----:2�ZS--- Total leaching area___x7-?5L,----sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by__ X �=i ____ _____________ f'`�----__......... Date...__._...._ ..:... .:_r?�`f._. Test Pit No. I.....:� _._minutes per inch Depth of Test Pit......�4�__�._. Depth to ground water......... '......._ . Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------ --------- - ------t......-.----............n............................................................-.........................-......... O Description of Soil-----------------. ---.----• '>_.� ... r W ........................................................................................................................................................................................................ Z. 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------ - ------- -------------------------------------------------------------------- -- ----- ----------------- ------------------ Date ApplicationApproved By .................................................. .... . . ................................................................ ..... ... ........................................ Date Application Disapproved for the following reasons: ------------- ----------- ------- -------------------- ------------------------------------------- -- ---- ---------------------------------------------------------------------------- - ---------------------------------------- Date PermitNo. ................................................................. Issued --------------------------- ------ ---...----....... --... Date THE COMMONWEALTH OF MASSACHUSETTS ..-- BOARD OF HEALTH ...................(1 ,dW---.... OF .......6A..�J a 7)"g7)4,i-------------------------------- Tue>rtifirate of Qlamplian.ce THI TO CERTIFY, That the Individual Sewage Disposal System constructed,17 or( ` Paired ( ) by..... : tea :...�. ................................................................. / Ins[aller at ---------( `t ( f A-'`= 1 `'1=--f' ` _ F f -..".. C `1 h'i tar) i-5.... .......------p----T- -�---................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No.�_-ram�h. .�. ...''..-..---- dated .-_............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-- t- :.- `.. .................................. Inspect THE COMMONWEALTH OF MASSACHUSETTS - �--�-` BOARD OF HEALTH .... oF.. �C� rid N ...._..... .. r. .. FEE........................ Uiiipuonl Vork.5 Tunutrttrtiun rrntit Permissionis,hereby granted....................................................................................................................................0......... to Construct ('1115 or Repair ( ) an Individual Sewage Disposal System at No................/ 1 1 , n V ,1 f 'Ac.t , i )•) I ,Id F' .............................................................. ............................................._...__............................_....._.................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... •------•----------------•------------•------------------------------•--•-------•----•-•--••-•••...- Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f 511.14,Ls FAM IL.( Co t31�R0s'�K r7 r--E PLA ti.L ON BAGIL {.&MEOF WIN -ACZ3A/,Q 4QWV6C- I _ / � NAQgpeS -PAiL- ( FWW = el X 110 =6&0G� �oT l^19 G2Au� tSL p 1�E ,t7 U4F_ 1500 GAL. /Z G,,,,,pArrutmeNr USE S' 2�x2� �Rr71l.�IE'S la&A 4s✓ too& A,TU"-MoN AIZEA 2Q'D. ��I ►�' i� `' iu �o GPD s s1: sofo 13�g SF u ►. : ,! A?PUG4?10N A2r=k DGM6I`4 222Z22Z2'2Z2Z22"'-22�`z 4�x2 lz)c r. w SF IW4 Tti�G�4 el 51tE1�SlALL AtaEA= 'I�ETA1 L OF LE" I�D-rroM Az A = 4 S x,22 x lep =4 So Sr-- p•a,. -TOTAL Ate, �. L ti11t1 IWCA Mex. l�oc-ATUX4 u-M 5 Z" '/8-�z stogy SOIL. Cl d.� Z — 4� OF A. 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APEA=4-S,xix z�c 5=9w sr- 'i7t="�'At L of �LEAc1�I W �c Tq ES tDrrOM AZ+t A = 4 5 x,%� X 5 -- A so p.&, lamL 4 s 13SdS(� :. ,�. .5 L Mry ,Nc�} Max PE VZOI.ATID9 ATE 5 +.Z" �18-�z '�To►JE soil c .� T — tof PETER p --- 2 HAM SULLIVAN A. &x " NO. CIVIL 3 co -�oN oR 'T mw—,Ik 9FGIS�Q��� Wp S/pN a 4 F6 =2/5 F6=2Z T9-23 Na,c� fC=zl lei � Lout �JGH W ;z i�4 Iry Sp.tlD 'Ln A lil 4 WOM No qv."Am- lews CE"RGD PLOT M AsA ,t/o uraT�� 1.vGAT ICJM�I O ys`� !�A+2'�0�5 3/6 tIM 6 •/3,69 I G 'I1 f`f rpAT 'f C- jDw eia-t oX, SµvtiuN PEAK! 2�EW- 4sweW C&APL K Wrr" T14E 7,IMuW9 AW. Lor 1"'19 4mucv- zwvi-zmms T of Iva 'm Y N OF A(AP -70 Pam- 8-S -'Bay"sTAl5t-C-- A►.* I S 4JOr LG%AT4M> W I T-4I N -wseAAL mrop HAZE Monk_. IaAX'�'i:sL. it NyL I•lc �`�- LAI1D SIJRVB`IC�S • CdJGI N6E>T� Sepr- 13,Iaq S P�� C° Q GV�" oST�2VIu..t MMfS. f oa-'sers; mom Bvi�jw,6 sNaxD woT" ab. ,d�PPL icANT: u5ea �b 6s'rABc�sN PRop�Ty Lr�lE*S. �!-�IT� A%oe-4ATZ25 �Arz-e-0 �F ���Sr- Zotlt f�F-( 3o�15�rs 7 zo•9 cis ti�"68 zl.g 179 A4, 1-11 sF .1\ - ( 4 T�,e►� ocp��51o�J 1 0 $13Jc9 M AC4 I b3 8Cc _ Co5•oc T6 °` c%- GLzV•41 -IM-0.00i C8 6 c�E oF� PVMr a ZA.Vb 5LAN� L:>Qi vr- tNOF A H . 4 PETER iN 'LRAKM SULLIVAN NO.29733 a CIVIL � � �$ ���j� ����� `_ , . _. NOTES: LEGEND: sv G,x, q a a 1.) The structures shown were located on the ground by EM conventional survey methods on 22/FEB/17. ❑ Electric Meter x } y QD Drainage Manhole 2.)- The property line. information shown hereon was compiled from ® Catch Basin D 4 available record information. Hydrant CBIDFI n 3.) This plan is not for recording and is not to be used for construction layout or deed description purposes. Light Post s rt r.�,� 1'(4a. CB/DH QE 6 , eact k Fnd BdDH �FClub, Inc F oyster Harbors 26g.75 � Location.Map 1"=2000't 0,24��E 141.59 x CB1DH N77'3 ASSESSORS REF.: _ Map 070, Parcel 008005 50' Minimum 78.2' ZONE: RF-1 Area (min.) 87,120 SF (RPOD) Fronts e (min) 20' Feriae Width Fimin) 125' closure proposed E^ Setbacks: Fron t 30' °moo' Proposed Pool o Rear 15' 1 OVERLAY DISTRICT: 42.4' o �� AP — Aquifer Protection District v � o :;;:::; :;: :; :; 10' FLOOD ZONE: O ................... CO c;+ 3 %" Zone X o Q. � FEMA Map # U° #25001C0756J July 16, 2014 1 e oco �0 2 0 0/ N T a=+ \ \ '21.93 Z o \ Z O / LQ — ---- cn O 41.0' ,-- co 7 / do \\ \\ Approx'Septid. As'.Per BOH Card n LOA \\ Stone Drive \\ '•, \\ w/metal edge \V, \\ 84.1' \� \ \ C8/DH F'nd j E o oTel \\\ \\ 65.00 13 W Trans Cry \ \` S80.53 I /DH 1 Find \ , L-j43•g6' I \ R_2420.00, \♦ ge 0 aye {e Way) FBIDN tj (Prlva L_116J20 .06 e)(40 Wld tN Of YASscy��� G (� g� RICHARD'R L'HEUREUX p No. 34312 �o . Fs O NO yJQ- 00 0 15 30 ' 45 60 FEET Sheet # Title: CapeSury C3454_13 1 1 f 23 West Bay Rd, Suite G At 611 Grand Island Drive Scale Q Osterville MA 02655 Barnstable (Oyster Harbors) Mass Date (508)420-3994 (508)420-3995 fox copesurv@copecod.net 02/MAR/17