HomeMy WebLinkAbout0024 HATHAWAY ROAD - Health 24 Hathaway Road
--- _ -- Osterville..
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TOWN OF BARNSTABLE
LOCATION w SEWAGE#,2oo 30
�UJL.LAGE ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. A,CC,I/S/ram- S, 0_8- d8-,S57a,
SEPTIC TANK CAPACITY /S00 Goa .
/ , 9
LEACHING FACILITY:(type) 5 DO (N c (size) ya X 83
NO.OF BEDROOMS
OWNER 1>g Alt-(Ck
PERMIT DATE: -L `O b COMPLI`ANCE 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
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No. Fee l ,
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Tk9p al *y5tem Cow5truction Permit
y�
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. Tlc `►W.t,JQ 040t Owner's Name,Address an Tel.No.
�$Cerlil��C AnnC . A�Mce
Assessor's Map/parcel f cS � c `j R-�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
'3rtj e.kAQ_r_cdl ` (cr stc on Ali
�s r ro A , o 662 a ^Yl � Sc�=y�8-636
Type of Building:
Dwelling No.of Bedrooms 7 Lot Size` '6 83 _ sq. ft. Garbage Grinder (PV)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) yli/O gpd Design flow provided ycSB .93 gpd
Plan Date �(/�, /d aoo6 Number of sheets / Revision Date
Title A f
Size of Septic Tank /$O6 GAtr Type of S.A.S Wo GRL r w I-0 ,�� k
Description of Soil 4S 4or- JgC an. 00 1A j +
Nature of Repairs or Alterations(Answer when applicable) em 0 VC e 3LL,5t ti CeS S o d I S ,% 00 G a[
Swzrz, (�n�T�ISI� ID6k Soo C(4 Z tfA}M1 C/A,&.
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 of Health.
Signed Date U./4 `p
Application Approved by A Date
Application Disapproved by: Date
for the following reasons
Permit No. � 'SL, Date Issued U
Nu ' r �" �� ~ i. r Fee /tx)
a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
+Yeses
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
~ RpplicatioH for Miooar 6p-mem Cow5truction Permit
Application for a Permit to Construct O Repair({Upgrade O Abandon O LJ Complete System ❑Individual Components
Location Address or Lot No. y (�11�C L",Q O°i�� ' Owner's Name,Address,and Tel.No.
Zji�nne . to,c2
Assessor's Map/Parcel F—S �i K'�l\`
S-/o 0-SITtr".t\r
Installer's Name,Address,and Tel.No; Designer's Name,Address and Tel.No.
�t�c�e ��a.ca11 ,5rc, S� e� a•� Kail
8-636 /
Type of Building:
Dwelling No.of Bedrooms Lot Size d 3 sq.ft. Garbage Grinder (A1)10
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures t
Design Flow(min.required) �/5/O gpd Design flow provided �f a o /�J� gpd
Plan Date O , O U Number of sheets / Revision Date
Title ef
Size of Septic Tank /5U 0 G")I r Type of S.A.S �C3 U GAS. �r y w e y,CW k r
Description of Soil A)S 4(', /04- o• �a 7 v
t
Nature of Repairs or Alterations(Answer,when"applicable) Re 4)0 V C P X t Z Ce5 s b o o(5 t Tn ST:y 1 1
(0,, c ►� ab«.�.
Date last inspected: a '
Agreement:
The undersigned agrees to ensure the construction and maintance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code,aand not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed f Date A)tif
f Application Approved by Date .0/7106_
a Application Disapproved by. Date
for the following reasons
ff �
Permit No. ��b Date Issued �/( 7111
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( !sr—Upgraded ( )
Abandoned( )by SHo f?
�•�yat J t( k4,,7 t'kc_w r, PW c S 1 e r v I�c has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. :)Do C —30 dated kh ?/�6. .
r +
t o Installer'Rr, rc kin r r, I , s l c r Designer
#bedrooms U Approved design flow qL/U gpd
The issuance of this pen-nit
ts�sh ll not be construed as a guarantee that the system will�fln—Mi'n a ,est�gned. sa
Date 9� I Inspector
—————�—n, ——————————— ———————————————————————
•�wG _—
No. 1 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
wigoal i§p.5tem con5tructi0tt ermit
Permission is hereby granted to Construct ( ) Repair ( �". Upgrade ( ) Abandon ( )
System located at o? 4/ 44�/,61 ram,i9 • 1 w
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions'-
Provided: Construction must be completed within three years of the date of th/is�permit.
Date 94( /01 Approved by (/
tt ,
Town of BArnstable
�o�tl1E r Regulatory Services
Thomas F. Geiler,Director
: .,�RA;SI;k6
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: k;Crz7J)Aa))
Desil�er: �L Installer: y im- "�`�CZ `�
Address: Address: �6v� •
4uc, l'Z;"6 ( permit to install a.�°�'006 � i�
On - r �,l�u �S�was issued a p ,
(date) (installer)
septic system atL based on a design drawn by
-d4
(a s)l
L dated.44V 3&
G'
design • �
✓I certify that the septic system referenc d bove was installed substantially according to
the design, which may include minor ap oved changes such as lateral relocation of the
r distribution box and/or septic tank.
I� .
I certify that the septic system referenced above was installed with.major changes (i.e.,
greater than 10' lateral relocation of the SAS or any vertical_relocation of any component
of the septic system)but in accordance with State& Local Regulations. Plan revision or
certified as-built by designer to follow.
�SN OF I14,gs, -
s ON
R.
er s Signature) Hail.
No.527 2
S+�rFAEDSP����Q
EVA030
gner S 1 ) (A$1X�CSi tamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC H]kALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE-I SUED UNTIL BOTIN THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE P LIC HEALTH DIVISION.
THANK YOU.
Q:Health/septicoesiper Ceatificatian Foam
TOWN OF BARNSTABLE ,,II
P
LOCATION I17 E�W�Y SEWAGE #� K
7—
VILLAGE (0 ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) '12M RK � (si
NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER-
BUILDER OR OWNER
DATE PERMIT ISSUED: "' cc-— �6
DATE .COMPLIANCE ISSUED: `2
VARIANCE GRANTED: Yes No ��.
1 y
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Fro-,
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S
No.-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................... .................. ..
"kV W
0 F.. . ........................................
Application for Disposal Works Tonstrltrftn rrrmit
Application is hereby made for a Permit to Construct or Repair Individual Sewage Disposal
System at:
.........................................*............................. . . .. .
Location-Address or Lot No.
...........V4-CA_
. ........... V'V\S.... ... ......................19 AM.=...........................................
Address
.
.......... ... .......
..................... ........................ ..................... .......
........ -------- ....
Installer Address
Type of Building (Size Lot.............................Sq. feet
Dwelling—No. of Bedrooms..........q..............................Expansion Attic Garbage Grinder ( )
Other—Type of Building ............................. No. of persons._..._...._..._::_..__.____I Showers Cafeteria ( )
Other fixt res ...............................................
---------------*--------*........... ...........*-------- ------*... ......
Total daily flow 71
WW Design Flow..........S. .........................gallons per person per day. T ........../.!�.O.....................gallons.
Septic Tank—Liquid-capacity............gallons Length................ Width................ Diameter................ Depth_..._______.___.
Disposal Trench—No._.................... Width....................Total Length______.....]....... Total leaching area...................sq. ft.
0 . t
Seepage Pit N .. . ........ Diameter,....La......... Depth below inlet...... ........... Total leaching area.................sq. ft.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by.......................................................................... Date.........................:...........
Test Pit No. I................minutes per inch Depth of Test Pit._.._.........._____ Depth to ground water..................
Test Pit No. 2................minutes per inch Depth of Test Pit.._____._._.____:__. Depth to ground water.:____.____..._.....___.
pG .....................
......................................................................
-----------------------------------------------------
0 Description of Soil........................
................................................................................................................................................
..........................................................................................
------------------- ------------------------------------------------- .............. ................................. .................................
;'"....**------------*-------
U Nature of Repairi or Alterations—Answer when applicable___ ........2i�........q-y(
w.... c...........
....................... -------- ..............................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'Ll'Aa' 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 oard of�health.
_77:Signed...... ...... Vs ..................... ................................
Application Approved By............0'k��_ . ................................... ....................Date............
•
Application Disapproved for the following reasons::...............................................................................7----------------------------
.......................................................................................................................................................................................................
Date
Permit No...3.2......V.9-?................... IssuedL........................................
• Date
` .. +/.�rJ^.-�+^w�'�...+_'.Y.:I' J'�, 3�-.wV'�'+T'.".. ..tin.. •A'�'r�ry.� N.c+...... .:.._... v-�'.�'Y.. M.. �+tr�-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......`........ ...`--------------OF.....-i_�Jcll:tr..?^r.S:1�. - ........-..._......................:..
Appliratinn for MoVasal Works Tonstrurtion 1rruat
Application is hereby made for a Permit to Construct ( ) or Repair ( ")-•M Individual Sewage Disposal
System at:
.............. .. ..�-- ------=--- .............. c ?.��. `1 . ..__......�.__-
:.
Location-Add ess u-
or Lot No.
.... ........... .
-•-- Owen Address
,Wa ov� . •=� 5�? 5........................ ........................ -------------------------------------»---_----
Installer Address
Type of Building Size Lot............................Sq. feet
�..� Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( )
a'4 Other—Type of Building No. of persons............................ Showers
yP g ------•-•----------------•-- P ( ) — Cafeteria ( )
d Other fixtures ... -----------------------------------------
W Design Flow..........�_�........................gallons per person per day. Total daily flow.. ....-�!; �.....................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-_---......... Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft.
Seepage Pit No...r.. . ......... Diameter....L.�-__.__..._ Depth below inlet................. Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( , )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f=, Test Pit No. 2................` minutes per inch Depth of Test Pit.....................Depth to ground water........................
O Description+of Soil...\.» 7:7...................................� r, --..............................................................» »...:._»__..»._». » - ..»»» »...
..........!...;-------------------- ----�r---= ... ...... .��.. » .
W - --
U Nature of Repairs or Alterations—Answer when applicable..-. ........;..._ ............
�..�_;.` ......�tlWt. � r ....--�'c!�r4.................•-----...-•--•----------••-•---•-------...........------:-........---.......�---.......----...-------•---....
Agreement (` ��
The undersigned.-agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 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 oard o h 11th.
Signed. —? • -' `^`
-- ----
Dat
Application Approved'By_._........... _: �7.� .�� '= " ......_. Date
Application Disapproved for the following reasons:..........................................................................................................---
...............................•-•------•--•-•---------------•-•----•-•------------...-----•---------------•---•------•.._..•--••-......•-_.................•••-••-•-•-•_........-•-•._...---........_»
Date
PermitNo.. --2:----_a. .................-._. Issued_........................................»._...-...-_
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. _L.w.V ....OF..... � r...Y... ,SV \ .......................................
f9rrtifutt#r of &Im�littntr
THIS IS O CERTIE at the Individual Sewage Disposal System constructed ( ) or Repaired
by........................» —...-•---- ••• - ....................................:...................................................................................
Installer
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described d in the
application for Disposal Works Construction Permit No.....� _�_y .. ...... dated........ :-... -".. �y ...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................... ? .r.-.-» .1............................... Inspector t ..................................
THE COMMONWEALTH OF MASSACHUSETTS
( .9 , BOARD OF HEALTH
�.. 14J.:.w..........OF....��c... .F. P................................
ya y Disposal Works Tnttstrurtivart Prrmit
Permission is hereby granted ----------- . ..__»..
to Construct ( ) or Repair (L--)-an Individual Sewage Disposal System
at No.............. `� (,A..4 1 tti� D OST
............
Street as shown on the application for Disposal Works Construction Permit NAo�7^��_/� Dated...
_�-_�.�...`7........
...........................+*^��_i`.':�5._st.- .`. .+_... .........................
�-Board of Health
DATE..----- --•--•--------------•-------.............•--•-_-•---•..............
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TOP OF FOUNOA-1 ION - -
rr �` -- CONCRETE COVERS ✓<L
:�G>X , � I ,.�� '� 'r,-,r„77 -r�*.--;-;.
4„CAST IRON 9�, � _�' ., ..
4 - / OR SCHEDULE 40 -- "Tr•� '1'�'�,
//t• � /of' �� rr✓ �L--�✓� / .NCH FUULE 40 P.V.C. (OtJLY
, /, / - P.V.C. PIPE h11N. - Y)
LEACHING NG TRENCH REQ.
/9 / ,f �' PITCH1/4"FERYT. PIPE- tdItJ• r 9 MIN . 1/8"- 1/2" WASHED STONE 36" MAX.
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PITCH 1/4"PErR.FT. �'L�'7. 2
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e l i'E R T , Gq - 89Fi -`�- -� t q,, Y :,'�.i Cl,L td
IN RT , �,,�; 24�
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{ G.v� C ► EL. 1•.�...... INVERT 4, - -
�EPTiC 1-/1(YK DISf. � C1 �•C7''Ct o a ��
\ ( INVERT l� EL�./INV BOX EL '...�'t� ,C7a!L�,[�;Cf,;p;'�7�•�7Jp,p .
.. .� ... GAL.. IfJVER7
) jJ{ ,._, / I — -_ E ?(y„ INVEi1i Precast 5000ai.Leach 3/4"-11/2"-�
6�CRUSHED�STONE E� (y) REQ. Chamber WASHED STONE
/ } 7, PROR LE 0I= I �rT� - -fir _ �-, .
1 � /Vo GROUND WATER TABLE
/ I I SOIL LOG SEWAGE DISPOSAL SYSTEiYI
TYPICAL CROSSSECTION
/ NO SCALE
DATE '���. a TIME .,��,�vc���.� LEACHING _TRENCH .
TEST RULE I TEST HOLE 2 NO SrrL
ELEV., Q �.. . . ELEV. . . . . . . DESIGN D 1lr`
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70 — � `q cu>✓»/00 /�, ,,... Hl!',1;._:t O_r C R 9. . Wt-SHED 36"h AX. i
n JOh,S
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�< a� - /oy?le/� ^GAS/w•�' SDIJE
TOTAL ES 1 P,,Ai ED FLOW G L_ONS/D
' _ A _ - '
-k" e ?)Ti1t,1 L=�+CHItaG AriE�1 �. . ^� � '�•r - 4
�' f JV /�F ✓ /�h�l / - G• �.. SO.r"T./iii=NC}I Cj •p 1 f
L� ' Q I� �: �, /✓D% SIDE LEACHING AREA' 7 .`2 . SQ.F-1-./TRENCH2 6�C OSA (0% AREA INCREASE)GaeGE DIS L ,
�
N
TOTAL LEACHING Ar = l�G'-1 / i SQ.FT.
/Q y7/� PERCOLATION RATE'. . , �;L.!`:�:'.J ... PcR.INCH
SITE PLAN 24 HATHA. 'V� 114Y RD, C�S� TE �� VL.- LE � 1f�,
LEACHING AREA PER P-RCOLATION RaTE7�-r�?, -�SO.FT_���.� � • I
9 -
APPROVED R GROUND WATER T:,?LE-n/C
( BOARD OF HEALTH
i SN F0 l� WATER ENCOUNTERED
DAT E
EDMRD
L AGENT ORS INSPECTOR
'�1�Ci A / ,� — ,
NO.251W N WITNESSED B
aoARo OF It`cALTII . . . . . . . . . . . �
ENGINEER
- PETITIONER _ ,>,r ✓, ': �`��!'7F SD/l F:=�. ON