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Home My WebLink About0152 ICE VALLEY ROAD - Health via Ice. UGI Rom o Oslvw � i I i I S M EAD KEEPING YOU ORGANIZED No. 12134 2-153LGN SUStRESTRY lE g0 MIN.RECYCLED INITIATIVE CONTENT 10% corm6Rbersoureinp POST-CONSUMER® wuwinproommarp W12W MADE IN USA GET ORGANIZED AT SMEAD.COM TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE L-2 � 'Vl ��2 ASSESSOR'S MAP&LOT -d INSTALLER'S NAME&PHONE NO. t h'100-OM he r SO fl :170 C SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 01 Imo` i S (size) 1000 NO.OF BEDROOMS BUILDER OR OWNER K�[ A PERMITDATE: ?, --2 — Z COMPLIANCE DATE: Id a 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 r ,, , . -._ -i-- ; � �� i 4a � �� i� � ,.f r � I � �� I S Fms... ....3.�.�.� :. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABL E Appliratilau fur Uinpniul Wur1w Tontitrurtijan 11amit Application is hereby made for a Permit to Construct ( ) or Repair (X)o an Individual Sewage Disposal System at: ,,,., 152 Ice_ Valley Road Osterville -----•----------------------•-----------•------------•----------•---------.......----------..-•-- Location-Address or Lot No. ....................Mza.y--X_...CrnW 1_e.y................................... -•----------•---------•-------------------•--.....••---.............--•--.....----..... Owner Address W -%................................. Installer Address UType of Building Size Lot............................Sq. feet. Dwellingx* No. of Bedrooms-----------¢_-_---_--------------------Expansion Attic ( ) Garbage Grinder ( ). aOther—Type of Building ---------------------------- No. of persons------2__-_-_---_.-..--__ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------- ---- . W Design Flow--------------------------------------------gallons per person"per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid`capadtv------------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 ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ a 1.4 Test Pit No. 1----------------minutes per inch Depth of Test Pit-----............... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..................... 9 -------------------------------------- ................................................................................................... .:................. 0 Description of Soil................................................................................................................................................. x Sand & Gravel U -----------------------------------•----••---- ------------------------------------------------------------........------------------------.....------......-----------------------........--•--•------. W --------------------- ........................................... ----------------------------------------------------------------------------------------------------------------..................... UNature of Repairs or Alterations—Answer when applicable..-Add---addi_tional..leaching...pit...tQ....... - ---------------------the---existing.-_tank...Rox...and...pit..................... -------- . 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 byy1fissuej by th e oard_ f health. Signed ------ .._ •�, - Date q Application,Approved By ---------------- d— -- ------------ ------------------ ------------------------------ -3- s�Date Application Disapproved for the following reasons: -------------------------_...--- ------------------..-------...r..-.-------------_--------------------------------------- V Date Permit No. q u - J ,�-- - Issued :---------- - ��.�-,- -5 ----Date C y THE COMMONWEALTH OF MASSACHUSETTS �-- BOARD OF HEALTH TOWN OF BARNSTABLE r� AVV iratiun for Diupuuul Works Towitrnrttun ramit Application is hereby made for a Permit to Construct ( ) or Repair (Xy) an Individual Sewage Disposal System at: 152 Ice Valley Road Osterville •---•---•-•-••----------------•--.......----•---.....•_-----------------------------.._..._....... --•----•••--------------•---••-----------------•---•--....._...._.__.........---•--•••----.....--- Location-Address or Lot No. --......_--•-_-•--• " �'t-,-_._CXnk11e.V.----•---•--------------•----•---- --•---------.........--------••----••----•------•-•---•-- ------------------------ ......--•---•--- Owner Address a J.P_9 ac.om er 'r- •---------------------•-- Installer Address Type of Building Size Lot............................Sq. feet Dwelling; , No. of Bedrooms.___......a-------------------------_____Expansion Attic ( ) Garbage Grinder ( ) aOther-Type of Building ____________________________ No. of persons______ ___._._.__.-_..._.. Showers ( ) — Cafeteria ( ) d , ~% Other fixtures --------------- ----------------------------•----------------_-_-... -------------- -----------------•-•-----••••••--•--•--••-•---•--...--------- W Design Flow--------------------------------------------gallons per person per day. Total daily 2.. .................................... WI Tank—Liquid capacity--.._-.--___gallons Length---------------- Width._,�_-_.___.... "is eter_...-._......._. Depth................ x Disposal Trench— No. .................... Width.................... Total Lengthy---{-------------- 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-------------------------------------------------------------------------- Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit_-__-__:__________ Depth to ground water...................... �14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ O Description of So•1_______________________ --------------------------------------------------------------------------------- x San � Crave x----------------------- v ....................................................... W i VNature of Repairs or Alterations—Answer when applicable.-.Add---additional--leach net---t pit to •------------------- ...tank...Box---- nd-••Pik-s------•--------------------------------•------•-----------------------------••-•------......_._. 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 b / iss'u`e�d by the aoard f health. Signed s- �'.. 1 .... _ 3/.21-/9 5...: ►,�. / Dare Application.Approved By ......_.... J' J ,ems,.^^, .- c .`�5....... Dace Application Disapproved for the following reasons: .......... ... ... .... .... ................ - - ............. . ...........I......... ........... ................ .....- ....... ........._.... .... ...._.......... ........ ......... . ...._....__...__................. ... .... ....._............. Date Permit No. — �..��.................. Issued - `� - Dare -_---—___—.,_.___.._..,..._- ...,—..-.----.— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE OUTer#ifirate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX)f by ..... .......J.,..R ..Macomhar----jr.---------......-------------------------------------------------------------------------------------------- --- ---------.------. Insr,J ley at ..---------------I 52.....T-c.e.... al.l e-y—_Road_..Os.t.eir v.i.l_le...----...---------------- --------------------..------------ ----------------------------...._---------- 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. ... .. --- .----_- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ........... _b " '� ' !a ---- ---------------------_ ------ Inspector .. ....Q..... ...� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH pC� TOWN OF BARNSTABLE No._._/....1'_ L� FEE.$.... 0•.•.0... Ditipnutt1 WorkB Tonotrudiun "unfit Permission is hereby granted__._ ---"r..----------------------------------------------------------- to Construc 1 ),or Re pa• (X an In ividual Sewiige Disposal System 142 Ice Va�lley� Roac� Osterva_11e at No.......... --•--•---•--•-•-•-•-••---------•--------•--•-•••-•-••--- ---•-•---•-•--------------.--------------------•.._..----•------••-----•-------•-------- ---------- ---------•-..........-- Street _ as shown on the application for Disposal Works Construction Permit NJ_. _.- ,�V��__ Dated.._ _-:�:�-_"� .............. "=} ^:! Board of Health DATE..........................- ._! _-.�f 4._.. ............... FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS L No............... :,_ FlUc............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD JQF HE,- T OF ....... ,.............................. Appl ration for Diiiposa1 101irks Tomitrurtion Vrrmit Application is hereby made for a Permit to Construct (4-11000r Repair ( ) an Individual Sewage Disposal I System t: Loc... c 10 1 ddress or Lot .F. ---L__P& Ow �/f A�dres� --------------- Installer Address S feet Q Type of Building Size Lot_..p�i q. U Dwelling—No. of Bedrooms-__-____.-__•. .....Expansion Attic ( ) Garbage Grinder 04 Other—T e of Building No. of persons____________________________ Showers — Cafeteria a'' Other fixtures -•---------------------•-------- - W Design Flow............ �._S_ �,_.��-,�`,_,��_,, 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.........j......... Diameter.4. ,��Depth below inlet____ ______________ Total leaching area-_ :�V1614-:sq. ft. Z Other Distribution box ( ) Dosing t42Y, ) np Percolation Test Results Performed by._____: .__ .'_.._.._ _r. :......._.. Date...7.. _ -_�'"----_____.... aTest Pit No. 1................minutes per inch Depth of Test Pit____...__.______._._ Depth to ground water-.__.____.._____-____--- fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Ix ................ --- - - -- -- --j O Description of Soil. 1A.-- -------•--� -- — ------- ------------------------- = V ---------------------------------------------------------------------------------------------------------------------------•------------•--------------------------------------------------------------- W V 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 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 issu b f;ar'of sign ---- - - ��---��-- �------------- - � ate a Application Approved By....... r . . -•---•............•. • .... ............ .....Y-1Z -/J�._�l/ Date Application Disapproved for the following reasons:.............................................-••--------------•-•------•••••-••••-----•---••----•----•-••••---• .........................................................................•....__......--.........---........................_...._......._..........._........................------...._......_.._._._._ Date PermitNo......................................................... Issued. --------j Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M P�� C DATA �`1___< .. J FEx.. . THE COMMONWEALTH OF MASSACHUSETTS y i ` BOARD OF HEALTH _..~1...(J� .............OF.........: ....................... .:lffr...------------------------------------ Appliratinn for Biaposat' lVorku Tonstrurtinn Prratit Application is hereby made for a Permit to Construct C ) or Repair ( ) an Individual Sewage Disposal System at: a _ i _ Location-Address or Lot No. Owner / � � - Address Installer Address d Type of Buildin �� Size Lot---?...... �� :_Sq. feet U Dwelling yNo. of Bedrooms____________ ______________________Expansion Attic ( ) Garbage Grinder P4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures ----•--••--•-------------- •--------------- - - - Design Flow_____________ "`_..�=' gallons per person per day. Total daily flow_____Tj.,o__,_....................gallons. WSeptic Tank—Liquid capacity6 __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_;;:%/--d'__,sq. ft. z Other Distribution box ( ) t „ Dosing to ( ) Percolation Test Results Performed by_____ _. _-___.___ _ + Date... _.,2,�7-:_.: ! `_____.. Test Pit No. 1................minutes per inch Depth of Test Pit.......________-___ Depth to ground water------------------------ r3� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.,------------------------ a -------- ------------ O Description of Soil ......... `' / �� U --------•-•----•---...----••---•••-•-----•----------•-------•-------------------•----._....-----•-•••----------------------••----------•----•--•-------•-----------•-•----•-------•------------•-------- w Nature of Repairs or Alterations—Answer when applicable._..___________________________________________________________________________________________ -----------------------------------------------------------------------------------•-•-----•-------- -------------------------------------------------------------------------------------------------- Agreement: t 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 Lby//the,board,of/rhealth.,e Sign, �----� �'�''+'�v' / /--- �/ 3 Date Application Approved By. e Din, Application Disapproved for the following reasons:-----•--•--•------•-----•--•-----•------•••------------•----•-----••---•------------•------•------•--•---------- �: ------------------------------------ Date _ PermitNo......................................................... Issued........................................................ Date i. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :...............OF ,....-.............-.-..................... Tnrtifiratr of Tiant0aurr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed or Repaired by------------ - _......... 1` •---------------------------------------------------------------------------------------------------------------------------------- Install at....... .•-�' `----------------- has been installed in accordance with the provisi s of rticle.XI of The State Sanitary Code as described in the .� application for Disposal Works Construction Permit ___ ;" _____________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL PLOT BE CONSTRUED AS A GUARANTEE THAT THE ' SYSTEM WILL FU CT� ON SATISFACTORY. c DATE*.-=--------•-`� K Inspector. -` .........:.............. • E^: 4; 4 I v ' THE COMMONWEALTH OF MASSACHUSETTS BOARD . F HEALTH ........ ........OF..... 4 ,l. ,,.---------------------------------- r.. No.___......................• FE ............... e �i��rn,�tt vrr � C�nit,�trttrtinn pt-ntit � _-_ Permission is hereby granted_,/_______________ ___ __ ___- .r___..-._._..._______ - to Constru ( ) o Re it ) an Indl u 1 Sew Di posal S stem jj� d atNo.--- �~•l fi'__....•---•--•------ •.. ........ ------------------------------------------- --------------_-----•---- ' Street //�� as shown oi%the application for Disposal Works Construction Permit No.__J�,;2_1__ Dated__._. ---------------------•--•-- .� . ----- _ _ r , /� Board of Health DATE... ° .- , - [[[-------------------------•-------•--------------- 6 FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - • �v 'S(146LF— V7-AAAtLl -_-,AA W 4.Ai8.4%&P_ A Y) L41 L_- 0. k(o k9 C / Its. STZ A Al so.4- 42 SY/7 4244 M, Izz��o TL All Xl� -0_'�T elpt-V I LLa Nor -7/Z* At.A 31 So IAIV XA 47,6 r47 44 47-o �A /coo P/7- j; 514 4- TtXA.'1-3 Y70