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HomeMy WebLinkAbout0060 LINDEN LANE - Health 60 LINDEN LANE, OSTERVILLE A=142-028 0 . a ✓, T Vj TOWN OF BARNS / LOC ATION 6� L���'i�`�� SEWAGE # 9r VILLAGE 4*85* 11111 . ASSESSOR'S MAP& LOTA�Z-`OZ-P INSTALLER'S NAME&PHONE NO. y'��zl' SEPTIC TANK CAPACITY LEACHING FACILITY: (ty�e) �F,C1y��o�s �y l (size) NO.OF BEDROOMS 3 BUILDER O OWNER PERMTTDATE: — � — COMPLIANCE DATE: Separation Distance Between the: Maximum"Adjusted Groundwater Table to the Bottom of Leaching Facility t 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' l ip, �I LQ,-CAjION e0�iv L SEWAGE PERMIT NO. - a VILLAGE o's INS A LLEX'S NAME `b ADDRESS BUILDER OR OWNER Cleo DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �klS 17 \� r, ,, .. --.. ; �` C9 �`� f ` • �-� ��/. No......................... Fx$..........................._. THE COMMONWEALTH OF MASSACHUSETTS y- BOAR®,9F• HEALTH .................OF..... ..................................................................................... Apptiratiun for Biipuu d Workii Tunutrnr#iun Vamit Application is hereby made fora Permit to Construct ( ) or Repair (/�,�a:n Individual Sewage Disposal Systet at: / s Location-Address or Lot No. i — .... • • ------•-•------•------------------------ -•----••-•------•--•------•-•---•--••-----....................----•-------•-•-----.............--- Owner Address a ........ .. .• -.._.......•....... ...� ... Installer/ Address Type of Building Size Lot-----------------------------Sq. feet U g— .__..Expansion Attic ( ) Garbage Grinder ( )Dwelling of Bedrooms.......................................a — Other—Type of Building ............................ No. of persons-_--•_-_____-_--_-__-__-_-__ Showers ( ) Cafeteria ( ) Q' Other fixtures ................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............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 Test Pit No. 1................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........................ a .. 17 O Description of Soil-• c - ••-----�------- ---- --- -'(.................................................... -...•--•-.........------.--•••-••-- ---- - ........................................ iy J -- x (� G� .. ............................ 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 iITLU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bpon issued by e board of health. Signe ------- �r - --.---•-•------------------------- Za ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons:................................................................................................................ .................•---•-----•-•----•--•-•-----•------------....---•--------------.....--•-------:.........-••-•-•------•---•---•••--•----••--•---•--•--•---•-•---•--•------------••••-••---•------------ (� ��......•......Date Permit No......................................................... Issued- !�-r� .... . - Date 0.0- ` �g� 4 �. 'i No......................... FEE... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ,f F HEALTH .................OF.....:.-....- .......................................................... Appliratiun for Disposal Works Tuntrnrtion Permit Application is"hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal Sys at: ----- ........-_... ................................................ ...... ,.: .....----------------------------------•-------------..............--------------......-•-•---•--- Location-Address - -•• or Lot No. ... { ..:.... ._... ........................................ ...........................•.... ess Owner .....................................•_•___.Addr a _ �.� --------------------------------•- Installer Address Type of Building Size Lot............................Sq. fleet _, Dwelling moo. of Bedrooms__________________________________..._______Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria QI 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-_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................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........................ .. D Description of Soil-• r. - ------ ---- ---•------------------------ --- ---- ----------------------------------- x W •----------•---------•-------------•---•----.__._-•------•---•-•--•--•-•-••-•--..__.----------••....-- - U Nature of Repairs or Alterations—Answer when applicable.----- -- ---- - - -._.•'. ;...E�r... ----- •----------------••--••-••-...-----...............-•-•-•--•-•-•-•----••-•-•-----•••-•-•.............--•--......--�••-•-•--••----•-•----•----y----------------------•--•--•••-----------................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal`System in accordance with the provisions of TIT 12- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bn issued bye board of health. Slgn ="04-- ............. ....`'.�.....------...--------••-•---•--. -------- �r ate ApplicationApproved By.............................................................................----•--•-•-•--•------ ........................................ Date Application Disapproved for the following reasons:-------•----------------------------------------------------•----------........................................ ...........................................................................................................................................-.............................................................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .................. .............OF.... ..: "°?!....r.......... .............................. ...... 01rdifiratr of (faampliaurr T S TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( " er y c� I nst.... at has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.'`" ............ dated----- ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS kGUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATE..--------..9.. ?T .... F �/i/ 'JCS Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - / .......................... ...........OF.... .............. No......................... FEE........................ M15110.AWork �e. ondr tion rrmit : Permission is hereby granted . ------�----- --._.I. .................................................................................... to Constr ct ( ) o Repair ( an Indivi vc al Sewage Dispo ternat No . r _ Street `�/ as shown on the application for Disposal Works ConstructiongPit N Dated.._.. ._.7. ...� '_.__._.... �f .....-------•-•. DATE........................... ................................................ Board of Healt . FORM 1255 HOBBS & WARREN. INC., PUBLISHERS j �14 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for Migpozar *pgtem Cow6truction 3permtt Application for a Permit to Construct( )Repair(y )Upgrade( )Abandon( ) L7 Complete System EJ Individual Components Location Address or Lot No. /_� / j1� �p� Owner's Name,Address and Tel.No. Assessor's Map/Parcel !/vo`1S/ 1_Z1 � gae Installer's Name,Address,and el.No. ! Designer's Ncamee,Address and Tel.No. tfp pz:0e C®1ld1147 7 7l- .39f Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder•(f-0 Other Type of Building SI tooVCP6 No.of Persons Showers( ) Cafeteria( ) Other Fixtures p� Design Flow ip gallons per day. Calculated daily flow rJ c�D gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 15_Z929 Type of S.A.S. y �•�' �/� S Description of Soil G����,33G Nature of Repairs or Alterations(Answer when applicable) 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 B d f Health. Signed Date Application Approved by Date Application Disapproved for the following reas Permit No. Date Issued / TOWN OF BARNSTABLE VJ LOCATION b LIMC eW lam- SEWAGE # VILLAGE as7� r44111e ASSESSOR'S MAP& LOTI/Z'�'Z� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACTTy LEACHING FACILITY: (type) Le l t-a Tara ryT_ (size) NO.OF BEDROOMS 3 BUILDER 0 OWNER PERMTrDATE: — Z — COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /7I� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) jl �I Feet Furnished by ;3 b 0 104 No. J Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION :TOWN OF BARNSTABLE., MASSACHUSETTS j 01pplication for ]Dtq gar *p$tem Con!tructiott joeriuit Application for a Permit to Construct( )Repair(" )Upgrade( )Abandon( ) /complete System O Individual Components Location Address or Lot No. o G�� �pn /� Owner's Name,Address and Tel.No. Assessor's Map/Parcel lJ Installer's Name,Address,and el.No. Designer's Name,Address and Tel.No. 7 Type of Building: I"s Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder�� Other Type of Building 14 eeC e No.of Persons Showers( ) Cafeteria( ) Other Fixtures m Design Flow gallons per day. Calculated daily flow c7 3d gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �,S-4O Type of S.A.S. Description of Soil 91 331 2 id Nature of Repairs or Alterations(Answer when applicable) r��y-�c Z77r01 G,DPll Date last inspected: Agreement: F , The undersigned agrees to ensure the construction and maintenance'of the afore described on-site sewage disposal system f 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 this B f Health. Signed - _ - `Date v Application Approved by Date Application Disapproved for the following reas Permit No. Date-Issued. . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSkQHUSETTS Certificate of CoiuPrlrattce / THIS IS TO C RTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (v)Upgraded( ) Abandoned )by AC111`�GO at �� �I►�,D�I� ti dv �[//. �' h s bee constructeo in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ted 9 /7 Jfo" Installer Designer The issuance of this permit shall not be construed as a guarantee that the Sys ill fu t� desigpe Date Inspector rJ�GQ.f^ . No. -'"' o= -----=—=----=--- 0Z_�--Fee�� _�•. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 4, lwiopozar *p6tem Cougtructiou Verritit Permission is hereby granted to Construct( )Repair(✓)Upgrade( )Abandon( ) System located at © Gin ,dew 14 - 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 m st be cohi leted within three years of the date of this Date: Approved by 0 r i } 10/9/97 lu. This Form Is To Be Used For the Rep air Of Fa>t e NOTIC P Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT . ENGINEERED PLANS) 1, k9 ,e/-rT ,��/� ��`/, hereby certify that the applicatiom,for disposal works construction permit signed b me dated �l/ ! concerning,the Y P g . . property located at D Z,)IfQBI-1 le- ®�' w,��� meets all of the following criteria: 2. There are no wetlands located 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" y There are no variances requested or needed u� If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation.- Please complete the following: A)Top of Ground Elevation(according tothe Engineering Division G.I.S.map) �72-,f B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED L DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER ' r ti [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, .this plan should be submitted]. ° q:health folder:art LPL