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HomeMy WebLinkAbout0070 NEWPORT LANE - Health LANE OSTERVILLE... A 166 090 - TOWN O/F BARNSTABLE LOCATION V SEWAGE # ZO® VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �Or ®Gy % wu 77/7,-Pyv SEPTIC TANK CAPACITY AAV gel 6 S 1, LEACHING FACILITY: j-d0 �C L�4 ` (tyre) k� a (sue) NO.OF BEDROOMS BUILDER OR OWNER / �� 4� PERMITDATE: ,!e/52/00 COMPLIANCE DATE: Separation Distance Between the: �� Maxim Feet um Adjusted Groundwater Table the of Leaching Facility 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) A I Feet Furnished by r ay6 .. • �3 i � I F E r No. � Fee 570 r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 21pprication for �Digonl *p-eUm Conotruction Permit „ Application for a Permit to Construct( )Repair(/)Upgrade( )Abandon( ) 0 Complete System 2�6ividual Components Location Address or Lot No. 7� �Q ��/� O �T wner's Name,Address and Tel.No. Assessor's Map/ParcelL/cel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 � 3 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building 3l No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /f® gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /e®O 19WI ,6_ 6?7`/X Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) l/ <P, 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 s Board H th. / Signed Date /© 31e90 Application Approved by Date Application Disapproved for the following reasons Permit No. 2-JZ/V Date Issued a '_ Z0?_0 TOWN OF BARNSTABLE LOCATION 7D ✓UP�Lv�Or'�'' ��, SEWAGE #. ZODO�{D3 VII LAGE d61' Y7/l SIG' ASSESSOR'S MAP & LOT i INSTALLER'S NAME&PHONE NO. Ae'r j SEPTIC TANK CAPACITY AWW 0.41 C- y LEACH3NG FACILITY: (type) j'do.�y� L /, �-fj A (size) NO. OF BEDROOMS . n1m + j DER VLC OWNER PERMITDATE: d COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply.Well and LeachingFacility ty (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility-.(If any wetlands exist i within 300 feet of leaching facility) Feei Furnished by._ �T r I _ i ; & i o 9hg AA at No. Fee THE COMMONWEAL'?WOF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2ppiicatiou for 30itpozar *p5tem Cott!5truction Permit Application for a Permit to Construct( )Repair(i�)Upgrade( )Abandon( ) El Complete System [fin ividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Aae Assessor's Map/Parcel ®y R�j Ile r, Installer's Name,Address,and Tel.No. 7 Designer's Name,Address and Tel.No. 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(__10 Other Type of Building G'31R°L'dlCe� No. of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow gallons per day. Calculated daily flow ?73© gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank OZ© 9�1 4X I:y7,�e Type of S.A.S. i Description of Soil ti T Nature of Repairs or Alterations(Answer when applicable) />° -Z iWAy r } 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 t is Boardqf H th. Signed / Date Application Approved by i ` Date Application Disapproved for the following reasons 1 Permit No Date Issued --- - ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that th On-side Sewage Disposal System Constructed( )Repaired ( Upgraded( ) Abandoned( )by _� � at r� �Al d/� h, Q SrU/� �'_ has been constructed in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer A d The issuance of this permit shall not be construed as a guarantee that the s�strem)will function as des*?ned. Date 1i 0 1017 Inspector h./� l����{- 0 � I� 1lV 1 ------------------------------ - ------ 6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwig;poar *pgtem Couttructiou Permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at �� 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 Date: Approved b pp y U&" ' NOTICE: This Form Is To Be'Used For the Repair Of Failed Se••tic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRIICTION PERMIT(WITHOUT DESIGNED PLANS) D I, !1 ��r� �'' 8�� � � hereby certify that the application for disposal works construction permit signed by me dated /01y149 concerning the property located at 7e �f/tfiYU,p®I'"r /"t7. *>7/i%11f meets all of the following criteria: i/The failed system,is connemed to a residential dwelling oniv. There are no commercial or business /uses,associated with the dwelling. Xnere ae soil is classified as CLASS I and the pe:coiation rate is less than or eaua! :o : minutes nee inch. are no wetlands within 100.ee,of the orouosed septic.system There are no private wets within 1=0 feet of the proposed sen_tic sase:n. +� '.here is no increase in flow.ana/or change in use proposed +' There are no variances.requested or.needed The bottom of the proposed leaching facility will not be located less than five feet above the ma.,dmum adjusted groundwater table elevation. (Adjust the groundwater table.using the.rimptor method when alicable} lif the S.A.S. will be located with 2f0 feet of any vegetated wetlands. the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please.complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation d v +the MAX Sigh G.W.Adjustment. 2- DIFFERENCE BETWEEN A and B SIGNED - DATE:. 1101 w [Sketch proposed plan of system on badcj. g ham SWW.an pe r ) If old '0 0 0 / 0 I 9argeP 7® liew���`r- ��t, LOCATION SEWAGE PERMIT N0. VILLA-}G- E INSTA LLER'S ' NAME A ADDRESS IB U 1 L D E R OR OWNER DATE PERMIT ISSUED DA T E C ,0 M P L 1 A N C E ISSUED , aryl- 1rY t i ���2 ., �� -\j Ili �r � (;� -1 . ��) a� . � i �� fll ��'� �r . _ _ .. � : • , ___ _ _ .,� r A No.A.2=..L3.Ne .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---------- ................. ................................................................................... Appliration for Bhipoiial Works Tom4rurtion "amit V Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................................ .................................................................................................. oc on-Address 0 A.....".t,--------f........ ......... ............................................. .....JZ.I�A....17fu--- .10.......... ............ .................................................................................................. ...................... ........... -------te------- ------ Instal Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.:_____3.....................................Expansion Attic.(qd) Garbage Grinder Other—Type of Building 7----------------------- No. of persons............................ Showers Cafeteria Otherfixtures ................................................................................................ rZ..................... Design Flow.......... I.........galloip i)er person per day. Total daily flow.. ..............gallons. iquid�cafacity?40.66"..gal� Length-/,(O........ Width.;K.2....... Diameter---------------- Depth............ Septic Tank—L V A Disposal Trench No_ ____________________ Width______._._____._.__./ Total Length_.____.___._ .... Total leaching area....................sq. f t. oc ..A Seepage Pit No.-J.:------------- Diameter........ ......... Depth below inlet____.._____._._:____ Total leaching area....ZQ.0......sq. f t. Z Other Distribution box ( ) Dosing tank ( 1) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutesperinch Depth of Test Pit________._________._ Depth to ground water_._._.........___.__.__: (Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._______....____.__._... P4 ............................................................................................................................................................. 0 Description of Soil............................................................................................................................................. U ..............................................................................................................................I......................................................................... --------------------------------------------------:--------------------.............................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable.................................................................................. ........................................................................................................................................................................................................ Agreement: _X The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance Vith the provisions of TL I TL 1Z 5 of the State Sanitary Code—The undersigned further not to place the system,�m operation until a Certificate of Compliance has b s ed y Atheb rd i h �h......... Signed . .. ... ........... .. ...q. .. ............. ......... ................. ............. Date ... ...................... Application Approved By......... .. ................................ ......5.7 Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date s.................... t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....---...... ..........�............O F....:..................................................................................... Appliration for Bi4poaal Works Towitrurtion "trout Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: :: .. � �-. ................................. ............................................ .......................................... ..... -- Location Address or Lot.No i�� ?tee. ' ' f �. c .....................__..... .... ............-•-...... O?vner Address W Q Installer' Address Type of Buildingd` c ,�jA.. ;i� `� . Size Lot............................Sq. feet Dwelling No. of Bedrooms....._.:.�................................Expansion Attic (?%e,) Garbage•Grinder N) Other—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------- •-•----------•---• . . -- d ,» a --------------------- Design Flow..........�4._�:_._� . ...............gallons per person per day. Total daily flow... =_M_._ _.___._.s P Y Y .................gallons. WSeptic Tank—Liquid ..gallons Length.A ........ Width._'`.2...... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length..___........,,...... Total leaching area___..__............_sq. ft. Mt 41 Seepage Pit No:..�............... Diameter•��...�:.____._._ Depth below inlet........_............ Total leaching area... ......... ft. Z Other Distribution box ( ) 'f Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1............:.:minutes per inch Depth of Test Pit.................... Depth to ground water--_•_-_-__-__•__--_----- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••-•--•-••••--------•--•-•••---•....................•-••---•---•-•--•-•-•--•........-----•----------------------------- ••-•-•-------•------------------------ 0 Description of Soil-------------•••------•---•--------•------.............-----...----•------••------------------------------------•----------------------------------------......._...._.. x W --•-------------------------------•-----------•••------•------•-•••-••-••••••...•••-•-•-•••-------------•-------••=•-----•-•-••--------•--•-----•-••••--•-•-•-----•••-•••-••••-•--•=•-------------_..... 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 Sanitary Code— The undersigned furt1,e sees not to place the system in operation until a Certificate of Compliance has beert'`'ss ed y the fbb rd h lth Signedt. .......................... _ Date Application Approved By.. y .............................. -•--=�.e.37n r'�=--•--•--- Date Application Disapproved for the following reasons---------------••-•....-•---•----------------------------...---------•-----------•-•--•-----•-••......-----••-•-- -------------------------------------•--...-----•-••-------------•----•--...----•--•-------•--.....-•-•--••••••••--•---------------------------•-•-------•---••-••-•-••-•----•------•-•-•--•------•---. Date PermitNo......................................................... Issued--•-------.......-----------••---•-••------•---------•. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD, OF HEALTH :.........................................OF..................................................................................... �rr�ifirtt#r of f�ont�li�nrr _. - - THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by, ..._....-- ........-•-.....--••--•..............•---------•.........-•---•---•.......--•-------.........••-•-•-•--•-•-------••-•-•--•-•---•-•---------.._..........----.....--•--•-•----•-- Installer at. ��'` ,r .._ ..... -•----------------------•------•---.........------•--.......---------•--------. 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 No..... z"_ _ .......... dated................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................................................... Inspector__._._- --•----------•-•-•---........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF....................... • FEE..................:.... Eliipooal Works Tonstputban Vanfit Permission ihereby granted................7,,o`-.........0-•-%:� ---- .. ...------•--...._..-----------------.........---•---•....---....... .... 11� to Construct_( or Repair, .I an Individual Se = ge Disposal Sy,�tem atNo... ��t, '`.. �...... .....� ~---•-----•-.................................................................. Street ass own on the application for Disposal Works Construction Permit No.................... Dated ice!! ....................................... G Board of Health DATE.................1S � FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS S%wGLC—. FAM1 -y - 3 BEoROO/v1, WO GAtz5A6E- 6QjwDEt2- 8'~' Df--%L*( FLOW = Ito X ?, = `330G•Pt� z SEPTIC. TAtiK = 33OX15C>% =-495G.P o Q I 1°oy'e y M•° f iam,x U51=- loan GAL. S �14 +1 -+ DI'5P5AL P1T E U5 tUoD GAI_. exr 1'2 -rnnK yl •N,- •5%DEWALL A?-S4 = 150s.t= ° s 150 5.>+ X �•5 = 3?5 6.r'q t3� $OTTOM AIZE-Az jO 1 S,F, ql'.' °R"P•' 6 GA q -ToTA1_. c>s,5iGN = 42-5 G.P�- •J 3 z FAD, -TcTAL. DA 1 L�( FL OV4 -= 33o G•PD. ay4�1 A` �,• N PS ZGOLATIO�l RATE: 1"iN 2MIN orZL1=55r qu'� LAN VriLL.IAM .` b N E�1 PoR`T L. fiN I, �PTS.i4cn � . STf wIOSe� TOP FWD 97,1 ♦�y♦�v 91,0 ►Nv. ♦7 ♦ % '�� S STD LCNM INJ. b suss so„ D1>T. INS. GAL. Bo�C St::vr�G 88•b' t oao I N� y.4.3 TANK ' GAL.. LE A C" P1T INV. INV. - ..-. WITu 93.E 54.1 �� '/L♦i G-- YL ` WA S►•11n D V () VroNE 87.'1 j �- GE2TIFIGD PLo-T Pt.-AtJ Ij i� PRoFILl� Locg-rloN OsT ERv 1`1_E, .I i NO aGALE SCALI✓ �1h = �Fr �AT.F 5�1o/e Z- go wAT>rR I 51-7 / 8 Z. p L p.N4 R E D E 2 E t-A GE 1 GE �TtFY THAT TNEP�oP• FovHn, SHOWN MER6o1.1 GOMPLYS �.D T 8� A Q 0 5ET5.GK 12- U19-F--ME.NT'!:5 oF -TNI~- -TCsWN ot= its, NOT' 3-1 3 D LOGp.TE- WITNItJ TOe GLOOD P 4.tW DAT Z- BAxTSV-. wyc- INC. R.EG I S��26U't-AN I,S u izY EYoL'S TW5 PL/-'\N 15 NoT . OSTGP-ViLLE- - MASS. IN5TRUM6NT Su2Vr--y �—THC DFFSE.TS 50,OU►,D I No'C ENE- V5<r0Tb L-CT 1-INE-15 APPLIGA"T- DP.'N� �L. � .7)A\-Y