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HomeMy WebLinkAbout0414 OLD MILL ROAD - Health 414 OLD MILL RD% OSTERVILLE A=143.021.004 00 o V G e t 1 No. � Fee /'kT3 THE COMMONWEALTH OF MASSAC ETTS Entered in computer: Yes / PUBLIC HEALTH DIVISION -TOWN OF BARNSTA LE., MASSACHUSETTS 0(pprication for Mi5po5ar *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System 1:1 Individual Components Location Address or Lot No. `'[ ( ©Lb Mill ner's Name,Address and Tel.No. ! , Assessor's Map/Parcel 1 1,f 0—k�o Installer's Name,Address,and Tel.No. —! Designer's Name,Address and Tel.No. 1 c►T �1sdltq W i 'GM �ErZ _?"? -®7 s� Type of Building: Dwelling No.of Bedrooms Lot Size 44,4M sq.ft. Garbage Grinder( ) Other Type of Building No. of Perso s Showers( ) Cafeteria( ) Other Fixtures Design now qqp, gallons per day. Calculated daily flow gallons. Plan Date !) j gqE Number of sheets Revision Date Title Size of Septic Tank_ ® Type of S.A.S. - Description of Soil r 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 Environ emal Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Boar f He Signed Date Application Approved b r Date Application Disapproved for the following reasons Permit No. Date Issued °' 4f/� TOWN OF BARNSTABLE % � j 3 b 1` • ' ' LOCATION �f S & u6,Ll k-'A SEWAGE # VILLAGE 6,ST2rt u,C._ ASSESSOR'S MAP& LOT S- INSTALLER'S NAME&PHONE NO. i !� lsst�d G 'P9V—b V�f�,! SEPTIC TANK CAPACITY /S�60 6wr LEACHING FACILITY: (type) D �.4L , cC (size) ,b'ar 33S S! NO.OF BEDROOMS .3 BUILDER OR OWNER 400m ,, PERMITDATE: 2a— COMPLIANCE DATE: Av- o yp 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) I Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - o 4 LA e J9 TO T� 3 Z j i l t Z N 00. r � Z Gtww � � 4 , � TOWN OF BARNSTABLE LOCATION s 6LA UA 11L &A SEWAGE # 9 S- VILLAGE u.(Lo ASSESSOR'S MAP & LOT 5" INSTALLER'S NAME&PHONE NO. 6 B t4,-) �` K iS6 Ll, )G 1V,9--t V yy SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3 - G.41 'l( (size) B"k' 33SY Z NO.OF BEDROOMS -3 BUILDER OR OWNER poW,&-A-5- PERMTTDATE: , — Zb-9j�! COMPLIANCE DATE: % '-f-5� 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 * -No. tJ�'4 Fee THE COMMONWEALTH OF MASSAC ETTS Entered in computer: PUBLIC HEALTH DIVISION — TOWN OF BARNSTA LE., M SSACHUSETTS Yes Application for �Digpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System, El Individual Components Location Address or Lot No. Lot J�" 4 l Q L-b Wh ner's Name,Address and Tel.No. I Assessor's Map/Parcel -. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. WME12r ►�u s I Type of Building: �,j Dwelling No.of Bedrooms y 1 Lot Size 446W sq.:ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures,'11 Design Flow N4V gallons per day. Calculated daily flow Ro gallons. Plan Date MAC& ( l l Numbed sheets, ' Revision Date Title a•,:3 �'„O Size of Septic Tank C70t Type of S.A.S. Description of Soil • Nature of Repairs or Alterations(Answer when applicable) 4 I Date last inspected: ` Agreement: h 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 Enviro ental Code and not to place the system in operation until a Certifi cate of Compliance has been issued b this Boar of'He 'h. Signed l Date Application Approved b Date, v �� r' Application Disapproved for the following reasons r Permit No. Date Issued ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TOWERTIFY, that the On-site Sewage Disposal System Constructed(`)Repaired( )Upgraded( ) Abando ed( by r_ at < hqs/been constructed in-accordance with the provisions o � itle 5 and the for Disposal System Construction Permit No rfa dated r Installer Designer The issuance of this q mit shall not be construed as a guarantee that the system will function as designed. Date Inspector V r2 —�.:-- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mis pogar *pgtem Congtruction Permit Permission is hereby granted to Cons t!��*( �U,pgrad�)A ando 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 permit. Date: Approved by APPLICATION FOR PERCOLATION TEST AND OBSERVATION O S 2'� - d� LOCATIONr DATE VILLAGE G FEE APPLICANT (Non-refundable ADDRESS TELEPHONE NO. ENGINEER TELEPHONE NO._ DATE SCHEDULED (Applicant's signature) • • • • • • • • • • • o o • o • o,o 0 0 0 o e o o • • • o 0 0 • o 0 0 • • • • • • o • • • • • • • • • • • • e o'o o • • . . . . . . . . . . . • • • • • • • • • •.• ASSESSOR'S htAP 6z :N f �L- SOIL LOG SUB-DIVISION NAME DATE ,l `` © ! TIME .��j Y �� �� L � EXPANSION AREA: YES N0� _ ENGINEER BOARD OF HEALTH TOWN WATER VPRIVATE WELL � EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact locat on of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: F �-gG ( oo 1f CO z1d f: s..1 1% OF Atz� Win' `4 CIVIL h No.30792 C F9ECISTE 4'� \ 1 6 01" t PERCOLATION RATE:- - C� �h TEST HOLE NO: ELEVATION: TEST HOLE N0: ELEVATION: 1• 5Y2 Z,5/Z 1 2 4" DUFF/0V-6 LOAM . 2 Z^ gut=r--/otw '2.5`, 51 Z 3 4 5'' (,c�ArM�' sAN0 4 I17> y 5/ L 5 12" �oDMy SAW"> � 5 6 (v 6 - 12" Lc),&,MV SANG . 32�� Lc�Aw�� SaN� 3 7 cLr�,t� cnAc2s�'s�+N� 9 9 8 8 1b �2,.� 6 10 Tex (z�v t-L_ G Z% 10 11 '� 11 12 12 13 13% 14 _ 14 ._.. _ 15 15 .16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD,—EACHING PITS f� LEACHING TRENCHE UNSUITABLE FOR SUB-SURFACE, SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY- $Y P. E• AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT _ i I TEST HOLE LOG l`JC_-ZD /��/��. �0�,� DATE:=.F�Z3. 9_l9S,e a e c ' SOIL EVALUATOR:--0<.•�llSo.; C s4 ". WITNESS:. 1009. 8Z./B f PERC RATE:- '� zit/�i✓,/%�.�h� , S" O La�+� j. S ,. q,,ti6 'b2 G $ Y low 45;plp IV s -� $. s ,. , / S�. f DATA,., ' '',4 ---`— DAILY FLOW: (y) DRMS.z 110 GPD�r1�`a f'GPD SEPTIC TANK: j/9c)GPD z 200/o $c� GPD - USE:/`5ao GALLON PRECAST.SEPTIC TANK. , r y LEACHING LEA FACILITY u F `` of 0 � CAPACITY:. ,. . r _ SIDEWALL:;7A_�_< yg BOTTOM-_f-.3'x3S' r , -PWEcc%M� 2 \_ TOTAL. _ .,_.. yS7. booell _ 7 r _ so, NOTES. " 1. ALL PIPE TO BE 4"DIA.SCH 40 PVC., t 2. PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION BOX. O �SUBYE1�p• 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN 6"OF FINISH GRADE 4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A - GARBAGE DISPOSAL z i S SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED ON A 6"LAYER OF STONE. 6. INSTALL GAS BAFFLE IN OUTLET TEE. r LAYEROF 3A"PEAsroNE OVER 3N"•11/2"WAME STONE ALL" w AROUND TOP OF FOUND. / ss,Sze SY$? sy?� � ✓�. , sz.s� 3�' ' �i Ss.®e` SS,zs SEPTIC SYSTEM PROFILE ; �,e�� x� - SITE SEWAGE PLAN GENERAL NOTES _21. ,� r FOR a 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL UTILITIES,ABOVE AND UNDERGROUND,'PRIOR �T..S TO ANY EXCAVATION OR CONSTRUCTION. 2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH PREPARED FOR 310 CMR IS.00:TITLE V. 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE DETERMINATION. 4 DATE: — -. 4. ALL DISTURBED AREAS TO:LOAMED AND SEEDED. Y SCALE:- S. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY REQUIRED INSPECTIONS ,p,,_ 4o�' DANIEL' eeAMAH N o CIVIL .^ V No.326W t " WELLER & ASSOCIATES _ � R. 1645 FALMOUTH ROAD CENTERVILLE, MA. 02632. 3 TEL: (508)775-0735 FAX: (508)775-0754 ' APPROVED BY: — — — — — — - TEST HOLE LOG ..� ��/�.C. .��©�,� DATE•.��•Z3. 9, /S�'e . °���u; . - SOIL EVALUATOR: d• .t/�lSo1�` csat I WITNESS:. �/. ;Iw•�.vi,�/c - ` PERC RATE: S 2.�//i✓, /.J�h� x , ,en>7.• W S� q DESIGN DATA DAILY FLOW'(y) DRMS.Z 110 GPD=Y1'`a .GPD SEPTIC TANK: f 1�vGPD Z 200%_ c� GPD 4 GALLON PRECAST EPTI • USE:/S� P T S C.TANK LA a � 4 � FACILITY:' LEACHING .USE C3) SXdSX � ' S �w�c.cs x. 5� ✓� �., , CAPACITY • ► _ `- SIDEWALL: - — - -- BOTTOM 13!x 3T SIX,b•?Y (� tY' -�' r ,L \. TOTAL. _ 5�• 9 ---- mow, �. Af 4"eL a .. • `,NOTES: � � M ., �� s �` 1. ALL PIPE TO BE 4"DIA.SCH 40 PVC. ' 2. PIPE TO BE LAID LEVEL FOR 2'OUT OF DISTRIBUTION `v fi BOX. 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN 0 SURtlE��p ` 6"OF FINISH GRADE A. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL I SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED F ON A 6"LAYER OF STONE. ' 6. INSTALL GAS BAFFLE IN OUTLET TEL 2•LAYER Of 318•PEASTONE OVER 3r4'-f I/1•WASHED STONE ALL AROUND TOP OF FOUND. 1 � SS,25 SEPTIC SYSTEM PROFILE s:' Y SITE SEWAGE PLAN GENERAL NOTES FOR I. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR• [[ATK� TO ANY EXCAVATION OR CONSTRUCTION.L SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH PREPARED FOR 310 CMR 1a 00:TITLE V. 3, THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE DETERMINATION._ �" 4. ALL DISTURBED AREAS TO LOAMED AND SEEDED. /��.�._/0 4.._!'�3 -SCALE /...— � S. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY ml REQUIRED INSPECTIONS. • AA OF& O DANIEL I.' �y BRAMAN o OWL V No.32"AC z,�= CIS E� , WELLER & ASSOCIATES _ .. 1645 FALMOUTH ROAD CENTERVILLE,MA. 02632 3 TEL: (508)775-0735 FAX: (508)775-0754 APPROVED BY: a