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HomeMy WebLinkAbout0043 PARKER ROAD - Health tA 3 i'ARKERgo:�a,�) OS 7 ERVILLE = 117-191 � m il cr TOWN OF BARNSTABLE LOCATION 3 SEWAGE # 7 S'f 7�'g VILLAGE ��� L ASSESSOR'S MAP &LOT 17-/V INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ISyd LEACHING FACILITY: (type) � (size) .30 X /y NO.OF BEDROOMS BUILDER OR OWNER _ PERMTTDATE: fo COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table and Bottom of Leaching Facility !G 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 l /� within 300 feet of leaching facility) "l/ #7 Feet Furnished by O C3o3y � • y3 r���J 3 No. � ;;+: ._ -�e. Fee �® VVV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Dioaal 6peum Cow6truction permit Application is hereby made for a Permit to Construct( )or Repair(4 an On-site Sewage Disposal System at: Location Address o Lot t No.�_ Owner's Name,Address and Tel.No. %3 �� 6_zO .* ADM -N pi-L efu s (TIr t t,Lt- , /V% R--V -a ae, V.L,3- c rc,(C /w4. Instal Name,,A-Address,and Tel.No. Designer's Name,Address and Tel.No. (e, 0(,J.dOLF.CC�b/ AjjJT771- C;r-TQPa �fr a�u� I Ci,JS-i7fAJe4---t0*3 'Alm , -I L _, , 6,14`f f_ Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building O r`f C,F_ No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow !st eL F�F- -:7 d gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs o Alterations(Answer when applicable) /N S'�-Lk A /JZ p '�3 svnL .•4f-)Y t J'� Date last inspected: Agreement: The undersigned agrees to ensure the construction 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 ' BaAdf.,Hea //SignedDate !� 7/ Application Approved by Application Disapproved for t e following reason Permit No. / Date Issued 0 36 _ No. / - `4. .� ..b Fee i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS , Zi pYication for )Di9;0o5ai 6pttem"Con.5tructioll pertuit Application is hereby made for a Permit to Construct( )or Repair(o<)an On-site Sewage Disposal System at: Location Address o Lot No. Owner's Name,Address and Tel No. '�it2 a ;Zf Z A-FJ rJ e_ f f U444-E S C,._e Arr vT-v/1c_LE 14 /lAA4. Instal s Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0/t-TVLb"777 0AJs7/1%JCA—(anJ f�VItF-Z,kA1-n C,orJS'n?^JGZ010 Type of Building: Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building 0 L No.of Persons Showers( ) Cafeteria( ) Other Fixtures /moo ..�yo y Design Flow __5A � �70 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date . Title Description of Soil Nature of Repairs o Alterations(Answer when applicable) / N S')A-(mil. A /IS70 0 ,(d yr L .3io Date last inspected; Agreement: The undersigned agrees to ensure the construction 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 ..<B and f Hea Signed Date �G 7��6 Application Approved by Application Disapproved for the following reason . Permit No. Date Issued -----=—=—=—=—=--=—=—=--—_ _ _______ ____ --- THE COMMONWEALTH OF MASSACHUSETTS f j PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/reIf-placed(j54 on by `, OlL�'�ua/' : UiNsi1'WcTanJ for G�.d / t1eC.S 0 Si`F/LW� has been constructed in accordance with the provisions.of Title 5 and the for Disposal System Construction Pe . it No. dated .Use of this system is conditioned on compliance with the provision t f rth below: w i No. .nr / Fee —7 0 THE COMMONWEALTH OF MASSACHUSETTS E PUBLIC HEALTH DIVISION -.BARNSTABLE., MASSACHUSETTS Xi9;po5al *pgtem Cougtruction Vermit Permission is hereby granted to 26/L,,r _tj i 17 CGS S /1nlcaTir�1 to construct( )rrepair(-J )an On-site Sewage System located at y� '✓Z /Zd�b and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his er duty to comply with Title 5 and the following local provisions or special conditions. All construction must b com eted within two years of the date below. © 4 Date: Approved by57 B l - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERTMIT(WITHOUT DESIGNED PLANS) I, �� - v/C-►U�� hereby certify that the application for disposal works construction permit signed by me dated /%-71gq� concerning the property located at meets all of the following criteria: " • There are _no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED : - J DATE: _16 z 7119.6' LICENSED SEPTIC SYS M INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. a• r W ' T is s: t 4 O < .00 s- ^ � r 3Y'rt ats83 • - °, kA 27 Lij .. � g5 �3Z •OOW 0� � �,;} w� ? , y o► o 8505T . c CJQ . 80-00 Y � �Y6 r 1}� � • •� �/1 by "T G78fie ': DS G P ote m s, � i �e7 ,t J"�; .�.rr .i � •V•Y I"' �- r� �/�� O r�Y' � � , ,1, O, I r .$r173� ec '�• ePIon Ra W `•. v�. Se (� y Lj ' 3 V v •a�t ouovIVIsra, PL.^" Of LO z- '� :$MOWN OK:s:pt.�► �-�'yTsW',`�t'�t'{: u1,�,ara t.� '•.t.r....,; a- ';�'1�. ; ' 'ti.+•f" "'i' Y .�. ,�N ^ �'G.� � ' ., ,Y..-n A r=. a y ��,'r�xx�• ��• e 7 LL .. r': -: aC7 •'. �, C,�{e n . (/�j CALL� �_� ._ �...' lu°.;p1. V.S.,71':��^•'✓ ie• S t ° �'i '' ` -TOWN OF BARNSTABLE _„�OCATION 43A Parker Rd. - SEWAGE # i R-117-193 & VILLAGE Osterville ASSESSOR'S MAP & LOTR-117-189 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY ��$r ' ©��l;A11&'A1 6� L i LEACHING FACILITY:(type) (size) ,0 f NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER PUBLIC BUILDER OR OWNER ` DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes k©W)r-b 6Y Ew-s 6459, 1 P loco _ c� TOWN OF BARNSTABLE LOCATION zl'3A SEWAGE # VILLAGE_ ASSESSOR'S MAP & LOT r` INSTALLER'S NAME PHONE NO. r SEPTIC TANK CAPACITY Iv coU 449 CA , LEACHING FACILITY:(type).,'� - j cN o c>C4 (,'-,T5 (size) NO. OF BEDROOMS -q PRIVATE WELL OR PUBLIC WATE ,1,V BUILDER OR OWNER --e5` � -®oc9 DATE PERMIT ISSUED: DATE COMPLLANCE ISSUED: 7 1 �' VARIANCE GRANTED: Yes No �a vs e Oic� %~C CPO- I��k (b-A i � ,ro I �" TOWN OF(B�AARNSTABLEAE r� LOCATION 4 A Qa�\�,2 �`�� SEWAGE #9;L:' VILLAGE_ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY 1(:'U O G­\ �.\ LEACHING FACILITY:(type) lobo 27T (size) �x7 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER d-�sL�. Q,- t>a-S�-�-P DATE PERMIT ISSUED: 7d i4-92L, DATE COMPLIANCE ISSUED: - VARIANCE GRANTED: -Yes No x� so US�-cA GS � a I No.. .. J....... U FEs.... ✓ 17 � THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uhipooal Workii Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: •-•-Loca'on-Address ••----•-••------------------------------•-or Lot No. y �--`...... ----..�?'QQSet -••-•.......................... Own Address a ....�.tO.. .----- �J.t�tl .... �................. 9.��.� ax...lQc°�r,.._Y1A S1N)1j t��s...-- Installer Address d Type of Building 11 Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..........=L______________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Otherfixtures ------------------------------------------------------•••--------------••••-••-••••-•--.---••--••-•---•--.....-•--...--•---------•----........._..._. 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........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... fL Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ P+ --------------------•------•-------------------------------...-•--------._...........---------..._._......................................................... 0 Description of Soil............................................................................... ---------------------------------------------••------------•--------------------------- x V = ------------•-••-•----------••----••----...---•.....-•----•-------••..._..---- W UNature of Repairs or Alterations—Answer when applicable................. ______________________________________________________________________________ -•••----------�A �9_Y�.R._..........I-Cs).Q.--__�.,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 Compli ce has b en ' ed by the board of health. Signed ....... .. .. . ..... . ............... .::..:........ ....--------....----- are ApplicationApproved By ... .... ... ... -0------ . ........... ... ... ..... .--- ................ -.-.----.-------- Date Application Disapproved for the following reaso - ---------.--.--.-._. .. ... ..... ................................ ...-.. ------------------ Date Permit No. � ` .......... .... ...... Issued .......��....-,1 '_` q� a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applutttion for Diipusal Works Tonstrudivalt ramit Application is hereby made for a Permit to Construct ( ) or Repair ()() an Individual Sewage Disposal System at: !� . ........0 S�c ctv,'4..................•-----------------------•-------------••-......----.... - • Location Address or Lot No. -------------------------•--- ------------------------------------------ - ------------------------------- Add .�..._...... ^� Owner ress W .....C2-Sg_ �'A .�'� - Installer Address Type of Building Size Lot----------------------------Sq. feet .-� Dwelling—No. of Bedrooms..........ti..............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of persons............................ Showers a yP g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures .......................-------------------------------.-----••-----------------------------•--------------.....----•-•--••----•-......--••--•-------•- 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 ( ) 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_---__•-----__---__-_--_ a Ire -------------- .........-------------------------------------------------------------------------------------------------- O Description of Soil------------------------------------------- ----------- ------------------ U W UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ---------------c - ------- ---------- .....4Q_..�...... .c-L , =► r 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 Compli ce has ben is ed by the board of health. Signed ------ U � ,----------------------- -- --- -�yj te Application Approved By �/D ._�/.L�-----�'�; --- -------- ------- ----------................. -------- Application Disapproved for the following reasonCy' ................................................. --------------------------------------------------------------------------------------- -------------------------------------- .------- -- ._�..-- .. 1--- --- - --------- .......... ) Date Permit No. y -------------------------- Issued �� / `� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cgex#tfiutt#e of (gIItttylian e THIS IS -0 C TIF , Th t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------- ' --= j� �% -- at ...................`. y d V-—' i- '--'� Ih t J ,�s�aii ._(..5--.,1/ .V f(i 1 has been installed in accordance with the provisions of TITLE f The Staaenonmental Code as described in the application for Disposal Works Construction Permit No. ._......._�.... ''------ - dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE e' STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------- /7..... -( Inspector ---------------- - I/ 1....,1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No. r FEE..... 141111off nrk nnm#ry- - tatt amit Permission is herebyranted-.!-_ ----Qe....... -._�.. � C. . ----...----•------•----- to Construct ,( ) or Re pgj'r ( )Ya grid v ual Sewa-t.- is osal System Y y' �a - '� - t - •••.. --- =' --------•-• ..---•------ Street dJ ,s ��,,��,, as shown on the application for Disposal Works Construction Permit o.... .............. Dated_ .2. __!-A__._.. _/.v...r� //4 Board of Healt ---DATE 7 ,� ------------- FORM 36508 HOBBS♦k WARREN.INC..PUBLISHERS