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HomeMy WebLinkAbout0190 PARKER ROAD - Health 190 Parker Road Osterville I� A=216 - -040 TOWN OF BARNSTABLE LOCATION SEWAGE# VfLLAGE ASSESSOR'S MAP&PARCEL// a INSTALLERS NAME&PHONE NO.�//Aer �l Z e'�4e/l %�Cf SEPTIC TANK CAPACITY ,0e j'"e"G "94e• LEACHING FACILITY:(type) Apo® 1�tlde 0A'/y (size) �4 NO.OF BEDROOMS P K� OWNER G�'i6' ► d�1'0�� T/�ldr � _� PERMIT DATE: 10;2 "4"—/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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) _ _oe) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Ife o OT1 3° 3 N . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftphration for 0spo8al *pstrm Constru>rfion i3Prmit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. j g 0 PAR j[qZ 10 05 r �Ouwn`err's Mpne,Address,and Tel.No.�� o Assessor's Map/Parcel ((p qQ � RD V f Installer's Name, ddress,and Tel.No. S68—ctn-9Fc7 7 Designer's Name,Address,and Tel.No. goukolo I5 <te Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ZA gpd Plan Date Number of sheets Revision ate Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) C-(NE C(rfAu6J Ems? 041 f 514G' ®f g00S6- Tn 56()(G TAU(:: Z'IUSi�IL AISL9 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 Certificate of Compliance has been issued by this Board of He h. Date Application Approved by Date cl d Application Disapproved by Date for the following reasons Permit No. Date Issued Now • Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: <„ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Voposal 6pstem Construction i3ermit VN Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) Complete System Individual Components F Location Address or Lot No. jq b PAW.JGPPL0 05-r Owner's Name,Address,and Tel.No. MIL65 4 KAz(4(4=190 pal c.us�c Assessor's Map/Parcel- (((o C': j �. Installer's Name,Address,and Tel.No. $13—c -n•f 9-7 7 Designer's Name,Address,and Tel.No. CGl0C0)106/RO49O-X Z' G,OUA Cep 153 ZOW04a NIA Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures n Design Flow(min.required) gpd Design flow provided d /1 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. _Description of Soil r - i Nature of Repairs or Alterations(Answer when applicable) (, N& Ck4v Faces o44�s/a cF' 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 Certificate of Compliance has been issued by this Board of Health. S' fied Date f R Application Approved by. Date Application Disapproved by Date for the following reasons 14F' Permit No. 7 Date Issued -- ------------------------------------------------------------------------------------=-------- - - ' THE COMMONWEALTH OF MASSACHUSETTS �4/ BARNSTABLE,MASSACHUSETTS y.4 (Certificate of (Compliance y THIS IS TO CER IFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by C1e4 D G Wi /D, , at P40 P040K Ebb ���"'¢ �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.— 12ated C� Installer� eflz �� Designer /J #bedrooms /� Approved design flow gpd I t The issuance of this ermit shall not be construed as a guarantee that the system will fu et as esigned. Date Inspector --------------------------------- ----------------- ----------------------------------------------------------------------------------- No. /o bz Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Veposal *pstem Construction 31ermit Permission is hereby granted to Construct( ) Repair OO Upgrade( ) Abandon( ) r System located at � �L RO� f 11',r and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 pe item t. Date d Approved by t TOWN OF STAELE LE CATION/ � f i�- _ SEWAGE # V,I LAGE� �P/�y��lF ASSESSOR'S MAP &LOT 2, INSTALLER'S NAME&PHONE NO.���f �E�o 5 1-26 f4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 12 (size) NO.OF BEDROOMS 2 BUILDER OR OWNER PC( l 0 W 2 l l PERMITDATE: / ' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility % Feet r 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 o�,1f �aching,fac' ' ) Feet Furnished by 41, /_C4 • ..�__ � i� �i .© 3 ,� o . �� � ' �, �_�� �� v1 `� / lfo - 0V No.._,f__y_'_ Fss...�Q�'�........ _ THE COMMONWEALTH OF MASSACHUSETTS j 777 BOARD OF HEALTH TOWN OF BARNSTABLE Ap ira titan for Bi-qVntiaal Works Tonstrnrtinn rami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System,at: l*4/2 �c.e .----.< �i'-.---•---- ----------------------•-...........-----..1:.---•-••-----------------......_......._..------ . ............ _..: - --- - --- r Los �ion-Address or Lot No. ............. --•---.._..-•-- ...>. -�.-A........cn..g r ..................... Owner Address Fs•----------------------------------- ------3 ............ -•----•-2-4 � �.. Installer .Address d Type of Building Size Lot__/ZA4,�........Sq. feet U Dwelling—No. of Bedrooms_______________3___________.____._______Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ______________ No. of ersons............................ Showers — Cafeteria Q' Other fixtures _________________________•.___._ W Design Flow...............................:_ __..gallons per person per day. Total daily flow...... _3�...........................gallons. WSeptic Tank—Liquid capacity/SG0_gallons Length_,_.®-_4`_ Width__5�K'__ Diameter____ ________ Depth_: .?."- 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 (✓S Dosing tank '-' Percolation Test Results Performed by-__. - C!fn�.�T-� �t _________________________ Date__ ."�S_-.�� W ............. Test Pit No. 1..... -.....minutes per inch Depth of Test Pit---lzlz!... Depth to ground water_______________.......... 44 Test Pit No. 2......i._____minutes per inch Depth of Test Pit...../.;k........ Depth to ground water________________________ Description of Soil.......-' ._. .._ st t3._...-_._. .. ld��'1_._1 6._ >�,- R - -------------------------- x U W UNature 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 Environmental Code—The and si ned furl er agrees not to /11acethnsystem in operation until a Certificate of Complian d by oard of• ealth. �Signed ....... -.. ---------- Dat ApplicationApproved By --------------j Z......0....---...---..................................--------------..------------ ---- --- Da '.. Date Application Disapproved for the following reasons- ----- ----------------------------------------- --------------------------------------....................................... --------------------------------..............................-------------------------- ------------------ -----------------------------------.................................................. ----- -------- ----------------- Date Permit No. - >-.... qq. • THE COMMONWEALTH OF MASSACHUSETTS 1 7.7 BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Disposal Works Tonstrn.rtiun jkrmijt Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 L_o_qjtion-Address or Lot No. _________________�__-_.__z.._.... ........................... ............. ..._....._.._._..__...._ Owner` Address ............... ---------•----•-•--•-------------•- ------------------ ........ ..................... Installer Address Type of Building _ Size Lot...&u ��% ......Sq. feet Dwelling—No. of Bedrooms...........:'_3_______________________Expansion Attic ( ) Garbage Grinder { ) '4 Other—T e of Building ............................ No. of persons____________________________ Showers — Cafeteria QI Other fixtures ......................................... WDesign Flow................................ _.gallons per person per day. Total daily flow...= a...........................gallons. WSeptic Tank--Liquid capacity15?.gallons Length__Io_........ Width_n '_ Diameter__--_ -------- Depth._`Depth__` =-q.."- x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No________ __________ Diameter___// ........ Depth below inlet......:`^:_....... Total leaching area__,".1 ___sq. ft. Z — Other Distribution box ( V Dosing tank ( ) � Percolation Test Results Performed by.... _________________________ Date... ............ Test Pit No. 1_.....Z=___minutes per inch Depth of Test Pit....ZZr t_t_L Depth to ground water________________________ (z, Test Pit No. 2!:_,Z_7-_minutes per inch Depth of Test Pit...... =?_•'..... Depth to ground water__________ _______ ........................................---•---•-• ........ ---------------------------------- ------------------------------------------ _........... . Description of Soil � ' ..a ! = --••` ..!L�',��t./.. � ................. W -----•---------------------------------------------------------------------------I-----------------------------------------------------------------••------••-----------------•--•--••----••---•------- UNature 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 Environmental Code—The unde s)ned further agrees n/Date lace the system in operation until a Certificate of Complianc,li ss. d by th oard of- �alth. Signed ------- ......�- / Application Approved BY � n.e4.,4 ------------------------------------------------------------------------------------ ---4: ( . Dace Application Disapproved for the following reasons- ---------------------------------------------------------------------------------1•---------------------------....I-- - ------------------------------------- ---------- - -- ---------------------- ---------------------------------------------------------- ------------------------------------------------------------- ---------------------------............ Date PermitNo. ---------------- ------------------- ------- ----------------- Issued ------------------:------......--............. ................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cgerttftxr to of Tantyliattric THIS IS TO ERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -� ' ,,� �p Installer at .......]--�V..---- ....... 1 ......................................- has been installed in accordance with the provisions of TITLE 55cyof The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....1 .4/-- ��--.-.9.............. 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 q TOWN OF BARNSTABLE No..... J...y.:. FEE.... /.?1-1......... Disposal � u—rks Tonstrurtion Uplami# Permission is hereby granted----------1<t/(1!k�- ........ P�'GK;}=----------------------•-----------------•-•-•-.._.._.............•••.............. to Construct (Q or e air ( ) an Individual Sewage Disposal System atNo........ 0-------- f�l?.'.1-_---..1Q�Q ., r. ^�. �'........................................................................... ' •- t -r--•`5--� Dated.-----1.�•—(...-. Street as shown on the application for Disposal Works Construction Permit No�. f_ ........................... .CIS..g._�1 .-----...----•--._.........-•---•-•--....--•-••-•••--•. �J Board of Health DATE ` =--- '- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS Y ; f { 1 ' c 3 i2i.i4 4 4`I 4 27 ' b R 1 v r_ 10 -- - — - I1,045 o{ �fL F j,,oa(� F 0 4 t (puGficJ i 44�b I +' i N 1 2G{ J !_ H p"S4 g 3 - j lvoo D-6 9 a A-LL Ccya e Cvtqi,ne.eAi,vus 49 �dc�oa t`?oad I l q /dganx ii, M 02601 I - V t � — pao ite No State ��-` • �� x I ltjit 44: ' N c i f•J — A �{ -1� i I I{'•{� F {jF6 `� t� ' '1 { i r ' No. be.dtoomi 3 Z• 4ti� stow 330 cpd + f„ t each.i n,, a tea 346 e " 346 SZ& /)� o .Land an vateiwZue, N� ; I Capacity 4141 qpd 9o�t IN. Pawtod.l.:i Cqeiru� Cot I as dliown on a p Pan made �olt + i plan C /Javtdb iucy dated 8-30-63. Ctevafi Dnd. ace on an adaunred datum, s I/ c�te:--Ace�it--- Ze-,Toa�To -wa7.th f 1` Jett Pit #P-8177 4 Made 2-I 5-94 f t` wit. cd. is" F r 4 NO water encouw,teaed /fie m. -teA4 2 nun. I -: n 9. f 49•ro - 49,c �elte-' :� COG/LJ e coal j STEM f R t vV -57 '��� _ .