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HomeMy WebLinkAbout0123 PINE LANE - Health 123 PINE LANE, OSTE.R_ VTf;T:F_ ,,;- ; _ =x°A T18:077 _ TOWN OF BARNSTABLE LOCATI1 i P SEWAGE # - f VILLAGE C)S t?Jf• k11ZZ p u ASSESSOR'S MAP & LOT jig 6 INSTA-,�LER'S NAME&PHONE NO. A C Q Z SEPTIC,,.-vANK.CAPACITY LEACHING FACILITY: (type)�2 /DLOl.I CAAaXM- ` ' (size) t!dd CIO NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: 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 • f f i a , No. //7 1 Fee$ rQ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication.for ai.5pogal *p5tem Construction Vermit Application for a Permif to Construct( )Repair( )UpgradeXX)Abandon( ) []Complete System ❑Individual Components Location Address or Lot No.12 3 P i ne Lane Owner's Name,Address and Tel.No. S5 0 3 2 7-44 2 4 0 4 Osterville,Mass. 02655 1'750'`S-.W. Terrace Drive �/ Assessor'sMap/Parcel ./1 Q Portland Oregon,97201 (� Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville-,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: DwellingXX XVo.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder(NO) Other Type of Building RES No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow 3 x1 1 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 500 + Box Type of S.A.S2-500 gallon chambPrs; Description of Soil Loamy sand to fine sand. Nature of Repairs or Alterations(Answer when applicable) Omit cesspools and install 1 -1500 gallon tank.1 -distribution box and two 500 gallon chambers Packed in stone. 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 y this B d lthd. Signed _ Date 61 3 0/9 8 Application Approved by Date Application Disapproved for the following reasons Permit No. _ ��� Date Issued _.. .... ,•Yif. .n.�. .-: _-. ..iy„ �iN` - • Tr-rT , n....e.. .. 'fin..... . ... .. � .., No. //( Y • ` . Fee $ 5 0 THE COMMONWE�k-T MAY. ACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BAR��,�TABLEs MASSACHUSETTS ✓ Application for X3tgPoga1 *pgtem Q, �%5truction Permit Application for a Permit to Construct( )Repair( )UpgradexX)Abandon( I Complete System ❑Individual Components Location Address or Lot No. 2 3 Pine Lane` Owner's Name,Add.-s s and Tel.No 1�L 4 044 Osterville,Mass. 02655 �;r =_ <Q�e Drive Assessor's Ma /Pazcel '/ � p f/ © 7 `.Portland Oregon,97201 �` � S Installer's Name,Address,and Tel.No.5Q8—7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. F J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling XX&o.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder(NO) Other ' "'Type_of Building RES No.of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 j1 1 0 gallons.' Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 + BOX Type of S.A.S2-500 gallon chambers Description of Soil Loamy sand to fine sand. ' Na a of Repa'r or Alterations(Answer when ap licable) Omit cesspools and install 1 -�500 gallon tank.l:-distribut�fon box and two 500 gallon chambers parked in stone. 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 Enviro nmental C ode d not to place the system in operation until a Certifi- cate of Compliance has been issued �y this B d,� lth. Signed Date 6/3 0/9 8 Application Approved by Date '_ '_ qE_ ` Application Disapproved for the following reasons Permit No. .. y�7 _; - Date Issued 2 '9 r ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )UpgradedXXX) Abandoned( )by J.P.Macomber & Son Invc. r at 123 Pine Lane Osterville,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 7— Z—97 InstallerJ.P.Macomber & Son Inmc —Designer J.P.Macomber & Son Tnc. The issuance of this permit shall not b yconstrued as a guarantee that the system will function as designed. Date AX Inspector No. --------------------------Fee 50.000 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mtgogal *pgtem Congtructton Permit Permission is hereby granted to Construct( )Repair( )Upgrade:KX )Abandon( ) Systemlocatedat 1.23 Pine lane Osterville,=Mass. and as described in the above Application for Disposal System Construction Permij jhe 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 ermit. Date: 7 z ' g Approved by :r 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, Joseph P MacomhPr .Tr , hereby certify that the application for disposal works construction permit signed by me dated 6/30/98 , concerning the property located at 123 Pine Lane ostervi i le,Mass_ meets all of the following criteria: • !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 I There are no variances requested or needed. • 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 to the Engineering Division G.I.S. map) B)Observed Groundwater Table Elevation(according to Health Division well map) r� � 14 SIGNED : DATE: 6/30/98 LICEN SEPTIC SYSTEM INSTALLER I 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]. q:health folder:eert 4 `' I 1500 gallon septic tank 1 -500 gallon 1 -Distribution Chamber Box 1 -500 gallon Chamber r + i TOWN OF BARNSTABLE LOCATIQW 3 P SEWAGE # VILLAGE P L L L '° _ASSESSOR'S MAP &LOT jig INSTA'LER'S NAME&PHONE NO. SEPTIC,,ANK CAPACITY LEACHING FACILITY: (type) ' �0 if,e�'��'�' (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: l 30-9 �COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) exist Edge of Wetland and Leaching Facility(If any Feet within 300 feet of leaching facility) Furnished by i i �� r � i�= / � � � � / f �v � � y� ; ". . i ' � �� i � Y'� is