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HomeMy WebLinkAbout0225 POND STREET - Health 225 Pond Street Osterville A = 119 030 I No. 3— � Fee J v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Mi0pozat *potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. "N!1 /� Owner's Name,Address and Tel.No. Assessor's Map/Parcel f J� —30 �PQ -C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �Ul�f✓/w Jr)�iu W�jj ILl5 `57 Ee-ts 4 tv 4l/ Lo5`��6r�rr ��� Type of Building: Dwelling No.of Bedrooms Lot Size L sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow -33 0 gallons. Plan Date W 4% /0 3 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. �i F iu G Li Description of Soil; ele"y 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ued y this Board of 14ealth. Signed Date `9/ Application Approved by . .S' Date 2q o,7 Application Disapproved for the following reasons Permit No. Z 00 Date Issued 03 / s /� No. ©3— b s�,_ _._,,; . - ` Fee 50 } ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes yy F[FF PUBLIC HEALTH DIVISION -TOWN OF BAR-NSTABL _s MASSACHUSETTS T 2pprication for Zigogal *p2;tem,/Q f4125truction, permit - 6 Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No.j a,:5r PdAICJ 51 /� Owner's Name,Address and Tel.No. O S To,r y// Assessor's Map/Parcel 3� =^ 5 1 e u ,PS Installer's Name,Address,and Tel.No. ,-Designer's Name Address and Tel.No. -1� ,^ I ' 0 8 yaZS 9 yam, J V C]►1/V W A Je te, S .51 d tv aLl I/ Q S fis v L/i // Type of Building: f Dwelling No.of Bedrooms 3 Lot Size A 14, L sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily',flow .31-0 gallons. t Plan Date W; 3 /0 3 Number of sheets 1 Revision Date Title Z Size of Septic Tank /000 Type of S.A.S. Description of Soil, 0/6 N Nature of Repairs or Alterations(Answer when applicable) Date last inspected: -- Agreement: i 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 place the system in operation until a Certifi- cate of Compliance has been issued by this Board of ealth. / 1,4.3 Signed Date / Application Approved byAgv=� Date 12qlc.7 Application Disapproved for the following reasons Permit No. 2 OU Date Issued 9 ` t as THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System_ Constructed( )Repaired( )Upgraded( ) Abandoned at - ©5+e-r v a_ has been construct d in a cordance with the provisions of Title_]. and the for Disposal System Construction Permit No.2a TT-'f76 dated 9 2 9 a 3 Installer TO b" Wh rlr le.�j Designer S A, The issuance of this permit shall not be construed as a guarantee that the system w ll�• c i n as destn Date 4 T t I Inspector , fj ------ -------- -- ------------- No. �LI ( ( — ——--— — Fee 7(/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migo!6al bpsstem Construction 30ermit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at :2 1 S P—o Ae G� 5' 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:Construc on must =e completed within three years of the date of this pe Date: 2 `� G 3 Approved by TOWN OF BARNSTABLE LOCATION ®" SEWAGE #,-20 VFLLAGE .5 2 �I i J�2 ASSESSOR'S & LOT //q — 03 0 INSTALLER'S NAME&PHONE NO. to�M W/te/e SEPTIC TANK CAPACITY LEACHING FACILITY: (type) riv c Lr (size) AX X 3 NO.OF BEDROOMS_ 3a BUILDER OR OWNER/ PERMTTDATE: 9 A)'910 COMPLIANCE DATE: I O 1 0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 3 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 fe t o leaching ci 'ty) (o.�o Feet Furnished by 4 4. 39 � - ,L 1 r ( TOWN OF BARNSTABLE LOCATION S ®/� ` SEWAGE #����b VILLAGE ASSiES,S)ORR & LOT 3 ��q "° INSTALLER'S NAME&PHONE NO / SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) Ir NO.OF BEDROOMS c�a (2) BUILDER OR OWNER + '��'� �- � S 03 PERMIT DATE: �l/-04 ,0 3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �3 Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Leachin Facility(If any wetlands exist Edge of Wetland and 8 h' Feet within'300 fe t o leaching ci ' ) Furnished by JSk M v LOCATION SEWAGE PERMIT NO. VILLIAGE � /V y IN.STA LLER'S NAME & ADDRESS ky B�UI'LDER OR OWNER DATE - PERMIT I S S U ED DATE : CO-MPLIANCE. ISSUED �__ E 01 No............ 5.............. THE COMMONWEALTH OF MASSACHUSETTS BOA!RD F H E •T ...... OF. ... .... ................................... Appliration for Disposal Workii Tonstrwtinn Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........ w S" ....T' ---11..o. ...................•--------...--•----------------------------------------•---.................... Location-Address or Lot No. ----------•--------------- -----...----...-------..-------..------------------- Owner Address .. -.---------•------------ -•--------•----••-----•------- ------------------------------------•-•--•- Installer Address Type of Buildin�g� Size Lot............................Sq. feet V Dwelling No. of Bedrooms_________ _____________________________Expansion Attic ( ) Garbage Grinder Other—Type e of Building ........._._p� yp g ............. No. of persons......'................. Showers (-i-) —.Cafeteria ( ) Q' Other fixtures Design Flow.................' �j .__..___.___ _gallons per person per day. Total daily flow__-____c _�_____r..__._.___.__._gallons. WSeptic Tank/-Liquid capacity gallons Length................ Width---_............ Diameter................ Depth................ x Disposal Trench—No........... ..... Width.................... Total Length......... Total leaching area....................sq. ft. SeepagePit No // Iameter.__.._" Depth belo inlet.__.. __ Total lea D /--------- � P --_-•---• sq ft. Z Other Distribution box ( Dosing tank ) /'3 f—'7�_ Percolation Test Results Performed by._.—. 4? . _. . - ..._ ..-.___.._._, �_. �Jn �._ Date.... _-t��-. ................. — aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------- ------- ........._.... --- O Description of So Q aZ / 2 z - - W 1...... 1 ................................•- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•--------------------------------•--••••••-----••----•------....•••••.•••-•-.......-------------•---••------•----•-----....•-•--•-----•-••-••••--•--•---•-•-------••-.-••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the'provision s of iITIZj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. .......... .. . .. .. ........................................... ................................ Date Application Approved By........ .......-_.7. ........ Date Application Disapproved for the following reasons:-------•-------------------------------------------------•---• -----------•--•------------------.......1...... •-------•-•--•---•---•--•----•---•-•-••-•••---••....--••......................•- Date PermitNo......................................................... Issued....................................................... Date FEB....��............... ' THEBOARDCOMMONWEALTH�OFUACS,SAC�SETTS f .........OF,-.-: i. . . ,�kpplirtttipan for Disposal Works Tonstxn.rtiun jbrmit Application is hereby madejor,a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..C96_71 k._:.11r. ................................................................................................. Location-Address or Lot No. k ' ................................ ..........--...............................................................................")-.... Owner Address F ,Wa /7'F'1.? �f .s . G �ft j.--___---•------••-•---------------------- Installer Address d Type of Buildi Size Lot............................Sq. feet ;g.", Dwelling�IVo' of Bedrooms__.__...........?__:_ __..................Expansion Attic ( ) Garbage Grinder p.I Other—Type of Building ____________________________ i&: of,.persons._____. :__................ Showers (r-) — Cafeteria ( ) QI Other fixtures _. W Design Flow______ ____:e gallons per person per day. Total daily flow_...__.v.w ............gallons-. WSeptic Tank I iquid capacitygallons .Lepgth................ Width................ Diameter________________ Depth................ x Disposal Trench No _..__. ...__. Width _ ____ Total Length______.__ Total leaching area___________________sq. ft. Seepage Pit No. -__.. _. Diameter....... _______ Depth belo inlet..... Total leaf' �a A _—sq. ft. z Other Distribution box' '. Dosing tank . '-' Percolation Test Results -:Performed by._ttt _- _ ________ Date___ "`" ............. F Test Pit No 1 minutes,per inch - Depth of Test Pit.................... Depth to ground water ................... fT4 Test Pit No. 2:____: _::_..._minutes per inch'<•Depth of Test Pit.......... "._.. Depth to ground water ___________________. O Description,of;So• •------- -----••• ... .+ " " __2 "r U W ----•----••--••-••------------------•-----=------••----•------•--•--------------•-••--------••------•--•-------••-------:..:-------------------=.--=----•--•------=--.................................. U Nature of Repairs or Alterations—Answer when applicable :,.-:_____________________:_._. .-_-_......___.__._:.___._.____._.__:______:____________. --------•-----------•-------•---_.... Agreement °y The undersigned"agrees to install the a€oredescribed Individual Sewage Disposal System in.accordance with.. the provisions of 5 of the State Sanitary,:Code—The undersigned further agrees not to place the system in operationw ntil a Certificate of Compliance has beet -issu'ed'by the board of health. igned ............. Date Application Approved B / ` •- '^�'? . PP Y---•-- L. '..r/ G Date Application Disapproved for the following reasons_________________________________________ __ ................................. ..................................................................................................... Date PermitNo....................................................... Issued.................................---t-.................... Date . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,: - �rr�ifirtt�r of f�unt��ittnrr � �� THIS,IS TO CERT4AI, That"the Individlual Sewage Disposal System constructed ( or Repaired ( ) by---ft. . ' el ..........................Iln�stall ( 1�/ has been installed in accordance with the provisions of 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No: 7.,�.._._ dated..._'"�." -1 .'. 7�'_____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEp'AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 5 � j DATE.......... _ ` _ ............. Inspector 1z`- ��_ -b------ .. ......... ••-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �1" ..........OF..---•-•-- ......_ .. No.---...1 f.7....... FEE........................ Diupuutt urku o#rion motif Permission by granted........ :ems.. -'- -•-•--------•---------•--•...................••-•-........._••-•-...... to Constru ' ) o e e ( ) an Indivi 1 Sewage DispZos , s em at No...`"•`I�t�: : -w- '�- _ `.'....�.: l ------- . Stree as shown on the application for Disposal Works Construction Pe No, _.____ ______ a Dated__'_:��. �_............ rt' ..................... oaB rd of Health DATE...." "~ '• ...... FORM 1255 HOBBS & WARREN,-INC.. PUBLISHERS - - ID, T LI Act1 3 D s ' L -� P h� i +a �>=IZTtFtEL7 p�oT PL !-al�.� LOCATIOt,.I �CAL� �n �4 124-7l= T►4 A T- T N E: P�� �iJH l.t UG S�lOtit�►J �-A►J R F c iZ E�.1 C E ' 1 lEQ E a►J GON�PL�(S W i TN T�-lE 5 vE.t i►-iE Auto SET$ACK VE-QUtJCE,V E:WTd; OF TNe 0c) -TO W U C4= F�vA-A?— JS`t A fi�s(—E BQXTE�Z �. u�(E I�•JG. �' REGIS"t'E.3ZcD 1..A1.1p SUeVEYo�:• TNl5 Di_AN IS LJOT BASEV' Oil-4 tN,5—MV tAEkJT 60ZVcY APPL-i G,&. -r ���rL1lC- tJDT USEo TO DCTEeMi LOT LiNa� Cam =tG?-A c:,t+�IGLE F L�Mtt_�( - 3 ��DiZL�oM C-AfZBAI c�r�1�►v t=LC>,AJ = 11b +� 3 3Sb G•P•L7. k o0o sat_ . �F'cxt�� t�tT u5E loco s[�L- . SaT-j a,L- AeE = cSo s.r-7. G.P.L . TOTAL �GStGIJ = 425 G•RD. c � .1✓>t_arloIJ E : t"tom 2kt t u, ofz L1✓SSl t . � 1 Tor 1 uo =,00.o 7owl,-------; r+� -�✓A4` �(�. f -Box •j SEQrIC i ,: t►N• f1i�✓ Ls cH a PT e, wi-rN / SO�7G wau+e� STOW /o C.<-C-T I P I ED P LC>-r I✓'1._ A V-j FQ.oF=I L-E L h C.A.T I O" uo cAL T SATE: 4 11 , { I C_1_t.-c t 1= ��� i�--!!-�T T 1-1 G 5 G-la�c.i►J \A) f•'t P Tt-1i�: '51 Diti L1►-1� -------- R C C,l S CL- fJeJ 05TE6Z�/1t_Lf= o IVCAS"i� ?tJ`, (-..'..i.✓\(=1J� 'iC)�;�/l�.`{ .� -ylni_: ,_:Fl-:�y���, ��t-1GE�1LD n.Nt�t_t c_n.�� T'� ��,,,4�S:r ��vTE� 16 ------ ...-.-.-. ....,.«. ....- ......,..-.- ..•-.•..—.,...s.:.-w....w.«.,.,-.....rna ,...,.rs..wnva.r•rim...,.x,.nweww.. •.w.,....-... ._...-,-..,.•---....n+.-w.+,.,,......-.•.+r••w. •,...r.-.•+c.».w++asarw,v..-..r...e•.=........,.,. ._.,,..,..-.._..+.a mn+•.,. t.•+ra_.••r.. r !t L i y 'y=- i-- _i��:,//�/:,;�,- -�,:���/G� LEGAL i7.�-�I r�{,3%�G.✓ f-o G�O'�G� -r c�".cc i f„�� 6e->"i—,�✓f.s- ,gs "- f •r1 ! ,��C��'��.7' fin/.E.S���i✓�!�.`S'T2y D F .�'!�� L�/.t��� �i�Gf' /S� , � p�t i i I c C ?✓�rc.7��t1�J�� f i I w�y o y �� a,,/ _ \ ti i .8� •✓ ss�'rl' � iyi � r ►� G Tom-._ _ � e� . . \ /\ �- I j / + �_ .f:?-,XP %Z T1�L C�LoR lvTl��✓l- fr � VA TION H;I. ,LE L ` _ E4D OB (�FF ol 71 { TO? OF FOUNDATION _ � CONCR�Tr- COVERS ✓1 Q� A �_ _ .. 4'CAST IRON \ ; OR SCHEDULE 40 4-SCHEDULE 40 PV.C. (ONLY) LEACHING TRENCH (` )REO. P,V. . . 9. MIN . / !. C PIPE UIM P PIPE- MIN. 1/a"- 1/2" WASHED STONE 35 MAX. " \ .., PITCH l/4 PER.FT PITCH I/4"P .r�. ell O 1 E I T_ _ L o o .! r l SEPTIC TANKNv'ci3T � j7 6, �9 INVERT i GAL_. INVE T D1$7 BOX INVERT SO°X�S.9 EF���/.3os� �i✓,�'iL7�ATI�s� r I CFi <' -1` V�r✓�/f7-^� !.. CRUSHED STOKE -� I �y� /� w."SHi� STt7NE� - -� LOG ROUND WAT=� $ SEWAGE DISPOSAL SYSTEYi , T..HLE ! DAT�L:.:' :.-.... TIME NO SCALE v C e TEST HO'� 1 TEST HOLE 2 „ 4 `".'.". . .. .. rLEV. DESIGN DATA . f .... ...... r.......CYA NU.BER OF - 1 - — . . 4 s_ gf I C �' r T / / , 8 v� TOTAL ESTIM:.7_0 r:'JW �'��G. .. GALLONS/DAY �' orb y4 S 1 L 1 L r� % L_ 0 Y Lam' STREL: T C, S f ,/ l (___ S _ - rj� a��a✓_ B = + M L=ACHING AREA � {' S,O.r,./ _NCH 3 ZO SIDE L AC4IN G AREA . . .�GS� •�.. . . SO.FT./T R=NCH r-1 1 F 0 f--� ., GARBAGE DISPOSAL . . !�.C�. . ..(50% AREA INCREASE) - PER. INCH TC7TA L L�CX',N G AREA ��: PERCOLATION RAT � - GEO RGE ES T�- �'E.S .�' r -t _�.-,::d:'?'`�l:.�'!: � ,<1 ✓� - 9 —l� j LEACHING AREA PER PERCOL.".TION P.Ai s f,!a $r.r,. APPROVE) .. . . . . . . . . . . . .. BOARD OF HEALTH mac;i L _- y� �«i—�1�r3= 2� �Do3 ✓4..WATER ENCOUN-MUtED - - - - ' DATE-E ... . . .. . . . .. .. . . . . . . . . . . SN 0 M AGENT OR INS?E:,TOR { P`�N or WITNESSED��� BY '. �`��� EDWA sir (%G F .�i':. .:✓�`?.'l.�.rlf�'�?�(''7Nl`.:+F+� HOARD OF HEALTH �`�o O a j ./ tl" r 1Q.✓ .�. T/ J C ^: " � ENG IN _ . . . . . : . . . . . . 7 e N 90 EY No. 261000 " RE S P,� Q f FCISTEP�• _ U P�1T10N� ' EVAL