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HomeMy WebLinkAbout0297 POND STREET - Health 297 Pond Street Osterville A= 119 —034 - 002 ir 4 ^ • 0 " a Y ^ v ° ° r A B : u e " � a ° a " n N < ^ - 2 r e � u d s In ° - a v. e u - 4` v a _o w " " " , R u n x c ° ° « ° a a � ° a " ,P ,6 " ' � `". .Q - a. - 't - ° r �" - oy� ; o� �^.. � " ,•� ...� d ° '.��e " , ,. a -:6 ° m °r ^ n `° ° .'� o " Ax° a °� " " ° �° • e ° °a ° rry o o T . .. v ..� �v ° _ e -, " ° ° ,.' a � x o. " a p .-•. n A�p , v � ... .g�w :9r<. " x � 9 x ° ^ e .Ark ° � o Ir Y a ° tia ti o n _ ^ o a ^+m ry d r wb � a 41 n r rtrt " c p q A , a° m p " e " r No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for Mi.5poar 6p5tem Cou6tructiou Permit Application for a Permit to Construct( ) Repair(,or Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.0 7 moo f'1. �.�'�' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel j "©� ��� �J-C// ���(1� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 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 o the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi SAOI af Health Signed fY g ate 0'9 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. `a Date Issued ,. � No. Fee THE COMMONWEALTH OF MASSACHUSETTS Enterea-in computer: �. PUBLIC HEALTH?DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes plicatton for �Di!gpoaY•�&p,5tem Cori!6tructton Permit.. Application for a Permit to Construct( ) Repair(i< Upgrade O Abandon O ❑ Complete System ❑Individual.Components Location Address or Lot No.aZ 97 'Oc"'i-4 rT OPT, Owner's Name,Address,and Tel.No. 02 L� 100A 14� 4P 1�wl< Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. .f" 070, 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 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ,OP�®`�4C.6--o -O—Zoid( t` Date last inspected: i 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 o the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this o 6 He lth01 Signed Application Approved by / `r�`� f,� 1 ;, Date Application Disapproved by: Date for the following reasons t Permit No. r9` Date Issued l THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS L S Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (!/) Upgraded ( ) Abandoned( )by at —1 97 0&"r--A�'.! fr: CO f%' has beep corlstructedyn accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. / 1.✓� dated Installer lr ,-72 Gt�L9E°U Designer #bedrooms Approved design flow , gpd yy 'G The issuance of th e, its al not b- construed as a guarantee that the system will nc ion as design d. Q Date �j Inspector v7 -----_- -- --_- ------ --�---- No � �01 ,-------.——---—.--- -- Fee ._ THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS M!9pofsal �&p!gtemc Con5tructton Fermat Permission is hereby granted to Construct ( ) Repair ( � Upgrade ( ) Abandon ( ) System located at .M $P 7 00'49 1'T' o 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 fon must�be completed within three years of the date of this fe�tmit. Date c Approved b� (/ pp Y / _ r TOWN OF BAMSTAELE LOCATION Pa SEWAGE # " VILLAGE USfi _ ASSESSOR'S MAP Cz LOT goy INSTALLER'S NAME & PHONE NO. [ SEPTIC.TANK CAPACITY ) LEACHING F�iCILITX:(type) (size �r.�—.� NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR DATE PERMIT ISSUED:_ DATE COMPLIANCE ISSUED__ VARIANCE GRANTED: Yes __No _ w � bfi No._ rl Fis....C�4.,�.. / THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----..�«.rN...................OF........ ............................................ O, Appliration for UWpatial Works Tomitrur#ion Prrutit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: .... ...°. NfIC , SA_f # ....................................... .................... =Tz............................................................... ij X Location-Address or Lot No. . .......... '�» ".'..:�:.: .......................... . ................. .....5:77........................................................ Address Owner W •--�� ..................................... ----------------Xn_25 . . Installer Address UType of Building Size Lot....... ...Sq. feet ,., Dwelling—No. of Bedrooms.................../y5vyz...:_._......Expansion Attic (A,1) Garbage Grinder (Alo) Other—T e of Building .. No. of persons............................ Showers — Cafeteria Q, Other fixtures .._........••-•••-•••---•-•-•• • .. W Design Flow................................... -5__gallons per person per day. Total daily flow..............................Q:o...gallons. WSeptic Tank—Liquid capacity..l S _gallons Length.l.LY.Irk".... Width..5 Le"_.. Diarnrtei___-_- ........ Depthg'..e. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__ :27---cz__.. Diameter....../d-`-....... Depth below inlet_.. Total leaching area.._!y'`.......sq. ft. Z Other Distribution box ( X) Dosing tank ( ) '-' Percolation Test Results Performed by... 3 ............ Date---•�_/�==-�--�------•-------- 14 14 Test Pit No. I...0�--------minutes per inch Depth of Test Pit..._!'4'a_"....... Depth to ground water..__. � ...... (T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water �+ : ......... .......... OF l{�� 0 Description of Soil...C>tnZ�....... p.aa it--. .. �r=ya►.f................. � ••••-•--•--••--•-•......-•••• .._! `.:..11?�r�r�r�i.. }xrr{zft�r � a ................................................. so• W ------Att'Vi� r„ ----------------------------•---•••-••-•••-•----•---•-••-•••-------••••----•----•••-••......••••••......•-••••-•-----•-------•••---•••••----••••......-•••••......-- U Nature of Repairs or Alterations—Answer when applicable............................................................. No:3C2t •-----------------------------••--------------------------•---•------......--------..........-•--------------------------...--------------.....-•--••......-•••-•---•-•• o a. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac ith the provisions of iITLL 5 of the State Sanitary C — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee iss d b he board of health. Signed.. �. p ;---------- ...... `• Date Application Approved By..... ... .. ... .......... ......... .. •..-•••••...... •••••-••••--.Date.............. Application Disapproved for the following re s:-----•••--••.......-••••••-••-•--••-•-•••-•-••-•--•-••••••••--•--•-•---••--••••••--•••-••...................... ..............................•••---••••--••...••-••Q. Date�••-•----••••••••--•---•••-------.......••••••......•-••••--••-••--••••••••-••--•••••••-•••--••----------------•----•---.._.. ....•---•-•. PermitNo...... ---------•-------- Issued....................................................... Date No..4............ �/ =-f' Fitz....G +•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH kgn�...................OF.......... ..... " Appliratinn for Disposal Works Tonotrurtion Frrutit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ................_« ._..«.......... ...__ ........._........_..._....... .........._..LC� T ......... .......................................... --Location-Address or Lot No. ..................: C M�aGT:....e(1 .1�L:G •< !?...._....._....._...__..._ . ......._.....................................) ............_.......................«.«..... ... ... .._.... Owner Address (S� C1I /� !'7:P.c�:':Zi!!6! c. ................................................. 14 Installer Address UType of Building Size Lot------- ...Sq. feet ,. Dwelling—No. of Bedrooms...................F�q!<.............Expansion Attic Garbage Grinder o/") a'4 Other—T e of Building .............. No. of ersons......-_..__.____._..._.____ Showers YP g --------•-•--• P ( ) — Cafeteria ( ) QOther fixtures --------- .............................................................................. W Design Flow...................................>S__gallons per person per day. Total daily flow..............................`_f-'ln...Olons. WSeptic Tank—Liquid capacity..1.:�Q.gallons Length.10'_ ".... Width.. L.23 ... Diam r ____ _____ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area__--___---_--_------sq. ft. Seepage Pit No.... �--.. Diameter....../C?......... Depth below inlet... Total leaching area...7!51.....sq. ft. Z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed by.._ .__ ._f__.� x frr.F/l/_c Date..... `/J:- ".......-•. Test Pit No. I.. .........minutes per inch Depth of Test Pit..../�'_"t.`...�Depth to ground water. — `�...... (s, Test Pit No. 2.............11 minutes per inch Depth of Test Pit.................... Depth to ground w DF �A M ss O " Description of Soil : .---•_Tu - - .I....'s__5�1r=t�i_(..._•.--_•___._ STEPHEN N X ALLYNi v �!_...1.4Z .. ........... ......WiL-SDN'----- x ---•-----------------------------------------.....--------•----------•----------------•-----------•---------------------------•---•---------..........-----•-:.......- ��38 3Fi-o V Nature of Repairs or Alterations—Answer when applicable.............................................................. 0 -------•----------------•--..........._............._._...---------.......-----•-----.....---•---•----------•-••---------•---....------......••--•-.....-••-••......... /p Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in ao ordance with g{( the provisions of 1I.IS 5 of the State Sanitary C —.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu drhe board of health. Signed.. I Date Application Approved By..... /�/�............ ... _... Date Application Disapproved for thXe following re s----------------------------•-------•-----•-•---------........_.........-----._........_...........-•••........« .................................. .........-•---•-•--••-•----•J-----••--•-••--••-•--.....------.........--•--.....•••-•---....---••----••-----•--•.....•••--•---•...••--•---...-Date ...••---.... - ri PermitNo......- ••- ----•--------•--------------------«--- Issued.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH .......................f/l/ .OF.......................:��...�....� :............ (Irriif iratr of Tontplittnrr THIS IS T_ CERTIFY, That the Individual Sewage Disposal System constructed .( or Repaired ( ) by........... .P...,..N_............................................ J --•••••.............................................__..._..••----.._........ .«_...« PONV at...... ------ ...3L-t �t5©L1 _ J f.....-•---•-•-•-----------•-•------•--•-••--- has been installed in accordance with the provisions of TTZLF 5 T.Ii State Sanitary Cod as es� . ed in the application for Disposal Works Construction Permit No.. .."' #- ......... 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 HiA TH F.........�...F` ....._......:.V���........._............ No.... _._.----•- Fn. ................. Disposal.3� r o ono`f nr#ion' rrttti# Perrmio r hereby granted._....._'' .:... ............�r1 n.......................................................................................... ««.. to Construct or Rep n Ir�d;v ual Sew e— o t at No.... - Street .......... ........ as shown on the application for Disposal Works Construction Permit_No.0_0= ..... ated... __��_ ........ ........ Board/ f Health t; DATE:: .If y.. ....-•-..._•--•--........ ........ \_1 v� FORM 12 31_A. :M. SULKIN, INC., SOS TON a 4 � • f ' so A 29 5.. 4y kk Q F ,9t, py SMc u STEPHEN G1� . .�g AL LYN .�- .. b fi1CHAP..D �M L,P A. �j\�%`\`,•_fig - BAXTER 45 dig./`�•SSi- i� s�• �.2'�`'�4j � �Qcs� � ol �. . wry vc we y DEsI�N ETA �� � 5 ►Jc u—= FAt l l,Y _-_4..:_esr:�G jzcoM t>A1L_YFl-C1W p VSt-rpT k<,I -T A%V-1< 9.4o.X i�o o ��o G.Pt� °° WCl PL-S PO S4L -PIT U 5e Ca.j W00 6TA1,,,,.. LEACH P I T5 4 i 5l TEE W A LL A,;2� 5, F, ' u • 51= ?c h O ��� ' oTAL .r .rrF �- O�N �"ft'. 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