HomeMy WebLinkAbout0065 RENOIR DRIVE - Health 65 RENOIR DRIVE
OSTERVILLE
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No. �>��' �"✓ Fee —
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migool *pgtem Construction Vermit
Application for a Permit to Construct( . )Repair(g)Upgrade( )Abandon( ) 11 Complete System 1:1 Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
gesAq%_$�rceYr. , Osterville Schaffer / Lindstrom
y
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P O box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 3 — Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Rand
Nature of Repairs or Alterations(Answer when applicable)
o f a- gas—baffle, D b era
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by t 's Bpard of H lth.
Signed d `f Date
Application Apprgved by Date
Application Disapproved for the following reasons
Permit No. 2 a,C3> "' Date Issued
No.
f,� Fee
'THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer:
s
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplication for. Zi$pool *p$tem Construction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( . ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
k5 ResWap pr pr. , Osterville Schaffer Lindstrom
ssessor s ap azce
Installer's Name,Address,and Tel.No. Designer's Name;Address and Tel.No.
Wm. E. Robinson Septic Service
P 0 box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms a Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Sand
Nature of Repairs or Alterations(Answer when applicable) !j!jt1p -5 leaeh system ee,-1s4q:1=41i
114
of a aas baffle, D—box a 92() concr_-tn ]p�Y► Shy l�nro
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 bye is B and of lth.
Signed
/1 Date ,dv�
Application Approved by7. Date
Application Disapproved for the following reasons
Permit No. 2j 04 Date Issued /
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
Schaffer/ Lindstrom BARNSTABLE MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( )
Abandoned( )by Wm. E. Robinson Septic Service r
65 Renoir Dr. , Osterville
Drat has been constructed in accordance
. �
with the provisions of Title 5 and the for Disposal System Construction Permit N AW / datedf
Wm E. Robinson Sr.InstallerDesigner l� j} A„/ U
The issuance of this pe j t sjhal�not6be ons. ed as a guarantee that the sy�s-tie—m-twill function a de/ignek
Date ►f ! Inspector A / i7Y�/ '� ��7'v 1✓ ��� 1
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THE COMMONWEALTH OF MASSACHUSETTS
t
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Schaffer / Mi0p6af 6pgtem Con0truction Permit
Lindstrom ,
Permission is herebygranted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at 65 Renoir Dr. , Osterville
t
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:Construction must be completed within three years of the date of thi permit.
y <,
Date: � /" "� ` Approved by
a
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 DESIGNED PLANS)
I, W i l l is in E. Robinson,S eby certify that the application for disposal works ,
construction permit signed by me dated Cr�J , concerning the
s
property located at 65 Renoir Drive, 0 s tery i l l e meets all of the
s i
Mowing criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the g. ,
• The soil is cl ed as LASS i and the percolation rate is less than or equal to minutes per inch.
There are o wed thin 1tw feet of the proposed sepuc system —
There• e no privat wells within 150 feet of the proposed septic system
Ther is no i in flow and/or change in use proposed
• ere are no requested or needed. ,
• bona of the proposed leaching facility will tt t be located less than five feet above the
maxim adjusted groundwater table elevauon. [Adjust the groundwater table using the Frimptor
meth when applicable] „
• if a S.A-S.ivill be located with 250 feet of any vegetated wetlands,the bottom of the proposed
leaching facility will not be located less than fourteen 1141 feet above the maximum adjusted
groundwater table elevation,
Please complete the following.
?►) Top of Ground Surface Elevation(using G1S information) 3�s
B j G.W.Elevation +the MAX. High G.W. Adjustment
DIFFERENCE.BETWEEN A and B
SIGNED : z�o DATE:
[Sketch proposed plan of system on back).
q:health folder.ccn
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TOWN OF BARNSTABLE
LOCATION
SEWAGE #6c5-0— ig d
VILLAGE- l %7 / ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. I` e 16
SEPTIC TANK CAPACITY f
LEACHING FACILITY:
(h pe)o2" Z G —I .-7.(size)
NO. OF BEDROOMS .3
BUILDER OR OWNS
PERMITDATE: /U "�,3-'tS—v COMPLIANCE DATE:
j' Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom Leaching Facility Feet
Private Water Supply Well and Leaching Facility y wells exist
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within 300 feet of leaching facility)
Furnished by Feet
------------
02
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64 p
C N 07
TOWN OF BARNSTABLE
LOCATION , �r�� �� - SEWAGE # — 9d L
VILLAGE- Tf ASSESSOR'S MAP & LOT
/A� '7W
INSTALLER'S NAME&PHONE NO. I�s /�^-S d �^-- ? �� -7!I
SEPTIC TANK CAPACITY 16--a-� /
LEACHING FACILITY: (type)a '-
NO. OF BEDROOMS3 ,
BUILDER OR OWNEI;s 1 L✓.e'
PERMITDATE: �� ""�3®'�'.V COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom Leaching Facility Feet
Private Water Supply Well and Leaching Facility 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
v
r ;
TOWN OF BARNSTABLE 000
LOCATION 01110-101 SEWAGE # -'75n�-
VILLAGE ASSESSOR'S MAP & LOT f4e--ff
INSTALLER'S NAME&PHONE NO. _tn�'ei
SEPTIC TANK CAPACITY P Scud 4*L
LEACHING FACILITY: (type)_f 2r��cLe-F— 33®`if (size)L10
NO. OF BEDROOMS—&
BUILDER OWNER
PERMITDATE: 12,.I 22/Z&O COMPLIANCE DATE: fi2 oo �
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
VA_ r w;':;; n 200 feet of leaching facility) _. Feet
"+old Leaching Facility (If any wetlands exist
°et of leaching facility) Pet
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ed
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LO Cj4T ION SEWA �°E PERMIT NO.- �
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VILLAGE
INS A lTL 'S NA & ADDRESS
Z4 Z, w ilf"/--)
t UILDE R OWNER
44
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DA T E PERMIT ISSUED
DAT E COMPLIANCE ISSUED�o��
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........3f
Apli iration for Diipn.ial Workii Tatuitxnrtion Vanfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
tam f ✓�
.............................. .� . --....2 ... , / .--...•.--.....-- ®� .. .....
Location-Add ss Lot N
� � -al /f�....-----C.(� ..........................: ,�..a. .._ � .L�....-----..............
� ' C'
Owner � ress
fWa �!N ..._. .. .f__s.S.U-1�............ .....` .....
.......................
Installer Address
Type of Building Size Lot...t:Z' j4S2_...__Sq. feet
V Dwelling—No. of Bedrooms.._....._____________________________Expansion Attic Garb ge Grinder (4,o6
pa-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
of Other fixture
d.
Design Flow................. ..................... per person per day. Total daily flow............. _�1.._f�................gallons.
1:4 Septic Tank—Liquid capacity_.lb QLkallons Length................ Width................ 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 (�}� Dosing tank ( ) /
`" Percolation Test Results Performed by.................................._1.��� ----__•------- -- Date____...---
Test Pit No. I--_ _ti Sijinutes per inch Depth of Test Pit--- t. ...... Dept to ground water.._._,�/�6sL^��
Test Pit No. 2....... __._minutes per inch Depth of Test Pit.......
Depth to ground water.... _�,y;
u+ ................................................ ........ ..----------.:. _--•-__----- •-•----•-.. -----
O Description of Soil Z•---' 6-'-`-f---r _bl.............•
U1.....�-�---Z'------•---....-•-- .. ........... _.
---.........----......................................................................................................................................................................................
U Nature 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 Sanitary Code—The undersigned further agree t to place the system in
operation until a Certificate of Compliance has been issu by the board of alth.
lSig d------------- -.........--•--.....__....._........._-•------•---•-••-----_-_.._ _.. .. ....... ...
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ApplicationApproved B ------ ---------- ------------------------------------------•-----....................... --...�._.__ .--- .............
Date
Application Disapproved r e
Y- following reasons----------------------------------------------------------•------------- ......................................
-•-----------------------------------••--••-•--------••----•••--•_.._....••------•----••-•.._._...--•-•--'--....--•----------------------------------••--••------•••---------------.....---••-------••---
Date
PermitNo......................................................... Issued.......................................................
Date
..:U/y�.. FEs..... �'�................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........re).1 a k+, o F.................... ,i.-I.... .S/.�4.r ... .............---
Appliration for Diipnoal Work,i Tomitrnr#inn Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: e , _
.. -•-•.........................� ... : ...�....K............. ... o � ..................../
Location-Add ss
•• " Lot N ,
- r„ ly ,A�.- ( /1r. !� .Q11 ......................................�. n. ....._ ".....Q....... _....
........ '
f
Owner •--
ress
.... .....--•••-•----•---••-------------------•---
Instal]er Address
Type of Building ''""�� Size Lot... ::Z_ /4t�?_.....Sq. feet
U Dwelling—No. of Bedrooms.......... _____________________________Expansion Attic Garbage Grinder (�
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .... ---------------------------------•----•-----•-......•••••• -•-•--•-----••--••••----••---------_..............-----•........_.....
W Design Flow.................__.___.............____gallons per person per day. Total daily flow.._...._.__.S._; ... ...............gallons.
WSeptic Tank—Liquid capacitylp-vGgallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.
................... ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (�)v Dosing tank
Percolation Test Results Performed b ...---••---•---......- �.!. �.,... Date �� 3
c} Y
a mutes er inch Depth of Test Pit.__.... De t to ground water._.__
Test Pit No. 1_.. p p } -- p gr A, j-X _
tz, Test Pit No. 2....... ......minutes per inch Depth of Test Pit......1..._________ Depth to round water..:_
P P P g
W ...............=------------- - =
_--•-------•---••-
•-
Description of Soil. :--••-••---------------------� ___"':�----•�......-------------� ```' ---- _. OP.........
-------------------------------------------------------••-••--•-•--------..........
W
----------••-----------------•...----------•------••---.....------....----••---••••••.....------•••----••---•---•••-••--•...••--•-•-----------••-------••••••-_---•--•------•-•.._..--•-•-•-•---....._..
U Nature 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 Sanitary Code— The undersigned further agrees uot to place the system in
operation until a Certificate of Compliance has been issued by the board of Aalth. /
Sig .........................................
-----
Application Approved B11re
•..--•------------------•---- - ! .l �
....._._..
Date
Application Disapprovedwing reasons:..............................................................................................................
_
----------•......................................•---•--------......-----.......------..........------.....-------•------•-•---......-•---••-•---•--------------...------------....-----•----••---•--•---
Date
PermitNo.......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OE HEALTH
(�.9iwf� /"-�
1......( �.Y..�...........oF...................................�8 .......................................
Trrtifiratr of Tontpliattre
THIS IS TO CER,,; FY, That the Individual Sewage Dispos/� System constructed X r) or Repaired ( )
1 or by d°r f •--- '--- ...l
t/
at..................................................... .............. p'l �1R!!....... ............. - ...
has been installed in accordance with the provisions of TITLE 5r of The State Sanitary Co gas scribed in the
application for Disposal Works Construction Permit ................ dated_.. _.
THE ISSUANCfi OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE
SYSTEM WIL F CTION SATISFACTORY.
DATE_..��___.l• •-•,� ....-.....••------- --------•- --•-•----•-------- Inspector....... ....................................................
e
THE COMMONWEALTH
BQARD ''
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LEGEND
EXISTING 'SPOT ELEVATIONHOF �s CERTIFIED PLOT PLAN
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0� .ROBERT�/cGtn ri'C—N o/rz i vE
EXISTING CONTOUR -- � s �oT zg,
FINISHED SPOT ELEVATION ` 0.. .. it. ,� O.S:.T,��C✓� L..�-�
SR.UCE .a
FINISHED
ED CONTOUR O : �;' ,u' �' ' .ELDRE CAIN
f{V Af V ED 6 IJOARD 0F HEALTH 4 /s.To� A �`J.
N0 �1/•�`IbA , x9� �
SURD
— --- --- 4a i DATE s�a r�3
DAT E AGENT SCALE
ELU}?EDGE"sENGINEER/NG ca,,!N
_ .,: CLIENT I CERTIFY THAT THE PROPOSED
� 7EG15TE4E REGISTERED J06 NO.; BUILDING 'SHOWN ON THIS PLAN
CIVIL LAND. , a} ,f{;�. CONFORMS TO THE ZONING LAWS
,E �9uItiI SURVE O;F BARNSTAGLE , MASS.
Y12 MAIN STREET :. CH. 9Y� `� "
HYANNIS, MASS. `' gHEET- 'OF Z. fME7` RED. LAND SUR EYOR f
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