HomeMy WebLinkAbout0068 RENOIR DRIVE - Health 68 Renoir Drive
Osterville
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No. �7J S A rr� Fee I00, i
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for Miquar *pgtem Con6truction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) complete System El Individual Components
Location Address or Lot No. G, �J i ay t Q ST Owner's Name,Address and Tel.No.
AA A--,-y do
Assessor's Map/Parcel //,� _P q
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size I `Q ft. Garbage Grinder( `
Other Type of Building Re-&&10,,LC No. of Persons Showers( ) Cafeteria( )
Other Fixtures !�
Design Flow �A 0 gallons per day. Calculated daily flow 44LA _ gallons.
Plan Date-5- C[q Number of sheets Revision Date S'6
Title
Size of Septic Tank Type of S.A.S. Jz 10 ijiTel X a.
Description of Soil �-' 84iaA
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned ag#' t
construction and maintenance of the afore described on-site sewage disposal system
in accordance with the proof the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has beSigne ` Date 12- z8-1•oo Z
Application Approved by Date 12—
Application Disapproved for the following reasons
Permit No. "" 7�S� Date Issued I Z"L 2 "�T�
Ce 68 0 Pl H G svr�e� �s-p+rc)
00
No. —7 S� w Fee
Entered in computes '�
fr �1 THE CQMMONWEA'LH OF�MASSACHUSETTS Yes
-, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS '
2pp'lication for 33igool *p6tetn Construction Vermit
- Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) C.�omplete System ❑Individual Components
Location Address or Lot No. G 8 0�'r av 1 µ�J Q S-T Owner's Name,Address and Tel.No.
Ao l Aer y 1*7 t 00 00 tjS 11
Assessor's Map/Parcel /�/6 _/f p
Installer's Name,Address,and Tel.No. / Designer's Name,\A/ddress and Tel.No.
f3a-�.C. t9 Y6v-5
Type of Building:
Dwelling No.of Bedrooms Lot Size q hE9R__k q$ft. Garbage Grinder
Other Type of Building M St&ML9_No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow ' 40 gallons per day. Calculated daily flow 4 gallons.
Plan Date--5-I_cj Number of sheets Revision Date 5'0
Title
Size of Septic Tank 1= Type of S.A.S. X 10'wOe x a I
Description of Soil �— ����
_RyM C 4
Nature of of Repairs or Alterations(Answer when applicable)
1
Date last inspected:
Agreement:
The undersigned agrees to enure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisi� f t S,of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been j's y hip B&dof = 'a h:
Signed (� Date as-
Application Approved b IOU<L Date A?
Application Disapproved for the following reasons `
Permit No 7 J-5' Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
w Abandoned( )by
at Z_0D %U j- ut- 01, h t r has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.Z4W— 7SZ5_dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as ndesigned.
Date ()1 !n / „7 Inspector ?
__ ____
No, �-7�s�'------------------------------------- --
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mtopool *p em Con0tructton Permit
Permission is hereby granted to onstruct( epair( )U rade'( )Ab ndon( )
System located at � 7�'
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 this permit.
Date: 1 CI -00 t Approved by G �-
r
TOWN OF BARNSTABLE
LOCATION ZZ146rt 0l � � SEWAGE
VILLAGE c�U-e-LA L-L-CZ . ASSESSOR'S MAP & LOT -0!
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY f See -4�+l _
LEACHING FACILITY: (type) 33o!s (size).:40 i-&-40 cJ AC A .
NO.OF BEDROOMS
BUILDER OWNER a
PERMITDATE: I A 112 2 I 1 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) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
/ p c„
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w , Cb
60
d � i
r� 6M !'
v9 w ttz)
APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS
LOCATION ing- NO. /� Cj
c 9
VILLAGE �sT�zy��� E _ ;.DATE'r
_ f E
APPLICANT . fL ���+v�7f�/�tic�E .---- FEr�G��� �
ADDRESS Gd�s <r, os ,TELEPHONE N0. ("Non-refundab�,e
ENGINEER iQ/% -C;¢,,,C--E14/,P- J // TELEPHONE NO.
DATE:'"SCHEDULED '3 -•Z/-FS'
T-- (Applicant's signature
. • • • •4,,0 O O o0 O • O • O O O O o O e O o • • • o o O\ o O • • • • • • o • • • o • • • e • • • • o e e o • i • • • • •O • o • • • e O • e • • • • •
• ASSESSOR'S bi1�P LOT N\�y�/j�� SOIL LOG i
SUB-DIVISION NAME DATE l'�%�� TIME,�C -Z!�)
EXPANSION AREA: YES INO ,i / :,�..� ENGINEER •
TOWN•I WATER PRIVATE WELL BOARD OF HEA.LTf
t 4
EXCAVATOR
SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and
percolation tests, locate wetlands in proximity to test holes)
NOTES:
H h G•;�.�
41
M`
�,
. N
n zA�
?ERCOLATION: RATE: L s•c;a ��
rEST.HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION:
;2 2
3 3
4 lifearv�-} 4 -
5 5
6 6 •
8 8
o g
10 @70 10
11 11
12 12
13 13
14 , 14
15 15
16 16
')UITABLE"FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS
LEACHING TRENCHES
INSUITABLE FOR SUB-SURFACE SEWAGE. REASONS:
TOM ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION
)RIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH
'OPY: RETAINED BY APPLICANT
comp IC' tCd by
11 -
:HI-GIt" GROUND-WATER LEVEL COH�'UTA7101t l
- ': Lot No. • _
Site t.ocat ion: - .-
v-f�rAl6_- Address: . E✓4�S
Owner: l I/i �A- Address:
Contractor: -- - -
Notes: ,
_o
tieasure depth to water table -.. ra
STEP l 0 f t. .
to nearest l�l • . . .. date
-
STEP 2 Using Water-level Range Zone .
and Index We trap locate _
site and determine:
A) Appropriate index well. . .. -.-- . .• .
B) Vater-level range zone . . .... ... ... �_;
STEP ' 3 Using monthly report"Current
Water Resources Conditions" EIDI
determine current depth to ••
r
water level for index well .......
mo yr
STEP Using Table of Water-level
Ad`ustments for index well
STEP 2A , current depth to
water level for index well
•STEP 3) , and water-level
zone (STEP 2B) determine ,
• water-level adjustment • ....•..:........•.......... . .•..... ......... .
STEP $ Estir,ate depth to high water
by subtracting the water-
icvcl adjustment (STEP 4) 4 , L
from measured depth to water
.' level -at site (STEP l) . ......... .. .. . . c
Figure
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