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HomeMy WebLinkAbout0159 ROBBINS STREET - Health 159 ROBBINS STREET OSTERVILLE A - 142 126 I � o No. 'w .Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 60 Yes �PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS - -- Zipprication for Migpogal *pgtem Congtructiion Permit 'Application for a Permit to Construct( . )Repair(V)Upgrade( )Abandon( ) El Complete System 1 /ndividual Components Location Address or Lot No. ®� r�� Owner's Name,Address and Tel.No. Assessor's Map/Parcel . I/ille r4rr#e-r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms---� C Lot Size sq.ft. Garbage Grinder(�® , Other Type of Building ea1 41 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /l a gallons per day. Calculated daily flow —:53f0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1000 9'P1 ZWj__3,;rZ_4A Type of S.A.S. /Z•S�it'� , Description of Soil l - S®O- --4f !ek4cl Ckoy1e1_`s 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 issued by this Board of Health. / Signed Date Application Approved by Date — Z Application Disapproved for the following reasons Permit No. —C4-rd`S Date Issued No. Fee , �.. r. Entered in computer: ✓ THE COMMONWEALTH OF MACSSACHUSETTS f ;0{ , V Yes ` PUBLIC..HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS application for Migoga[ *pgtem Congtruction,vermit Application for a Permit to Construct( )Repair(t/ )Upgrade( )Abandon( ) O Complete System °; Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Installer's Name,Address,and Tel No. Designer's Name,Address and Tel.No. 771 � " Tape of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A Other Type of Building S l P�c� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3;J1 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1I® �i�/S�`i/�� Type of S.A.S. /Z Description of Soil Z— ©G� .���4� ��DGy. GGIQ•�16�'/'S 4 Nature of Repairs or Alterations(Answer when applicable) xl g Date last inspected: r ; ' Agreement: r" 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.is Board of Hea jth. _ // Signed. Date 19/ZelG� Application.Approved liy c. Date 9— Application Disapproved for the'following reasons Permit No.' y ` Date Issued 9 __ . ________ ______ ---------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS NSA Certificate of Compliance � THIS IS TO CERTIFY, that he On-site S wage Disposal System Constructed ( )Repaired(11 )Upgraded( ) Abandoned( )by! f 7`D,D�/ (/_ at /5 q lee 44 ej -57, �oS �G'r-vi IT? has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No-Zorl"'o ' r dated Z /- ?-f" Installer Designer The issuance of this permit- h 1VF of a construed as a guarantee that the sy teem ill function as deshed'f� Date Inspector IrA /V1 11 i � V 0 No. L �<1—���------------------•---—6/ �.,,/Fee �•"" t THE COMMONWEALTH OF MASSACHUSETTS �"/T�/ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigogar *pgtem Congtruction Permit Permission is hereby granted to Con,�c ( )Repair(Upgrade( )Abandon( ) System located at /� J 9 yr O �k4_55 ✓`' 1525 1jrl�1161117�//( J 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 iYust be completed within three years of the date of th� Date: 1 Z �� Approved by // TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT I4/Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY. LEACHING FACILITY: (type) 6-0 G 9! G 4 (size) NO. OF BEDROOMS J BUILDER OR OWNER `Qwl�Ce- PERMITDATE: 91ZI14n 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)- 4/� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i i hr_! sta' seq. VW9 NOTICE: This Form Is To Be'Use'd For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) L l o esT J del- ' �1�/ hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at l,,9 OQe&45 0f � �lrevl/le meets all of the following criteria:. AlLe fa iled system,is connected to a residential dwelling only. There are no commercial or.business uses.associated with the dwelling. The soil is classified as CLASS I and the oercoiation rate is less than or equal :o minutes per inch. v The:a are-no wetlands within 100 feet of he;,r000sed septic wstem v _ne:e are no privare wells within 1:0 fee;of;he proposed septic s_+stem, There is no increase inflow and/or change in use proposed +� There are no variances.requested or.ne-ded. The bottom of the proposed leaching facility will not be located less than five feet above the maeimum adjusted groundwater table elevation. (Adjust the groundwater table.using the Frimptor method when applicable}. If the S.A.S. will be located with 250 feet of.arty vegetated wetlands, the bottom of the. , proposed leaching facility will not be located less than fourteen(14)feet above the ma:dtnum adjusted groundwater table elevation, ' Please.complete the following:- A) Top of Ground Surface Elevation(using GIS information) B) P.W.Elevation +the MAX High.G.W. Adjustment.Z = 7' DIFFERENCE BETWEEN A and B D p SIGNED: DATE: . / `�® (Sketch pneposed plan of system on back). 4;boft saw.an 1 \� 0 AP AI5 S�' TOWN OF BARNSTABLE c� kLOCATION J �/�,� 0 g ST SEWAGE # ZIA:�7a--5'3 J�' VILLAGE Z9 5 72i✓Vl lj e-. ASSESSOR'S MAP & LOT � k INSTALLER'S NAME&PHONE NO. MZe1P41 SEPTIC TANK CAPACITY IJ,0000604 LEACHING FACILITY: (type) 6-6064I Lam$ (size) �•��$' � NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 571- Feet Private Water Supply Well and Leaching Facility (If any wells exist I on site or within 200 feet of leaching facility) 4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by gC.� g \ w NO.. o-ll.6'C u Fes$... .... .'�.... THE COMMONWE-AL—T-H—OF MASSACHUSEr TS- B®ARD E HEALTH Appliration for Uhipoii al Mork.5 Toutitrnrtion Vanfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal systemt -76 ....... . - s - .. ......... ..... ---_... Lo i Addre or Jet, o. h"--- ---------------••-.-�:`: *-----'�-- � ---------- Owner �. Owner Address W14L.`11 .D ...................................... ..... ..... .......................................... Installer Address QType of Building Size Lot.. �,,1__` ---- feet V Dwelling—No. of Bedrooms............................................Expansion Attic,( ) Garbage Grinder- WO) 1 aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria' ( ) Otherfixtures ------- ----------------- --- -----------------•---------------- WDesign Flow............:..........ZK-G.........gallons per gersert per day. Total daily flow.........................3_._ _..........gallons. WSeptic Tank—Liquid capacity &tons Length...... ..... Width_...`.......... Diameter------------_--- Depth_ ��________- x Disposal Trench—No.____________________ Width................... Total Length..............__r Total leaching area_'`2—C_�__.sq. ft. Seepage Pit No.___._. .____... Diameter.______ '' ___.. Depth below inlet___...__.____ Total leaching area..................sq. ft. Z Other Distribution box (�'i'J Dosing to ( o aPercolation Test Results�f Performed by........ -l. .l'`.................. _............................ Date../`ZL� __.. 4 Test 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------_.............. __. t� O c��,. �i. !� 3' � � �G� �� � ('=SIN Description of Soil �y ` /... -----------•------------•----------------------->-------------....----•----• W •--•--------------- --------------•--•----._._..._.--------•-•-•----••-----------------•--•-------•---------_..-----------•----------•-•-------._.-•---..__.-•--•-•------------------------••--....._.__ UNature 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 ii: y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has be issued by ty board of health. Signed_--- ................................. .. �0 /Application Approved By _ .A Date •----••---, Date Application Disapproved for the following reasons---------------•-------•-------------•---------------=------------------------------------------------.._...---• ---------------------•------------------ ••-•---. ..................................................................... •---•-•--------•-•-------••--•-----•---•------•---...---------••---•--_...------ Date Permit No......................................................... Issuer- Date THE COMMONWaALTH,,,QF MASSACHUSE,hTTS BOARD F HEALTH -...................OF......!!.1. c:�`. ....1_•./....4'..�/'. Allp iration for Uhgpasal Vorkfi C omtrurtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal . -.syste;.�Chj t � 6 !........s --------------------------------- ------------- - ------- - =.---------- ----- ............. Lofn-Addr* r .._... ............... ........ ............... Owner •Address W / Installer Address Address Type of Building Size Lot_._,l r�}...._ �Sq. feet a Dwelling—No. of Bedrooms.................___ ..................Expansion Attic ( ) Garbage Grinder ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria'( Other fixtures . ------------- --------- -9--Z,/Xiri-V------- G Design Flow_____________________�l_Q_..........gallons per.p�rsaai per day. Total daily flow..................... -llons. WSeptic Tank—Liquid capacity/G..O.gallons Length._...'__--_- Width---- Diameter................ Depth---.�_.--_-- x Disposal Trench—No ____________________ Width.................... Total Length.................... Total leaching area...,_C-_ _sq. ft. Seepage Pit No------ Diameter-------,1_ Depth below inlet....... Total leaching area.................aq. ft. Z Other Distribution box (p< Dosing to '~ Percolation Test Results Performed by._____. C.!_..12_./._ .�___ _________________________ Date_ 9._.. a Test Pit No. 11.' s.minutes per inch Depth of Test Pit.................... Depth to ground water........................ (4 Test Pit No. 2%X.z!.minutes per inch Depth of Test Pit.................... Depth to ground water........................ a2" .......... s . . ..... O Description of Soil �� _ _.--••- �-�--_- •� --•�< ..- --- .�......_�.._C_ ._r'^. c J�\y'5 4 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 ii p 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.... btu-+ ... ----- ate, Application Approved , % � • ate Application Disapproved for the following reasons__________________________________________________________________________-----------------'-----"......I........ __...._ .---'-'......_...'---...--•---'------•---------------'-'-'-'•------------------'......•..--•-------'•----'-'---••-•-------•---•'---.._.."•-"--•...................................................... ,.�p� Date Permit No......................................................... Issued....6...`_/y.V�' ..._.. -------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---"" �-- h....................OF..]:%r-^�','' ........................................... Curdifiratr of Toutpliatta THIS IS TO CERTIFY, That the I aividual ,Sewage Disposal System constructed 41) or Repaired ( ) a y........... a --- ............................................................................. ell— In er - at.............. --'- _ -- ----._.--_--------------------------.__------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-1 •"'.-1.1 Ij----•______--__- da.ted.......................________..._............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIJL FUNCTION SATISFACTORY. DATE.......... ... �1.........U`..r- .................................. Inspector...----1.2 Jr THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ...................................O F..............:................._._......._...: Nod L1.. _ FEE........................ %posal Workii Towi#rrurtion an it Permission i hereby granted--- 7'1s 1....----./ sl�......---•-------------'---........._.....'----------------.....---------............--•-•--- to Construct or Repair ( ) Individual Sewage Disposal System at No. -------.->--------------- z x�' _--.... %✓------- t� � ` Street dd as shown on the application for Disposal Works Construction Permit Nok.O.-/!/�_ Dated..... V!_; __sff..p.........__, Board of Health DATE............ f"' ........................................... FORM FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - �rl..�n z + _ �. Y *�( ;n .-.'-.T k rH. -.,, r t 5 't 1'•r`r S } d C w '1� y.. 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