HomeMy WebLinkAbout0040 AMELIA WAY - Health V►rl � t_. L S \
'y � TOWN OF BARNSTABLE �/ ` '
1
LOCATION �! /1�t P./T SEWAGE#
VILLAGE.�.�7�0III I ASSESSOR'S MAP&�L
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY "KQ sa /o4
LEACHING FACILITY: (type). (size)
NO.OF BEDROOMS_
BUILDER OR OWNER
PERMIT DATE: 4 COMPLIANCE DATE: '
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 facihty) Feet
Furnished by
1-7
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Ali-pwial Wurk,i Tunitrurfiun Urrmit
Application is hereby made for a Permit to Construct ( 1-l'or Repair ( ) an Individual Sewage Disposal
System at:
to Iddr s r Lot No.
ncr dd s
a ............................
Installer Address
Type of Building Size Lot---,<"- <—?- ._Sq. feet
V Dwelling— No.No, of Bedrooms___._-----------:a _Expansion Attic ( ) Garbage rinder ( )
►-+ , � j
114 Other—Type of Building _W_ -��.�o. of persons---------------------------- Showers ( ) —'Cafeteria ( )
a' Other fixtures ------------------------------- ---
Design Flow-------- ... g P P P Y Y
W J�.5------------------------gallons per person per day. Total daily flow.......... gallons.
WSeptic Tank—Liquid capacit,�/OQ gallons Length-_._...... Width.... --- /.... Diameter---------------- Depth...... ...
x Disposal Trench—No. .................... Width.................... Total Length------_--___.�._--- Total leaching area...................sq. ft.
Seepage Pit No------/-........ ameter-_1/�---__.__ Depth below inlet-_- .... Total leaching areaSV�2.eq.
Z Other Distribution box ( Dosing tank ( ) -�o
Percolation Test Results Performed by4C;LA I_CEn,1 _� ------- DateVwater__;*_1_,>.'
Test Pit No. l..s�' _.___
.. minutes per inch Depth of Test Pit�� __.._ Depth to groun .".
f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
..................--------'--------- ............................................................•...........
.......
..........•------------..................................
0 Description of Soil......... �----- .............
V ....--•-------••••-•----...-••--•--•---..------•--•-----•-----•--•-••---'-•-'---••----••-•--•-'•----•----•-•----------------•-----••------•------•--••••------•----•••-•---••-•--•-•-•---•---•-••--'---•-
W
VNature 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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has bee ssued by the board of health.
Signed ------
Dare
Application.Approved By ..._-----—- ------------------------------- - ..... �'.. .............. ----2~..�1---�---�--��
Date
Application Disapproved for the following reasons: ..................................................................
---------------------------------------------------------------- ------------------------------------- -------------------------------- ----------------- --
Dare
Permit No. ... ............. Issued ---------- �l - "1�5 --------
---------"-------'--.... ---------Date
THE CGNNlMONt`�'VEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applirativit for Bi_nVv!3a1 Workii Tl'nstrnrtion ramit
Application is hereby made for a Permit to Construct ( i or Repair ( ) an Individual Sewage Disposal
System at: k
� - or ............
---------_. •'
Loeatio
Add ' Lot No.---._-------------------• ---- ----O Add r-'ss
w_ncr
�'7
........
� Installer Address ���
d Type of Building Size Lot--- .__.______....-._,_.___Sq. feet
U Dwelling—No. of Bedrooms._-----•- -�-- -----------------_.__-Expansion Attic,( ) Garbage Grinder ( )
Other—Type of Building /� ..._ Ro. of ersons---------------- --. Showers —
a g --- ���--•--•-------�--- J -•-----: ( ) Cafeteria ( )
d Other fixtures •------------------------- -------------------------------- -------- ------
W Design Flow.... ..................................gallons per person per day. Total daily flow_.___--_---��-_-___�—`._ .............gallons.
WSeptic Tank—Liquid capacity ogallons Length_........ Width---._ry.-.------- Diameter---------------- Depth...4/...._ �
x Disposal Trench—No. .................... Width.................... Total Length-------------- Total leaching area....................sq. ft.
Seepage Pit No......r/ ---.,Diameter..- /ram`_--.- Depth below inlet----Cry.......... Total leaching area__5 ,�. .2_sq-ft-
Z Other Distribution box ( Dosing tank ( ) �:o
�, y
Percolation Test Results Performed by./c� .� -z..�_--- ......................... Date-
0-1 Test Pit No. 1__-'-�' minutes per inch Depth of Test Pit-, �`,,,X---- Depth to ground,water-. ek.4 t............ �
Test Pit No. 2................minutes per inch Depth of Test Pit.-------------------- Depth to ground water........................
0 Description of Soil........-`-5�..... -
x
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 Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has bee issued issued by the board of health.
Signed ... -- -- ---------------- .............................:..--..
A hcation Approved B UJ, 2 .._T._ ................. ......2._J---- ----�.�--�
• ., .!...-.-..-..'........C."....._.._------..._---------------------- � Date
PP PP Y _
_ Date
Application Disapproved for the following rea.rons- ----------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------- ------------------ ---- ----------------------------------- ----------------------------------------------------------------- -- - --- - -------------------
q //��// �" Date
Permit No. / .7--------------------_. Issued ......... -`5� 7� / 2
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
&r#tftra e of Graplianre
THIS IS-TO CERTIFY, That,the Individual Se--:wage Disposal System constructed ( �or Repaired ( )
L /�' �/"�l lam'
by .................................................................. - ------
Insnrl Ye'r
at .....` 6- ..._I................................-__-------1/`-'..re'`----------------- ------------..----------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE�,of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. — - ------------.. dated .. -`.0-------- S
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. f�
DATE...... ------- ------- Inspector"'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�S-_ 11�� TOWN OF BARNSTABLE O
No....................... FEE..�..__.............
Mipwial- ark �un�tr r#inn rrutit
Permission is'hereby granted y .....................................................
to Construct or Repair ( ) an Individual Seage Disposal System
at No.... 1 -i �oL ( aZ1�(.P.!l�l rCQ.+-1
............. -= l
�/�,/,
as shown on the applicat';on;forlv Disposal Works Construction ermit No______ ________�J_-'y%jD" ated/-Adl. ___.. �S 1�
•p•- Boar�d,��/Health
�011 ----••---------------•---•--------.....DATE..................... - ------ -
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
IST BOLL LOG
DATE:-
TEST BY: WELLER&ASSOC.
WITNESS:_ - ✓ ,diSz.0
PERC RATE:
�b 4 sS O
4
v -13
4�s F�2
DESIGN DATA -
\ +1 DAILY FLOW:-, 77 WED�,S
5 f ' ��,,,� ,, �I�-��� � 20 _, r ...� . SEPTIC TANK: 33a x 150/o- y�
4`r' !�/ 5�, . USE: /JaD
LEACHING FACILITY:
/ •_�- USE:
CAPACITY:
SIDEWALL: /8,4 SX z: .5 r y'V z l
42 BOTTOM:
TOTAL:
PIPE TO BE LAID 2"LAYER OF 3/8"PEASTONE
LEVEL FOR 2' OUT OF OVER 3/4"-1 1/2" WASHED
DISTRIBUTION BOX STONE ALL AROUND
TOP OF FOUND.
@ EL,
10" 14"
O 7rs y sS Ja ao .. / ni4
ALL PIPE TO BE 4"DIA,SCH 40 PVC
RAISE ALL APPLICABLE MANHOLE
COVERS TO WITHIN 6" OF FINISH
GRADE
THIS SYSTEM IS NOT DESIGNED FOR
THE USE OF A GARBAGE DISPOSAL
SEWAGE SYSTEM PROFILE
SCALE: 1"=10'
�. GENERAL NOTES
CONTRACTOR TO BE RESPONSIBLE FOR THE
SITE-SEWAGE PLAN 4� LOCATION OF ALL UTILITIES,ABOVE AND
�c
UNDER GROUND,PRIOR TO ANY CONSTRUCTION
FOR
OR EXCAVATION.
2. INSTALLATION OF SEPTIC SYSTEM TO BE IN
PREPARED FOR COMPLIANCE WITH 310 CMR 15.00: TITLE V.
YS/�G 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY
��/��/,�� /,� /o���p`�N OF �y��s/ � LINE DETERMINATION. +
SCALE:f,)a % ''� DATE:
WELLER & ASSOCIATES "viv��,
P. O. BOY 119 YARMOUTRPORT, MA. 02675
(508) 362-8131 APPROVED BY: