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HomeMy WebLinkAbout0033 BOSUN'S WAY - Health 33 BosunsWay Marstons Mills- x A= 046 - 131 k i No. G7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for nigonl 16p5tem Con5truction Permit Application for a Permit to Construct O Repair V Upgrade O Abandon O ❑ Complete System D Individual Components Location Address or Lot No. ����5 �/ Owner's Name Address,and Tel.No.�j J o 174t, Assessor's Map/Parcel Installer's Na e,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (-00j1C7 Other Type of Building $ � j'GG� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided F gpd Plan Date Number of sheet / Revision Date Title 5% Q /® �'' CD /"l�G l��l Size of Septic Tank c Type of S.A.S. ✓�® V G= ��9� '�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 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealt . Signed Date 71 Ile.®� Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued ®� 7 t 0f/1 ' s / _ No. 2 ;�J �4- e r Fee 1 Entered in THE COMMONWEALTH OF MASSACHUSETTS computer >s Pt PUBLIC HEALTH DIVISION -'TOWN OFSARNSTABLE, MASSACHUSETTS Yes Rpprication for Dig6.5a[ *p5temc Cow5tructtou.Permit Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑ Complete System U Individual Components Location Address or Lot No. 30 '���es f/u1 Owner's Name Address,and Tel.No. r odd Assessor's Map/parcel 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 1�Y'j0K_.& No.of Persons Showers( ) Cafeteria( ) Other Fixtures y9 Design Flow(min.requijed) i�✓ gpd Design flow provided ��(�' gpd Plan Date o/� �0 umber of sheetp Revision Date' Title Size of Septic Tank /®0!7O'4� Type of S.A.S. C �,n54e is Description of Soil y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: J 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 Certificate of Compliance has been issued by this Board of Health. Signed - Date Application Approved by Date Application Disapproved by: .. Date for the following reasons Permit No. _ Date Issued O THE COMMONWEALTH OF MASSACHUSETTS 'I BARNSTABLE, MASSACHUSETTS : (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Dis osal System Constructed ( ) Repaired ( !/� Upgraded ( ) Abandoned( )by Xp/_ ��/© C/ / 5 �''/ �/y- ' at 3,3 �D 56/W5' been constructed in accordance with the provisions of Title 5f a_nd/the for Disposal System Construction Permit No. y ' 0 J�IY dated �y Installer >b l t�t `1,P) Designer _�-? ; � 5o #bedrooms Approved design flow gpd The issuance of this permit sall riot be construed as a guarantee that the system will function on as des ned. Date 7!l 1 Inspector ---No. �Q�.1� ��(„v ---------=------------- Fee , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1wi!6po.5al 6pgtem Con!�truction Permit Permission is hereby granted to Construct ( ) Repair ( V) Upgrade ( ) Abandon System located at 3 xdD sae 5 wQ' 7/ny.5, / !S 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 !u 1124 Approved /Z._ Town Of Barnstable = Regulatory Services ' . Thous F.Ceder,Director spa Public Health Division °i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-630k Installer&Designer Certification Form Date: Designer: _C) _8- W. 1Q<< Installer: I��i�rl�ol��ie Address: • DEL*C( m ��w�I rt Address: e, 64t-4 pLo 1C,IA M4 AxAS- On O was issued a permit to install a (date) (installer) septic system at - W L�5� based on a design drawn by (address) r (ZS dated 14 , �c7 (designer) V Certify that-the septic system referenced above was installed substantially according to .the design, which may include minor approved changes such as lateral relocation of he dio�bution box and/or septic tank. y , I certify that the septic system referenced above was installed with major changes (.ie. greater than 1.0' lateral relocation of the SAS or any vertical relocation of any component of the.septic system)but in accordance_with State&Local Regulations. Plan revision or rY certified as built by designer to follow. ZN OF __J1,ovZ DAVID ees Sig6attne) B.MASON CA —i �j No:1066 v y �Q/STEPS ., sgAIITAa�P� (Design Is-Signature} f ea's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFIICATE OF CO LUANCE '911 NOT BE ISSUED UNTIL BOTH -THIS FUItM AND AS:M- 1 LARD.ARIA RECEIVED BY THE BARNSTABU PUBLIC HEALTH'D"V 10N. THANK'Y'OU. Q:HealWeptic/Designer Certification Fonn TOWN OF BARNSTABLE LOCATION 43 %a5'c�n S SEWAGE#"1,166 -3i4 ® x YILLAGE � ;\� ASSESSOR'S MAP&PARCEL Oy6 INSTALLERS NAME&PHONE NO. .c��ic : �L SEPTIC TANK CAPACITY\ LEACHING FACILITY.(type)Z So :,qQ\ c"L xG (size) 13` (2-W A-e t NO.OF BEDROOMS OWNER ; PERMIT DATE: 7 it y /& 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 0, - 1�`221 LO A p SEWAGE PERMIT NO. V I L,L A GE,/ IN.STA LLER'S NAME S ADDRESS �fll D E Rl` OR OWN R DATE PERMIT ISSUED DATE COMPLIANCE ISSUED S-- 3-- If- . �� i ,, �� �' � n �` � ,,., �! _ .. Y..,,�..- - �- "� -. •. 4' No.- - -3• t >; =, F�s......4.`....... THE COMMONWEALTH OF MASSACH;USETTS Y&_ i t _ BOARD OF HEALTH . ..............OF...... :. '� .. .. .2 ----:_........._......_.. e* 33 ApplirFation 'fur Dhiposal Works Tonstrnrtinn Vamit Application is hereby made for a Permit to Construct (j) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or t No. /� .... � s .---...13.�'_J e.fiz--------------aaR 6 Ga �/7aAe ��'e._...�.:_/..���.�"�.......-- s ... ---•-• •....................................... �� Owner C ___. .�. 1��/ ss_ t Installer Address dType of Building Size Lot0793 6 9.7__....___Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type T e of Building ______________ No, of ersons______.__.______._.__._._.__ Showers — Cafeteria a YP g ------------- P ( ) ( ) 0.? .Other fixtures -------------------------------•-•••._...--••---•-••-••••----- W Design Flow____.____0 ____________________gallons per person per day. Total daily flow........ .................gallons. WSeptic Tank—Liquid capacit}/kgq_.gallons Length_�e_A_____ Width....lk_w_.__:7Diameter________________ Depth_.__�t_......... x Disposal Trench—No_................ n. W,idth_..6.._...-__.___._ Total Length_.........2:....... Total leaching area....................sq. ft. Seepage Pit No....../............ Diameter____6._......... Depth belo v inlet.... ........... Total leaching area... �...sq. ft. Other Distribution box (/ ) Dosing tank `/ Percolation Test Results Performed by........�:._�__.� 'r .____._ __________________ Date____ _________.. 11 ` d a Test Pit No. 1.....s2Z.......minutes per inch Depth of Test it_____.&-_____.__. Depth to ground Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............. ODescription of Soil,_______________�. .... d'_ ..... ..... ..... .............................................................................................. V ...•--••••--------•••-•----••--•-•-•••-=•----••------•--...-•••••---------------- -•----...______••---•-----•---••--•-•••-•---._...----••---•••---•-•-•--•---•..__....-----...---•-•----•--••- ------------------------•----------------------------------------------------...-------•----------------------------...---------------------------------------------------------•----•••-----•---------- 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 not to place the system in operation until a Certificate of Compliance has be issued by the o of health. r ),J/ Signed.._..- -•• - -----------•..... ........... -----•-•--•••--•--•• -•-•S--w-....�. Date Application Approved BY--•-•-- ------.•.•.-.•.--.... ..................• Date Application Disapproved for the following reasons:............._................................................................................................ _ ........--•------------------------------------•••-•••---•-....--•--••-••...._•--•----------•-••--•-•-----••--•••-••--.._..•----•-•-------•-•-•-••-•-•--------••••-•-••••----••--------•-•••-----= rr Date ' Permit No.....................:. _. Issued._.._!............ 7 . Date No " �> ., - Fps.......... ..... 1e) THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Nl ew/►...-------------OF...... 4. .! ,S 7 V2 App iration for Biipos al Worko Tonstrur#ion "amit Appiicat ony is hereby made for a Permit to Construct OQ or Repair ( ) an Individual Sewage` > pc' al Systepri.at, Id K q 6014 d Loc n-ppAddress �l / 1 f or t No. ........... ......................................... -- ............................. !........ ...--••--. Owner Address a ' t. Installer �W e SL Q Type of Building Size Lo70(o° 7S f. .._.._.. q. ee Dwelling—No. of Bedrooms........."'.................................Expansion Attic &10 Garbage Grinder ( '4 Other—Type T e of Building No. of persons..................... ... Showers — a yP g •-------•------------------- P ., ---- ( ) Cafeteria ( ) Q' Other fixtures ___________________________ ��.w --- ------------------•-----------•------------------------------- Y W Design Flow!......... * ±__......�De�..gallons per person per day. Total daily flow _... gil 9 .Septic Tank—Liquid capacit .---.--..gallons Length. A-_ .._.. Width._ .1........ Diameter................ Depth_....-._.._..--. •. W Seepage Pit No...... ........... Diameter-_--:---r-- Depth elow inlet..... __ _.___. Total leaching area__: �___sq ft. x Disposal Trench—No...... ...............____ I t ___ ..._... TotalLength_.____._ ___ ` • Total leachingarea......_...________s . ft. P g q• z Other Distribution box (/ ) Dosing to ( l a Percolation Test Results Performed by........1!.` t-__ .._."'�Vit Date... �lf° `r ___ ... a minutes per inch Depth of Test .....�..__.-.__ Depth to ground water--------------- � Test Pit No. 1...._�______ _ �,,-� Test Pit No. 2................minutes pet inch Depth of Test Pit.................... Depth to ground water............... 6i/rJ l��"✓ ...•--- Description of Soil ' �" ------------................-------=----------------- -- •- -- ------ --- ---- V __•------------•-••---•---------------------•-------------------•-------------•------------------ •----------------------------------------- ------------------------- -•----------------------------------•---------•---------------------------------------....-•----.-----------------•......-------- ------------------------------------------....-•••--•-•--_•--•....-- 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 TITI1 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued by th and of health. Signed- ��� _ -a r � � Date Application Approved By F........--•------------- ------ ---- ._ ....-- ............._..._ Date Application Disapproved for the following reasons:-------•------------------------••-----•-----•--------------------------------•------------------•-•••------- ..............•------------------•----------------------........---.......----------------.....---------.._.....---------•-------------•---------•--•----------•-----------...--••-•............••-•-•--- Date PermitNo..............------------------------------------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH M OF.... ............................................. Tatifiratr of Tompliatnrr THIez/... 0 C TIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) .. --------- - X r; scalier has been installed in accordance with the provisions of 5 of The State Sanitary Co& as described in the application for_Disposal Works Construction Permit ......... dated. ...- '*- - . .............. THE'ISSUANCE OF THIS CERTIFICATE, SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEA4 1dlIILL FUNCTION SATISFACTORY DATE l .M... ...:.�. ...........• ,� Inspector.. e ° THE COMMONWEALTH OF MASSACk USETTS BOARD OF HEALTH t �+ ....OF...............A.. , ......................................... No.. .......... ..... FEE....... .......•-•-•- Rpo orkaion Trani Permission i* h7eby granted..... -- -- . ,�►--------------------------- ------------•-----...........-----...........---.......... to Constiu ( or Repai ( ) an Ind'vI •ual S w Dispos S t at No..... . .:.._fit... as shown on the application for Disposal Works Const uction� tre t' ., }r�' . . Permit No.= Dated ----------------------- Board of Health DATE.... V. - ...- 7 FORM 1255 HOBBS &WARREN, INC.. 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G G.�Aw. i conC. covers S .4 cast iron or •`; ,� ; 2" laver of Sch. -40 PVG �'' ve - �z nrn. pipe- w1 rni n. ;;• : •;'" $'rnayt. `��7 ', Gv a.s.lie a� .. o r/ pifc/7 %4"per peas E - � foot e 4'N Pvc pip SQnd i ,. (} j inv.G . — .. • 0 .. << _ 1nV.e� r-3 cm //7V, •• • • •• • • v O ! • ♦ • ♦ . • • • . • • • • • .. se tic fQnl� - �_ � • . . ., . , „ . -. ., ... .f• • /mV. a • ' • •• •' S• • •i •• • • •• �• MM -77 uSh'e-%St,ne, base:•;•: G�iSf: inv. e/. �y l3 I /s ~ �vrL v'�,u�t��7 9rourrcJ wafer f-a�!•� elev. _ ,�• h bo#o Pest a /ev. = Z lA/r9GE SYSTEM P�2OFILE_-� -- not y`-o Sctx/e � S,'9,57- � COS�cST SO Cj0ik,� c�re� w� 110, 31 LU SIG JV OAT�9 TE T LO G AIUMa IF? OF BEDROOMS _ S H OL GARBAGE D/SPOS,g4L C!N/T : TEST GATE : 707,9LEST/MATED F _,. �! !�//TNESSED B'Y:,- \ ;GALISR-IDAT x. .5 Ems : PE/ecOLAT/O/�/ )eATE /IVCH �c1�-ram 3� GRz /oAy' ram' ELF Z. Y/D�3, �'I�t GrS, SEPTIC TRN/•�: CAPACITY: G,9Z_ HOL E Z HOG E Z ' 1 6' 7`UAL SEPTIC TA.,S/a-! S,'Z E�� : , �_ GAL. ,- / :w u� SIDE WALL,.2 � f1•�.� Ly- /*' - r ! 0 T Tt3 h-/ .� .: C� -�_ %"OTAL ' C-EACHlNG CAPAC/T N) GAL. . S14 a _ 1 , o i 4 I � ,�.'E SE�2VE L ERCH/NG CAPJ9/c:JTY � GAL. � a _ - AJO 7 S . . _1 ALL lrtl0,eRMAAISH/P AN►D MAT = R/ALS Z1'�7/ r S H A , L G ONFa,e�-? TO �?, P. fi ND 7-H& 7-0IVAJ of 9�e jt RULES q"D REGULfiT/'ONS FOrE' �� .4 .. . SCIL,aUeFACE DISPOSAL OF '''t� � DD A K I T A/2 Y S EW A G E. t`1'� -- j�' 2,1 CG� ` rPL/R/VCE WITH 2OARAIG A2&G"ULo9T/ON.S � � -'�� - �,';.••e'��G. BE DE•TE/2MIIVED . BY gL�/LD//.:G /r';15r-��.= cT0,+2 /Co^-IM/SS1c7NEi2. ,=INRL GRADES SHALL ,e E M R I N `. 5 E N T/ A G. �' THE S ff i'•`?E. a _ , �._ E D 19 TE APPR o vE O .�-oow dam- ' F HE A H �' v �T �Tl ut Z -� Cam• = '- .CSC. �`' /off ,'7� /� j-j'/q AGE n/T ' r P L .9 ./ �o F ,�)e a c s o w sT vcTio w Boot) Gu • .5 7 EF P,LAN - � � �- r F-o �2 v.{�../ s � f3 t..� Huh.✓ �� 5'c m/e : / = 3D S c �, �j►•,5 SNOGt1�l.1' ATE �. t_EGF rr ca Mason . :it stimC? `spot elev. = o•'o , ,�. o o v Septie U ade Re aiis -lams , yA prop. firr. spot e/ev. _ o. o prop. fin• Gonfov o o- S -f-esof• hole location = �, W c.oc �•�/o/v , ,A East sandwich, Massachusetts