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HomeMy WebLinkAbout0017 CHOPTEAGUE LANE - Health ��- �� Q a' �" Q � ! �c�r5�c�5 �I � 1S . 1 LOCATION SEWAGE PERMIT NO. VILLAGE. INSTALLER'S NAME & ADDRESS JT®s&?h S o voa7E e%ft S7-Lf "*f/s .��. GUILDER OR OWNER TV hu/el i / W-A s�.�1 Zu6- e% DATE PERMIT ISSUED DATE CORIPLIANCE ISSUED � _ h� ��� � � .. G� ,t .�. ��� �, ��� �� U C?, 1 6y ,NoA-- .... ' Fss....d/ ..a:........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF.......................................................................................... j r7 Appliratinn for Uiipusal Workii Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ()v or Repair ( ) an Individual Sewage Disposal System at ....................is e.` e ....I� .... s��,1. ..................................................................... .... •o on-Address or Lot No. ............................. f�'Y �1 lq....I.S A c _?�2..F.... Owner A ss - go ...................•--.... nstaller Address Type of Building Size Lot.... .P__..Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (14 Other—Type of Building No. of persons.......e7 ............... Showers / — Cafeteria P4Ot r xtures ---------------------------------------------------•--.............................................. Design Flow.....Y --------------------------------gallons per person e ay. Total daily fl?w...•---.3............................................. WSeptic Tank—Liquid capacitylQM..gallons Length..._... Width. ........... Diameter................ Depth..... _. x Disposal Trench—NO...-./........... Width.....Y......... 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.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.---................---. -------------------------- ---........ -----..... -.......... •... •.......................................................-........................---....-- 0 Description of Soil........................................................................................................................................................................ x x ------------------------------------------------------------- ---------•----------------------------------•----------------------------------------•----....-•----•---------------------------...••••-- 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 Co —T*nrs.*. ed further agrees not to place the system in operation until a Certificate of Compliance has en ' suedf health. ned. .. -------••---•---------------------- /jD .......--.•..... ApplicationApproved BY--------- ---- --- .. ............................................................... . ............ Date Application Disapproved f the ollowin r asons:.------•----•-••--------•--•----•---•-----------------••-----...---------------....------. •-•------.._...... ....-•--••-•-------------•-••----•---•---•--•---------------•---•....... ......--•-•-.........................------.........--•-•-------------•---------------..........-----•------....._......------ Date PermitNo......................................................... Issued....................................................... Date •�_�yLl .....3110............... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .. ...................OF Xplifiration for Elhipoiial Workii Tomitrurtion runfit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 1!�"& A 0-///S:......................................................................................... o tin-Address or Lot No. ...7 ............................ ............... .... .....T Owner/,, dres ... ................e.................... ............................... stal Address Type of Building Size Lot.... 'feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Pk Other—Type of Building ............................ No. of persons........4?................ Showers Cafeteria P4Oth r xtures ....................................................................................... ........ . tl� ,? Design Flow...... ...0.........................gallons per person pgday. Total 41Y flow._____._.___ _ __,__.__._......._._._gallons. 1:4 Septic Tank—Liquid capactv/dzz-gallons Length_____y........ Width___.___......___ Diameter............."_ Depth.... No. ..../........... Width......Y '....sq. ft. Disposal Trench .. ......... Total Length____________________ Total leaching area.1ZP* .. > Seepage Pit No_____________ _______ Diameter_._...._._....._..._ Depth below inlet__.____.........._.. Total leachino,area..................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date_______...._.___.........__.._......_... Test Pit No. I................minutes per inch Depth of Test Pit..._..______....____ Depth to ground water_.___..____._.____._._.. Test Pit No. 2................minutes per inch Depth of Test Pit___._.______________ Depth to ground water........................ ......................................................................................................................................*...*------------------- 0 Description of Soil........................................................................................................................................................................ x U ........................................................................................................................................................................................................ . ...................................... -----------------------------------------------------------------*-------------------------------------------------------- --------------­*------------I 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 oftlITLE 5 of the State Sanitary Cod — The nders* ned further agrees not to place the system in operation until a;Certificate of Compliance has b en sued, of health. edt..77 ......................................... Application Approved By...... .................................................................. 40* Date Application Disapproved f y the olowin r sons:............................................................................................................... ........................................................................ ..............w.............................................................................................................. Date PermitNo................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntifiratr of TOutplitturr "1 0 ' ividual Sewage Disposal System constructed (.,-for Repaired T C TIFY, That the Ind. 0 nfT by..... ... ... ......... ... ................................................................................................................................ Installer C X_ at..... ......c... . . .... ...... ........te. .............. .. ................................................................................. ... ........................ has been installed in accordanc ith the rovisi ns of T 5 f The State Sanitary a XLegcribed in the application for Disposal Works Con r ion Permit NoT.1.77XO............. ..R_4"70 - THE ISSU NC OF THIS CERTIFICATE SHALL NOT BE CO/NSTRU D AS A GUARANTEE THAT THE SYSTEM WI CTION SATISFACTORY. DATE..... ........... ................................................... Inspector---..... ......................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..................................................................................... FEE.. ........... dii Tomdrurtion "amit Permission i!,Oreby granted..,.. ---• 2r ------------------------------------------------------------------------- to Construct, epai ) ..Va-ge -o-s-al' System� - atNo.......... ..• .......... . . ........ ......... .............................................................../- - -------- Street as shown on the application for D 0 ks Co ruction Permit No..... .................. Disposal ........... ...%P6 ed.../ .................................... ....................................................... oard of Health .................. DATE.- FORM 1255 M. SULKIN. INC., BOSTON 2 06 7 -- -No.- --- q....- Fee----- --------------- BOARD OF HEALTH TOWN OF BARNSTABLE Z(pplication-*rVe[c Con!9tructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (man individual Well at: Location — Address Assessors Map and Parcel Owner (/✓� /� z� Address — N—� AA 1, ------------------------------- --------------------- Installer — Driller Address Type of Building Dwelling--�'v`�r-`--- Other - Type of Building---------------------- No. of Persons------------------------------- !" � Type of Well --�e ----------------------- Capacity---------------------------------- Purpose of Well --------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certific to f Compliance has been issued by the Board of Health. Si ned � - - - ---- - - -�' '--�-------- g date Application Approved By — D___ __ __ date _--_---- Application Disapproved for the following rea s:----------------------------------------------- ----------- — ---- ----------------------------- ----------------------------- Permit No. ------ Issued-- - _ date da BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIF�_c, That the Individual Well Constructed ( ), Altered ( ), or Repaired (✓) � ccw l(- --- ---- - -- - - -- - ------ ---- // / Installer - — has been installed in accordance with the provisions of the Town of Barnstable Boarj of Healt Private Well Protection Regulation as described in the application for Well Construction Permit No. W�9-Dated---THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—----- —- - Inspector------— - -- - -- ---- - i f4 ----- ---------------Fee NO.- -- --- ----- LHETH it TOWN Ot S,T�4y3 L F� < < Cication fotructionPermit Application ishCe_reby made for a permit to C .( ), or Repair (man individual ell at: /rOLL4 ,L .�, I!Location Address 7 Assessors Map and Parcel --------------- - c_d -� ---------- -- Owner —— —U U ! 6 U Address ——---- --� i n�n..c' -.. -------------------------� -�------------------ Scu- - -_ -- ---- N►�� Installer Driller Address Type of Building 1 Dwelling 1 Other Type of Building--- ------------ -------- - No. of Persons---------------------------------- { Type of Well`� cOJ C.---- - --— - Capacity---=------------------- - —=— Purpose of Well-'----- ------ Agreement: ' ' 'w The undersigned agrees to install the aforedesc bed individual well in accordance with the proAons of The Town of Barnstable Board of Health rivate Well otection Regulation - The undersigned further agrees not to -----place-the-well-in-o-pierati tific to f Cor�plianoe-has-been.-issued,by. the Board of Health. Signed date Application Approved By _--- date i Application Disapproved for the following rea s:-------------------------------------------------- { --- ------------------------ date Permit No. -- Issued-- - aat -------- ----- !eliti��i�lita5e'aiYa'.t'it�t'e6clo!"oYulcyBif►_ Y2e.eKTmlEritR1YR'.l.++slfe@+!G�'i�sl�ilbe2Sd�Geial�aMrsNE4+f'Si4We�i'ika4faltliSi!'o sB%Rs>asisl3@f'lovaisi!'fi.TevNt°i"L'a!'ifiiB.aCGlDe4i9Pclilim.6�.E94R-Tasr^e�' 1 r BOARD OF HEALTH TOWN OF BARNSTABLE Certfitate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (✓) a Installer -- at r has been installed in accordance with the provisions of the Town of Barnstable Boaro of Healtb Private Well Protection Regulation as described in the application for Well Construction Permit.No. ---1 -'Dated-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL 1 SYSTEM WILL FUNCTION SATISFACTORY. li F 1, DATE—--- - - Inspector=----------_-�- --_ ays'+lil.Mt&!+KlitiK!itilMiaititi3i!a!i4iei9PGi!i44?itit�rKlilliMaGW.l6li6NlititGfGKPi4ill�lYBilY�if4tb�igl�1�!iRi!Y.!aeYi!!�:`+rrViK^�'!v?itiTi!�ili!i!�'ti!4liN!..N!i!i!iti BOARD OF HEALTH I TOWN OF BARNSTABLE j Veil Congtruet ion Permit No. Fee- — Permission is hereby granted ------ to Construct ( ), Alter ( ), or Repair. (I ) an Individual Well.at: No. —L-L__L �o _ e e.Q t;X c — �y' ti+�< �.. / �n� Street ' as shoNi'✓V licat' for.a Well Construction Permit No. - —�--L -- Dated - — - - — -� - Board of H t DATE 6 ' x �� I( III SOIL LOG- - N0. 1 NO, 2 AN ' S I .-T E P L p q.. S 1 LT`1 vv 67, j✓ GL S r :t • ,. TOP Of FOUNDATION Et.. q .mil •.. . swn Tw e o 1")1r.111., 8.J2h1n -- c l� 9 . , a+ tops, IN.EL,. - t l 10 _ IN.EI. IN.EL. .4- E 8 , , 8q . . .. •• : - 2 COVER 1J8 3/8 WASHED STONE l2 b IN.EL�` a :.. o a o . . IN EL., , 8$,� � Y >. IN. El. n® a a © o a a n . 13 v 11/ WASHED, STONE y W 6 3/4 2 WAS E D/B � SUMP o � o -� o , e _ � _ 4 - LIQUID I D ` LEVEL a -� . 4 o n.vroJ . c _ 4 - -_ oe a i - EFF, DEPTH. . - y/n PE TEST RESULTS . (� RC .. _ s � : a � o�, U l 4 0 � �,� �F r-o A e Z __ PERC RATE. .: M t►w I Psi c. PRECAST EPTIC TANK WITH _ one 0 � o ,---,-� . S �����a-� � � o � PRECAST LEACHING PITS p , O e • b WHIT NE D BY. :R ._._C .�. - WH N SSE 0 0 6 #� o . . CAST IN PLACE INLET AND, :' p � .� EL. .,��R o NO,,..�_o SIZE: rL . . - .; �. EA TH OUTLET T S . ... .PER TITLE Y �, BOARD OF -HEALTH 2 DIA . . f - , SIZE . ?E 7 2 ' p .4 a' d 5 . a •� TES G ? "h1 �E ' o / ..' .3. '.. ..E X . D r . . F PR T s y PROFILE t"� C�PQSED SEWAGE . SYSTEM : ,� SYSTEM DESIGNED BY THE TOWN OF .-REGULATI REGULATIONS N - 1 .. --STATE ': TITLE FOR SUBSURFACE DISPOSAI OF SEWAGE . SCALE 1I4 0 ! f ,B , - N - ,. PI HA BE; HEOULE 4 P.V. . : SEWER PIPE _ 1. ALL. . P S SHALL SC 0 . . , . 1 • 2, ALL :PIPES SHALL BE SLOPED 1i4 PER FOOT EXCEPT FOR:. THE FIRST 2 FEET BUT OF WHICH ,THE 0 / B SHALL . BE LEVEL p - ' 3. DESIGN FLOW BEDROOMS AT 110 GALDAY PER ` BR. c> GALIDAY :• . : b .- ..,. SEPTIC TANK SIZE �� X _ GAL. O-G r, • o0o W! o GARBAGE DISPOSAL USE. �. .. G A l, —� u LEACHING SYSTEM, USE 1 , O N EFFECTIVE : AREA.. SIDE jT x o _ G - BOTTOM °I :TOTAL FLOW .� _ N O GARBAGE DISPOSAL REQ O FLOW X WC �., 3 230 RESERVE FLOW � __ � GALIDAY - _ �, > 4 Fa 2 G A L c. ��.-�' .G J_T /.S ; 2 - ,lEL G /O REFERENCE PLANS .-0. , B APPROVED Y . � 77�. BOARD OF HEALTH DATE S 1TE ARID SEWAGE ,,: PLAN PROPERTY OWNER . .. , .w _� �-�. a x �.. ���_r .q. .. � BEDROOM :SINGLE FAMILY_ DWELLING . P / Tom' d , Rrf y yy DATE :. y , _ DOYLE ASSOCIATES FALMO TH MASS. - U