HomeMy WebLinkAbout0174 MISTIC DRIVE - Health ill ate+�r�sfiis
--
275 Millway, Barnstable
i
A= '
Triad Therapy i
No. 4210 1/3 BLU
ESSELTE
10%
(D
o m
t`1 TOWN OF BARNSTABLE 0 ,7 `g��
LOCATION ',t�`�' /Q 1 " SEWAGE # [7(o, 51t/S
VILLAGE M A P-S tom S i L.tSASSESSOR'S MAP & LOT Lo T %d
INSTALLER'S NAME & PHONE NOr�_o j A) M l pr_&-' `lV"f 3 S
SEPTIC TANK CAPACITY IL5 a D
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER I"'A,,n Ai g7T �z v i
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
y.
VARIANCE GRANTED: Yes No �� /
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71
S
3 �
LERK
��INS'j BLE, Ws �
No.---...��_...��_`.'.'.��� Fps ®..�
A ` .. .. �
THE COMMONWEALTH OF MASSACHUSETTME MAY —g � 8 45
BOAR® OF HEALTH
D..W' H......................OF.... �4.r.h.5e...J? 41._R.--------....------._.......__.........
Xpliftratiun for Uiipuiia1 Works Tunitrurtiun Prrutit
Application is hereby made for a Permit to Construct (K,) or Repair ( ) an Individual Sewage Disposal
System at:
L
--••------or Yot_No.
�, .........................................
on-Addr s
W Owner Address
.........--•...............•--•-------..--................--••---•----------------••..._....-----
Installer Address
Type of Building Size Lot...�__�,�._7 ---Sq. feet
U IV
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures. ..........................
W Design Flow......................r.............. per person per day. Total daily flow____.::__._..:y o_. ............gallons.
_ v Widthr3'"._ v Diameter................ Depth_.��.�. v
W Septic Tank—Liquid"capacit✓Z .gallons Lengthld..6.___. LO-_--
x Disposal Trench—�Z.................... Width_..._............. Total Length.._... ..._...... Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter/.---•-__6...__. Depth below inlet_G..._C.._..... Total leaching area---r. .sq. ft.
Z Other Distribution box (X( ) Dosin tank ( )
'-' Percolation Test Results Performed b .__. >l� . _..___.SGry A,�-�.
Y -- �`� Date---/"�--- ---
Test Pit No. 1......�_.....minutes per inch Depth of Test Pit..zo. a Dep4h to ground
f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_--.---_-_---___.___.
a O/Z`�..._.4-4&e..!_fyl�ita.( ..................................................
O Description of Soil..__!z-9G" �ICd_....- __-
S?'> .
"►� �� - /Lo S�bso / µ�tY -----------------------------•--
--••--••------ ---------------------------- y t-tF.- ...............................................
Y v
W ------------/Zo. ZO ----�l`K---S� � `'
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 iTi'12 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 board of health.
Sig ed---------
y
Application Approved By...........................
. -- ------&��
....------ ZS t 0-C
Application Disapproved for the f ollowin easons:--------•-•-•-----------••----------------------•------•------.......---------------------D--.........•---•-
..............................................----••------...-------•----•-••-----.....---•-•------......--••----------------••-•-----------•-•-•----•------•-----•-•--•---------------•--••----•-•-•---
/ r— Date
Permit No.---- la ��li ................ Issued.......................................... ---....---
Date
j
No......................... Fss..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-ToGu..0......................OF.... �-"K,nS..�':"..4_� ....
ApplirFation for Bispoii al Works Tnnitrnr#inn .ermi#
Application is hereby made for a Permit to Construct ( ►C) or Repair ( ) an Individual Sewage Disposal
System at:
LU �1 41, r v e �1• 5-..... .._..�U........... . ...-- •-•-•-•-•............................. ..............................................` - •--------•--......•---••........_....••--
L Pion-Address or Lat No.
.......................... ................................................... ..................................................................................................
W Owner Address
Installer Address
U Type of Building Size Lot.. G,2 ..Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of
a YP g -------------•-•---•-------- persons............................ Showers ( ) — Cafeteria-(---->-
Otherfixtures ....................................---'•----------------•----------------------------------------------------•---
-
W Design Flow.................... r........_..__..gallons per person per day. Total daily flow............._.�� 0
........................
WSeptic Tank—Liquid capacit}.?S- .gallons Length ". Width,S7L0 _ Diameter................ Depth_.f..� .
x Disposal Trench—Zip..................... Width.................... Total Length.................... Total leaching area___-_----•-_-----•sq. ft.
Seepage Pit No.....................•Diameterl`:.....U_.��. Depth below inlet.6.�..c._...._. Total leaching area.... e��sq. ft.
Z Other Distribution box (A ) Dosipg tank
'-' Percolation Test Results Performed "!F"r .__.. �!_°i'.. Date /��� /
Y -------•••-••. .......-•••••.-•-•
Test Pit No. I......A......minutes per inch Depth of Test Depth o ground water-__- � N
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x -,z - ... �.... rs�<,su
i z- *er(,
x Description of Soil-- 7 ..........r v.a-� i�:!1-------------•---••----•f' �............ 'd
rY ................................
,W
2a . Z.. S� �il� .?.sy ./ L �,C
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 TTTL i� 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 hez-lth.
Siged......•-•-••..................... .........---•-.•...
JA
Application Approved By......................... ...•. .....------5-- t K....--
D
Application Disapproved for the following easons:--••-•--•---••--•--••-••-••...--•-••-------•----••-•-------•-----•......---•-----••--• e..............
Date
PermitNo....................................................... Issued........................... .....----------------•--.-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TrrtifirFatr of ToutpliFatta
THIS T CERTI Y, That th Individual Swage Disposal System cons ructed (''� or Repaired ( )
by --•- ..--•- .............. ...... . ........................."tom`......••- '
...// ,, . Instalpleerr�� _ °'']�''_ •�/IJf//J
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.__��....._' .!_..�-................... da.ted_....__.. ))�� fit._.____.___..._._..
Y {-- J-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
` SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................... '... t ..................... Inspector.... ._..... .............
THE COMMONWEALTH OF MASSACHUSETTS
p,a eoan-}•0 v -14ti�e �'Se+lde
BOAR OF HEALTH P►fVA A-t m&t i eZ► or\ `lh(.
$e W dye to
...........................................OF........... .......
/.ic:t✓s.t_1..u+..r�t1t�
No ....................
..........
Disposal Vorkv LTnntrnrtinat prAilf"�
Y g A -------------------- -"���.1.c1 ....i��.....q�z:$A 1tv. ,
Permission. is hereby ranted...............��__�__..�'l___..._._._...__._.._ .__
to Construct' ) or. Repair ( ) an Individual Sewage Disposal System
atNo. 5 .....1 ........M_r.j .ir.. --` _X................ .... r
Street 5m- I!
as shown on the application for Disposal Works Construction Permit No-------------------- Dated.... _ .4_�:gro.._.._..........
ard�af�FIee
DATE= �__E._ ?. ..� ----------•---................................
DATE
FORM 1255• HOBBS & WARREN. INC.. PUBLISHERS �'"
f
~ � ASSESSORS MAP NO- 7
II No. ---------- -- - Fee- ------------------
41
PARCF>�&Ifd�o A FrH F A I T Y � T
TOWN OF BARNSTABLE
Application-*rVell Congtructionpermit
Application is hereby ade for a permit t Construct (b , Alter ( ), or Repair ( )an individual Well at:
------------------ --------------------------------- -----
Location — Address Assessors Map and Parcel o
/Owner Address
- — — - -
Installer — Driller Address
Type of Building
Dwelling--------------------------------------------------------
Other - Type of Building-------�D------------------ No. of
Type of Well- C�`-�-�'� -- --_ Ca acit -S___
Purpose of Well-----y—--- U`-^-----
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 un ' a Ce ifi t f o pli ce has been issued by the Board of Health.
Signed - ----- -- — a
ate
t a� � e
Application Approved —�--��-��------ ----
PP PP
���%'� date
Application Disapproved for the following reasons:---------------------------_______—__— ____
----------- —
date
Permit No. Issued-- - 4__F
date —
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance
THIS IS.10 C T That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by-- _ � ��-------- - -- - - -- ------ ----- --
Installer
at �-761—��$ / C /110/ 9 6 5-has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit N04"14_�-"Dated 7
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- — - - Inspector-------------- ---- —
_ in, 7 car
No. ---------�-= (J Fee--A-----------
BOARD OF HEALTH T
TOWN OF BARNSTABLE
Application_*rVell CongtructionVermit
Application is hereby _ade,for a permit to.Construct (G.- , Alter ( ), or Repair ( )an individual Well at:
--j�v 'f=
-- --
Location Address Asses rs Map and Parcel _
_—
Owner G Address --— —--- —
- -- -----------
Installer' .Duller, Address
i
Type of Building
Dwelling --- -- -
1
Other - Type of Building-=----------------------- No. of
Type of Well- -=¢— - `�- Capacity--- f�-� - - ---—
Purpose of Well ------------- -- , ___: a
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 Ce ifi ate f o A ce has been issued.by the Board of Health.
Signed - ( --- ------ _—— ate �r
Application Approved N� �-- —— �� e_f 9
date
Application Disapproved for ahe following reasons: l
— —-- — -- ---- ---------------—
ate
Permit No. . `: � ----- Issued-- --- �- --� - --- --- - -------
date
'�c4i+z^39a?a-:3'?d�d CB*i9a K?e cRilr!►4i.?.Y.a'ti�3Pi4�!i14lPr Y_i!G1��OWea!rc�xi4r#iv,Stiff;.iM;tFaQrliP;si.,imiW9ii�f.`s9i9i�iVi9rRtTpT;BiMct4t9;K1o�!�ei5Ar9;9MrQr!r1r�P�rtl.�;fottiq�1
BOARD OF HEALTH
:TOWN . OF BARNSTABLE
�ertifitate®f Compliance 4
THISY I§.,10 C T That the Individual Well Constructed ( ), Altered ( ), or.Repaired ( ) µ
by - - --_- -- -- - - ---- — ---- -
Installer .,
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
p �
f.. -- Dated.-,--
- .. ]
Regulation as described in the application for Well Construction Permit No��'�
THE ISSUANCE OF THIS CERTIFICATE.SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY:
DATE------ -- --- —_ Inspector-=-------- - --- —------- I
._,. -».���'4s�s§a?al��r?�^�.=,�eN{,ssF.ea:is•.w:�reaa:w:.�iieaai�eaati3,scgevaAiersr++i4�4r+aRrmr4nea,Era.��ascasrw►.ceaeaw?rea:Xawa!R+N!�:r:w:a:re�r,�Tl..�r�rgan?isir.as5a.srei�awxrarwgaaeaace+�Rq
BOARD OF HEALTH j
TOWN OF BARNSTtABLE
� . �I
,wellortgtructionermit
d Fee— ='
Permission is hereby grantedto Construct{ ), Alter ( ), or Repair ) an'Individual Well at:
No.
street
as shown o the a plicatiori for.a Well Construction Permit
I Dated No._
. 1
Board of Health
DATE
s
t
7-
�77
`777`7 777777777`—"
7 1 1:
S Ys TEM PROFIL E '�
NO T, TO SCALE,;�.,_. ,�,. :
TOP 'FDN
'FNISH GADE 0 FINISH
GADE
EL .'�57-
FINISH ,GRADE. OVER DIST. ',_ FINISH GRADE:,
BOX
�OVEI_
LEACHING. PIT
TANK
SEPTIC 4�5(�2. 4"
�A VARIES
12 AX
3 OF ,:,
PECA S T, CONC. OR
:d. .I I . I -1 1 1 1,�"," -I
SHED 'PEAS TONE
BRICK
MOTA
iOU7LET,llpjpE_L'LEVEL�,
�7, TO J 2 BEL OW 'GRA DE
FOR
p
�c7T.: �WIN.
oo F
4
6
:6
A�4 06
C. I. OR PVC TEES
50 T A, 'Pt T
GA 'DIS BOX,
`85MT FL . LLOM
TRIB&TION
,�70,on
EL
DN LEVEL ,,BASE, -3 'TO _1
INSTALL
P
RECA
-T�_ CONCRETE , 14 12 ST
PRECAS
NA SHED
CRUSHED
CONCRE STONE
-0:0:4:0. '4
0
SEP TIC -.TANK
'90'40
NO TE, EXCA VA TE TO ELEV.
INS TA L L ON LEVEL BASE OR
LOWER, TO :REMOVE,A L L 'IMPERVIOUS
Z, -01
MA TERIA L BENEA TH THE LEACHING AREA
EXCA VA TED, �MA TERA L WI TH ,
REPL ACE ^v
_SA V�,
CL EA N, CL A Y FREE N
V_
i p - o, EFF*Ec Tr vE viA TER
ME
r
H
LA C ING
T A/0 TES
GENERAL
INS BA
TALL ON L E VEL SE '
"ALL ELEVATIONS SHOWN ARE BASED
ALL PIPES IN THE S YS TEM MUS T ,BE CAST IRON
op 4o..P vc. 'P.Lr T
OBSER VA TION
OJ7
3. ThE BOARU t7 Y:A L TH MUS T BE NO TIFIED
-PRIOR
NHEN CONS TPUCTION, IS COMPLETE
PERCOL A TION RATE.
TO BACKFILLIN6
A - CH Z MIN.11N.
NY ANGES IN THIS PL A N. MUS T BE A PPRO VED
EAL TH AND -CAPE & ISLANDS
BY, THE,.BoAR0 CF, H
SURVEYING CO., INC.
-700 t 6r— AND INS TALLA TION SHALL BE.,IN
461 -
5 MA TERIALS
F. HEALTH
COM DESIGN DATA
PLIANCEzX17H THE STATE SANITARY.�,
DA TE.
CODE -- TITLE D �LOCAL 'APPLICABLE 3-�
AN
eL. 5G.7
RULES AND REGUL A TIONS
0
11 1 1 - I DPOOMS
NUMBEP OFE
-AN
4 ,
0
6. NORTH ARRO s FROM RECORD PL A NS D
GA PBA GE DISPOSA L
IS NO T TO BE USED FOR SOLAR, PURPOSES
im
_OU DAIL Y FL ON
7 LOOO ,HAZARD 20NE
F
SEP
8. HATER SUPPLY 7(DV/Q ATE-2 ( Z 5
TIC TANK 'D
e7o
SEPTIC, TA NK PROVIDED ,
LEACHING REGUIPED ,
40
zoo
........ F.
A5
F. S.F. .4 7 1 ,�GPD
GI
'BOTTOM - REA 7 0 S.F.'
GPD
L ilEEND
_I!E�_S.F."X I. GIS.F.
Z_
e L.5,3 -7, , .L EA CHING PO VIDED A515 0 GPO
'Z, IT6 I 10QCiP0, '
'5 4
PFDPOSED EL EVA TION
50 EXrSTrNG' e0NTOVR
IDENCE (g ,
4%W
OeSERVA TION 'LPIT
0 r
UTION,BOX
10
' DISTRIB
r CONCRETE ,
:S YS TEW
L EA PrT
PROPOSED .SEAA GEr DISPOSAL
-IING PIT
L FA Cl
iPPEPARED OP,,
0 ,
ANK
TL—Lxmssnvrous tR twsur7-AaLE HA MAUL SEPTIC T
NITHrIV Z.5 Fr. OF THE L5ACHMS
0 0
TT .:
-.rs-.ro eE REmovED
rA crL r 7,Y:
MIS
A7 1 CLEANSAND:
AAAD REPLA CED -(RPI
DPIVE ,
REER VE.
7c
_-BAPIV
MA 55.
TABLE,. :' �,,,:M MIL L S.,,�
PIPE,`IN VER T EL E VA TION
DA,TE,' SLANDS SURVEYING, INC ,
CAPE 'I
�6
'D
SCA LE A S NO TED :.
PLOT:'PLAN
BOX '�334
SCLE.,
A 4, MA
Ss.,
T;
PCL,j� L Or TEAl,TI,CKE
I ' PLAN., NO,.
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