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HomeMy WebLinkAbout0122 OLD MILL ROAD - Health _ _ c�- og� ��rs�ori� l��ILs TOWN OF BARNS'TABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION ADDRESS: /� `7✓� t'?�tl IL-7 r-r J MAP NO. .} PARCEL NO. OWNER NAME: a�ip,7ar 1 ,,,,,� %fir � `//. VILLAGE:./ /� `l !,.2 INSTALLATION DATE,_:: BY: ADDRESS: .'i' !/ ,, �„I : /�" CERT. NO. � l o I O [) l TANK INFORMATION LOCATION OF TANK: `' CAPACITY Ar—.3 TYPE _ / AGE FUEL/CHEMICAL TESTING CERTIFICATION E I PASS E I FAIL DA1TE LEAK DETECTION E I CHECK IFIN/A TYPE/BRAND ZONE OF CONTRIBUTION E ] YES I NO DATE TO BE''REMOVED FIRE DEPT. PERMIT ISSUED E ] YES E 7 NO DATE UUNSERVATION E I CHECK IF N/A DATE 490 BOARD OF HEALTH TAG NO. ]E JE ]E ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ���K { r LOCATION �� S.EWAGE PERMIT N.O. VILLAGE INSTALLER'S NAME & ADDRESS BUILDER 0R OWNER �2 c \DATE PERMIT ISSUED DATE COMi'LIANCE ISSUED O - � r �� �t r� � ,�- �.� � i3 �� D e�J� LL �� No.............. P Fins............................. THE COMIMONWEALTH OF MASSACHUSETTS BOARD OF HE TH Z_ 00:;.�� ............ ....Y_...................OF......... I .... . .... .................................................. Appliration for Di-qVooal Works Tomitrurtion "amit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: r..................................................ectle.1.3-------- A01ra.owele.-�,%...No— /J Z, ' at, Address _*7 _ or Lot NC q 0 og _ r.V I...........?_ ........... ......................... ,Qwner Address ca%rze".15,14r.07......... ................................................................................................ PQ Installer Address 1� Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------­--5-----------­­-------Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons......7................ Showers Cafeteria Pa Other fixtures ................................................................................. -------------_----................................................ Design Flow............................................gallons per person per day. Total dail flow---.........J.J.0..................gallons. WSeptic Tank—Liquid*capacity/06-gallons Length......e...... Width....... i---- Diameter................ Depth_.._Y....... x Disposal Trench—No..................... Width....._._...._____... Total Length_................... Total leaching area....................sq. f t. Seepage Pit No-----------/...... Diameter.........4........ Depth below inlet.................... Total leaching area.AV6&..sq. f t. Z Other Distribution box Dosing tank 4e Date...Percolation Test Results Per-formed by.... .. ...........7 �4 !0 of I . ..... ............ Test*Pit No. I ----- inutes per inch Depth of Tes Pit.................... Depth to ground water.._....___.__._...._._.. Test Pit No. 2... .........I rXq ��_4.minutes per inch Depth of Test Pit..__............._.. Depth to ground water_-__._.............._... ................ 94 ...........................Z............................................................................................................. ..........IiZ 0 Description of Soil-------... ............................................................................................................. U ........................................................................................................................................................ ................................................ W ....................................................................................................................................................................................................... �4 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 L IT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been j ed by the board o li&lth. Signed. .. ---------------------- Application Approved By---.. ......... ...................................... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued--------------------- Date No................-.....-- � _. Flcs.....�........-y........... 83-ISS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........-----------------.......OF................................................ ................. Applirativ for i n �a1 r n� rnriiun [anti Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ti Location A11,4ss or No :e/,., ,+ r �.k ddress `j".V W •-•••••--------------•-` ...... ................................................... ........................ 1UflQl1 f} Insta o:r�; c-r � �P Address UTYP ri � Size Lot............................Sq. feet Dwelling—No."of Bedrooms....................:.......................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers Cafeteria a' ,Other fixtures ............................ ............................................... W Design Flow............................................gallons per person per day. Total'daily flow_-A........................................gallons. f� Septic Tank—Liquid capacity..........!tigallons , Length................ Width................ Diameter--__-_ _ _ Depth...._.._....__.. Disposal Trench—No..................... Width_.._................ Total Length......._...........,_ Total leaching`ar .__.______._____Sq( ft. Seepage Pit No,._�................. Diaak44.............. Depth belo inlet........._______ !. Total leaching area..................sq/t. Z Other Distribution box ( ) Dosintank ( ) Percolation Test Results Performed by__________________________________________ _____•___......-:_.___._;-:_ Date...............---_------ --- ---- -- Test Pit No. 1................minutes per inch De �t� ,P ot,depth to ground wat� _ti .. _____ _ 44 Test Pit No. 2__.'_._�!-, " mutes per inch Depth o �est Pi ......._.'Depth to ground water........................ a' ---------•-------•---------------•----___.---.--------.............._......_--•---••-•--•.._......_..-••••-•-•-•-•••-•••--•---•...--••...•. 0 Description of Soil.............................................................. --.------•-•••-----•------•-----•-•••---•-•-••••••----------•-------•--------------•--•••••-•••_•--.- x W ....................-................................................................................................................................................................................. 0 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 TITiE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the board of filth. Signed.. : r' --•-• __:_ Date ApplicationApproved By..............................................................................................•--• ........................................ D Application Disapproved for tae,fg rei ==T 'l °2y ---•--•-----•-----••...............•••---•--•------------••••-•-•---••-•-----•---••••••-•-•-•------....•. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......:..................................OF..................................................................................... fIrtifiratr of Tamplianrr THI E .TIFY That Ind' 'dual Sewage Disposal System constructed ( ) or Repaired ( ) by--••-..:....... e! _� ,. '.r :r.., .�'.........................................................................•-------...•...•....._ Installer at ---- r / ........ �';t°' r ...e�" _:*.rat" .:�irrtr °- -------------•__--•----------------- 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_________________________________________ dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOpjf.,a ,OYSTR E® AS A GUARANTEE THAT THE SYSTEM ��UNCTION SATISFACTORY. DATE.. ..............:........................................... Inspector_ .__ ..0....�`__��______.__---------•-----------•----- _-•---•-----•-_-____---- i THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ..........................................O F..........................................---._...................................... No......................... FEE........................ Permission is hereby granted.................••.._ ..._. It' Os� ... --.... ..-•-----. ...._.._.... ,,��rr� - to Construct ( ) or Repair ( ) an Indivf i�al Sev stern at No. ,,_._.. :5 ,; 1.. V 0- as shown oilr�appriltion St " eS . ..... .................... I r} �Board of Health DATE...............Y................................................................ <,.... .• FORM 1255 HOBBS & WARREN, INC., PUBLISHERS va � >\ J x s - e M 1 Q � 0 OFM nui su (pgym pp ,�� �QQN ,OppQD taw�� ti. . .���, ��� Z=dE 0� �, -�� o moo 66 3o` F,S. B. ASSUME'o PQcsi-Ec-nc:)" ukjbe'Z ftRilCL� IIZ G1-1A£'iC12 ITT G-e, EL= loon LEGEND ` // CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION OxO / EXISTING CONTOUR 0 --- A qLET• 13 FINISHED SPOT ELEVATION A� oy M A� TCa1..1 M i LLS i FINISHED CONTOUR 0 /. i. HI °� IN � EINBERG APPROVED s BOARD OF HEALTH N6:-366 n, STS AGENT �Fss�oNa�ENG . SCALE, I "= 30' DATE - DATE d1. Ia a3 � LDREDGE ENGINEERING CGt IN CLIENT Ul _"S I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO., 8�'.._.�i4 BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS RV DR$BYf '--- �-- OF BARNSTA E, MASS�-� ENGINEERS As uc�rExJ i• 712 MAIN STREET. CH, BY _�. - HYANNIS, MA;3S. gMEET,I,,, OF 2 DATE. Q. LAND SURVEYOR NOTE /F E/7-He-T THE SE oT/C TANK OR � 20 A7. M//V. LEfiGH/NG P/T ARE MORE THA:"J /2BELOjV ` /O PT• MIN :RA/7E, �i sad"�D/.4 M E TER CONC e—,c 7'L' CO i�ER _ SJ,IALL 8F BROUGHT TO GRA OE. IV EXTRA CONCRtTd 4 PYC p/P� h+EAVY CA ST /RON CO{/ER SA1.4 L L .3E USEO P/TCN ✓EWA Y COVERS �9•P1�iQ FT. aMA0 COVER CLEAN SAND B.4GXF/L4. Llopulo LEVEL 1 2 L Y - A ER -a' -*'CAST - i o e ! 3 - V8 RON • e•v a QF 8� P PE / I MIIV.P/TGN e W :b A SHFO 5MIYE D/ST. S.EPT/C TANK , • • • • • • ,� • =`i- BOX o • � 8 • • • • • e � e . ?fi- • Is. . •EFFECT/VL e ` • •r 314 - �2 • e •• DEPTtI • • e • WASHED STaNE o • • • D 2.S = 4-71 4f6/D . a, • •e • T• • • • . • p ••v PRECAS SEEPAGE -7 6,S x t. a = 75 L� v . • e • • • . . • e a p P/7 OR EQU/V• EYA /ON s a .4'r EL T . _lNfiP r=L- 98.0 /NYER7- AT 4U/1-D/N6 0 •© FT. c� b 6 F7" D/AM: ►� FI. O/i41�'!. C. SEE TAB[/LATJON� INLET SEPTIC TANK 10- -0 =r - *[ OUTLET SEPTIC TANK LOG, FT _ t LO o GROUND P447,ER 7AOLE / I U /ON BOX FT, T ® T N OS R/ LET 0U7LETDISTRtaarlON BQX 105,8 FT ECT/O/V 4 /NzET Lgs�CNING P/T (04,0 FT. SEh/AGE O/SPOSAL SYSTEM LEACH//VG PIT TABllL.9TlD/V JCAIE :. DIMENSION A 3 F7* D,ES16M CRITER/A Di•yenrslcN 8 6. FT. NUMBER OF BEDROOMS DIMENS/ON C 4- FT. �AA►W) GAReAGED/SPO-SAL- UNIT l,I0 NG SOIL LOG S`Q/L TEST TOTAL E.TTIM%iTED FLOW' GA4.1DAY SOIL TEST 01 SO/1- 7-1='ST#2 MUM8ER OF LEACMING P/TS f BYQ . �I�- 1 S �SIDE LEACHING PER P/T SD FT RESULTS N/TNE5S6D (ot\M im c$OTTOM L6�IG'N/NG PER P/T 7B $Q. PT. To4 ,5=tL -eVC04AT/ON RATE,*/ Iy/IV INCH TOTAL. LEACH/NG AREA SO. .FT.- o FFNC0GA770, /RATF fk2 M/N.I/NCH K,ESERVELEACHING AREA SQ. FT. 16"--1` tftfi4 gar- ,A :, �y a -it%OF '' V , LoT 15 - <=>L D M I L L AA G M A 111-5 cn"—s NA I L.LS � y I WEI, RG y � to •' � o se EL DREDGE ANG/NZER/NG CO,INC. ` �Lz 9�'�.� 7/2 MAIN Sr. , HYA.c/N/S. MASJ. � ) su t [�NO GROCINO kVAr M 41FNC0IJ/V7EREO CL/ENT: *5 AZ ' { / Q GRO U/VO YVA TFR AT EZ-ZFV _ >,/ .IOB NO,• 83�1l1 SHEET '1- OF 2