HomeMy WebLinkAbout0452 OST.-W.BARN. RD - Health $52 (.O3_ _�.�.•. (a4d�
MARSTONS MILLS
-� A = L (�4S
TOWN OF BARNSTABLE : G
OSCAT10N 1-62 Q:J Gvy 6,6^ 1Za SEWAGE # 77 1 j4
'%rIL1:AGE 0 S ASSESSOR'S.MAP & LOT 2- 6 ,
INSTALLER'S NAME&PHONE NO. rZQJ s 4er.S a ,L- 7<S 8
SEPTIC TANK CAPACITY &Q--0
LEACHING FACILITY: (type) �L C. (size)
NO.OF BEDROOMS 3
BUILDER OR OWNER 1:f 0-S a=
PERMITDATE:/O-!S—9 7 COMPLIANCE DATE: /6 :74&- g 7,,,,Separation Distance Distance Between the:
Maximum Adjusted Groundwater Table and Bottom df Leaching Facility Feet
r
Private Water Supply Well and Leaching Facility B(1f any wells exist
on site or within 200 feet of leaching facility) " Feet
Edge of Wetland and Leaching Facility(If any e tlands exist
within 300 feet of leaching facility) Feet
Furnished by
� J
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No. '?/ 'i� /� W Fee $5 0 /
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for Migool *paem Construction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
ocation Address or Lqt No. Owner's Name,Address and Tel.No.
452 Ostervllle-W. Barnst ble Rd.. James Grose.
Assessor'sMap/Parcel Marstons M11�s
/
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson ''eptic Service
P 0 Box 1089, Centerville , MA
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
' Other Type of Building No.of Persons Showers( ) Cafeteria( )
,,•' +' Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Sand.
Nature of Repairs or Alterations(Answer when applicable) —
n—bnx and 2 chamber 6 6
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 Certifi-
cate of Compliance has been issued by this d otkfealth.
Signed !/li Date G` S
Application Approved by i Date ll l T
Application Disapproved for the following reasons
Permit No. ZY"(0 7 Date Issued /0 lS
TOWN OF BARNSTABLE ,
LOCATION �,`� �.[) �ovt l�c f SEWAGE # 4;"F-6'2 4
VILLAGE_ (1 S ii ✓!✓l,i l a� ASSESSOR'S MAP & LOT
2 d '
INSTALLER'S NAME&PHONE NO.- tk7�,> �� ,� 7`7 S g 7 C,
SEPTIC TANK CAPACITY ✓G o--o
LEACHING FACILITY: (type)
(size) }
NO. OF BEDROOMS- 3
BUILDER OR OWNER
PERMTTDATE:/o —1.5 `3 7 COMPLIANCE-DATE: icy
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 facility) i Feet
Furnished by
i
L
' • I
pia
E �
$
No. r I Fee T 50
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
a Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS
0(pprication for -Mie;poml *pztem Conotruction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System El Individual Components
4o ion Adss or Owner's Name,Address and Tel.No.
, Osd e erviLgtiie-W. BarnSlible Rd . James Grose
�Assessor'sMap/Parcel Marstons Mi s
G5 � -
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson 'Jeptic Service
P 0 Box 1089, Centerville, MA
Type of Building: _
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other ,yType of Building No f`Parsoris t-'-I' Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title P
Size of Septic Tank Type of S.A.S.
Description of Soil Sand
i
Nature of Repairs or Alterations(Answer when applicable) - v
D-box and 2 chambers. L)
Date last inspected: 1
�r
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 th6 Environmental Code and not to place the system in operation until a Certifi-
cate oRCompliance,has been issue by this �d'o ealth.
�. Signed Date A-1,-�i 9'
Application Approved by i1y '�,. Date
Application Disapproved for the following reasons,
..Permit No. —w 7 6 Date Issued
1
THE COMMONWEALTH dF-MASSACHUSETT�S
Grose
BARNSTABLE, MASSACHUSETTS
,. , -
Certificate of Compliance --
THIS IS TO CERTIFY,that thg On-site Sewa e,Disposal System Constructed( .)Repaired(X )Upgraded( )
Abandoned( )byIft. E . Robinson Septic Service
at 4.52 Osterville -W.Barnstable Rd.. . Marstons Mills has been constructed in ac oordance
with the provisions of Title,5 and the for Disposal System Construction Permit No. 74� dated
InstallerWm. E. RoVinson Sr. Designer
The issuance of this permit shall not be sons a g aranteeg that°the syste .will'f�us�ion as designed'. *
Date Q I ! Inspector ,,�� t -'r
Fee $5-�rp --------------------------- —
No. ��`!1
/'Z Z --0 LI$ THE COMMONWEALTH OF MASSACHUSETTS
Grose PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
wi!6pozar 6potem Con.5truction Permit
Permission is hereby granted to Construct( )Repair(l )Upgrade( )Abandon( )
Systemlocatedat 452 Os#erville- . Barnstable Rd . , Marstons Mills
t
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. ..
/o//S //! Approved Date: %"
V6/99 <_
1�
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
T, W i l l iarn E . Robinson,SAereby certify that the application for disposal works
construction pemnit signed by me dated /fs" , concerning the
property located at 452 Osterville-W. Barnstable Rd., meets all ofthe
Marstons Mills
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
be,soil is classified as CLASS I and the percolation rate is less than or equal io 5 minutes per inch.
T e are no wetlands within 100 feet of the proposed septic system
Th e are no private wells within 150 feet of the proposed septic system
LThere is no increase in flow and/or:change in use proposed
eei' are no variances requested or needed.
• The bottom of the proposed leaching facility will not be located less than five feet above the
maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor
method when applieablel
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Pleas:complete the following:
A) Top of Ground Surface Elevation(using GIS information) SS,
B) G.W. Elevation +the 1AAa. High G.W. Adjustment .
DIFFERENCE BETWEEN A and B '
SIGNED
yG DATE:
(Sketch proposed plan of system on backs.
q:health folder:cen
ry
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L,-nCATION ' SEWO,C�E PERMIT UO.
nL-
IWS-TaLLER 5 ►.I&ME ADDRESS
BUILDER 5 Q &MF- ADDRESS
DATE PERMIT ISSUED
0 ATE COMPLI &MICE ISSUED ; — — —
GAL �✓��
q7,
No......1ZY FEa....,f .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
.........OF............ ........... ..... .............
. pphratioo -for Dhipoiittl Works Tomitrortioo Vrrotit
Application is herebymade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Y
sUa
TV. Loc tion•Addre m or Lot No.
Own Address
:' ..................--•----- --•---•----------------------� .:............................................
Installer Address
Q Type of Buildin Size Lot_.1-alrbage
` q. feet
U Dwellin —No. of Bedrooms_ ___ _^�_ _--__Es ansion Attic (i
Z.......................... p Grinder Vy)O
p, Other—Type of Building _ _ -Z._.•. No. of persons.......q-________________ Showers ( j ) — Cafeteria ( )
a' Other fixtures ..... ................................................
w Design Flow _ 17------------------------gallons per person per day. Total daily flow___•-_-_-_���-----------------gallons.
USeptic Tank'—Liquid capacitv_��__gallons Length--- ....... Widtl.........7_.. Diameter................ Depth................
xDisposal Trench—No. .................... Width-------------------- Total Length------------_------ Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inl _.._.fir_,_.__.._._. Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) 02 C - - �/- 74
aPercolation Test Results Performed bY---------------------------------------------- --------------------------- Date------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit--------_----------- Depth to ground water---_-__--.-____._-.-_---
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.....__-_.__..-____---.
--•-
Description of Soil;-�'-----�-� ''� 1 t - a-- -----
c., ---------------------- --------._..t.z ..... .--------------------------------------------•-----------------------
w
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 Article XI 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.
ned.. ....... -------- --- - $ ---------------- --------------------------------
Date
Application Approved BY r� 1v'- �1
Date
Application Disapproved for the following reasons:-------•--------------•-•----.....------•------•------------------------•-•----...._....._...-- ................
--.......--•-••-•-•-•--------••---•-------------------------•----------•-----•-•---------••------...•-•--•----•-••---.........•-•-------------•-----------•---------..._._......--••-•------------.
Date
PermitNo------------_----------------------•-••-•`..-----_..... Issued........... ............................................
Date
h,
t7/ �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
` -'... _ �.
�' '3... .....0 F............. .....��%'��°��✓/.._...............
Appliration -for DigVoottl Workii Tomitrurfioii Prru it
Application is hereby made for a Permit to Construct ( ) or Repair ( )__an Individual--Sewage-Disposal`_______
System at: ,. i
{-�v �4- Z_._ 0�I P v 11.t a A I l
Location•Addre or Lot No.
"J -----••----
Instal - -•-•--,. Address
S l v•-- G" ram' _ &G l T_:-
Q Type of Building-,-'_ Size
Address l
Size Lot_.JIT
_�__CA(- _�_Sq. feet
DwellingsNo, of Bedrooms. ___Expansion Attic (J& bage Grinder (��U
Other—Type of Building ___ _�4✓_�.._--__ No. of per sons...._._�"/________________ Showers ( I ) — Cafeteria
Otherfixtures ----- ------------------------------------------------------------------------------------------------ •..._..
W Design Flow__ _______________________gallons per person per day. Total daily flow_.._._.._._��!�_..._...._..__...gallons.
WSeptic "Tank Liquid capacity._1LW__gallons Length______4______ Width._............. Diameter-----........... Depth_.__.__._-.._.-
x Disposal Trench—No_____________________ Width-------------------- Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No-------------------_ Diameter---------------_---- Depth below inle _______ ______.____ Total leaching area.___..______..____sq. ft.
z Other Distribution box ( ) Dosing tank ( ) Oh- �c?" _ - 3- / `t- -7f:
a .Percolation Test Results Performed by-------------------------------------------------------------------------- Date-------------------------------------
a Test Pit No. I................minutes per inch Depth of Test Pit---------------------Depth to ground water...______.___.___.-.._..
LT, Test Pit No. 2................minutes per inch .Depth of Test Pit-------------------- Depth to ground water----------------------
P4 _... ;+ Z; --- -----------------------; rr 1:-------------------•--- ----- !'
/ • -------- -----------------
x Description of Soil------"---- 6 �`�"'{ ---------l ' !� '�" �-----� ----�---. .F-sue` ^'�y! `�`L. -
/ / -----------
V --------------•---•---....�p--- ---__J.2--------- iP-��-••- ... ....L e --�------------------•--•--•---___-------------------•----
W
V 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee issued by the board of health.
,%0 Y- 761
ned./ ......._ ...•--- •--_ ................. --------------------------------
Application Approved By------ ----- ,ef...t✓.. -------------------- .....X- -- Date---f��..._
r Date
Application Disapproved for the following reasons----------------------------- ---------------------------------------------------••----------------------•----
-------------------------------------------------------------------------------------•--•-------------------------------------------------------------------------•----•---___---------••---___.__.--•--
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF' HEALTH
I /
err#if iratr of Tompliatta
THIS�1 . TO CE " IFY, That the Individual Sewage Disposal System constructed ( �or Repaired ( )
by_.�..._lr?�+�,�. ------ -------------•----------------------------------------------------------------------------------------__._-----------------•---------
E A Installer
,p z <
at. - ------------ --- ---- - `` - -/ �-----------------------------------___-------------------------------------------
has been installed in accordance with the provisions of ArI�XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._-':_______-_I-�? 'K
;"I_ . • dated__.___Al-,,/y-._'__7.6..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE----�•-P.: S��=7x0 ................................. Inspector-•- --•-----
THE COMMONWEALTH OF MASSACHUSETTS /: ,� 4 n ��)-j��
BOARD F HEALTH !�"�
a -�
No. �•----•-.---•• FEE....../..............
Bi ipwi l orkiq To ritr#ioii motif
7v /
Permission is hereby granted------ u 4 �� {l, - ------------------------------------------------------------------••------
to Construct ( <o epair (' aty�I.ty i vidual Sewa e Disposal Syste
at No.= - -- •E-, ------- 61 - .....__ ,
h _ ...........
Street
as shown on the application for Disposal Works Construction
P it No v..._. Dated----Y: ..-•-....__----r .._
- -..... ...............................
Board of Healt
DATE.....
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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1 HEREBY CERTIFY THAT THE "
wry PLAN. OF LAND aSTRUCTURE •
s -, 6TRUCfURE SHOWN HEREON WAS LOCATED -
c `' BY:'AN ACTUAL FIELD SURVEY ON ON N
j A` "APRf C, 7 u '197� AND CONFORMS TO THE '
: OSTEt2V!LLE — Ain ST,�13 :� ►J .
tfi'ZONING BY LAW OF THE TOWN OF
�g2NSTig6�E ASSACHUSETTS ` IN x
A S'f ht e a.,E� MASS.
,x REGISTERED LA D SURVEYOR '
SCALE I°- 40
. . 'P R I L 197� `
' �;Y, st t ��' wok 9vy ,,: • -
� � CAPE COD SURVEY CONSULTANTS
EDWIN A. rn
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YOUNGa "` �t"� ��•�'j`Y�� �� ., ' s�' y A DIVISION OF BOSTON SURVEY CONSULTANTS,INC"
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