Loading...
HomeMy WebLinkAbout0711 OST.-W.BARN. RD - Health 17 RAN& Can v �► v� -- i vvv S M E A® No.24 53LY UPC 12934 smead.com o Made In USA SUSTAINABLE FORESTRY INITIATIVE cad RbK Swc q WAWANPCWSMXe LOCATION SEWAGE PERMIT NO. Z p 7-4 ©5-re/yo 1/C -'6UeS rI3�A).rlk Cl V I L L A G E ASSESSORS MAP NO:/4 /a-7 PARCEL NO... - - pa INSTAL R'S NAM E ADDRESS B U I L D E R OR OWNER DATE PERMIf ISSUED DATE COMPLIANCE ISSUED ( � 4 �� rs ,�o No.._ _.... �� F .............. ...�.J:.�� THE COMMONWEALTH OF MASSACHUSETTS BOAR® PF HEA TH - o..✓.✓.............. ---.-.--......................... Appliratiou for Ili-qVviial Works Tamitrurtintt ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a -.- ation-Address or eAV .. 4211. ...... . . t W Q L'..._...9OwV`[ l G. eJl Gl'" Address �/ / .... . .................... •. ... ..... ----•---•---....................... ...- ...... ............ � Installer Address d Type of Building Size Lot..2-VA...... . feet U Dwelling—No. of Bedrooms--------•� .--------------------------•Expansion Attic V4P Garbage ri ?LO '_lPL4 Other—T e of Building 4F4. No. of persons............................ Showers — Cafeteria Q' Other fixtu es� ----------------------- W Design Flow...................4 7__.............__gallons per person Der day. Total daily flow.._.._3.3.v..................._...gallons. WSeptic Tank—Liquid*capacityl4.�G.gallons Length_ ..5'... Width4--S..._ Diameter________________ Depth...... ......... x Disposal Trench—No......a ._ Width.................... Total Length........__. Total leaching area-__--__...._ JJ.sq. ft. _ Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area._ fa..Sq. ft. Z Other Distribution box Dosing to ) ~' Percolation Test Results Performed by t 1icL e............ Date--- ..'. ..J aTest 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 W ------------------------------------------------------------------------------------------------------------------------------------------- ........................................................... 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 iITL1 5 of the State Sanitary Code—a further agrees not to place the system in operation until a Certificate of Compliance een i edhealth. Signed...... ..�i . ............................... ApplicationApproved By........................... -.......... •- • .. ............. •--.................................... Date Application Disapproved for the following reaso ------------------------•-------------------------------------------------------•-----------•-••----•-........... ............. ...........--------------------------------------------------- ------------------ ••----------------------------- --------•------------------------------------------------Date-------------- PermitNo.......................................................- Issued_....................................................... Date Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT j WELL LOCATION /P Address a �D U r� <( !. t(' • tfi' r. City/Town rear s To I-P 115, G.S.Quadrangle Map Grid Location Owner .L>t; E'+,( 9,m es Address too Lor /wig► 1WELL USE CONSOLIDATED WELL stic e❑ Public ❑ Industrial ❑ Type of Water-bearing Rock r Water-bearing Zones Method Drilled 1) From To ti 2) From To Date Drilled '( ' 3' 3) From To 4) From To CASING a , Depth to Bedrock Length 2 Diameter Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface "11 1 Sand: fine❑ medium 0,coarse❑ Date measured (r'&--) Gravel: fine❑ medium❑ coarse[] Screen: GRAVEL PACK WELL /� ` Slot# /0 length 3 from to Yes ❑ No Split Screen (or 2nd screen) WATER QUALITY TESTS MADE SlotO length from—to- Biological ❑ Depth To Bedrock PUMP TEST 'wdown feet after pumping days hours at GPM. �'•` ��', Hrw measured C4 Q 1 J@r rr%r Tl Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To Cb o' 1 'rl DRILLER Firm rE'Q�1 fi ���t yJl i o � � � �' ( Address r v sGG City r Of CIS-10cR ,L Registration No. Aerators lgnature Please print rrm y BOARD, OF. HEALTH COPY 15M-2 84-176471 No......................... Fizz............................. THE COMMONWEALTH OF MASSACHUSETTS -' BOARD OF HEALTH ---`.... ✓.�................OF.....................................> f.i ' :• Appliration for Dispati al Works Tonstrurtion amit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: , ... -- ..............••--------•-----•--•-•--•-•-•--........-•-•-•......•...... -•-••-•---......---- ......... ..................................................... /Location-Address / or Lot No. _ J 7 ::_............ ...............:•---1�... ...---•--- ..................................................... • � .....-------••--- '=;--•--- __.: .. -----... -•---............------• Owner Address � ..!---•----.: .. ........ =--'.'..r!......_....••--•-------------••-------•-•-••------•-•---•---•••......--- Installer Address Type of Building Size Lot..........Z.........:...Sq` feet Dwelling—No. of Bedrooms...........::�.............................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—Type T e of Building No. of persons............................ Showers — Cafeteria Pk YP g . P ( ) ( ) 0.' Other fixtures.-----------------------•--•--•. ... W Design Flow............................................gallons per person per day. Total daily flow____.__1_--- !::......._..............._gallons. WSeptic Tank—Liquid capacity '....t..gallons Length_ff_.`...�... Width................. Diameter................ Depth......-__-___. xDisposal Trench—No. ................ .. Width.................... 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.___Z................................. W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... ._- gZ., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------ •------------------------ --.----------------- ------------ •------- --•----•---------.-........ --------------------•---...... 0 Description of Soil........................................................................................................................................................................ W V ....--•------•---------•--•-----------•--•-•---•-----------•-----------------------------------•----....------------------------...-•---•-------•-------------------•----....-------•------.....-----•-- W Z -••--•---------------------------------------------------------•---•-------.....•-•-•------------------•-----•-•--------------------------••--•-----••----•------•-------------------------------_------ 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 TITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance Ihas,been sa d by the board of health. ... Signed---...--=--•-r':................... .:..... ........•-----•----------------••-- ..---..:-�•-------- Date:' r Application Approved BY W1 ------. .....-- ---- -----------• -----------------------.----....------•. Date Application Disapproved for the following reaso --------------------------------------------------------------•-----------------------------•----••--------.._._. ..............•--•---------•-•---•-•----...--•-------------.......------------...........------•---••-•----•-------••-••--•......--------•-••-----•-••---•----------•----•------------------•--.._._..-- Date PermitNo.......................................................... Issued....................................................... Date THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH d / J�'r}� ..1 ✓1 ..f i (9rdif iratr of TontpfiFanrr THIS,IS{TO CERTIFY, That the Individual Sewage Disposal'System constructed ( ) or Repaired ( ) ! f . by...._._.. ;_ C._..rt'............................................;,..r_.. ...Installer ..........._... _...... ... ........................... =----------------------------------------------•- •----•------------......•--•--......---•----•--•---------•--------•-----••------•---=--•--•-----...._..:....----•-------•-••-••-----------. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Cgdie, s des It in the application for Disposal Works Construction Permit No......�.�...�T0 6_.._...... dated.............. .. '�__ _........__.._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON AS A GUAR NTE ,THAT THE SYSTEM WILL FUNCT SFACTORY. _ ?/ 2AT � DATE.. ................................ Inspector.................................................................................... ' � 1 `= 3 ' ©O� THE COMMONWEALTH OF MASSACHUSETTS ' , BOARD OF HEALTH L.� �p - :' '_r .O F. 1.�.r ar,•1 �i she.I"".......................... .. .......... ......................... No........ .............. FEE........................ i to �t ory Toni n tr ion amii Permissioshereby granted----•---------------------------••--•---•-•---.-------•-------•-------- •-••:------------------ --•-----••-...-•-------•••----............_._.. - to Construc1` J or Re air(+ ) r Indivi al Sewage D�i.,sp}sral Syst� at as shown on the application for Disposal Works Construction Permit tNo.g -? (' D to ........ .. � ! _ ....... oard of Health DATE--==•-•===--------�..--•------..�-�-i-� �................. FORNI";nti2$5 HOBBS & WARREN. INC., PUBLISHERS 'ems r a4 r� • tt� ' M ,,7 lit. T•, Z-vT 44741 MAP i� 3 ti f f x1 7 /46'0 OD- , Y.r>* ��✓LaK`CG Mom_ ! t, ;"--._.�,�\' '; r ��./d�fu� A 40 UI' ry LOT .bV. t �D �✓a �� 1 `tS ti ,r sEi�ricv `. max• r fx _ ._L t o 12 Z, YY J�RO AV Gc szr S. s fPit/ +•L t 1.. } � � j 0 0 p s �J E -- /l yl� '/ 04G6 /V0 TLC f'r,u 7-r c7-j:0A' T-6-P, 513 f s S 7 C- or j-�'v 3 ' I>,�T3LiC. 4v , wiry s'� E f 4 AlB-RT A " � t �i MORSE w, U � ,+ tN ©f �1a 'Nv:10951 f r ass �(�wQw` tir �o ROBERT'. i R. t i. ;Kr LEGEND . ELDREaGE EUSTING, SPOT ELEVATION 010 No. 19367 �� ELST'!N® CONTOUR -- 0 ——— CERTIFIED PLOT PLAN ' �F�Mf$NED, SPOT ELEVATION , (� "��'�? ' # �E H,E®' .CONTOUR 0 LOT` .6_. M.41 1 7 Z ?L $K 12Y, P6,75 .: Est The` aocation of any existing uunnd rg �ound sewerage, .. i N. . I�Tz�e11s, nor other utilities;.shown.on this plan is approx- E ` ate only as determined from records and/or verbal �+ ��a�•�' ��� 116 ormation. The contractor is .responsible. for the vis g5 _ F v6iification of the existing locations in the 'field.- $GALE, / "—�pf DATE ��� � � - �2Ns is • RED GE ENG/NEER/NG Ca 'NO CLIENT. How 1. CERTIFY THAT THE PROPOSED 7 EGI$TERE REGISTERED �� BUILDING SHOWN ON' .THIS PLAN' F` CIVIL- . LAND CONFORMS TO THE ZONING LAWS.:.. E 0 ER RV DR.BY, 'Q OF BARNSTABLE MASr ' 712 MAIN STREET "' .' CH., By l3' � _ . ' �; :wf H_YANNIS, MASS: 9HEET.LOF Z D TE S REG. LAND SURVEYOR A 7 /-IV _x L- az- us v y CA S7- C-,O codycAt 77 6CAII, . A/ A/7 NOR V-='W,4 Y, v! CDYERS • COVER -.TAIV AO c Z 01,1111--�� �7 .... ... ... 2 LAYER OF o CAL.' - WA Svro 57�,,Vc -fjv.,Prr&W DIST "S EprIC' 7ANX—' . z WASYA=.Z> 577.0NE k 377 A— PREC.A.SrSIE&PA Z' JA.7;� X 1 P170R ZVVIV�- R.VA7 6 F/7- C�*A- At K.C-l'77 /A-I�F j A IA 0 .i . .� OF ic " F7 VIA � J 3 'Njoo' AT T AWL ��5°FT ( SE E T,J VL A 4tJ7LET SERTIC TANK- GROVAW 7TX 7AALE SECTION 0 A VrL&rPJSTR1AV70N 97 tT AWA.66, 01SAWA LEACHIMS PV797.S rA0411ATION. LEACH Ive D/ftANTl lk , FT y w -1 V DESl6N CAITZXA ScA WS GAR . PISAMSA voSOIL LOG 705r fa SOIL. frsr*2 TOTAL NUA &EA0=A0ACNINC A/ 73 ffLFV PA A/ 6Ao $lz &4eAcAIve PSt.P/I RESVJ75 PVIrNsy j o 4 VCH 1077rO^f l-Z4ClW1Ncv P&R pn ALjCO • XrXCOLAt10)V.AA7-.F c .AREA 4z�WhVd Aq" so. MI �70ffF A O T REDGE�-t r. E' AMP N' • .7 yr A"A