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HomeMy WebLinkAbout1525 OST.-W.BARN. RD - Health F t'illi 037 f OWN OF BARNSTABLE '� LOCATION ' v. UJ BA,61V, Rci SEWAGE.# J SI VILLAGE KE;AlQ >J.ASSESSOR'S ''MAP & LOT INSTALLER'S NAME & PHONE NO. mQ p f tv .2-- 36 6.6,g SEPTIC TANK CAPACITY LEACHING FACILITY:(type) L e-sR-C_� �f� _ (size)00 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: -1,9- 97 VARIANCE GRANTED:�Yes No F/ A � � /w w\J \Zy `� � � t •Y�e d �C6NAQi11h�, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `.. �I.NA ................oF.. a - ` L ............................................ Appliraffou for Mipaa al nrkg Tonstrurtion Vamit Application is hereby made for a Permit to Construct (k,.) or Repair ( ) an Individual Sewage Disposal System at: i �Z5 C3g�e .. � ........................ a .Qn 1-�z i2 ems' + ' /Location Address //��,,_� \, i or�jot No. _ .90 ` ... _....--- l.li��12i - � - •- O no Address a -------�' / ------....-•- -------------------------••------•-•--•---- Installer Address _ Q Type of Building Size Lot..12_!1Q.- -. U Dwelling—No. of Bedrooms____��______________________________________Expansion Attic (up) Garbage Grinder Other—Type of Building No. of persons............................ .Showers — Cafeteria a 'Other fixtures W Design Flow............5,5........................gallons per person per day. Total daily flow......33Q__........................gallons. WSeptic Tank—Liquid capacity_10M.gallons Length.......... ..... Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No---------I---------- Diameter..._..0i......... Dep�i below inlet....:............ Total leaching area`bQ16_.....sq. ft. Z Other Distribution box (Ye, Dosin tank ( o ` 1 '~ Percolation Test Results Performed by._..V M!4._9y�.l -.................... Date.W...31}.1_,5 .].._... ,aa Test Pit No. 1-_-_--A.......minutes per inch Depth of Test Pit----1_15-__-_____- Depth to ground water.9.0.4,c....... Test Pit No. 2.....4------minutes per inch Depth of Test Pit.....11>_S..... Depth to ground water--_�aML�.____.. � -------•----- --------- •-------------........_ _...._........_........-•-•-•-•--•--•--•---......................................................... \ O Description of Soil--TA-1--q6---.D.-�i_►7_5'.....ABM.... ���t C, --�`�� ��� ��t-�.�2A���C?.��1►-►D 2J110 ` � i,. ._.1�tc.�LG�zoa �ara'� 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed --------------------- ------- - -- -- ------------ ----- ---------------------------- ------------------------- Dace Application Approved By ---------------- J v Dale Application Disapproved for the following rea.rorir: ................... ----------------------.............................................................................'------------------------------------------------------------------------------------------------------------ -----------...Dare -- PermitNo- -------------------------------------------------------------------- Issued ...........--- ---.........---- ......--- ---.....-------. Dace L — — �� S 3p (,Cc�w�•3 [vc ,�� • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........d�!.. .....................0F... A.�' ...S.�:{>.L ............................................. Appliratiun for Disposal Works Tonntrurtiun Vrrutit Application is hereby made for a Permit to Construct ( YQ or Repair ( ) an Individual Sewage Disposal System at: OS�Z\/i L l t _ L dT 2 ................_.....__...... .ocation-.Address ................................ •......................•...._..... -•Or•..t No. ....-•--- ... �J bN I.t C:_ --------- !%�?t�t?�1-Lc k�_�(�I {....� �n.......-- Owner Address .............................. ........ ...... ......................................... Installer Address '2,i U n Q Type of Building f Size Lot............................ . U Dwelling—No. of Bedrooms..__.��.....................................Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures --------------- -----------•--- - Design Flow.....:......`?J�......:.................gallons per person per day. Total daily flow........ .....330.._......................gallons. xSeptic 9 P y g ' gth.....-•--_._... Width-----------•-•-- Diameter---------------- Depth-----------••--- W Dis osal T enchLi undo c. actt ..... W dthns Len Total Length.................... Total leaching area....................sq. ft. Seepage Pit NO..........I...-_.___. Diameter.......-y......... DepG below inlet..... ...._....... Total leaching area..S.©$......sq. ft. Z Other Distribution box (yam Dosin ank ( _ `-' Percolation Test Results Performed by... KK-M Z4 !V y��!'.L____------- _........ Date_ _9._t.__.. Test Pit No. 1.._._..------minutes per inch Depth of Test Pit....�3.......... Depth to ground water_4�� .'-C.-.---.-. (i Test Pit No. 2....... ......minutes per inch Depth of Test Pit......l l t5----- Depth to ground water--_P.. .L._... 0 Description of SoiL.TN-_�_1._..Q.-417.57....1�._A`M--�:.._Ve3S01 <✓ �1, 1 S — 13 c'LL. G.V*_A�c� SA"0 ............................................................ - ---- ---- v � -Z .0 �:So....�oA'V4 S:u3so� �' - k�- ��(��t. GcZr ,�6 ,� i`l�� ---------------- W ..................-..................................................................................................................................................................=.................. VNature 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ---- ----------------------------------- --- ------------------------------------------------------- ..........----------------------_---- Da[e Application Approved By ................ �' ----------------------- ------ Application Disapproved for the f ow-ng reasons: ...............................................------------------------------------------------------------------------------- .............................. ...... .. .. . .................. .. ................................... ......................... ......1......................................... --..-------------- -------------------- Dare PermitNo. ........................................................... Issued ........-- -- --.........------ -- . --- --- ----------.. Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I p k a t----------------- OF .7 A Z Q S i P%t3(.. -. ...................................... C'IEr#ifirate of C�umplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ------------------------------------------------------------------------------------------------------------------------------------_-------------- ................ ------........... -- --........ 1n5[ 1-0-r 12 D5�Z (1 trLL, lr�lLSo r1�+.1 S fi�1�v at ........... . ........ .................................................. ........... -- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..-t.. .._.-. .. -. dated .......................... . ------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT CON� RUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ --^-1.�...'..L .. .................................. Inspector ........ ............ [ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Diagonal Works Tunn#riun unfit Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or I,. air ( ) an Indiv'du a) Sewa isposal S stem — at No...............................�?_t iZJs ,Eli, � N(Q1�'oA OT 1Z Street as shown on the application for Disposal Works Construction Pe o.`?_ . 1___ e ! �............................. ! Board of Health DATE........... ............... • •--•�---•-•----------------------------•-- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS rl R5 1 / o OP C.19, T I Rs.p P,8.G. Ct 666 �oN J Ali 0 I � e � Le AsBuilt Page 1 of 1 I O CAT E IN A C E PERMIT NO. VILLAGE '7 INST LIER'S �1NAME i ADDRESS ,A OR OMEN ER OATS PERMIT ISSUED DATE COM/LIANCE ISSUED 1 , http://issgl2/intranet/propdata/prebuilt.aspx?mappar=127037&seq=1 6/6/2012 I 4 a CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1675 ROUTE 28 -- CENTERVILLE. MA 02632 (506) 790-2380/FAXv(508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F.A,* • I LOCATION: ADDRESS OF RELEASE, t E; DATE OF RELEA3E: .1��„L� �> PRODUCT RELEASED: ,�•,� f,b«,'./��,. ESTIMATED QUANTITY: CORRECTIVE ACTION TAK66Y RESPONSIBLE PARTY; ray- -- NOTIFICATIONS: I FIRE DEPARTMENT: YES(k ) NO( ) DATE TIME:- NATIONAL RESPONSE CENTER YES( ) NO( ) DATE:—TIME- DEPT. OF ENVIRONMENTAL PROTECTION YES( ) , NO( ) DATE:__TIME:._ OIL SPILL COORDINATOR: YES( ) NO( ) DATE: TIME: TOWN BOARD OF HEALTH: YES(, ) NO( ) DATE:c/_-- TINE: TOWN HARBORMASTER: YES( ) NO( ) DATE: �L_' TIME: OTHER AGENCIES: COMMENTS: REPORTED DATE;—Z -,�-_ WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D:f.P, PINK COPY-BOARD OF HEALTH C-O-MM FORM *58 P Fizz..2 ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ,0F HEALTH ...... ......---.....OF........ .................. Appliration for Uispmial Works Tonstrurtion rnmit Application is here mad for Permit C �t Re an n u,al -ewA e 'o air ( ) - I%a Disposal System-,at-: A.0; No o"S4............ .................................................. ........ . .. . ..... C -6 dress .......... .....e..2;. ........................................... ... .............. Owner..... .... Installer Address Z2---- Type of Building Size Lot_ __ t U —No. of Bedrooms-----�3.................................Expansion Attic Garbage Grinder 06 Dwelling V�6 �4 44 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria PL4Other fixtures ................................................................-:................................................. ................................. Design Flow......................... gallons per person per clay. Total`day flew.._..........7'C3.0............. W �ns. 1:4 Septic Tar capacity/.C.C. gallons Lengthf� ...... Width... Diameter--------------_ Depth.........�_.6 Disposal 116 1 No.........I.......... Width....IZZI...... Total Length... .... Total leaching area,;, ------sq. ft. Seepage Pit No Diameter.._____--___-___--__ Depth below inlet.......... ........ Total leaching area..................sq. ft. Other Distribution box---�_V Dosing Percolation Test Resultp Performed by_.XW�_ it ... ............. Date.... as Test Pit No. 1-- 2�=j6rn. inutes per inch Depth of Tes it..... .... Depth to ground water../ ............ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit----- ----- Depth to ground water/,�./--............... 04 ........../...... ........ ..e------------- - ------ ---------4--------- --- ------ -----------------...................?'._12 .................I.................................... 0 Description of Soil----- =3.......... ----------------------------------------------------------------------------------------------------------------------------*---------------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 of TL I Tl 1:12 5 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 bpprd of health. Signed........ __ ---------- --­-­----_------ -----_---_---------------_ t D/a . ........ . ........................ .. . ................. Application Approved By.......... = i;� � .. ..... Date Application Disapproved for the following reasons:............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo.....................................................I---- Issued....................................................... Date No..... FEB .......� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f.l .........,`-.. ......OF. /f:.l' � •//Ti/('- ..................................... ApplirFation for Dispusa l Works Tonstrur#inn Prrutit 11 Application is hereby made for a Permit to Construct A or Repair ( ) an Individual Sewage Disposal System at• � - — 1 ....... - ...:%.. '�. - '�f r' !�•:7. C_. _ ,? '! s, ............... ...................... ll / cats ,t�ddress or Lot No ............................. ��l'.,/ - .W 7 O 'r� •-------•----------------- C� C... wner �✓� (�� Ad !i/ <� GEC Installer Address d Type of Building Size Lot� �:.....-_._.___.._:_ aDwelling—No. of Bedrooms._...._......... Expansion Attic Garbage Grinder ;( p.l Other—Type of Building ............................ No. of persons........................I.... Show rsl;(d ) — Cafeteria ( ) QI Other fixtures ........................................ W Design Flow......................... .. ?-f....._gallons per perso .p� day. Total da}ly flow............. %„ '- ..............gallons. r r 9Septic T'a —Tl quid capacity' _ a.gallons Length............. Width... ::1 ... Diameter................ Depth.............. WE1 f x Disposal ch—No.................... Width.../.;_2.......... Total Length..2'7..&..... Total leaching area- 4Z:........sq. ft. Seepage Pit No-----------_---f. Diameter................ ... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (�C)j Dosingrtank ( ) 1 '-' Percolation Test Resul s Performed by..- ---/--;--`-----. °f�:�;,{r���.. <:�.�`�..:.............. Date.._`3 ter...........�.� r..... Test Pit No. L.: ::._-...minutes per inch Depth of e'sPPit..._l_ ----- Depth to ground water./<%f Test Pit No. 2................minutes per inch Depth of Test Pit....L.. "Z..... Depth to ground water/_.................. ror DescrlDescription of Soil ��--•--••--•-•...•--- --•--•..............................•-•-•••-••-----•••-----••-••-•--�....z••-- •-•-... y 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'T`:I 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 health. Signed.... /� ... _:... Date Application Approved BY ,...... .............. Application Disapproved for the o lowing reasons:- .....;:--••••---•-•--•-••.....---•--••---•--••--•--••---•----•-•••--••••-•-•••-•----•--•----.......� ------------•..----••-•-••••---•--•-•--••-••••-••••----------•------•---•-•-----••-----•••.....-•-------•I--•••••-•--••----------•--------••-----•-•••----•--•------•-••-••--•-••----------------------- Date PermitNo......................................................... Issued---------------•--• ................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.............. 4........................................... / rr�t�irtt .. THIS IS TO CERTIFY, That the dividu ewW Disposal System constructed ( ,)nor Repaired ( ) by............... l✓ Installer has been I red- y IK_5( Code as described in the application for Disposal Works Construction Permit No_____}_�___ ____ __ ._......... dated_.-----.................-__..................... THE ISSUANCE OF THIS CERTIFICATE SHALL CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. nn DATE............................... ............................. Inspector d �/' THE COMMONWEALTH OF MASSACHUSETTS '. BOARD OF HEALTH No. .. .............OF....... r -.r ......7x.....-................... FEE....... ,.r� xx 3 Permission is hereby granted---------------- ' - to Construct ( ) or Repair ( ) an lgvi dual , pe. al-,System t atNo...................Ile"----------------------•-------.----------------------.-----•.----------- ----------------------.---.------.- as shown on liz°ation fo Wo onstrucfio Permlt No:" -------- Dated.._._.__..'`:r.......................... .....V ...._. ...._............................ ..4i• ................................ DATE..-•-••-----------Jr. 07 . ... ..................•---•- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �C-a,� ���j� . ».. �, � �. , ti :, 44 Arc, CAI L:,y t=t.�w s 3 z t t o = 33o G't� " �5'W A M o ! tJ gT IG 'T-ANIi = y3o ,c lSo y •4Qcj 'ypp. Cy4E- 1000 G&L. .o . . .. ... dot 1 t • 1.SE �'• _� l rr� •c� ,rr .•L_ PLOW Ut FFUSSaeS izo P��s o •StD .L b.2E[�' 194. 6-Po. 'L'_•OT-TCAA 5F :S TGTAL mxmSt 6w db tAToQ Cu.T� l° W 'LMty ��lG-�{, . : . . I #h: : . . No WAI TOL _ =Tti'lt t_ 1 .t4 viv i z(4X 15) •1...—. ._._.......��—_....._.,_�._ .. l LFLOW ,t4us,oaspLO lot 4Y- I t c, .rn u�.z' Yut� VRaposEIP.'I OMOAY10A �� T''iFt1cD PLOT pt t•\i 'J W V I 'l"•+=l-.r`tt;. �.1t.i7 r="L?AGK. RrDU12l'.Jl�{I:.{.lT�j.Q: .. , .. .�•' �� - r --T•,t,- -1"G';J I 1 B^,Q N wr , i't$ Fd T �. .L._.C, .3'1 15 7 �.Vj'' 'J4;:11S'1�11jt'E r. 1 ' ! i �.�-• :�INto100 T ' �t1� �QGT.2�;�198/ t.. !r �`.�• ..A1IT� ��Jfd Q. . , _.., r.'&1(TC2 uyt� toe,. 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