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HomeMy WebLinkAbout0140 TUPELO ROAD - Health C5cc)7 t 0--- a rr�-T-V nS Yr1 C li�No.- -.. UK- Fss............._........... ._ THE COMMONWEALTH OF MASSACHUSETTS ---�� BOAR® OF HEALTH ...._.......TO Q.----....OF..... . ............ Appliration for Disposal,Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ()9� or Repair ( ) an Individual Sewage Disposal System at: 1J ...- __...._T:u.PCL.0.---•-• .................................. ----••------........ �-®-:r--- ......-------•----... .... j......'...-- .. -•-- L cation-Address t No. ......... .r�.u.�._.F: �-, . o.:aa---=-=-----------------•---•---•--------------- t-6a.-Old..Fax..Alk........M�1 n----.....-- W O er Address . .. •-- ................... .... Installer Address U Type of Building Size Lot.` 73,;11....Sq. feet Dwelling—No. of Bedrooms..............5...........................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------• P ( ) — Cafeteria ( ) Otherfixtures --------------- ----------------------•-------------.------------------------------------------------------------. ---_.. w Design Flow................',"?_-_45.................gallons per person ppr day. Total daily flow......J __ ....................gallons.ly WSeptic Tank—Liquid capacity_ PP.P _ :.gallons Length. ._".�a.. Width.--._-�®-- Diameter__._.. Depth...S.- _4. x Disposal Trench—No.:................... Width............ Total Length__.____T_----��Total leaching area..........$__....sq. ft. Seepage Pit No........I..._...... Diameter.12._.-_�_. Depth below inlet.. ?.............. Total leaching area......__....-1--sq-#t6 PP Z Other Distribution box ('1� Dosing tank ( ) '~ Percolation Test Results Performed by_--BEaK,i6f.._ever............................. Date... `-as-------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .r - cx� �s Descri don o-f Soil.... --... . .z o .516................ �... . . .'� -----era- -------------------- --------------------------------------------------------------------.-.-.---`--v--f-------------------------•---......----�------ 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 Sanitary Code—The unde signed further agrees not to place the system in operation until a Certificate of Compliance has beer and iealth. Signe. - � Date ..._..-•-•----..._..--•-•--------- Application Approved By..--•-. --- � y ----------•------------•---_----- .__ Date Application Disapproved for the f ollo i reasons----------------•----......_...---•--•-----------•---•--------•------------------........._......-----•.....---- • --•-•--------------•----------•-----•---•---••---•---.................---•----...................._....---------••------------------------•-•------------------------------- - -- ------- Date PermitNo............ ......��f-----•----..----_ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS --�° BOARD OF HEALTH ._._........�...0..W.. .........0F..... .., .Q../ J.S. ( - .t-.. ................ Appliration for Disposal Works Tonstrur#inn Errant Application is hereby made for a Permit to Construct ()4) or Repair ( ) an Individual Sewage Disposal System at: `�::�,_.g_ca_:.�.......IQ :....................•--- -•---•----............ C'6 --------.'.......... cation-Address No. ....:................................•-----_.... ... 1d.. ---•----•-------- Owner Address W Installer Address U Type of Building Size Lot431,_(2 _�.1 .....Sq. feet a Dwelling—No. of Bedrooms............ ............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------•-•--------••••----•--••••----••-•-•------................................................... W Design Flow...............5.5__________________gallons per person per day. Total daily flow------ __ .....................gallons. WSeptic Tank—Li uid ca acitY�-10.0_. allons Len th '-" a-•- Width�__-1� Diameter._._"'' Depth_ __�__ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------I........... Diameter_/_,.._-.O.__ Depth below inlet_�_. .�__._. Total leaching Z Other Distribution box (v,,) Dosing tank ) Percolation Test Results Performed by... ft.C '__._Ov _______________________________ Date__® Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p „ ; --........ -------------•------------------�, t v rh ---- ----_... Descrl Description of Soil--- r %r _�S �. ......as _t d =... -- ----•L 1 - ... idea! �- --- 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'I'12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b 7wisped a and health.Signed--••-•. ..... om .......-.-1--_....�� �-- `� Date Application Approved By..... _ .:!:> �4r (( :��L�`-=e' �........... 3 = .�.... •---------------------------•---••-••---•--•-•--•-•••----...__--•-•---Date Application Disapproved for the f ollo�a g reasons______________________ _ ..__......___. li -------------••-----------------------------------------.._....----- 1 Permit No.......... t - =l"-:._.....-•----._. Issued..............•-•---------•--------._.......a�---... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ..0..9VA).........0F.. s .��.�.T�l. �................................ Trrtifiratr of Toutpliattrr -. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..................... ........... v .. r?s _..--••-•---------------------------------------------------------•-----........----------•-•----••--------•------- Inst ler at--------------- _-_-----� _.+ :-0....................... ----=.............. ......------- -----•--1� has been installed in accordance with the provisions of TI ,IE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._-__.'__�_.____�_z_ -.___...._ dated.......... ....-_�_ �:___ .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................It 1- .-. ................................ Inspector................ 7/14)11 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF............R_lelh.5:rzo� FEE........................ Disposal Works Tunotrur#ion rruti# Permission is hereby granted 1 ---------------------•-------._....----......._..-•---.......------- to Construct (\4 or Repair ( ) an Individual Sewage Disposal Systen at No... .._.. - P = -=�:. r- o------------------- Street as shown on the application for Disposal Works Construction Per it N00.. __-_-I.._ Dated......... _.-_ �.Z"•�1 ----------- ............... 1. - 1 DATE................................................................................. Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS Y t' E,1 G) 12'1>)AM• LEACW•P,T 41 S,gl,EFf`, peFT#3 1 ♦ 11�r u TTANIc $0+ 1 4"Souv P.V.L. 1 P2oPo5�-D � $O{ , Iil 2G' Z 3 B,R.4-jit I, a� 47 ° 2¢-, 07" E /87. 27 L-3o. 3i 7'U PEG OF -D) s P 0 S- A- L PL�.t,,J SMITH,JR.CIVIL PA V L F:, L. Y D o" F-�-w ai p�.A,55 a c,I N c oI A 01 p 500,1 1 " PIP C' �°, to •P C � � 5�� � `� 5�5. � „ ,1� �� '� , ' ocsr:.e� all /� wa5kcd' S�onc rnao G 1. ScP{ice Tat, lc 9:5'•.�f 4 4Q Co,tc.lEAc}t1uC,� Prn 4 4A4 . G1:A4 •. F i 40-5 a ne a , I • goT. PST E�ey e All OW TO P50/L, I sv DES RA•Tlr: 2/1if/,V 11N C 1.� DR•o P i Te~ST p��oRMED i7c-G. 2 198� b QeDROOMS >C 1 t O d� f qe >,: IV.O C�Ar-z��E DISPOs IOOc� �PD LEACNINC, . AL l) S� looc� .r' PEES ` ,48',; 1QAL—SEPT'icTAglK CAPAGITy PR.oV1Dep.; ' �o`t"T O 1•� "�'' ' z` eC t O S�N9 SIDE'S 5 I13. G, p�, i -TT/2 ec 7 1 C P D oTaL ITy f�-ZovID 584 CPp ` oTE -- D IS Po SAL S�Sr= tet DGsIcgNED I N !' A G GO R DPI N C E �� •! -,- {� c T L.F- 5 0 pz 86.5 _ ho.G Ro UNo WATeE- u c_ l.y Do AJ SST P-� LoT 2I u PELo ->U , � `,�c gJpC kAIZ50M Nt il.L'S• `I o TOWN OF BARNSTABLE \ LOCATION LA D T aje Lk SEWAGE # VILLAGE t �Q', ASSESSOR'S MAP 6z LOT /D INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1 O©o LEACHING FACILITYAtype) ) (size) ®C- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: a DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1� � p/� e ey�dh �►� S e Ff- 9�r6 p,si POK /dov �s6f! fi�dY� S eert G -r.**Ic /s Wil So/to rpbco LOT 47 Lo T 19 8� --_ L T. 43. �o 0 LOT S Z(614,T0 SFt A x, /GorC75 SS!- I c�0 1 �q -TCO k r r 4 LOT !� 4 LET Of s �eoch o. 904 too '^ , '��1S••.....• OCR,�.,�� 79 9FGIST�R�� •. IT N • ZA,Z • INC. 1911 moo : . �,, ; ^ O •. • `L • INVERT 0E5CRIPT/ON 5 ���G•••. ••'c�J•� ��� ��� ID-..98.8 5epfl•c Tconk`5 /n/ef-. [hv �i,f'F ••.�°°•° �Pv,`�� Af r,t 2 98_. 0 7VC.' TO•nk OUlef OF 1 3 08- 4- 1 D. 8ox In le NOTES ® 98.2 0, 5ox ou7`/e Qs 98.a D• ,sax Ou//e>- `LTHIS . PLAN IS VALID ONLY IF IT IS STAMPED AND 9G.4 Geoch SIGNED IN RED. THIS * OFFICE ASSUMES NO Qj 97. I Leach P1f /n/e� RESPONSIBILITY FOR INFORMATION CONTAINED ON COPIES WHICH DO NOT HAVE ORIGINAL STAMPS AND SIGNATURES IN RED 2.THIS PLAN WAS NOT PREPARED TO THE STANDARDS SET FORTH IN 250 CMR SECTION 6.04, F.nc/ E/ _ /03. 0 ri9ssurr7et71 Dal uln J THEREFORE THIS PLAN IS NOT TO BE USED FOR TITLE INSURANCE PURPOSES r. I. . CERTIFY TO Marcus i UleOn C'onniZZOro AND TO Sentr- Bank. "AS BUILT" PLOT PLAN THAT TO BEtT OF MY KNOWLEDGE ,H AND BELIEF , I THEMATION , I QNST^ELE- MASS. strUcf�reS SHOWN ON THIS PLAN I LOT S -T'2/a QD, CcsTUt j �APaJ . (�'� CEY Ai HAS BEEN LOCATED ON THE GROUND AS INDICATED AND THAT IT IS��ss oC T N 9-10_87 R J. O/1G4/?/I/ //VC. FLOOD ZONE G' PER F. N E I II _2_g� SWAN RIVER PLAYA RATE MAP DATED . 8 - / , , 35 ROUTE 134, UNIT 2 SOUTH DENNIS, MASS. 02660 J E I DATE : 9-8-87 SCALE: I -30 JOB NO. 39Z8 CLIENT: EGAN �' REG. PROFESSI AN RVEYOR I DR. BY JD6 SHEET OF --L_ ,J; LOT 47 / Lo T 8� Sq. - LOT S 26,450 SF± x` /Garage 1 0 � 31- �l L3o x�i a ��eP f,�c 7an k /� 4 dp LOT � 1 - LT 9 =e -� ��H OF Mgss beach .� `` U /II,IIurrlrN/•�•i --- N N . 904 •••`S�jECHNp�0 •• 60.79 ,%..% C�. - '�EGISTER``O • �,s•, ; INC. 1917 •�, P. • � 0 • INVERT DEScRIPT/ON • • �:�� '•. ••�c�J�.`' (L 1 ��57 Q . .98.8 Seof�'c Tdnk in/ef %''.Fq(TH OF �(►PS;•o• (� Ao z 98.0 se tic -Tao k. ou/ef i 1 3 98. 4- D. ,6o x In/e�- /1111111141 -- ® 98..2 D• f3ox Ocif/e ,NOTES: 962 0 /30x ou//ef ."LTHIS . PLAN IS VALID ONLY IF IT IS STAMPED AND 9G.4 Ceoch P�f. /n/ef '-"SIGNED IN RED. THIS ' OFFICE ASSUMES NO RESPONSIBILITY FOR INFORMATION CONTAINED ON 97 1 Leach Pi'f /n/ef %COPIES WHICH DO NOT HAVE ORIGINAL STAMPS {AND SIGNATURES IN RED 2.THIS PLAN WAS NOT PREPARED TO THE STANDARDS SET FORTH IN 250 CMR SECTION 6.04, F.nc� E/ _ /03. O �f7ssurr�er� Da�u�J :fTHEREFORE THIS PLAN IS NOT TO BE USED FOR TITLE INSURANCE PURPOSES I. ,• CERTIFY TO Marcus ¢� aeon CannIzzar�o AND TO sel7tr f3anK "AS BUILT" PLOT PLAN THAT TO THE BE T OF MY INFORMATION , I ������`� MASS. SHOWN ti KNOWLEDGE , AND BELIEF , THE I 1111 strucf�reS SHOWN ON THIS PLAN I LoT S 'T2AC_Ey•QD, C-OT"UI T 9AP_`) Mq HAS BEEN LOCATED ON THE GROUND AS INDICATED AND THAT IT IS LOCATED Iv' 7 /� J. FLOOD ZONE G' PER FLO D� E 1 10-s O/>lCA/?N //VC. SWAN RIVER PLAYA RATE MAP DATED . 8 - / - sic 35 ROUTE 134, UNIT 2 c SOUTH DENNIS, MASS. 02660 //— DY DATE : - 9-8-87 SCALE: 1 -30 /2 57 JOB NO. 39Z8 CLIENT: . CGALI __ 1, REG. PROFESSION` _ S OR I DR. BY JDG SHEET --!—OF 1