HomeMy WebLinkAbout0074 OLD TOLL ROAD - Health 74 OLD TOLL RD.
WEST BARNSTABLE
, A = 109 078
e
CONTRACT Customer Name ON-_ _______ Customer Signature_ ��f/�t c�'y :� 4 r
SKETCH Contract Date S1506 _ --- Sales Representative Signature__
ATTACHMENT CustomerP.hone 0-9 6:4 77&5— —_ Contract Price 47
2 3 55 1 8 9 10 -11 12 13 1. 15 16 11 18 19 28 21 22 23 2a 25 26 27 28 29 30 31 32 03 34 35 36 37 38 39 40 41 42 43 44 45 aE 41 e8 49 50 51 52 53 54 55 50 57 58 58 60
8
22
51
i`
14
15
21
3.
26
9
32i I
30 - V fi
91 '11J�`dh V
32
39
NOTE$' ^Each box equals me tool unless otherwise noted.This sketch is a good faith
---__—+----------------------_._,-_--.--._---- ------------ --------- - representalian'of Ihv work to be done, it is underslood that a n ll dimesions
derived h'om II'1i s sketch PUO:pproximaie,and that adl locations of oullets.light.
Ilxlel'es,plugs.fa1e;11:.;and/Ur switchw',a subjecl fo change if necessary.
f /
Lw `TOWN OF BARNSTABLE L G
LOCATION _7q O Ik --6(1 t2oWD SEWAGE # a000-W?
VI LLAGE (3A2wSFw ASSESSOR'S MAP & LOT l�l
INSTALLER'S NAME&PHONE NO. (Z14"SQyy Sc-pFtC '?'7S-$7 A.
SEPTIC TANK CAPACITY i.606
LEACHING FACILITY: (type) 3 O lZY W- Q- S (size) t t >< 2 ,X 30
NO. OF BEDROOMS
BUILDER OR OWNER aAtZV4
PERMITDATE: glad lac>00 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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) Feet
Furnished by
301
67-9
No. Fee$5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS _
ZIppfication for �Dfgpooar *potem Construction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components.
Location Address or Lot Nero//i.✓ Owner's Name,Address and Tel.No.
Assessor's 4paankeq (.. Rd. , W Barnstabl Dan Parka
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Servic
P 0 Box 10891 Centerville
_ Type of Building:
Dwelling 1 No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
.-Other, Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date a .r Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system consisting
of a D—box and 3 precast, Cenc-_rP_tP 1Par-h nhamherct with stone
all areund.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu d by this d ealth.
Signed s.,..i.^/ Date
Application Approved by Date 15! ;
Application Disapproved fo the fo owing reasons
Permit No. ',70049 9�?Z Date Issued
TOWN OF BARNSTABLE s
LOCATION '7y O Icy Fo l( (Zoi9 SEWAGE # _a000-443
VILLAGE ASSESSOR'S MAP & LOT
g
INSTALLER'S NAME&PHONE NO. 2o`oiyS[iyy �rti^ ?7S—$?7tr `
+I SEPTIC TANK CAPACITY t_ 608
LEACHING FACIL=: (type) (size)
NO. Or BEDROOMS
BUILDER OR OWNER 04tZkC--2
PERMITDATE: COMPLIANCE DATE: ycga/�Nood
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
i 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) Feet
Furnished by
i
4
_w
O
o�
. �s
, +
i No. — � Fee
$50
V/
`. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
Zipplication for Mioaal bp0tem Conttruction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot N6��� Owner's Name,Address and Tel.No.
74 Old 1(' Rd. , W Barnstable Dan Parka
Assessor's Map/Parce
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Servic
P 0 Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 4 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
consistinsteh 5 leach s
Nature of Repairs or Alterations(Answer when applicable) Title- Y m» 9
of a D-box and 3 precast, concrete leach chambers with stone
all around
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 issyed by thi ar ealth.Signed Date —42gg
.2—06
Application Approved by '� Date P j
Application Disapproved for the fo'owing reasons
Permit No. ��'�%' g� Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Parka
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X i):Upgraded( )
Abandoned( )by Wm. E. Robinson Septic SerV�ice
at 74 Old To Rd. , W Barnstable i' has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. - Q:B, dated
Installerm. E. Robinson Sr. Designer A AlA
The issuance of this permit shall not, 'e c�onstr�ed-as=a.guarantee that the 4-item ill function., sUesigned.
Date Inspector
No. o�(.C'C/ " —j /,,,,� --------------------- Fee $50
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Parka lwtgpozal 6potem Construction Permit
Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( )
System located at 74 Old Toll Rd. , W Barnstable
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. f -
Provided:Construction must be completed within three years of the date of this permit.
Date: Approved by
�f
i vk f`
� f
MM
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)
1, Will iato E. Robinson,Srhereby certify that the application for disposal works
construction permit signed by me dated Z—.6 , concerning the
property located at 74 0 l d Toll Rd W R a r n sf a b l a meets all of the
r
following criteria:
• The failed system i 'connected to a residential dwelling only. There are no commercial or business
uses associated the dwelling.
The soil is cl ed as CLASS I and the percolation rate is less than or equal to S minutes per inch.
There are no tlands within 1 W feet of the proposed c s stem —
P P -
Them:irr t private wells within LSU sect of the proposed septic system
There is increase in flow and/or change in use proposed'
• There no variances requested or tteeded.
• bottom of the Proposed leaching facility will tot be located less than five feet above the
. a u adjusted groundwater table elevation:[Adjust the groundwater table using the Frimptor
ethod when applicable)
• If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed
leaching facility will snot be located less than fourteen 11.1)feet above the ma.-(imum adjusted
groundwater table elevation,
Please complete the following
A) Top of Ground Suncce Elevation(using G1S information)
B) G.W.Elevation +the MAX High G.W. Adjustment. = 6
DIFFERENCE.BETWEEN A and B
SIGNED:�fJ J L ,(/� DATE: in
� in �
[Sketch proposed plan of system on back).
y:health fotda:cen
37 �
----------------
/ I
No.-W —507 Fee-----q 5------
BOARD OF HEALTH
TOWN OF BARNSTABLE
0(ppCicationforlVe[r Congtruct ion Permit
Application is hereby made, or ermit t Construct ( Alter ( ), or Repair ( )an individual Well at:
1 d O t- Z
-----------` --� - ---- �Q 1 - � -- _- - ---
Location — Address Assessors Map and Parcel
-- �s �_ � .-k k - ------ - -u --�1dK-=� l�-- -------------------
Ow er Address
V)CLU---1-----1�- _ A- 11 h------- --- O - � -1 . �3� ws �✓
---- - ------------
Installer Driller Address
Type of Building /
Dwelling------ l - -----------------------------------------
Other - Type of Building --- —------------------- No. of Persons-----------------------------------------------
Type of Well- -- -C-- - ---- ---- Capacity---------------------- - -- --------------------- -
Purpose of Well---
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate .of o ance ha been issued by the Board of Health.
Signe -------- - - -1 —v- -
_ date Z
Application Approved By -----. ----- -- — -— --� --� '-0---ry
date
Application Disapproved for the following reasons:--------------------------------------------------------------_____—___—_________
------------------- --------- - --- --- - —- —----------------------------------------------------
date
145-0
Permit No. ——_—_ - - — — - Issued--- -- --- --- -------------- - - — --
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (Altered ( ), or Repaired ( )
by---------- �-� —� P -- ,,1 ---------
-----------------------------------------------------------------
Installer
at--------------- �--A---------C�&------ --- =------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No-UP-9..�-- ?I_Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
Z
DATE----------- I --- - -- Inspector-------------------------------------------------------- -
:u
No.-----�-------------- Fee---------------- ----
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appiicat ion Ar V ell Conotruct ion Permit
Application is hereby made fo a permit o Construct ( , Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
Owner Address
V)0- t)1-----_L_L-----
Installer — Driller Address
Type of Building � i
r
_- Dwelling-------- - ---------------------------------------------=--
Other - Type of Building --- No. of Persons--------------------------____—___________
Type of Well— -- �L—C'---- ---— --- Capacity--- - - -- — -- - - - --—
Purpose of Well
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Co p iance hag been issued by the Board of Health.
Signe - - ------ — Z _o
d...k..
----
date
Application Approved By ---="' --------______--_____—___ _______—
date
Application Disapproved for the following reasons:------------------------—---------------_--------_---_--------____---—-----
---------------------------------- -----------------------------------------------------------------------------------------
date
PermitNo. --- -- --- gd--------------- ------------- - —— --------------
------�------ I••ssu y. � date
---------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate ®f (Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed Altered y(,,,'), or Repaired% ( )
by------------ ----------------------------------------------------------------------------------------------------------------
-4 Installer
at----------------' --- ------ ---------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit N . --0-()7----- C-Dated--i---A-5--�-----7
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---------G '2 5-- I d� --- — -- Inspector--------------------------------- -
----------- - --
BOARD OF HEALTH
TOWN OF BARNSTABLE
Vell �on�tructionermit
No. ---------__�
Fee---- ----- ----
Permission is hereby granted--�1---��' _ `tv�'\�� p
-------------------------------
to Construct (Alter ( ), or Rep a' ( ) an Individual Well at:
No. -----------------------rl--q, -—� -— -�t----------- -------------------------------------------------------
street
as shown on the application for a Well Construction Permit
No.---------------------
— - ---- --- — — - Dated---
-----------------------------
'd - B rd of Health
DATE----------------------- ---
i
.Aff.nber: 45607 UNREGISTERED LAND —T
'I
Cnsnr. Wynn & Wynn,`P.C: ----- 0ee0Book_._6327 page: 333_
'I
owner Prudential Relocation Management Plan Bock_30 .._aoge:, 99 Lot(q, 82 II
n a ame � a Ran too. _..._ ,._of !i
Applicant; a n o n u e o r a ---
COMus Tract Number. None Available REGISTERED LAND
Reglstrotbn Book-- __ page.
00 .
Auetsor Mopt Block Parcel: j
Certif►cote of Twe
Date: 7/26/90 Scale. „_ 1
1 a o
M O R T G .AG E B q R I`� S T AT A I o b�+ � L �N t�,p
BLE
k
a°
Lot 85 �� ►r
cr Rk h
k ,
�` ► �� y PD6
h�
t.
IGO
hod \ N 4
T- Tverhang
Lot 81 Lot 82
358,265 S.F. t
000 Lot 83
C7
M
{ n b A'PRO
rj0 L a "
' 160.001
—7 q.
OLD TOLL ROAD
HIS IS THE RESULT OF TAPE MEASUREMENTS,
URVEY.. NOT THE RESULT OF AN INSTRUMENT
CERTIFY TO WYNN $ WYNN, P, C„ SENTRY
VSURANCE . FEDERAL SAVINGS BANK, AND THE TITLE
COMPANY, THAT THERE ARE NO EASEMENTS OR ENCROACHMENTS WITH
:SPELT TO BUILDINGS SITUATED ON THIS LOT EXCEPT AS SHOWN AND THAT THIS
_AN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION ,
1E .LOCATION OF THE . DWE.lLL _ING AS SHCIVIN ,HEREON
,c A^&# �,,....... _ _ .. _ ITHeR WA$ IN CQMPL (ANf F Wi'fH
7L .
LO-CATION r7 S E W A G PERMIJ NO.
VILLAGE
NSTA LLER'S NAME & ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED.
V -
DATE COMPLIANCE ISSUED
20
- f
-7 -�
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Town .....................OF......-.......--...Barnstable
ApplirFatiun for Ropuual Workii Tonotrartiun Famit
Application is hereby made for a Permit to Construct (g) or Repair ( ) an Individual Sewage Disposal
S stem at
Old Toll Road, West Barnstable Lot 82
-.. . ------------
Location
A - ...or Lot No.
....
•--•-•L.A. -Babson Cororation .......R�...Qe..R753....... ..02.5..6..3...........
Owner Address
W
Richard R. Lindstedt 4-Shaw Rd._F__Saj.idwiohlass.•....-•-----•-------------- --
Installer Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms_._......._ .Expansion Attic ( ) Garbage Grinder ( )
3 -=
Other—T e of Building No. of persons........!................. Showers l — Cafeteria
Other fixtures .__-_-Dishwasher___________________.......
_.__• __
W Design Flow...........��........................gallons per person per day. Total daily flow.__ _L .........................gallons.
WSeptic Tank-1-Liquid"capacity-Za25 ,41lons Length________________ Width................ Diameter---------------- Depth................
x Disposal Trench--No, ..............*..... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet ....... ...... Tot LLleaching area...................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) � ' �G ' !'�d�- -7 j.
Percolation Test Results Performed by--- antery_Assoc ;ates____________________________ Date....Sept._... ,__1929..._.
Test Pit No.,1...../a.—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........................
---01....................................................
.. ---- •• �•------ S
{� `Description of Soil ....V '*( . --- / :1_
' �-a
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 TIT1Z 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.
Signe ......... .............................................. .............................
Date
Application Approved By.........: L/. O M...........
77 Date
Application Disapproved for the following reasons----------------------------•-•------••-•-------=-----------------------------------......_.........-------•---•.
.....................................................-•----•--------•--.......------•-----•-------•-----------------------------------------------------------------------------....--------•--------•.
Date
PermitNo......................................................... Issued.......................................................
Date
No.- -•--- FEE... ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF....................................................
ApplirFatiun for Disposal Works Tonutrurtiun thrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage,,•Disposal
System at:
................-_--....--......•............................................................... --•--.._._....••-•-•••••••-----•--••---------••._...-•-•-••-•------•-••-•--•-----....--••-•-------
Location-Address or Lot No.
......................_.......................................................................... _..................:
Owner Address
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms..............._...........................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type T e of Building ............... No. of ersons_____.____.___.__._.________ Showers p., yp g ------------- p ( ) — Cafeteria ( )
Q' Other fixtures ---------------------------•-••• - 0-----------•.....................
W Design Flow...........�S........................gallons per person per day. Total daily flow._Z...`5......_.._.____________.____.___gallons.
i Septic Tank I Liquid capacity............gallons Length................ Width................ Diameter----------...... Depth................
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet ...__._ ...... Tot I leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( ) 0; ' 7 9
Percolation Test Results Performed by.......................................................................... Date.........................................
aTest Pit No. 1-----2:l.—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........................
........ .
Descriptio of Soil---... . - .. --+/--. -- ----------� -- .......
U ................... ......4.. .a......................................................................................................................................................
W .......................... .---------......................................................................................................._............................................................
U Nature of Repairs or Alterations—Answer when applicable....................................................................................................
----------------------------------•..........•._..-•----•--------------•--------------------.........----....-----------------:----------••---.....................................................
Agreement
fThe undersigned agrees ..to,,install the. aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TI'TfE 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:
Signe ............................................................... ................................
Date
Application Approved.By..........�__ 7
,/�. � -
• 7.Date
Application Disapproved for the following reasons-------------------------------------•---------•----------------------------------------------..................
-------------------------------------------------------•----------------.....----------........----•----•----........----------------------------------------------------•----•-•--••••......•-----•----
Date
PermitNo........................................................... Issued------------------------------ • -------------•--•-
Dato
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
j`
..........................................OF....................................................................................
(Irrtifiratr of f�untplianrr
THIS.IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by..................••-•-••---•----:.....•••--•---•--•-••......-•--••-•...._...•• ----------------------••---•--•-----....-•----------•---------------------.....................................
Installer
at...................--•-•--• ..................•---------•---••--------------....----•--_--•- •.---.............--•-••••••--••-•-----•-•----...........-•••••------.._...........------
has been installed in accordance with the provisions of TFf, 5 f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. .. .,-�......... dated__..{.0......,t 0-.t.. ........
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. r
... t
x
DATE. .%��,/ / -f..................................... Inspecto _•••----•• . -,- .............................
! t
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................:..............O F ..�"'
No...... .... .... :. ,F FEE.. ...........:...
Disposal Works (11,unutrur#iun rrmit�".
Permission,is hereby granted---------------------------------------------.•---•--•-•-----••-••--••.......••••...•-•••...................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
atNo................................................................................................................................. .............................................................
Street
as shown on the application for Disposal Works Construction Ppfgt No..... .._. _. ated..�D.� U..`-.-•..�....
-
Board of Heralf
«� �
DATE----------- . .... . ......, ,'-------------
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
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