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Home My WebLink About0336 OLD MILL ROAD - Health (2) O�T�r✓� � � �. No: U2,1 L3 4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RpPYitatiou for Disposal 6pstem Coustruttion Jermit Application for a Permit to Construct( ) Repair( ) Upgrade 1) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 31(0 01 d kl\k (�00,Q Owner's Name,Address,and Tel.No. Sa f0.V% Assessor's Map/Parcel v (p 2.10 07- ys('. 016 Aox 900.a OS�Cu•1�,.. Installer's Name,Address,and lef No. b J. e_W .A�o n Designer's Name,Address,and Tel.No. f O.So n 34 (�oJ1c. 00 SAndW►(k� 50$ (l�-'� ObS3 darnSkabl� �a , Type of Building: II '' Dwelling No.of Bedrooms "1 Lot Size �� q0( sq.ft. Garbage Grinder(Wo) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) yyo gpd Design flow provided S$ J'� Gltd� Plan Date IA yt Number of sheets Revision Date Title Size of Septic Tank I Sp 0 \ar% Type of S.A.S. (3) Soo 0,aA0n GhamlogS Description of Soil 5e4 Dl0,n6 Nature of Repairs or Alterations(Answer when applicable) 11askawr-k�0" a 1500 QG.klpn SIT. d-boy. and SAS 3-15,00 Ao.\kor\ c,ho.n,'6M5 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 Certificate of Compliance has been issued by this Board of Health. Signed Date 12N 2 Application Approved by Date LZ Application Disapproved by Date for the following reasons Permit No. ZZ Q 2, -1 Date Issued �i Z No. F' '1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH.DIVISION ; TOWN0F BARNSTABLE, MASSACHUSETTS 01pplicatl6n for -Isposal 6pstem Construction Permit Application fora Permit to Construct( ) Repair( ) Upgrade(y) Abandon( ) ❑Complete System ❑Individual Components " Location Address or Lot No. � (, 0l 6 I-k; (�0(,,6 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � ,�s(j 0 110 0 2 ^JS U 1 !`� tk t Installer's Name,Address,and Tel.No. ('j �� c.�c .�n Designer's Name,Address,and Tel.No. gn ' Type of Building: Dwelling No.of Bedrooms L' Lot Size sq.ft. Garbage Grinder(j}o) l Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design F16w(min.required) �1�1C) gpd Design flow provided y S k pgpd� "04, Plan Date 1.1 2 2 Number of sheets Revision Date, i Title Size of Septic Tank 15 Q 0 CN"\\o TYPe of S.A.S. (3) J0 b a�llp:.Description of Soil e pl c,n s J ~ Nature of Repairs or Alterations(Answer when applicable) ',i rr,1i r 4 51 t!. tkx ' 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 Certificate of Compliance has been issued by this Board of Health. Signed , Date 1 I<<, Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Z Date Issued �i�➢.A) .-- •--- - - -- ----------- ----- = - l THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by �( r (r we i f f at �j�� G�(( N1.t� �ZOc`ck has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. WL Z 03'f dated �(a/12- Installer Designer Uv t 6 hA t,E,(,n #bedrooms f{ Approved design flow y � gpd The issuance of this permit shall not be construed as a guarantee that the system willeR ction as designed. i t Date 3 1(�3 P;— Inspector No. ?/'On-43 q FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon( ) System located at D(I (MA Kit R oa ti f and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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. " Date �i/Z-�2,Z Approved by TOWN OF BARNSTABLE LOCATION 33/ OLD M,'!/ Rod SEWAGE# ZOZZ - 03 y VILLAGE C)J "' ASSESSOR'S MAP&PARCEL y Z D L 2 00 Z INSTALLER'S NAME&PHONE NO. 13 4 3 SEPTIC TANK CAPACITY /.500 9a- LEACHING FACILITY.(type) , ppga (..l C 3� (size) 13 x 33 x Z NO.OF BEDROOMS q OWNER rcAN h -iC. PERMIT DATE: Z Z - Z 2 COMPLIANCE DATE: L3 �3 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 c, �l- Z8 Z AZ• 35'S " A3• yo'3" 83. 3z 3 A9• y8,� C,AaAc.E B4. 37•/0 old {SEAR Novs:c Town Of Barnstable Inspectional Services ' ustntsrnaa,x, Public Health Division Thomas McKean,Director � 141a �rgs � 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form �/ Date:c 22 J Z Sewage PermitN Assessor's MaplPareel lqz e6z Z Designer: DUO A' . Installer: £ y Address: _b /Z)r1 _ Address: On a 'a ' a t►►'-i' ,� was issued a permit to install a (date) (installer) ,n septic system at Oup Vq lu, based on a design drawn by (address) 'C11� Jdated (designer) I certify that the septic system referenced above was installed substantially:according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10'.lateral relocation of the SAS or any vgrticat relocation of any component of the septic;system)but in accordance with State&Local?regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the to rms of the IAA approval letters(if applicable) � C�OF 41 DAVID 0:3�,c B. (Installer's Sign tune) ASON �as-r 68 `tt (Designer's Signature) (Affix Here) PLEASE RETURN�TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL, NOT BE ISSUEll UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC HEALTH DIVISION'.. THANK YOU. WonldopiAHEAL,TITSEWER connecASEPTIMsigner Cersifleation Form Rov&14-13.00C I 1 19=13oard , — ASSESSORS MAP: TEST HOLE LOGS ) ply with the State.Environmental Code Title V and Town of of Health Regulations. JAltC '�Z2,, IL , Zl' , CS Z) The septic system as proposed on this plan shall not be installed until a licensed.town PARCEL: SOIL EVALUATOR. P p° Installer receives approval and an installation permit from the applicable town. REFERENCE: , L� Z 1 �& -� p pp WITNESS: 3) Prior to Installation,the installer shall verify the location of utilities,sewer inverts, DATE: ,�✓ - sewer lines and existing septic components prior to installation. 4 All) gravity sewer piping is to be 4 Inch schedule 40 PVC at 1/8"per foot. The first 2 - 1 h PERCOLATION RATE. feet out of the distribution box shall be level. All piping connections to be glued. 5) This septic design plan is not to be utilized for property line determination or for any r T.H.#1 ELEV. Z , T.H.#2 ELEV. other purpose other than the proposed septic system installation. LOCATION MAP 6) All TMe V components are to meet Title V specifications. p �c( , / +4-,UY 7) Parking shall be prohibited over Title V components unless components are H2O ' I 1Dr loaded. 8) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Leaching and cesspool(s)and contaminated soils within — {{ the proposed SAS shall be removed and replaced with clean sand per Title V �R TES - WAYAl, - specifications. G � 9) Septic components are to be UY from a water service line.Sewer lines crossing a ;"""' i �p ^� L water line shall be sleeved with an appropriately sized schedule 40 PVC with ends .�• 536`�"30'•E 14'�,ST L*�6.49 grouted. The water service line or the septic line can be sleeved with the sleeve being of �� b04 �g0 �� >> a distance of 10'on both sides of crossing the line. pt_�_� 1D 10 If a *'garbage) grinder exists in the structure,it is to be removed if the septic system is � •- �t�1,,�,�.,� � 1. � � �}��-- not designed to accommodate a garbage grinder. ( 12)The installer is responsible for care of excavation around all utilities on the property and protecting the structural Integrity of all structures during the installation process 1 SEPTIC SYSTEM DESIGN CALCULATIONS 0 \ � � of the septic system. t FLOW ESTIMATE: 12)This plan only represents that a septic system can be installed on the property (� meeting Title V requirements. BEDROOMS AT � GAL/DAY/BDRM= GAL/DAY 4t 13)The property owner shall review design criteria to approve the total number of SEPTIC TANK: . j to► k✓ bedrooms and design flow. installation of the septic system as proposed and receiipt . J ` ' GAL/DAY/BDRM X 2 DAYS= GALLONS of payment for the design shall be deemed approval of the design criteria by the 1 ' ! property owner or agent of. i ' • - / USE GALLON SEPTIC'TANK r"t� 14 The validity of this plan shall i) ty p expire with the expiration of the town Installation permit I ) ''Cr:o (GARBAGE GRINDER IS PROHIBITED) issued for this plan or the validity of this plan shall expire on the expiration of the Certificate of Compliance issued for the installation of the proposed system SOIL ABSORPTION SYSTEM: P P ys 1 on an. w ,I - a - _ - IxOF 127 SIDEWALL AREA: �J s -t- 1-2 , �iC �. 1 7 t J l fi ( I BOTTOM AREA: �J` t'�' MASON 13 - .��bo.foss O { cs TE40 ¢� 'o ,� coo'` SEPTIC SYSTEM SECTION ol GMAGE \` ,ram �' � �.��.♦ •ti' VD) �, � dry BENCHMARK - It TOP OF FOUNDATION �i 5011 2 0P�3 MAX o . ELEV. '�'' EJ�jl 1 ,Dl:j � �17 p,� �1 � F1 •`�� 6 STONE BASE ! � _,,w DATUM ASSUMED) —•••r...,.,,• - H2O D-BOX 6"STONE BASE OR COMPACTED BASE ,�. WATER TEST FOR LEVELNESS GALLONS �'`•. SEPTIC TANK SITE AND SEWAGE PLAN LOCATION. P LICIE, 1' wk PREPARED. � . ��! DATE: SCALE: