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HomeMy WebLinkAbout0614 MAIN STREET (CENT.) - Health (2) ce"?te,- v t L e 07,0 la � TOWN`-OF BARNSTABLE LOCATION G 1�'[ wlot k SI i SEWAGE# A.0d,k—OR0 VILLAGE C.e�-�-�e�V!��� ASSESSOR,'S/�MAP&kRCELd VIA INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY #02—�,�Od l 4�ZliCr< LEACHING FACILITY:(type) 16'' (Size) VC2 NO. OF BEDROOMS OWNER l..Gj/tQG2 d a v, - PERMIT DATE: COMPLIANCE DATE: Separation DistanMBetween the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _i(/Ohte Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 206 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY n4 / /! Q�12 C3 -"4.1 19 D3 L1N �b 49 03 No. G��'UQ lj Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pphLation for Disposal 6pstem Construction Hermit Application for a Permit to Construct%V Repair( ) Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No.6�(.l,m`� a i k Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 6go Ca YZ ok 1U2 i Installer's Name;Address,and Tel oC5-0&yG 3 Designer's Name,Address,and Tel.No. sa y v o Type of Buil ing: Dwelling "No'.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) r_-5�2 gpd Design flow provided gpd Plan Date 1 -22-,2 At Number of sheets 6— Revision Date Title �^ Size of Septic Tank l�0 O Type of S.A.S. UPC_ $O d (5�40 pj N Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Bo .d of Heal Signed ��� Date 3 Appli�,ation Approved by Date Application Disapproved by Date for the following reasons Permit No. a- ) —0 J�U Date Issued No. 1^G f''�� 0 Fee THE COMMONWEALTH OFF MASSACHUSETTS Entered in computer: , PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppl cation f0.r Disposal *pstem Construction Permit Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) nComplete System ❑Individual Components Location Address or Lot No. (l 1 1/o a1;, G ` Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �� ' Ca Pe( 0) f7aI a!Installer's Name,Address,and Tel.rfIo;i f� ; t Designer's Name,Address,and Tel.No. r 11.4.GtA Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ` Design Flow(min.required) (, gpd Design flow provided �(� / gpd f Plan Date Number of sheets . Revision Date Title �t Size of Septic Tank /_-O o Type of S.A.S. 0 CJ1-f- (-14C/tvj Description of Soil r-' Nature of Repairs or Alterations(Answer when applicable) 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 Healt , � n ign A - — - Date - Application Approved by t -) J L, 'etQ � � Date Application Disapproved by Date for the following reasons Permit No. 7 a U(fU Date Issued --------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed O Repaired( ) Upgraded(, ) Abandoned( )by at �F;( . In;i has been constructed in accordance with the provisions of►Tide-Nand"the for Disposal System Construction Permit No. dated Installer Q..G ti �sr f tv ( r../ 'j Designer 1 #bedroomg �` Approved design flow ) gpd The issuance of this permit shall not be construed as a guarantee that the system-will fund' cttio as`d'signed. , Date Inspector_ - _- . - - -- - _ _ No. --o i'U Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS MispoSal 9�pstem (Construction Vermit Permission is hereby granted to Construct O Repair( ) Upgrade(\i) Abandon System located a4 w� 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. 3 Approved b -1/ � t'� !�`- -C� ���• j PP Y Town of Barnstable Inspectional Services a Public Health Division BARNST MASS Thomas McKean, Director ++ ° 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 , Fax: 508-790-6304 Installer& Designereertification Form Date: Sewage Permit# Q Assessor's Map\Parcel dO7 `a Designer. 1 tGs Installer: LIQ Address: / Address: PO 13 o) On was issued a permit to install a (date) (installer) septic system at l>� L based on a design drawn by (address) / ►` dated - (oesigrer) - - I certify that the septic system referenced above was installed substantially ucording 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) wa ins ected.a9d the ils were found satisfactory. �►P"(� 10 I I certify that the septic�systenn referenced above was installed with major changes (i.e. greater than 10',Iateral relocation of the SAS or any vgrtical relocation of any component of the septic.,system) but in iaccordance with State & Local legutations. Plan revision or certified as-built by designer to follow. Strip out (if re9uired) 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 I\A approval letters (if applicable) OF�qS s DAVID qua (In Caller's Signature) MASON ��1 No.1066�� ign re) (Affix. 44TAIR\ Here) PLEASE RETURN PTO,BAUNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE- WILL 'NOT BE ISSUED UNTIL BOTH THIS FORM AND AS� BUILT CARD ARE RECEIl,ED BY'THE.BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. \\wa\depts\HEALTMEWER connect\SEPTIC\Designer CerfifcC tfon Form Rev 8-14-13POC. 1} The installation shall comply with the State Environmental Code Title V and Town of WIN ASSESSORS MAP; _ - TEST HOLE LEGS � Board of Health Regulations. PARCEL: (� SOIL EVALUATOR: U I +''� 2) Tlhe septic system as proposed on this plan shall not be installed until a licensed.town !/ i - installer receives appiroval and an installation permit from the applicable town. REFERENCE: "' � WITNESS: ���� � ''`'"' `'r`�� / 3 Prior to installation h installer h of utilities severer inverts. W I ) ,theshall verify the location , I _ DATE. �-`�"� `Q-� 1 sewer lines and existing septic components prior to installation. Z I j 4) All gravity-sewer piping is to be 4 Inch schedule 40 PVC at 11r per foot. The first 2 j RATE: f� } ' feet out of the distribution box shall be level. All in conneetlors to!ice glued. PERCOLATION RA >�p !r; , 5) This septic design plan is not to be utilized for property line determination or for arty #2 ELEV T ELEV.EL . + .H. . �� ✓ - - other purpose other than the proposed septic system installation. LOCATION MAP 6) All Title V components are to meet Title V specifications. i L y ' 7) Parking shall be prohibited over Title V components unless components are H2O A 10 hZ 1 ,� ID loaded. Z 2 LD 8) The existing leaching or cesspools-shall be pumped and filled with material per Title V 57 a abandonment procedures. Leachingand cesspool(s).and contaminated soils within y�� the proposed SAS shall be removed and replaced with clean sand per Title V specifications. 9) Septic components are to be 1W from a water service line.Sewer lines crossing a water line shall be sleeved with an appropriately sized schedule 40 PVC with ends E ! . grouted The water service line or the septic line can be sleeved with the sleeve being Or a distance of UY on both sides of crossing the line. 10 If a i removed 0 the septic system is I � ) garbage grinder exists in the structure,it is to be rem p not designed to accommodate a garbage grinder. ` 11)The installer Is responsible for care of excavation around all utilities on tlhe property SEPTIC SYSTEM DESIGN CALCULATIONS and protecting the structural integrity of all structures during the installation process of the septic system. i 12 This art on 4• ��Z ! ' FLOW ESTIMATE: } plan only represents that a septic system can be instAed on the prmperty meetingTitleV requirements. } _BEDROOMS AT GAL/DAY/8DRM= !-�' GAL/DAY ° -hn, 13)The property owner shall review design criteria to approve the total number of I , "� SEPTIC TANK: bedrooms and design flow. installation of the se 'c system as ra I and receipt _ - r Pti P R Rt { ° Q o " "' r� of payment for the design shall be deemed approval of the design critedia the . • ���' GALJDAYISDRM X 2 DAYS= V D _ GALLONS P ym S RR g �y� propertyowner or agent of. USE `Jt�l.� . GALLON SEPTIC TANK UT1 L17.�6,� Z- �-�f oo I . o ;,F} _ __ _ 1. ''�. 14)The validity of this plan shall expire with the expiration of the town instaliation permit !(} I 0,5+ (GARBAGE GRINDER IS PROHIBITED) issued for this plan or the validity of this plan shall expire on the expiration of the • �' ram, Certificate of Compliance issued for the insulation of the proposed system on this \ t SOIL ABSORPTIO SYSTEM: plan. r Y ..viz- SIDEWALL AREA: �. t f Z Z� D h1 -11OZZ9 BOTTOM AREA: _ .. PO v 3 two v5t' �-1- �1...:.-- 6012 SEPTIC SYSTEM SECTION � t BENCHMARK w �r00, TOP OF FOUNDATION ELEV. �� � Q� ���4 ��,b ~1 og- 6 STONE BASE JdATUM ASSUMED) ?� M !V H2O D-BOX V STONE BASE OR COMPACTED BASE WATER TESL`FOR LEVELNESS U & ' ��� �U/ ✓ ©l� GALLONS 1� T F �' j M, 0�. ` O� SEPTIC TANK o � t AIVC, L4wr 13. . � � SITE AND SEWAGE �PI,A--N IVIASON LOCATION• `•, r a3 JF. r PREPARED: It- �f5l �` SCALE: R �r � DATE: 4 2 '