HomeMy WebLinkAbout0011 HOLDER LANE - HealthJILA=�174.014 xLAIv�:
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No. yy Fee$5 0 .0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes
ZippYication for �Dtgpogal *pgtem Comgtructton Vermtt
Application for a Permit to Construct( )Repair(x:�o Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 11 Holder Lane Owner's Name,Address and Tel.No. 3 9 8—3 5 6 6
W a�'�"��-�t' l Sal Elacqua 63 Constance Ave
Assessor's Map/Parcel �—��=v y�� e ����
/ 7y-- p/ W Yarmouth 02673
Installer's Name,Address,and Tel.No. 77 5—8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Service
P O Box 1089, Centerville 02673
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Install T 5 Leaching consisting
of D—Box, and three H2O Maximizers t_f
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by thi Bo of Health.
Signed y Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. — Date Issued —/�'
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,.. No. - ov- Fee$rJ Q.00
Entered in computer:
- � THE COMMONWEALTH OF MASSACHUSETTS p Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
� �i
ZIVVrtcatton for Migogar *rmem Construction Permit'I 'I
Application for a-Permit to Construct( )Repair(X)i Upgrade( )Aband}onp( ) EJ Complete System El Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
11 Holder Lane _ 3 9 8-3 5 6 6
Assessor'sMap/Parcel M_aa-vastable �f �� Sal Elacqua 63 .Constance Ave
/ , W Yarmouth 02673
Installer's Name, d ss kAlel.No. 7.7 W7 L Designer' ame,Ad es a 1.No.
!-7e 7
W E Robinson Septic Ser$�tc
x 1089 , Centerville 02673'
Type of Building: Itr
Dwelling No.of Bedrooms 3*' Lot Size sq. ft. Garbage Grinder(nd
Other Type of Building No. of Persons _ Showers( ) Cafeteria( )
Other Fixtures
• 7 LJ
Design Flow gallons pei•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 panel
Nature of Repairs or Alterations(Answer when applicable) Tn. to 1 1 T 5 Leaching ng consisting
of D-Rox s and three H2O Maximizers
Date last inspected:
Agreement:
The undersigned agrees t6.66-s it�e?the'�constrA(ii n aN dmaintenance 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 issued by this Bo of Health.
Signed-,,." Date
Application Approved by Date
01
Application Disapproved for the following reasons �.
Permit No. Date Date Issued ��- q
————————
TH CO MONWEALTH OF MASSACHUSETTS
,4MAr �qBL SSACHUSETTS �e'r�a
Elacqua Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired (X%�Upgraded( )
Abandoned( )by
at 11 Holder T n a try Rsannnat-ahl P has been constructed in accordan
with the provisions of Title 5 and the for Disposal System Construction Permit No. - ! dated -
Installer W E Robinson Septic Sry Designer
The issuance of this permit shall not be construed as a guarantee that the syst 'll function s esigned�
Date '7—, 5'=g¢� Inspector
No. Fee SO.00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Elacqua M009;ar *p-5tem Construction Permit
r
Permission is hereby granted to Construct( )Repair( x)Upgrade( )Abandon( )
t System located at 11 Hol dereLhANE
W Rarnstahle
Installer W E Robinson -Septic SArvice
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.
Provided: Construction must be completed within three years of the date of this permit. �^
Date: 7 Approved by O C
At
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
ENGINEERED PLANS)
XA /// / 7 V 0 / I
I, William E. Robinson,Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated concerning the
property located at 11 Holder Lane, W Barnstable, meets all of the.
following criteria:
* There are no wetlands within 100 feet of the proposed leaching facility.
* There are no private wells within 150 feet of the proposed septic system.
* There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
* If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the
proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S. map)
B)'Observed Groundwater Table Evaluation(according to Health Division well map)
SIGNED: Y DATE
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998
(Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan;
this plan should be submitted).
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/ TOWN OF BARNSTABLE
LOCAT /ION fJ h d/%, SEWAGE #
VILLAGE 14J r ��2as�d�J� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.JfO7 97 J — 9 24
SEPTIC TANK CAPACITY ST �S-�
LEACHING FACILITY: (type) 3—X/9<5 io;;x ` S (size) _ILI--76•-T�
NO.OF BEDROOMS
BUILDER OR OWNER r o sO A
PERMTTDATE: 2-1f-9- 7- COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Vaching Facility Feet
Private Water Supply Well and Leaching Facility y wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If aaywetlands exist
within 300 feet of leaching facility) Feet
I Furnished by
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TOWN OF BARNSTABLE 101,s1o(v
LOCATION Ad ';RWAGE # qi -$/4/ ,F
AS9e§§t MAP & LOT)!1Y—®/
INSTALLER'S NAME&PHONE NO. 9? �74
SEPTIC TANK CAPACITY`6-a—O
LEACHING FACILITY: (type) 1)g'16 Mx ' S (size)
NO.OF BEDROOMS
BUILDER OR OWNERS u stiff
PERMIT DATE: "> /ASS--9 COMPLIANCE DATE: 9= S_0X
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of aching Facility Feet
Private Water Supply Well and Leaching Facility y wells exist
on site or within 200 feet of leaching facility,) Feet
Edge of Wetland and Leaching Facility(If anywetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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L'O AT ION SEWAGE PERMIT NO.
r ,� - L99:24 u
VILLAGE
r
I T A L ER'S NA i ADDRESS
® U I L D E R OR OWNER
a.
DATE PERMIT ISSUED `7
DATE COMPLIANCE ISSUED
51
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No......j.Y.4.j9_1 T' Fizs..............................
THE COMMONWEALTH OF MASSACHUSETTS
0 BOAR® OF HEALTH
................OF............ A ................................
App irFation for Uhipaii al Marks Tnnstrnrtinn Prrmit
Application is hereby made for a Permit to Construct et/or Repair ( ) an Individual Sewage Disposal
System at:
� ��................__.........�-al---------------- k_. .... . ..----
� LocaonArs L or Lot No z.
. _--.... ..--- .. . . _ �... ............ -----------
Ownery f Address
WW1 ---•----------------------------------�.t7.*�%rG 1---....._� �...... --------. -------------- ----------------.---------------------
Installer Address
Pq
d Type of Building Size Lot_YVt-7:f.3....Sq. feet
U Dwelling—No. of Bedrooms---..._.__. Expansion Attic ( Garbage Grinder ��"�
------------------------- —
Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( )
a' Other fixtures --__•_____________________ .........................................................................................................
W Design Flow........................ -.........gallons per person per day. Total daily flow.._........`3.a._Q.................gallons.
WSeptic Tank—Liquid capacity.(0.9t0gallons Length................ Width---------------- Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) r
`-' Percolation Test Results Performed by............__________________ "?�_..4/e .. Date_.__��___._...._..
aTest Pit No. l...4:ff._S---minutes per inch Depth of Test Pit------�".Z.....Depth to ground water----J�.,� U °*✓l
Test Pit No. 2....12 B'minutes per inch Depth of Test Pit.................... Depth to ground water___-_�A,,.o
--------------------------------•---•--------------------•---------------------
O Description of Soil-------------------- .••� --%-0. ......'.Q �—
w = --•-----p^............ � --;�------------------------------------------------------•--------------------
x ------------------------------------------------------------------------------------------------- -------------------•------••-•-------------------------------------•-------------------------•--------
V 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 TITLES 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 b board of h -
Signed....................... I •-•-• - Y• -
Application Approved By---- _ ....... ---- -- ----- ..................................
................
Date
Application Disapproved for the following reasons-------------•-•-•-••----•---------------•---------------------------------•---------------••-•-----------.:_...
------------------------------------------------••-•-•---------------------•------------------.....---------•-------------•-------•---•-------------•--•-------•-----------------..._....---•-----------
Date
PermitNo......................................................... Issued.......................................................
Date
`
No......JR-lQ..`/ Fizs.....$A...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ApplirFation for Utoposal Works Tontrnrtion Vamit
Application is hereby-made for a Permit to Construct e) or Repair ( ) an Individual Sewage Disposal
System at: , `„--
........-•----... - ........
..:..
Location-Address or Lot No.
f--1-- "owner f f Address
•--•...................•-X1`:."°.e '.ZJ.........!� ............ -•--•-............................r?:'.: :t�........�, -----------------------------------------
..
••-•--------•
Installer Address
Type of Building ti Size Lot_..._ �C.._. -----Sq. feet
I-, Dwelling—No. of Bedrooms............. .............................Expansion Attic (A,•)) Garbage Grinder
'4 Other—Type of Building ............. No. of ersons......-_•-__-__---__-__--_-_ Showers
G.I YP g ---•----------- P ( ) — Cafeteria ( )
Q' Other fixtures .----------•-----•-••---•-----•. .
Design Flow...................... .`�" ............gallons per person per day. Total daily flow------------?_!.._Q..................gallons:
W W Septic Tank—Liquid capacity f.!<W.gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... 'Total Length.................... Total leaching area..------------------sq. ft.
3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'~ Percolation Test Results Performed by..............................................:..�._.................. Date.........................................
�6..
Test Pit No. 1.. -' s....minutes per inch Depth of Test Pit.......� ?...... Depth to ground water-__.. :__
►� !�t
(s, Test Pit No. 2-------?_....minutes per inch Depth of Test Pit...............:_.. Depth to ground water------,L
�+ ----------•--•------------••-----------------••-----•-•----....... --------••-•----•---•---•----..........................................................
O Description of Soil.....................0...-- e_
U ...___.__6
W
UNature of Repairs or Alterations—Answer when applicable..............................................•..._.._.._______._..__._._..........._...........
i
Agreement:
The undersigned agrees to.install the aforedescribed Individual Sewage Disposal System in accordance' with
the provisions of TITLI 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 b ,.the board of health.
S� � ram' �✓ )
I nedVJ
---• r_ = =-- ----------------- ',. .._...._
Date
Application Approved BY . .r. ... ----------------------------------- -----�--"/���1 v....------.
Date
Application Disapproved for the following reaso :--•••--------••-...•----••------•-•----•••••---••-------------•-••-••..-----.................................
..............•-----•----.....................---•-•----------------.......--------.....•---------.........
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS t`
BOARD OF HEALTH
.......!. ....w..'.�:'� ...-..OF................�...... �C�....5�`��51�. ..•
J .. .�.. Y mow.................
(Inrtifiratr of Tomplittnrr
THIS IS TO CERTIFY, That the Individual Sewa Disposal System constructed ,(4- or Repaired )
'f 7,a ------'-----•------•---•- •.................PL fr
at.....,. ... ---.............- / -- v�.? ",r ' " '�
---------•--------•-
:-- ..._. ..�'1-.--w ...........................................
has been installed in accordance with the provisions of LE 5 of The State Sanitary Code as described in the
7 application for Disposal Works Coonstructlon Permit No .•_...1_..0A.1V........... dated,_`............................................
#THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
............................
DATE, _. Inspector ✓
THE COMMONWEALTH OF MASSACHUSETTS
.,.. BOA�RID OF HEALTHlie �
f . `1.._r 2.i.�...:................. c`
�� fit, .................�.�......�+?.1�s•-b�--'..OF'...._.....1............................. /'.�' y .../` rs
........�r.....7......__ FEE........................
� �i��ro�ttl� ork���on��rtion .rani#
Permission is''hereb ranted......_. ....... '? -^_. ._.�......__.._...
J 1'
Yg o• 4----------------------- ----- r
to Construct j or Repair an IndividuallSewage Disposal System
i.' " f I St ee[
as shown on the application for Disposal"Worrks Construction'Permit vNo1.................. Dated..........................................
a oard of Health
e.i „
- DATE...................... --•--•-1-�-`-�'-�-•---•
FORM 1255 A. M. SULKIN, INC., BOSTON
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CERTIFIED PLOT PLAN
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cad AL E T �� ROBERT . fps CEfV 7-C:I?
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SCACEr / �= q o' DATE 7 !? �Y
, > ;',•,C eeENDRIER
k L®RE' �aE �lY�i�N ' ' I� r ° 11�1 CLIENT----- 1 CERTIFY THAT THE PROPOSED
fj EGISTERE RE613`TE�IvAr fu JOB NW' BUILDING SHOWN ON THIS PLAN
' -'CIVIL 6AN0J�: CONFORMS TO THE ZONING LAWS
EN®INFER R � ®R�K�Y�t OF BARNSTABI� E MASS.
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12 MAIN S T-R,E ET � CH, �3 �y �
h H.YAWN I S� MASS; , r¢ � �:�; Z -
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t'K• -. ti tt y6 S c'S X to y J eV'4�� r ) ...
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20 FT M%N. N07E /F E/Ti'fER TIlE SEPT/C TANK OR
LEAtC/v/ivG P/T ARE MORE THAN /2NBELOpV
/NRAOE,Aa 24'D/.4MFTER CONGRET� CONE.R
/O FT M SWALL BE BJ?DUGNT. TO G)qA DAF.�AN EXTR/4 '
q"PVC O/PE
CONCRETE t/E,4vy CAST /RON COVER Sh�AL-L BE USEO
M/N. P/TCN !F/N DR/VEN/A Y '
Ez- COVERS
CONCRL-TE
2 HIM.
�y i4OE CO✓ER CI-EAN .SAI?v
_ BACxF/LL
- _ UQU/D LEVEL
2 LAYER
M/N.pir N ` /oo a GAL. o •a o '1 • • • • • • • e • WASHED S720NE
DIST. a • • • • • + • ea
SePT/C TANK BaX • e • • • • • + .•a ••
• Q • + r t •a 314"— f V2"
e p 1 • •EFFECT/VLF • ♦ s ►.
• • + • • DEPTi/ • • • • v O /iA5AFD STONE
v + / • • • •• • i • o •
•.Z.�6 x. `2,S = S(�S ; eao� / • • • • • • • ► o p o PREfA1ST SEE.PJ4GF
Pi 7 C/1P/Fc!T}/ (�78 e O o • • • • • • • • i es p t=L. `I S n OR �V/V.
lMV4-A r L'LFVA77DNS D
/NYE 7 AT B!//LD/NG, /d &-,DFT � 3 CCSEE7;-WZll-ATlON,
JNL ET .rEPT/G' TANK l o S ,9FT !Z FT O/�1 M.
pt/TLFT SEP7'IC TANK lUs3 fT. -
//VLk r DJS MAD//'T/ON BOX /0 4,0 FT OF' GROUND I447ER TABLE .
Ot/TLETDI STRJBIMON BOX /o g•9 FT
%NLET LEACNl1/G F�/T Er. SEyV�4GE 6?IS'®��S°�4 J. SKS71EM T�@ZWLi4TlON
LEAG'H/NG P/T plM�nrs/ON Id �'T
D�S1GJ� CJ?JTER/A SCALE : V4' /=O~ DINK-2YS/OM p FT•
NLA�/e3ER OF BEDJ�oO/`9S 3 D/MENS/O/d r,�_FT. /'���r,
G,4/a�GE'D/SPOS/4L(/N/r /✓UNE SO/L LOG S®/l. 7,E.17'
7-07AL E3T/Ms;TED FLOit/ 3 3 y GAt.�DAY SO/L TEST A/ SOIL 7L�ST02
MUMMY OF L,FACNINt. P/TS / f ELEY. DAITE OF SO/L TEsT
SIDE LEACHING PER P/7' ZZ dY R 8,C• G/� 2.v
�o7-rOMLE4CN/NG pEJZ l�/T / / 3 So. C7 Last rr PeRcoLAT/OJy /4'A7'F�/ ass J„J/N�INCH
TOTAL LE�4CH//YG �4REA '> 3 SQ PT. S!/t3- 0!L PEVCOL�4 7YON Rs�7E�2 T� MJiV�INC►N.
RESERVELE.�CNIA!G APEA 33 SQ. FT. t- 7TEs7 . T-33 9T
of MAss�Pti T- /�
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