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HomeMy WebLinkAbout0111 HOLDER LANE - Health 111 Holder Larne A= 174=001 =008 Marstoris Mills No.-w a--------- Fee----— ----------- BOARD OF HEALTH TOWN OF BARNSTABLE Z(pp[icat ion-for Well Congtructioni3ermit Application is hereby made for a permit to Const uct (J), Alter ( ), or epair ( )an individual Well at: _1LL_ADA —C.Lam 0�1 -- Location Address Assessors Map and Parcel Q CO.�G�O�f Q 1 — -- 1�� �Lr�_W_ UCtiS�o W 1?jtVU�1�?kv Owner Address Q 6,,e1. �� a1 L�� P: _ d� z--►�3 -orl----- s�- - --- ------_ — _- ---_— — — -- - - Installer — Dri r Address Type of Building Dwelling Other - Type of Building------_—_-_______ No. of Persons-- TYPe of Well '�` C�1�1 PY C. ------ 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 Compliance has been issued by the Board of Health. Signed ----------—_— - �)_aj/0 date Application Approved By m'"= Application Disapproved for the following reasons: date �, // D V E' `_--_—_—_a--——— — — --- Permit NKY _- — --- Issued ---------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed A, Altered ( ), or Repaired ( ) Installer athas 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. ---------------Dated—_--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------ -_-- --__-- _ Inspector------_ _—____---------------____-- No.-- Fee-------------------- - BOARD OF HEALTH ,. TOWN OF BARNSTABLE 01pplicationfforWell Con0ructionPermit i Application is hereby made for a permit to Construct (�), Alter ( ), or epair ( )an individual Well at: Location — Address Assessors Map and Parcel oh,n _—Co.(dacLv�,_�(. �rsab�AAA z 6�------_ Owner Address 1\GA �c.-------- P u �o� Z�1�3 ,4(_ O Y\ Oz..b 53 ---------------- -----___----------------- Installer ---------------- — Dril4 r Address Type of Building Dwelling ----- -- — — ------ r Other - Type of Building-=------_--._____ No. of Persons--- `-I•'S0N46 pJC- r Type of Well 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 Compliance has been issued by the Board of Health. Signed N� �' -------------- --__7 a a1_l 0 G Application Approved By �' �'� date a Application Disapproved for the following reasons: date Permit NWa ro / ___ ------- Issued— ---� _--------__—_..-------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (�), Altered ( ), or Repaired ( ) b 2S YY1 w��\- ���� 1�L __-___..__ Y— -------- —_— ----- ------- ------------ - t 1 Installer [ ► `, at_ 1_ - I d 2 LY1 �NacS�oy"3 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. _—_—__________Dated—_----_--____-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ___ — __ Inspector--__---_—_..---__-__._-- ----__--___--- ` BOARD OF HEALTH TOWN OF BARNSTABLE Well Congtruction Permit No. Fee t of Permission is hereby granted _to Construct ( `�), ter ( ), or Repair��( ) an Individual Well at: No. —"I v &r 1�— ��� _�G�S}oY]S_�1��S - ----------------------- - - street as shown on the application for a Well Construction Permit No.- _ _---_-— Datedrh ---- -- --__-- --- - L Board of naltW DATE __ �A ' r � �vN OF P f r szo IT �3Z I SETt V� X4 I'Z jiv, Joe vT io4 b9 19, J,/a.,O� Q® t�l TOWN OF BARN TABLE LOCATION ' p r '� � M�( � 3 SEWAGE # q o-,3®,;l VILLAGE ASSESSOR'S MAP Cz LOT? !-D� INSTALLER'S NAME& PHONE NO. 9'Cltf,, (cye+S SEPTIC TANK CAPACITY /_5700 LEACHING FACILITY:(type Pre ('ems l+f�S (size) IzaD6 NO. OF BEDII.00MS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER -�7C�t l CAN -r4-A. .DATE PERMIT ISSUED: DATE COLiPLIANCE ISSUED_ VARIANCE GRANTED: Yes No • P � C q'7 �....... r Flms....... .. No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 76�,n/.vd......OF.... .: lZ.^�.- ..>- .... .�::................. ------.... .._-- Appliratiun fur 11tipu,ial urku Cnunutrurtiun Prruti# Application is hereby made for a Permit to Construct (V<or Repair ( ) an Individual Sewage Disposal System at: /-/ v ti ,--/Z H/&4_= l e. . 1 l � I-f � L l -- -' ..._...... �� �- -... ............................................................... ::�........ 4 - Location-Address or Lot No. %Z }�ffT3>Yj..... C-- = �I;� +Q1✓/LLi'S y Owner Address Installer Address Type of Building Size Lot........c___�v...........Sq. feet U Dwelling—No. of Bedrooms__________________..............._ _____Expansion Attic Garbage Grinder U Other—Type of Building ____l__._/._=__etc"`?___ No. of persons.......�________________ Showers ( ) — Cafeteria" )— Q' Other fixtures .--•-•••--•--•••••-•-•--•••••••••• ••• __ W Design Flow............................576�7_._gallons per person per day. Total daily flow____._._�__�_______.................galpons. .1W Septic Tank—Liquid capacity/,�4?�allons Lengthi p�G_.._ Width _...`P Diameter________________ Depth+,__._._. Disposal Trench—No. .................... Width.................... Total Length...... _. Total leaching area....................sq. ft. Seepage Pit No------------2---------- Diameter....J__.;?n.r.... Depth below inlet___3. .. Total leaching area__ ..Q!asq. ft. Z Other Distribution box ( Dosing tank( . '-' Percolation Test Results Performed by---- --------- _/-_ ...�2r:.__—e t .... Date...... ,...a Test Pit No. 1___�__..___minutes per inch Depth of�Test Pit.../ `tea ___.____ Depth to ground water_______.__��:.. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x -•••-•-•-•••••---------•-•••••..._..._..--••-•-•...._._..-•-•---.--•.......................................................•--•--1=--.-Jr,_,1.r-..€8.,Z> 0 Description of Soil...... �L�!_�!--n--------��-�'--�........-------------------------------------------------------------------------------------- x 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 TI'LIZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ed by th b ar health. ne, --- ----------- ...------ Application Approved BY e. ....•.- •- _. .••.----•--------••----•-•------------•------- ---- ---- ate Application Disapproved for ka#owing reasons:---------•--------------•-••--------•---------------------•--------------------•----------------------------- ........................................................ --------- --------------._..._.._...._.....-----•-•----.._...-----._.----------•-...................................... ---- Date PermitNo.---.. . ...-•.'.�...�-------------------------- Issued..............................................:........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... :�-.V OF.... °. .:�:` . 7—,, ................... Appliration for Disposal Works Tons#rartion 11rruti# Application is hereby made for a Permit to Construct (tl` or Repair ( ) an Individual Sewage Disposal System at: ... .�".. .. ..: .*tee €. "rr.. _ �+...P..E.�_?..... .......•• •f .r d r +.'a... :!.`:::_G Location A dd�ress il or Lot No •--•• .. yy Owner '.p / Address WP'- ..?.. ..... ..............................•--.............................•.. Installer Address �+ Type of Building Size Lot.._1..l�.a._r.........(Sq. feet U Dwellin No. of Bedrooms.................: ...Expansion Attic Garbage Grinder �., 04 Other—Type of Buildin .""`" a No. of persons....... ................ Showers — Cafeteria - Other fixtures W Design Flow........................... gallons per person per da Total daily flow....................... ..................gallons. ' R: Septic Tank=Liquid capacity,l✓,- ]Ions Length/q.4..._ Width.. .0 Diameter................ Depth: .."..'S. Disposal Trench—No. .................... Width.................... Total Length i Total leaching area....................sq. ft. � e Seepage Pit No........_.2....... Diameter....t... ....... Depth below inlet.....lt�'..n.Z..... Total leaching area.. ..22sq. ft. Z Other Distribution box ( $or Dosing tank4_ "' �, � � /V 7 Percolation Test Results Performed by.. r'°�%'_'. / �" ` ''. ._...... Date......: f � .. a ....... a Test Pit No. I.... ..:;?!k minutes per inch Depth of Test Pit... Depth to ground water.._... y .. f3. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ....................................... ........--•--•--•-•-..................................... . .<+ le O Description of Soil.. --.... $ .�` !" ' ...... s:: : !! r ..................... 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 TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bM issued by the bo�arof health. ed- --• - --. - .._.. K --•-.. t .•��, _ t Application Approved By....... __. p .- ._............................... ....._.. ate Application Disapproved for a llowing reasons:--------•--•-•....................•----•-------------------•--••-------•----...............----....---•--....._ -^•-•................••-----...--••-•--•--... Date -f --- ^-------•--•------....� .... .... ----.....................•.......-----•.................................--.......... ............_ Permit No..-..�J - - -._.... Issued.....••-----••-----•-------------••--.....-----••----... Date THE COMMONWEALTH OF MASSACHUSETTS } BOARD OF HEALTH '? .3eV ...:.OF....9 i (y? , GA Trrtif irate of Tontplinurr THIS A(0 CEATIFY, That the Individual Sewage Disposal System constructed ( _ or Repaired ( ) by .................................................. ---••--•--- -•-------•------------...............:.......... ...................------................._...._ Installer at. ...= --..-.----•--------------------------------------- ------------------------------- ••-- has been installed in accordance,with the'provisions-of T 5 T e tate Sanitar C s d�s m the application for Disposal Works Construction Permit No.- } i THE ISSUANCE OF.THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEIoA Wj1�L "FUNi*ION SATISFACTORY.{ r DATE---•--....-•-----•---•-------•---------------------•-•......................... Inspector.................................................................................... ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF........ .................................:. .. NO- ...... Fim..................... _.. Disposal Works Tono#.rur#ion Vernti# - ter .. lei: , Permission is hereby granted................... ..._ ........ �_..... to Construct (k4j"or Repair ) an Individual Sewage Disposal System at No.... i fSs= + -re - .lam , : �" .... Street as shown on the application for Disposal Works Construction Permit No...........RV Dated....; . _ .. ... R / .........................................-:r.-._�...................................................... _ rj C. Board of Health DATE...........................1_� _: ..5..:? :..---------•-•-----------•. FORM 1255 A. M. SULKIN• INC`BOSTON BENCH MARK: n!Gz, ✓,-D. TEST HOLE RESULTS P# 8d D A T E 1 WITNESSED BY �7LE7 n iz ;/ ED cJ/V/V/A/6-, Z 0 /. 132 © TEST HOLE%n _�F - c7 TEST HOLE 2 - 27-HE 2 2, 0 10 � 2 �I i / 00,1 40GROUND WATER GROUND WATER vim- ENCOUNTERED ENCOUNTERED LEACH' � I n-�.f —J os�n3' PR AMII� 1 / / ? Z ' SO h4A HOLES AND COVER TO BE 8U1 LT TO C. T"DF LEV. TOP' OF WITHIN 12 OF FINISHED GRADE OUNDATION o FINISHED GRADE MIN. 2 /o SLOPE 4 of D IA. 4 DIA. PIPE FIRS 2'M1 ____ „ . + _.. n��N. `_. --- . 2 LAYER 0 F �- OT / O4 I!Z►�'— P! P E _ .,,�,,,� MIN. PITCH I FT. 2 LEVE MIN —`�. ` , . I�g' ' PEA STONE r '�� O 4 .'• MIN. PITCH i��nnw. ��'. • - � d ) 2 .;•: 14/FT. /Sow_ 119,Sa . .. I I q.2� � '. • O ' •r —� / I N'V E R T 6"suMP INVERT 11 !e p � � INVERT GALLON • p cn mom. I 3�7 J� � / / 9,7b EPTIC T4'NK J 2 DIST, Q z o �2 DIA. FOOTING TO BE PLACED INVERT - INVERT BOX / I � `' © 3.5� v © ' WASHED STONE ON A MINIMUM OF 18- OF W �. ' PLACE ON , INVERT Vie® cc 0,; ALL AROUND VIRGIN OR COMPACTED :' IO� MI FIRM BASE 4 -- ---I`T a .1 p:' BOTTOM AT ELEV. / /'S.S SAND �� c O GARBAGE �} 1 ~'= GRIN DER 4 DIA. PERFORATED M i3 o7- 'o.= T, H�L ELEV. DRAIN .PIPE WITH /4 PROF I LE OF GROUND WATER TABLE t3 ��© vw- TO- 1 DIA. STONE DIRECT FLOW TO ��AZ SANITARY D I S P 0 S A L S Y S T-E M ( NOT TO SCALE ) DESIGN DATA • CONSTRUCTION OF S•ANITARY . 'DISP-OSAL BEDROOMS SYSTEM SHALL CONFORM O T-FIE M A SS. r-. - .d, ca r nv _ DESIGN `' OW GAL. D . ENVIRONMENTAL CODE" TITLE .:� LEACH RATE 'C MIN./INCH (REVISED 7- 1-77 ) AND THE' TOWN , HEALTH DEPARTMENT REGULATIONS REQUIRED LEACHING CAPACIT-Y � • SEPTIC TANK, DISTRIBUTION BOX AND LEACH - PROPOSED SBA GAL�DAY ING UNIT TO BE : OF REINFORCED CONCRETE 2Z2.�(3.Si'T ! 2) �- A 77(! MIN. CONCRETE STRENGTH 3000P. S.1. REQUIRED SEPTIC TANK /2S0 GAL. MIN. STEEL STRENGTH _ 20,000 P. S. I. MIN. DESIGN LOAD IN G : '/y�� PROPOSED SEPTIC TANK IC00' GAL. • DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED • ALL PIPES AND FITTINGS TO BE WATERTIGHT AND TO BE OF - CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE . iTE S LAN SHOWING PROPOSED CONSTRUCTION! ZONING DATA LEGEND LOCATION BARNSTABLE CT-o•� /�'�� � is) �'!''�!�-• Fo R : J'�� c /� C ,A TZ � �}' r2 �" � �.. .�' -_ DATE $� Z O N E : OPsN S P.�cs i nN Tt l� z OwE' 2S� TEST HOLE LOCATION ` EFERENt: E LOT / QS" AS SHOWN ON REVISIONS 2 �9 890 EXISTING SPOT ELEVATION (7.6 G `� REQUIRED AREA --�43-�° �O� r.`` CrAl PLAN BOOK '�3`� PAGE / t'9 S/8/8 REQUIRED FRONTAGE : �O) 37.5' EXISTING CONTOUR 16 .._ _ �l c� c- REQUIRED FRONT SETBACK: C3o) 30r. PROPOSED CONTOUR I6 �k27493 it r GISTE SCALE REQUIRED SIDE SETBACK : (�s) PROPOSED WATER SERVICE W ~y REQUIRED REAR SETBACK : '� PROPCSED CAS SERVICE —' --- v 4A41'89 PROPOSED ELEC. & TELE E aT GRAIG R . SHORT , P. E PRO FESS10NAL C I V I L EN G I N E E R BUILDING INSPECTOR APPROVAL DATE I :1I OLD ROUTE 132 , HYANN IS , MA. 02601 FILE NO. / -( 4/ ( TELE. (617 ) 362 - 9411 ) SHEET / OF /