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HomeMy WebLinkAbout0271 CARRIAGE LANE - Health r . 71 CaxY "'g- Laxu- y _ TOWN OF BARNSTABLE %'G� ° CATION,:7- � CAYL�1 Lokz- SEWAGE # VII.1tAGECKNS �� ASSESSOR'S MAP & LOT aq7- ✓ INSTALLER'S NAME&PHONE NO. Calk'�G SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 'Z NO. OF BEDROOMS 3 BUILDER OR OWNERL�fi�7l)t� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: z Maximum:Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Waier Supply Well and Leaching Facility (If any wells exist on site or within 200 feetof leaching facility) Feet .- Edge,of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching-facility) Feet Furnished by Yl� No. � ' p�Qip Fee y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for M!6poot *pgtem Congtruction Permit Application for a Permit to Construct( )Repair Grade( )Abandon( ) ❑Complete System ❑Individual Components 1 Location Address or Lot No. a-7 �A/�l�r Al [.A Ow er's N�e>Address d Tel!,Po. I ����6//GG t S l'� We `�A.v,v, Assessor's Map/Parcel �Tl D 3 � S Installer's Name,AddT�nd;�'eVXNCO Designer's Name,Address and Tel.No. 335440t� ttM33ia(n��AgStreet N( � 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 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 Nature of Repairs or Alterations(Answer when applicable) L✓i S flt:� �Oo ofA-t' ��1`YGJ�clls jr-' 67'0nC__ 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 this Board of Hea t Signed 1 C � Date S" a `� Application Approved by , Date _60 Application Disapproved fort following reasons Permit No. lwoe, 2L S Date Issued r TOWN OF BARNSTABLE LOCATION L/4.k)e�_ SEWAGE # 2 2— VILLAGES �� ASSESSOR'S MAP & LOT T V INSTALLER'S NAME&PHONE NO. � 'c U r SEPTIC TANK CAPACITY �Xti �UUO tj f LEACHING FACILITY: (type)r 2 (size) `7 S>< I� r� 2- NO. OF BEDROOMS 3 BUILDER OR OWNER I PERMTTDATE: COMPLIANCE DATE: J� Separation Distance Between the: I: 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 j 2Lo . zl ' No. �� \ Fee C] THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for 30igpogal 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair( /,,,upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a 7/ C,4 r r"A C (A i 07er's N�tne,Address s and Tel N�. /fw ZSr, 2. IAA �v� Assessor's Map/Parcel S U 3 ®� ' S o w uc Installer's Name,AdditAnwe co Designer's Name,Address and Tel.No. 350 Main Street A1114 W. Yarmouth, MA 02673 Type of Building: Dwelling No.'of Bedrooms,... .3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Build�49..f 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures {i Design Flow g llens 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 Nature of Repairs or Alterations(Answer when applicable) L/1 S tj-r lls W/ Y " S 7(0,q z 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 this Board of Hea t1 � _ Signed , �cc,�..... Date Application'Approved by Date .5- -( 1_0 e) Application Disapproved fort following reasons Permit No. hmo,,.2 a Date Issued --------------------------------------- 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 1U C O at 0 7/ CS / i 4 1 / Gad/i J-�A tC has been constructed in accordance with the provisions of Title 5 and 4 for Disposal System Construction Permit No. �_2&! dated Installer Designer AQ The issuanc this e t shall not be construed as a guarantee that the to wi f ct' n a sig Date Inspector Iq No. ")000—7." Fee S G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS &5pogar *pgtem Congtruction Permit 1 Permission is hereby granted to Cons ct( )Repair upgrade( )Abandon( ) System located at 7/ � T r a�'t rt e� l?r� i r+ �}A 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: _ 1 �L 4d Approved by Q 1/6/99 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) I, Q i) a � , hereby certify that the application for disposal works construction permit signed by me dated •I /d - c5 0 concerning the property located at C A r t'q YLe-- meets all of the following criteria: 1 / ✓• The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to°5 minutes`per inch. ✓• There are no wetlands within 100 feet of the proposed septic system 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. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method 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 not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 1 ' B) G.W.Elevation 0 1 •�+the MAX.High G.W. Adjustment�• 1 = DIFFERENCE BETWEEN A and B S SIGNED : V /L �y DATE: � ( � - '0 C [Sketch proposed plan of system on back]. q:health folder.cert a `s _ Q . f v v VOCATION SEWAGE PERMIT NO. V I L L A G E ASSESSORS MAP N0: � PARCEL NO: INSTALLER'S NAME i AD-DRESS BUILDER OR OWNER 9. 6-%,6 50.E DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� ,� ,:, q _�,re. �. ..✓ o�. . ��n �� J��" "�G -� �� ��� _ � �'".,..—..' p f r' �.. 0 � •� (/��/, V ....................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTf-I -. -.to..�....(Q ...............OF.....�.! .25 Appliraa#ion for Dispoiaal Mirkii Tontrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....--..........-........--...................................................................... �-n_T.��`�........................ ocation-Address e d �n \ or Lot No. I..I. -••- �r1B.S.� ---•----•------•----•------------- -----......---..t........__..... .....1�A._lam ........................................ Owner Address a �.......... -----------------------------------------------------=--------- .�Y� 'R 5 �.. .M. S .......................... Installer PQ Addr ss U Type of Building Size Lot_3vt ----------Sq. feet Dwelling—No. of Bedrooms__.....ff................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of,persons............................ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures -----------•--- --•--•-------•---•-•----------•--•----•=----•----••---------••-••-•----••--•------•----••----•------------•---•..................... WDesign Flow.......... ..........................gallons per person per day. Total daily flow__.__.....VP.................._....._gallons. WSeptic Tank—Liquid capacity/..gallons Length__.q.......... Width., . Diameter................ Depth. !.A.1-W_. x Disposal Trench—No..................... Width.................... Total Length...................." Total leaching area............. .sq. ft. Seepage Pit No..................... Diameter/©t 4C_--___• Depth below inlet......6_7!a.--. Total leaching areaAK?� .....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by-e... ...Pct............. Date_..&kAAA%J................� 1.4 Test Pit No. 1-----.^.....minutes per inch Depth of Test Pit......1P....... Depth to ground waterllfztl&_.7r0, . (r, Test Pit No. 2................minutes per inch Depth of Test Pit-----i.Q......... Depth to ground water........................ P+ -----•----•------------------•-----••-•-.......••-----•--.....------•.....------.........-•-•-••••--......................................................... 0 Description of Soil_...CL ck!v. a £......IME41S .M....stl-d�1J.......------------------•------------------------- - x - ------------•----- V ...........•-••-•-••-•-•-••--••...------•----••.............................•-•••...--- 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 iss d by thq board of halt Signed S�. > g - ---------------- 9 ate Application Approved BY s_.,r -{1/ -A=------------- Da................ Application Disapproved for the following reasons:............................. -------------••--------------------------_..._ ------------------------------------- Date PermitNo......................................................... Issued-....................................................... Date -3o .......J. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C. ................OF...... ............................... . .. ... Appliration for DisposalMorks Tonstrurtion "umit V Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: LOT-*S Ij I .............................................................................................. ................................................................................................. L%Uion-Address or Lot No. ......................................... CA................................. .....................IN. ..A.0 Owner Address ............................................................... .............. .......................... Installer Addrbss U Type of Building Size Lot..3��C,__&..........Sq. feet ins.......V:3 Dwelling—No. of Bedroo ..................................Expansion Attic Garbage Grinder ( pal Other—Type of Building ............................ No. of persons....._..............._..____ Showers Cafeteria ( P., Other fixtures --------------------------------------------------------------------------------------------------------*-----------*­---------------Design Flow........... .........................gallons per person per day. Total daily flow___..._. .........................gallons. 1:4 Septic Tank—Liquid capacityo4� ..gallons Length---'7.......... Width.-5-—-------- Diameter__._____--___-- Depth,.e/--- Disposal Trench—No..................... Width..............._._.. Total Length..................._ Total leaching area....................sq. f t. Seepage Pit No....t............... Diameter/o.-.>..........Depth below inlet...... Total leaching areaA53(!_,57_7..sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed .. ..............7................... Date.2A.1'............................ Test Pit No. I.....24��.....minutesperinch Depth of Test Pit......!�D...... Depth to ground water/_)a&?�..741c/, C14 Test Pit No. 2................minutes per inch Depth of Test Pit-__.d.47.......... Depth to ground water....................___. P4 .................... ..................................................................................................................................... 0 Description of Soil---. ........ ....... ........................................................................ WI........................................................................................................................................................................................................ U W t� .1........................ ............................................................................................................................................................................. 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 i r is ed by the board of I 11 e '�eayh. Signed------- _t4............... .......................... Date X Application -Approved ---------z-------- I------------------------------------- --- /kate Application Disapproved for the following reasons:.................................................................................................................. ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (J"FlyWrtif irate of T"'Outpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by.................... ............. ............................................................................................................................................ e, n staller .. . �. /V I A-at. ; . _ ..........................................I......................................................... has been installed in accordance with the provisions of TIT 5 oj.j e State Sanitary Code as described in the application for Disposal Works Construction Permit No.-__2?...I.......................... dated........................;­---------------------- THE ISSU F CTI(NSJE OF THIS CERTIFICATE SHALL NOT BE CONSTRU AS A GUARANTEE THAT THE I SYSTEM WILY ON SATISFACTORY. DATE._... ............................................ InspectorZ.............................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF..................................................................................... No...... .......�Z� FEE..... ............ Disposal Works Tnnstrurtion ermit Permission is hereby granted...........4, elr .............................................................................................................................. to Construct orRpair an Individual Sewage Disposal System at No.. .......LZ�............C^ '&'/Z 1,4 6 e` e Z�A ............................................................................................................................................ Street ..as shown on the application for Disposal Works Construction Permit No.........._ Dated.......................................... ------------------------------------------------- yt 13oard of Health DATE------------------------•--•----= ............................................ _Fqftm 1255 A. M. SULKIN, INC., BOSTON SECTION - SEWAGE r 1 - SEPTIC TANK - - "D" BOX - - LEACH TOP OF FDN Wt l4�•• __ (MSL)z "2"OF F/8T0 4z" T'�C:It•-�G '`�`L-L- `GC•N��L•�-r TG7 WASHED STONE �.. _. o' cps"F t,41' -1 6 .De t �, q..P4% /4 IN- OUT IN - ` ' OUT • IN- 1 9�.,_I SEPT IC �lS.�Z/ TANK _ ELEV. ELEV. V. ELEV. �11 .iv 9"i•03 ra.5_...+ Q � ..� 1 l D 1 !U� �...� !� -�•- ELEV. ELEV. Z, Z, OF 3/4"• 1/z.. 1 '� \ ; \ \ 1 f / WASHED STONE I 1 �n+aGoo,-v -ra T_L.85.0± - TEST HOLE LOG TEST BY CPA S401?__r rPle, 13AP-w1. r!t> 4 4AE.At_2TbA ( „i TEST DATE �t (Z•i �I WITNESS '� 11 ' DESIGN BEDROOM HOUSE '� T.H. # 1 T.H. # 2 1c�z.S - too 47©" ELEV. OO"_ ELEV. NO LZ DISPOSER DISPOSER Su SOIL 1_ � —1 `zrS• o vorc. PERC RATE —MIN/IN.LOM1.4M .� FLOW RATE -2:,-2 C (GAL./DAY ) 2-4" 1 DC�•1 -L4•`` / 1[�0. SEPTIC TANK 330 x(�•S)= hl 1 ,�,�,. REQ'D SEPTIC TANK SIZE ! ovt� ---- / -r.r"• ��"' lay -� 1 "'�`•A" � ''� / `1.. oss c_L.•G^ , oSE. LEACH FACILITY _ ++ {` - S 4'-~ SIDE WALL �><10.5 x G )• iz.5 ) = 4g4.'�E G/D. BOTTOM 112' S•15`xy.ZS= 8G,.lm ( 1.0 ) _ $Cn•!n G/D I I / �i�.� �• ��c•'� TOTAL 29-4-.5 G& . USE: �1> o►•►E _LEACHING .a l ti.l ck . ��'' -�= �. , ; ✓ y }. ✓ F J`1� �. N O WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) �F Mq �1 s o� I d 1. DATUM (MSL)+TAKEN FROM..-_&4:'r'^�`'��t_`sj.._....__..QUADRANGLE MAP �yy� C�iG + a ALA GArc�v/?F�t 2. MUNICIPAL WATER----_-------__1�._._.-_.-_._..___..._...AVAILABLE C) AR NE F � CIVIL Q ) 3. PIPE PITCH: /4"PER FOOT H. -E!=1Q4•(�j �V"► tol too 9� `(p f 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO - N (`� 44 OJALA No. 30792 DISTANCE AS CERTIFIED 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. *26348 Q 6. PIPE JOINTS SHALL BE MADE WATER TIGHT T T. �r — 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM. OF MASS. �Q A_ I HEREBY CERTIFY THAT TBUILDINGy !L1 C� a SITE PLAN ., STATE ENVIRONMENTAL CODE TITLE 5 �,9 �-IS - y� ALE SHOWN ON THIS PLAN IS LOCATED ON THE We GROUND AS SHOWN HEREON &THAT IT LOCUS: CONFORM TO THE ZONING BY LAWS OF THETOWN OFREG.—PROFES ONAL ENGINEER WHEN CONSTRUCTED. DATE F:Lc>1 c4 - �.-PL. RE _ '"a4 I down cape engineering PREPARED FOR:^ ' CIVIL ENGINEERS _----------- '� LAND SURVEYORS REG.LAND SURVEYOR `BOARD OF HEALTH _SCALE { r CONTOURS (EXISTING) -------.---- APPROVED DATE ��` �"� F A"4'Lr DATE MA Yarmouth&Orleans,MA (PROPOSED)—O—O—O-0—