HomeMy WebLinkAbout0215 HARBOR POINT ROAD - Health 21,5 Harbor Point k ad
'Barnstable
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TO OF BARNSTA.BLE
LOCATION o7��r'{a,R 6UtL e ilk"%� • SEWAGE #OZy%�'ZIS
VILLAGE M•Wtact ASSESSOR'S MAP & LOT 3SL 6
INSTALLER'S NAME&PHONE NO. A" Pew w
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS_' `� A ,ems
BUILDER OR OWNER Sh Ik ,'T�im&U
PERMITDATE: COMPLIANCE DATE:
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
s Furnished by
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Town of Barnstable
' '"r Regulatory Services
Thomas F. Geiler,Director
s�errsresz.e. •
NAM Public Health Division
E0 ` Thomas McKean,Director
200 Main Street,Hyannis;MA 02601
Office: 508-862-4644 Fax: 508-790-6304
III ,
Installer& Designer Certification ForLn
Date:
Designer: 6`,DWewZD 41. Installer: I"
NI
Address: Address:
cr ti"Aa�� a. NJ,g• ozG,37 S aZo[Al2�
6?16
On. was issued a permit to install a
(date) (install )
septic system at //#9,9 pT- /40, 4, W 04 a, D based on a design drawn by
(address)
L%�W�ttO Gs MA /2� 2 0 0 4
7arrso" rz i�
� dated Rrjk/strn ov". 4bo-4—
(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.
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 vertical 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.
P`NN OF ,M OF A9q
o EDWARD O
(IIIS 's Si ) E. CO
Igo.ZB100
(Designer's.Signature ` (Affix Designer's S
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH D SION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:HealtWSeptic/Desiper Certification Form
No, 5 ��
e i/
' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppYicatioin for Migonl *pgtem Cottgtruction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Z j S 14,4&SCIL A91uT ap Owner's Name,Address and Tel.No. S^p ��,� 'LY7
cvEr✓�r,�-ro�� ��n dzc37 �,t}�� j,�cpoF�,�.c0
Assessor's Map/Parcel v z637
Installer's Name,Addres, d Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size L 7 sq.ft. Garbage Grinder(,t-fcl
Other Type of BuildingS! �F�No. of Persons 3 Showers(2 ) Cafeteria(Io)
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)
Date last inspected: '
,k 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 iss d by is ar of Health. �Z{--vP- IU7'M�
Si Date 3 °�
Application Approved Date
Application Disapproved for the following reasons
{
Permit No. &9-<Z�O`J —® Date Issued a TWO,
Fee
f 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
f
PUBLIC HEALTH'DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2ppricat on for ;Mtopogal *pgtem' Con,5truction Permit
Application for a Permit to Construct pp' ( , )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components .
d
Location Address or Lot No. 2 l l tLgC/L O/«T op Owner's Name,Address and Tel.No. (47 7
1-4A 4zc 37 e I c I,2 C o o rlA-(0
Assessor's Map/Parcel 3.s2 /�O tC(� l�p �j t, �® ,C /� zGf
Installer's Name;Addre d Tel.No. ,\ Designer's Name,Address and Tel.No.
�,
Type of Building:
Dwelling No.of Bedrooms Lot Size 7 sq.ft. Garbage Grinder(X-e
Other Type of Buildin F4kl 0 No. of Persons 3 Showers(2 ) Cafeteria(114�
Other Fixtures
`l
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 " 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 syystem in operation`until a
Certifi-cate of Compliance has been issued by this Board,of Health. �Z�!ppit�f tovJ
Si ff A b0 Date 3 4/5
Application Approved F ;- Date & /y 0
Application Disapproved for the following reasons
� A
z- Permit No. C?��5 _� 5 Date4,Issued �' �y 4�
—
THE COMMONWEALTH OF MASSACHUSETTS _.
x BARNSTABLS, h SSACHJSETTS -
"Certifi.cote of Compliance
THIS IS TO CERTIFY t at the On-site-Sewagii Disposal System Constructed (',K)Repaired ( )Upgraded( )
Abandoned( )by f m^AU' \
at I � �poc- of r) -Cttm%&4ka j has been constructed>in accordance
with the pro •sions . Title 5 and the for Disposal System Construction Permit o. (V 2 -25 e dated
Installer Designer -IQ Soon
The issuance of this pe shall n t be construed as a guarantee that the s stem wi tild,ct on as designed. ,
Date P4 0 Inspector
No. � �J `d5 g Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
migpooaf *p.5tem Con!truction permit
Permission is hereby granted to Co tructl(�-Repai )Up rade( ( bandon( ).
'> System located at 31
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 oath's it.
Date:_ 1)�T O.5 Approve y.
r
�t T OF BARNSTABLE
�r LOCATIONon�1s[7aRkbv/L" eif �� SEWAGE #° 7J ���y
VII.LAG E :K ASSESSOR'S MAP & LOT 3SL 6
INSTALLER'S NAME&PHONE NO. 6,0_D :w*,m&i _766 4 24 (a4ro
SEPTIC,TANK,CAPACITY S�Od C1 1�-I
LEACHING FACILITY: (type) \. (size)
NO.OF BEDROOMS �—t , � VINDbm&ka,
BUILDER OR OWNER?� a fta c-
PERMIT DATE: COMPLIANCE DATE:
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
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3L.0 80� __ _ �— EL. 4/,off•. _ _ ----------
5�� 14 — TOP OF FOUNDATION
CONCRETE COVERS
214" 11; 4"C13T IRON 9"MAX,
OR SCHEDULE 40 4"SCHEDULE 40 P.V.C. (ONLY)
' P.V.C, PIPE MIN, 12"MIN.
r✓�tid��,��, ��! �
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PITCH 1/4"PER.FT. LEACHING FIELD (.1-REOUIRED)
WASHED STONE L'
� . INVERT . . . . .. .
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AN)( INVERT s" E INVERT WASHEO toSTONE /,
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,•• INVERT
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•' EL.•1.:.. INVERT
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N
FIrjLO° �;•, 26 3/ 8' 30�. o�/ 7.3¢ t
` PROFILE OF
J
GROUND WATER TABLE
% / SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION
NO SCALE LEACHING FI ELD
b P? NO SCALE
y DESIGN AT
1/8
NUMBER OF BEDROOMS , , , , , , , , „ 12 MIN. STONEWA-SHED
(! TOTAL ESTIMATED FLOW . . ¢�, ,• GALLONS/DAY
0 4' SCHED LE 40 P.V.C.
�.� `t l� BOTTOM LEACHING AREA . 1. 8'.Q,V.. SOFT/TRENCH ATED PIP
SIDE LEACHING AREA
. . . . .. . . . . .. . . SO.FT./TRENCH
Ls/4-I V`t"
�oCU S M/-� SC/nGC= 000/ '/=/ ' --- �� w.-4- — -- �_vLv c A-_ ;.
_ _ 4 GARBAGE DISPOSAL . .:`!4^/A (s0% AREA INCREASE) WASHED
TOTAL LEACHING AREA Gob OO '
STONE
v w B S0.FT. .�' ,¢8/' 1Ba -48",
PERCOLATION RATE !�S -;2/ 1,v 7��
�� .. PER. INCH �G,o^
' v'I
LEACHING AREA PER PERCOLATION RATEf,'`�,zSO.'FT
ww 3 -- GROUND WATER TABLE
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-,,W / U' _ _ Q APPROVED BOARD OF HEALTH
�7- ��- % 60' DATE .. . . . . . . .
AGENT OR INSPECTOR
�HOFM
Assgo
\ ) SOIL LOG �� STETSON
L/ti1i T DATE P4-P.•A;?Q°�r. TIME ./ A9.'5�!`y. Q R.
HALL t4
HOLE Iv i tS i HOLE �s No.52' �P
ELEV. . . . .. . . . .. . . ELEV. �R SPN\
ED oQ. .
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.. . . ...WATER 9L ENCOUNTERED
WITNESSED BY
\ �� -_ __ - _� `2O ' - -- - - // N /� • • A�?. . . WNi . . . . BOARD OF HEALTH
ENGINEER
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