HomeMy WebLinkAbout0334 MIDPINE RD - Health 334 MID PINE ROAD
BARNSTABLE
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N. �-d l � Fee $ 5 0.0 0
THE COMMONWALTH OF MASSACHUSETTS Entered in computer:
Yes /
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS
01ppYfcation for Mfgpool *pgtem Con! truction Permit
Application for a Permit to Construct( )RepairXX)Upgrade( )Abandon( ) O Complete System D Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
334 Mid Pine Road Cummaquid,Mass. Emil Masotto
Assessor's Map/Parcel `,y /I �' 0 2 6 3 7 334 Mid Pine Road
Installer's Name,Address,and Teel.No. 5d0+8—7 7 5—3 3 3 H Designer's Name,Address and Tel.No.S 0 H—7 7 5—3 3 3.8
J.P.Macomber & Son . Inc. J.P.Macomber & Son Inc.
Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632
Type of Building:
Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 4 6 2 gallons per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Loamy sand to Fc1ay._:fo.,c:w_n sand- 5-'—dig Gut
Nature of Repairs or Alterations(Answer when applicable) Adding 2'`-E;0 0 ga lInn 1 Aa r-h; n
packed in 4 ' of 1 '--" stone. There is an 4xis ert%t
and a 1000 gallon leaching pit. Alzi, p
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 issue by this and He th.
Signed Date 1 2/7/0 0
Application Approved by Date 2 v
Application Disapproved r the following reasons
Permit No. `Zi4_ �0� Date Issued ?/
W TOWN OF BARNSTABLE /L
LOCATION �3- %��/� 90 SEWAGE #.2 00/- 0
VILLAGE C aARA ASSESSOR'S MAP & LOT3 —OZ�
INSTALLER'S NAME&PHONE NO. %r_ ,A'MA CO,M ,9eA Soy
SEPTIC TANK CAPACITY /Q ao y ems/ QZ V
LEACHING FACILITY: (type)A=f 4 QW C&,9,V d of°S (size) 0 Z�� L"_
NO.OF BEDROOMS
BUILDER OR OWNER &N
PERMIT DATE: 2 COMPLLANCE DATE: a
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 eidst
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
V oo s t
I211
/ /�f640
TOWN OF BARNSTABLE > lJ
LOCATION 3 3�/G� fv!✓P RW SEWAGE #.2°aI o
VILLAGE C U�-AfA QU/d ASSESSOR'S MAP & LOT3 —07-
LNSTALLER'S NAME&PHONE NO. J .',M,4 CO A /9ex, S ox
SEPTIC TANK CAPACITY Q rso y P/T DL V
�. LEACHING FACILITY: (type)j=f L OW C,&d 1q,6 of`5 (size) ( 3 x Z X_ Z. t-T
NO.Of BEDROOMS ,3
BUILDER OR OWNER
PERMTTDATE / ® r COMPLIANCE DATE`'
Separation Distance Between the: .
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
b y
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.
I
No. 0C) .`v" Fee
. .
THE COMuoM#sALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN.OF BARNSTABLE, MASSACHUSETTS a
Zippiicatfon for �Digogaf bpgtem Congtru`ct on Permit
Application for a Permit to Construct( )Repair=�X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
334 Mid Pine Road Cummaquid,Mass. Emil Masotto
Assessor'sMap/Parcel 3 y� O/t 02637 Cumma34 idid,MMa Road
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber, & Son Inc.
Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632
Type of Building:
Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 4 6 2 gallons per day. Calculated daily flow3X 1 1 0=A 3 0 gallons. 1
Plan Date Number of sheets Revision Date
Title
' Size of Septic Tank Type of S.A.S.
Description of Soil Loamy sand to' a. da3 � t
Nature of Repairs
airs or Alterations Answer when applicable Adding J-500 gallon leach�na packed in 4 ' of 1 " stone. There is an existing 1000 cfallon 51 T
and a 1000 gallon leaching pit. .�.� -�
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 issue, by this Foard - He lth.
Signed /"a Date 12/7/0 0
Application Approved by f Date 2 U
Application Disapproved or the following reasons
Permit No. Zdy " 07 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
o, Certificate of Compliance
'"sj rf3
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed 01 )Repaired(XX ),Upgraded( )
Abandoned( )by J.P.Macomber & Son Inc
at 334 Mid Pine Road Cummaquid,Mass. has been construct d in a cordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 41V I-09_�r dated L l U 1
Installer J.P.Macomber & Son Inc. Designer J.P.Macomber & San nc_
The issuance of this pernut sh 1 not be construed as a guarantee that the syste ill function- s -esign.
Date I.&V Inspector
LA.tirl,.,Q r�oc}L
--------------------------Fee 50.00
�l p_0 2 / THE COMMONWEALTH OF MASSACHUSETTS
f� PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwiopooar *pztem Cone;truction Permit
Permission is hereby granted to Construct( )Repair�X)Upgrade( )Abandon( )
Systemlocatedat 334 Mid Pine Road Cummaauid Mass
l
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 m st be ompleted wi
' � thin three years of the date of thl
�
Date: : �Zo Approved by
M99
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, Joseph P.Macomber Jr, hereby certify that the application for disposal works
construction permit signed by me dated 1 2/7/0 0 concerning the
property located at 334 Mid Pine Road Cummaquid,Mass. meets all of the -"
following criteria:
/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.
:;
cre are no wetlands within 100 feet of the proposed septic system
/ There are no private wells within 150 feet of the proposed septic system
�d 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 n2 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 nZ be located less than fourtecn (14) feet above the maximum adjusted
groundwater table elevation,
Please complete.the rollowing:
A) Top of Ground Surface Elevation(using GIS information) 7 3
B) G.W. Elevation 6 +the MAX. High G.W. Adjustment.7i
S y
DIFFERENCE BETWEEN A and B
SIGNED : DATE:
(Sketc posed plan of system on back).
q:health folder.een
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N:s 33 �t
Ld-CAT<I0N ' - 4 SEPIA G E PERMIT AD.
Isg
V I L L A t (, Y►x'
IUSTA LLf.E S NA.ME ADDRESS
BUILDER , OR : OWNER
og
DATE PE , MIT ISSMED� � J_,�Co.
r - �
DATE COttPLIANCE * ISSUED. �� _ /,2 -1Q
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No...._��.e--. ... Fus.... `�--
Nj d..
THE COMMONWE-ALTH OF MASSACHUSETTS
BOARD OF HEALTH
------rowlj-----------.0F..... ......................
Applirtttion for Bispniittl Workg Tonstrnrtiun runfit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:
............./---........................................... _ _
Locatio A ss- or Lot No.
Owner
Installer Address ^^ `
Q Type of Building Size Lot___ -----Sq. feet
V Dwelling—No. of Bedrooms............. ___________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons......................... Showers ( ) — Cafeteria ( )
a'' Other fixtures ____________________________
Q --•-----------••-------•--•---•• •-•-•--•---•--••--------------•--------•--------------------•-----------•-•••-•--------
W Design Flow_____________ ` _...._.___........gallons per person per day. Total dai��ow.........�, ®_...................gallons.
WSeptic Tank—Liquid capacitv/i�allons Length_9__.Z__. Width__- .. _C_ Diameter________________ Depth...5. _C
x Disposal Trench—No_____________________ Width............ Total Length.. _._..___ _��.Total leaching area______�___.._...sq. ft.
Seepage Pit No._, _____________ D meter/��-'47 Depth below inlet_ . Total leaching area___
Z Other Distribution box ( Dosing tank
0-4
a Percolation Test Results Performed by ...... Date------ ____
,-� Test Pit No. 1.G __minutes per inch Depth of Test PiL 4_ Depth to ground water----e!v_ ......
fT4 Test Pit No. 2__!!�7:.®1--_minutes per inch Depth of Test Pit._,Y.` _____ Depth to ground water_-_R! .......
x Des iptio of Soil---��- Z n l � ` ``<�>......
n---�e
W ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•-••--•-•-•-•-•..............
0 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 ii '- y g g p y
S of the State Sanitary Code— The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signe
Date
Application Approved By....... ------------------ .... ... =------
/ Date
Applieation Disapproved for the following reasons__________________________________________________________..---•-•-----------••--•---•••••. ..............
----•_..._._...•••-----------••--•••---•••••-----•••--------••••-•----•-••••---•-•••-••-•...----•-••--••----=------------------------------------------------------•.--------------------------•-•--••--
Date
PermitNo--------------------------------------------------------- Issued.......................................................
Date
.. THE COMMONWEALTH OF MASSACHUSETTS — �U,U, //l
BOARD OF HEALTH /ud 7hk/ r1i-Z-�e-e -
- —
......� (,t/.�........OF... ..................
�rrtif irtttr of �nnt�littnrr
THIS IS TO_G T FY That the Ind4idual Sewage Disposal System constructed { or Repaired ( )
�'�
by.....................!/. 0.---... _... --......-----•-------.....----•-
sta
has been installed in accordance with the provisions of T K ` of h State Sanitary Code as describe in the
+application for Disposal Works Construction Permit N .�!`. _____ __._ __________ dated__-.._ Q." ._. ............
THE THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTIZUED AS A GUARANTEE THAT THE
4 SYSTEM WILL FUNCTION SATISFACTORY.
DATE......... 2 ...... Inspector ; 104. ._.........
, , � - -
FEE
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
*r .� ..........OF....
S/ ......a-�( .......................
Appliratilan for Uhipati al Works Tontrurtiun ramit
Application is hereby made for a Permit to Construct (60)or Repair ( ) an Individual Sewage Disposal
' System at
�_ 72...?/r ...._ .....-•-•.... .........•-----`'�,cam �`�L%------•-----•-------..._..................._.
Location-Address or Lot No.,
�//4/?/4 its r CV G.T `.� 7-77 .
- ..........._ ..................................... .............•-------------•----•-•••_..... ....-•----._._...._..•••--•-•••-•--•--•••--
-
Owner Address
,-� ................................----...............
Installer Addressco 4Type of Building Size Lot._ZA_J�__:......Sq. feet
U Dwelling—No. of Bedrooms.......... ............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ............................ .
W Design Flow...........` ` .....................gallons per person per day. Total daily flow.......__---�__3_�-�__......................gallons.
WSeptic Tank—Liquid capacity's gallons Length%_____-_.___ Width�. _�-_ Diameter_______________ Depth..---a'r---. __-_.
x Disposal Trench—No. .................... Width.................... Total Length----------.____..__ Total leaching area....................sq. ft.
Seepage Pit No- --------------- Diameter�� ram___ Depth below Total leaching area..-"5 ...sq. ft.
Z Other Distribution box (4-1 Dosing tank ( )
'-' Percolation Test Results Performed by_�:� .- ��'.` • 'fi�3''JG"-�.J,.�c�C., ��,.....................................
��
Date
„a� Test Pit No. 1" -r....minutes per inch Depth of Test Pit_� `.��_V__ Depth to ground water___ J_. ...........
f=, Test Pit \o. 2_,0"-__�-•..minutes per inch Depth of Test ------ Depth to ground water........................
a ---------------------------------------------•---••------------------•-•-•-••--•---........................................................................
0 Description of Soil..e9 ,e-/ '4 0" `--/ � .S✓=�- �`5)r <
------------------ --------
V ......................( C_-C,) -/"0A C--T-•= ,. t`�..............' " c� t'&&97--&=L-
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
/'1�
the provisions of TIT
'1 I l 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 by the board of health.
Signed,.--•-•--••••-•-->-•--------•-----•-•---••••------------------••-•••--••...-------•---• ------ -•....--------•---
' Date
Application Approved By.... f. ... -�!r?,�7. ..................... ��-"�? .
eDate
Application Disapproved for the following reasons:.............=...........
-----------------------............................................................
..•--------------•----••---------•••---•--------....--------•-••••-••--•-•-•-----•------••-----••--••--...---•-••-----••---------•-------••-•-------------•----•---•----• ...............................
Date
PermitNo......................................................... Issued_........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..�.(:' .................t"} OF.... ...................� ...............
TWrtif irate of TamptiFanrr
THIS IS TO CERTIFY, That the In4_�vidual Sewage Disposal System constructed ( or Repaired ( )
by.......... / /`- D14 (-V ..............
Installer
. . ------/mil i�8 GC_ ..U��
has been installed in accordance with the provisions of Lr 5 of The Ste Sanitary Code as described in the
application for Disposal Works Construction Permit N ___.$7Ad___._...___ dated.._�(�.*'_��.- �_____________
THE ISSUANCE OF THIS CERTIFICATE SIIA NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................................•••••-----•-•--_.... Inspector-....•---------------------•.......................................................
THE COMMONWEALTH OF MASSACHUSETTS
4 t BOARD OF HEALTH
ppe�rr -q
No.3 .................. FEE.r''.............•-••--
. �t��v��aa1 nrk� �nn�trnr�tinat_ prmtt
Permission is hereby granted. ..............._1....---'f. .. �....-------------------------------•---------------•---..............--
-
to Construct (4-) or Repair ) an Individual Sewa e Disposal System
at No.../ .0. •--••--1 ? = ------- / ------•--... ..--
Street
as shown on the application for Disposal Works Construction Per o__________ _________ ted_�G_'.�_'._�._..__.t.__.
t k
l�a of ealtoh I
DATE ...--- -(- -/----.•---C•.. ........
FORM 1255 HOBBS &-WARREN, INC.. PUBLISHERS
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