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HomeMy WebLinkAbout0357 MIDPINE RD - Health 357 MID—PINE, LOT 160B, CUMNIAQUID 1 A=349-038 e t o o No. ¢ ; { Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migoal *pgtem Congtructiou Permit Application is hereby made for a Permit to Construct( )or Repair( 'anon-site Sewage Disposal System at: Location Address or Lot No. LOT (' Owner's Name,Address and Tel.No. 35-7 m7oD-p` can w\aQo asp _04_10r Vs c1 C99-e ula Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `�7�'- gallons per day. Calculated daily flow 3�0 gallons. Plan Date Number of sheets Revision Date Title i Description of Soil yV-. trJ- Cy AC.5e__ i Nature of Re airs or Alterations(Answer when applicable) -S'tk.�T P�` l 000-.�—r 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 is s f Health. Signe Date 4d�--d6`jF4_ Application Approved by Application Disapproved for the following reaso s Permit No. �� Date Issued 6 3t No. 2? n -� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSE rTS q Z[ppYtratton for Mtgooal *pgtem Contrurtton Vermtt Application is hereby made for a Permit to Construct( )or Repair( �anon-site Sewage Disposal System at: Location Address or Lot'No. Lar l(re 1 Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's`Name,Address and Tel.No. s+ Type of Building: Dwelling No.of Bedrooms �✓ Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ` gallons per day. Calculated daily flow � C7 gallons. Plan Date Number of sheets Revision Date _ Title Description of Soil yAr\C i.)- c C C_ c,(A-(- Nature of Re airs or Alterations(Answer when�applicable) �'tti`7i Ak\ t 000 k 06 k ex%s`r' J 6cy- —t 5�z)�1LT14vC� itil ��`�TG'i�r V 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 iss ;-� s �oard o Health. Signed-"' .j Date,�v � a Application Approved by Application Disapproved for the following reasons Permit No. Date Issued. --------®------------------------- — _e THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certiftrate of Comphante THIS IS TO CE that tth O -site Sewage Disposal System installed( )or repaired/eplaced( )on by�ti,r- / 17�d~�S for `°'!'"{�crw l�5 � ✓cdc as ion a - 1 V_A0 . Cv vv,, :(2.-v, has been constructed in accordan e with the provisions of Title 5 and the for Disposal System Construction Permit No., �7 dated Use of this system is conditioned on compliance with the provisions s forth below: No. / 7 Fee �— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwtgaar *p.5tem Con5trurtton Vermtt Permission is hereby granted to --.0-1 to construct( )repair( %-4-aY On-site Sewage System located at -3 ? C .,.s ✓VL 1N11 Cy,,.'V1.4�, 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. All construction must be completed within two years of the date below. Date: l/' -)-',Or" G� Approved by .; r»: 1 CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED r' hereby certify that the application for disposal works construction permit signed by me dated �o—o�D�l�P .concerning the property located at 3�7 � �— �- ��► meet#all of the following criteria: There are no wetlands within 300 feet of the proposed septic ttystetn There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the teaching fbdlity • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. i SIGNE DATS: . LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NL%MER [Attach a sketch plan of the proposed system. 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Vg LLACE I N S T A LLER'S NAME i ADDRESS ® U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED y i 3� 43 � ' tD iSq� TOWN OF BARNST LE LOCATION J !/D �� SEWAGE # 0 RZ "Vn.,LAGE �f/fib ImnJR9 �O yy�� ASSESSOR'S MAP & LOT-Ft?"ld�f INSTALLER'S NAME&PHONE NO.�//i� Q(e AfiC- - O 6g- SEPTIC TANK CAPACITY 1660 V"% LEACHING FACILITY: (type) f T (size) (0 x NO.OF BEDROOMS BUILDER OR OWNER �� d�''"4� , ' /cl�•: PERMITDATE: G —;?<�1^9��—COMPLIANCE DATE: ` Q^ Separation Distance Between the: / Maximum Adjusted Groundwater Table and 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 leng cility) Feet Furnished by ,/'% �' ve_,e _ t �� FaJn��60�1 T � \ Y � � � 1' '� �; �- r °� ® � � � � � � 3 �.>- ,,,;� - {;t..„, !,>, _� _. ;: s r No.�.l.......!....... . •f Fps.. � C- ......._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ._.........................................O F....................--•........................ Appliration for BiipuuFal Works Tonstrurtion rrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System a r�.O..... ORL............................ . ---•--. � -�........ -•--•-------............................. catio - ddress or t No. At• .... . tl 4f...- ---. . .._.... .�./.......`.A..e s •..... ....�?(. ®®,��T l �e._.�� oews .-��!��- ....-----••-------••--. w ....Q !�_... P. 5 '`' if f'!� Y__.�_.!!!�...J37.......Sv A� e . .f.J---------------------------------- a Installer / Address Type of Building Size Lot............................Sq. feet ►-a Dwelling—No. of Bedrooms.......................... ...............Expansion ,Attic ( Garbage Grinder (N Other—T e of Building ............. t a Other—Type g _..�L._ No. of persons........................... Showers (� Cafeteria ) Other fixt res .............. .................................... Design Flow................,�-XI ..............gallons per person per day. Total daily flow..'....... ..................._......_.._.gallons. w W Septic Tank—Liquid capacity..._./� _...gallons 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 ( ) Percolation Test Results Performed by.........JJ.YJzs.... �►� '?!� �"`:.................. Date.. 3 do-� ---- -........ Test Pit No. 1.._. __minutes per inch Depth' of Test Pit------ .._ Depth to ground water...--- :'.... -...._.__. f=, Test Pit No. 2....�-2".minutes per inch Depth of Test Pit....., -------- Depth to ground water...Mnf_.1f ' �+ - -------------------.......................................... O Description of Soil....L( ._�__. e._.S Q____ `E�It�.�__.:. 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 TITTIE 5 of the State Sanitary Qode—The undersigned further agrees not to place the system in opera ' u it a Ce ti to of ice as a issued Dbthe'kaud . healt /De ._ . ..... . •-••--------------•. - •-- AlicationApprove .......-•...... ........ ••----•--------•-..._........----------•-......-•••-.`....----•---_... .... -----• - Application Disapproved for llowing reasons----------------•------f----•--•-----------------------...------------------------------------------....._....-- ------------------•-•----•...........------• -•-•-----...-••----•------••-------.....------•-------.......------•--•---•--•••-•--•-•---••-------•---------------------......------- ......------•- Date — PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' .................................I........ urrtif irate of Tomlt��rr T,iIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired. ( ) by ----....---s ? n f�v----------------------------------------------------- -------------------------------------------------------------------------------------------- Inst ller /J,� _... at -................3-----------�'-�-�--�-'--... . ..- --------------------.--.------.-------- ----- ----------------- has been installed in accordance with the provisions of TI" .F of The State Sanitary Co e a s- ' ed in the P Y application for Disposal Works Construction Permit No: .._..' ___.�..__.._._. dated_�.._z.� .•......:......... THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................-................................................. NQ ..... �.! Fps . . ......... t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.......................................................................................... 1tratila lor 11spo' al Works T ustrurtion amit Application is hereby made for a Permit to Construct ( P, 4rRepair (/j ) an Individual Sewage Disposal ........ ..... d `.... .... ......... ...................... • -•--- ! ------ y - -----*------ - r --......----------•-------........ ioS fddress a +�i ` 1lar' eJr oYffN(IN y� ............. - ........ .ow l=... ..-••--.............. ...... C .. .... .s...............-----••.. ..._.......---- ..: a .............................f.-........... --- -----• Installer Address d Type of Building 7 Size Lot............................sq. V DwellingNo. of Bedrooms-_.. ---••--_•----___•-__-__--__ ``sZi ' Garba e Grinder— 66 ..Expans>.on Attic•'(, ..:,f.: r,-.. g ) Other—T e of Building �rr1.'�/_'._...___.... No. of ersons......... . .}�^ 1 a Other—Type g _---- p � ----..__ Sho �.,.(.:: Gafeteria,( �) d Other fixtures •---••••--•••••-•--•---••-••••••••••-••••••••-•••-••--.••-•-•---•-•-•-••-•-----•---•------•........•... .3.. U------•.--;---•--------•----- : W Design Flow................. . .J I ..............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..,(?PV llons 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 ( ) f Percolation Test Results Performed by...__..__5.Gt_,5..... tw................ Date... i.".3........... �a Test Pit No. I ....((� .minutes per inch Depth of Test Pit.................... Depth to ground Ovate _ ..._� ; w Test Pit No. 2..... minutes per inch Depth of Test Pitt- �=•Depth to ground water.--j,�,_/:-71. JV -� = { Descriptionof Soll- +...........................................,... ......................................-................................ x t f �� . W - ---- - ---------------- ---•-•- --------••••............-- ......-•-••• ......------ ---------•-••-•••••-----•---••••--•---••••-•••-•--•-•---•-.....--•---•--•----••- -- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .................................-.................................................................................... ----------•-------------•-----------------------•---..................-•-••-••... Agreement The undersigned agrees to install thjljo&edescribed Individual Sewage Disposal System in accordance with the prow° is f iITt� oft ate Sanitary ode_ The undersigned further agrees not to place the system in oper on u it a C t Compliance has e issued b the ado healt Si f - Application Approve =. --1--• ---------•-•-------------------------------------------------•....... ------- ,r - te- R Application Disapproved fo t ollowing reasons:................................................................................................................ _ ---•------------•-----------•--•----....•....--•-----••••--•-••••--••••----------------------------------------•---------•-----•------------------------ Date PermitNo...:........................•---•----•--- Issued....................................................... .. � -- '. Date THE COMMONWEALTH OF MASSACHUSETTS F BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifiratr of Tourpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------•-jp. a� = 'i�fEf�4r4! : ..•....----•---- ----- -------------------•-----•--••-----------•------------•-•--•-----•--•--.....--•------•--...---- . t A a ,A salter at.......• : ...3 S-7-----F`.J t,-?n� .-..-L- Cti/ ------------------•-••. has been installed in accordance with the provisions of TI` r The State.Sanitary C e� es ibed in the application for Disposal Works Construction Permit No.. �_'' ................ dated_/._.__ ............ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /V .. ...........OF....................... r/) N ........................ FEE. ................... Permission is hereby gr ed_cl/Ly"_ "%-�zl- - .............. �. } to Construct, or ) a Ind'viduA_ra e- isp sal :S stem at No j , �,r��� � <. .............�•-•••--•-T•._....._.. = ..... :.Stree as shown on the application for Disposal Works Constluction Permit No Dated.......................................... r . C Board of Health DATE -...... .............................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS. �� o t C t.} 20 f'f: rain. 4i to o f f`o ft rw ¢ Cast' iron or � ,/a : s'ct,. 40 )-VC- pipe /t n7aaG. Gorrc- y,,rts pi rain. f'Gh �ua.Sf7td n �+tr ft 4" Scfi. zo pvc- pipe. ptastona a r min. pif-ch /a" ptr l f/ow J;n 17 '.O ir7V. e/ dish �y�� .` =',• ' r• p d • ' 4GA7/0A.1 /^✓Ii9P Septic fd+.nK inv et p vdp. 3 •- v �/� �,, was/7ad oso V . Q, .o S7f'one ., in .el. � . ti' pr's adL s /C1%C-/7ir.9 •opo Ci. , o ba.Sir7 SE ��4p �e i•WAGE S�►'ST� M PROF/L � yr • 7 '''' r7of f-o SGa./e. B�ui✓a/tn o 21 OU ✓3' S-7-0 Fi ' 1 bo7�i'otr� fast ho% OeES /G " L)ATA T 5-7- H �' G. E NUMB 3 ' 6 S T6 ST G3ATE t .• Z E; � ` . , ` .. G P rE B A G& 0!S PO S F�L UN/T: rCl/i° W/ B Y T N E S g E p �e 0 .. AT/0AJ ATE . M/N TOTAL T MATEO 4- W a,E./o�Y x are.) : 7ir - �, / ' :t , 13 GAL . IDAY HOLE 1 ._ HOLE �•- �"". -'' .,� w- GAL. f. �_.._. -- -- \ O � LEA<. HING A/E'�Fl h'EQJ/�' EMaA/T5 a 6 To ACA4/N'G GAPAC/TY -� - 3&" .~- ` 'lr { N !� re V E L E i9 G H/A./G am - ^ � i ti. -- G APA G/T Y /,V O T S ALL !/VoA_kMRNSNIP AND MATE�e/ALS C0NF0r2M TO 0-E. a c- T/TL_E THE —row" OF / RULES AND ieEGULAT/ONS PO PE rE �,-_"""'-_. ,vp u/��"iZ �'it,�CcxJsJ/c"�Z E•;✓,�;' '` �` SU�Su�2FfIC� L7/SPoSfIL. CJF .sAA// AGE-. ,' 2) GOMPC-/AA1CF-- WITH ZOAI//VG R&GULAT/OA/S ' °' ! 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