HomeMy WebLinkAbout0035 CAPTAIN BELLAMY LANE - Health 35 CAPTAIN BELLAMY ROAD
Centerville
A = 230 - 177
_i'
UPC 12543 wo
No.5_ 3LOB
HASTINGS, MN
No. �y\!1 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes /
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS •�
ZIppYication for �Digaal *p�tem Cow6truction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot NQ. Owner's Name,Address and Tel.No.
af
Assessor's Map/Parcel
Ce .-c—vilL,
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
j— P M/eII)
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 -;?3 d gallons per day. Calculated daily flow 3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 4S G® Type of S.A.S.
Description of Soil
Nature of Rep irs or Alterations(Answer when applicable) L /�G�i X�X
J� �1_ �
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 T' e 5 f the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has bee ' ued this o oX
Sign d — _ Date
Application Approved by el Date
Application Disapproved for the following reasons
modgmRsunit No. Date Issued
Fee
.. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS,
Z(ppYtcatton for btgpogaf &potent Congtructton Vernal
Ap lication for a Permit td nstruct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Locationcddryss or t L t�No.� k Owner's Name,Address and Tel.No.
Assessor's Ma /Pazcel
te.,�/`f- -,__ r /(-,- n P-a -30-177 _N1
Installer's XM ,e(h)
e��,Ayd1d&ress,and Tel.No. Designer's Name,Address and Tel.No.
-75- S',a (fi- 'AL- /�ls� ",/'C•�I�1/
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow3 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title 1I
Size of Septic Tank Type of S.A.S.
jDescription of Soil
Natur of Re rs or Alterations(Answer when applicable) �/►R/J4 K�.X -Z
Date last inspected:
Agreement:
The undersigned agrees to ensure t construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions.of. 'tle 5 f the Environmental Code and not to place the system in operation until a Certifi=
cate of Compliance has bee ' ued this !fo
of -- '
Sign r-"" P Date
Application Approved by v Date
Application Disapproved for the following reasons
Permit No. r Date Issued ---
-——————————— ——————————————————————————
t
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certtftcate of Compliance
THIS IS TO CERTIFY that the On-site Sewa e Disposal System Constructed,( )Repaired ( 41 Upgraded( )
Abandoned( )by
at 35- /n � X constructed in accordance
A with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer 7- P 1-;7,0.e i e-/ Designer
The issuance of this perm shall not be-construed as a guarantee that the system will functio as.detsigned.
Date " 3, 1 `1 7 Inspector
_
No Fee
� l
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
1t9;po5a1 *pgtem Congtructton Vernttt
Permission is hereby granted to Construct( e air(mac)Upgrade( ) andon( )
System located at
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 's/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Cons lion m e mpleted within three years of the date of t pe it.
Date: Approved by
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 hereby certify that the application for disposal works
construction permit signed by me dated 2—&,/5 f'7 , concerning the
property located at ,meets all of the
following criteria:
• There are no wetlands within 300 feet of the proposed septic system
• 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 leaching facility
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
SIGNED : DATE:
LICENSED SE4YSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified:plot plan,
this plan should be submitted].
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TOWN OF BARNSTABLE
ocATioN 1ti� (3e���-/yI SEWAGE#
VILLAGE— Q/VAO_4 y( ��C' ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO. o N
'SEPTIC TANK CAPACITY S�O
>:LEACHING FACU nY: (type) 'J (size) 3 X
OF BEDROOMS 3
.......BUILDER OR OWNER
.PERMTTDATE: 5-�-j 7 COMPLIANCE DATE:
_ ::Separation is Between the:
aximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
:::;.Private Water Supply Well and Leaching Facility (If any wells exist Feet
"on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist
,c....: Feet
within 300 feet of leaching facility)
'Furnished by
. Y:
I U C.
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3�
.
J
U L_ TOWN OF/BARNS'T/ABLE r
LOCATION p14/� `ver �' -N 1L SEWAGE #
VILLAGE G2N� y( ASSESSOR'S MAF,8i LOT .
INSTALLER'S NAME&PHONE NO. 2 l Al
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) ��'� (size) 3 y-
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: -97 COMPLIANCE DATE: Sri 21 -1`7
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 leaching facility) Feet
Furnished by
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e }a C3<0
40.
3
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140 V 9
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...._...�O!1W................0F....... ..�f V .=r_.---............--------•-----..---
Appliratiou for Disposal Warko Tomitrurtiou Permit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
•• .............. ----
Location-Address or Lo o.
.C::: R !d ........................ C:2.:._L3�?' X...51.0...... -- tel:i_ .............
Owner Address
W ail'S �.....�)Z�S C7l.....r-.........-^^...... T.r
Installer Address
Type of Building Size Lot...�3t.�_�Q---Sq. feet
Dwelling—No. of Bedrooms...... ....._..........................Expansion Attic (,ve) Garbage Grinder (Na)
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures -------------- -----•-----------------------------------.---
W Design Flow......... .........................gallons per person per day. Total daily flow.......... . ...................gallons.
WSeptic 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.......................................................................... Date........................................
Test Pit No. 1_. minutes per inch Depth of Test Pit......... ........ Depth to ground water.._
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--_-______--•--__.-_---
l ------••--•----------- --------
O Description of Soil----®----- ------ ....40,4ftl...r4�.... ..........................
U ---•-------------•--•-••--.------ 1 -..-•-------�- - .&2..� ��t (/`� .-------------- •---••-•----.
W ..
----------------------------- --------------------------------•--------------••-•-----------------------------------------------------------------------•---------------------••-------•----
Ut Nature of Repairs or Alterations—Answer when applicable.......................................::......................................................
u%
--------••------------------•-------.......................•--•---•---•-----------...............--•---------------------------------------------------------....-•-------------------•------...----•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordancevith
the provisions of TITLE `J of the State Sanitary Code—The undersigned further agrees not to place`the�systen in
operation until a Certificate of Compliance has bee ed by th rd of health.
Signed----- --- --------------•----•-------•- flltr ��
Application Approved By....._._ _
t,
+_. at
Application Disapproved for th f llowing reasons:.......................................................................................
. •-•------..--•--------------••----••--•-•----------•-......-------- - -------....•....--•----------------...........................
j--
D :-;�
Date
PermitNo---------------•--•--..........--------...._.._ .. Issued-------•------------------.........----..........------ ,.i
`.
- Date
w
.
No................_.....--
FEs.....:f^�'t:. .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD •OF HEALTH
��a J .................OF.... �,�f�+" ./.. ....................................
Appliration for Biivusal Worko Tonotrnrtion ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
.... f "__._. ......� .? :. 4 i�. � i' `f -----------------------------------------
Location-Address or Lo No
........... , `�``- � ` 1" �£,7e a>�'=--------------------- '1 .._f : _ ..;5/ + ` '�� ?Fi .i ......--
owner Address
._._.. .................. ---- v'..............................................................
a Installer Address
Type of Building Size Lot_. 4 S....->_. ...Sq. feet
UDwelling—No. of Bedrooms._... ................................Expansion Attic (klo) Garbage Grinder (fvc)
pal Other—Type of Building ........................... No. of persons............................ Showers ( ) — Cafeteria ( )
aOther fixtures --------------- ---------•---. •...........................................................
Design Flow............ . ..........................gallons per person per day. Total daily flow........ ...................gallons.
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.......................................................................... Date........................................
Test Pit No. 1-_t' _ minutes per inch Depth of Test Pit....... . ....... Depth to ground water._ ----
Test Pit No. 2................minutes per inch Depth of Test Pit---------------------- Depth to ground water........................
... ......---••-••. ..._ ......••...---•- -•------•--•--•...........-•-•----•-......-•------••-•.....................
0 Description of Soil `?-.'...__lG �i�j�_..� / ` tr
U ...
W -•-•---•••-•-----•---------•--......•••••-.-----•-----•••••------•--•-•••-•------•-------•-------••---•--•--••-•----•--•-••-•------•-••---•---••-------••----•--••--•-•---••••----•-------•......•---•-
VNature 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 bee 'issued by the..bo�rd of health. 1 49
Signed--- ...........................................
> c•_ r_
=�--
ate
y
Application Approved B -•------ •-• . •-- ti -- ---- -----------------------
Application Disapproved for th f llowing reasons--------------------------------------------------------------------------------------
.........................................•......•.....•-•-•-••--•-•-•-•---•••••-••••-•-•-•--•••---•-•-••----••--.... ......-•-•------
Date
PermitNo.......................................................-- Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
ta +4'...........::....oF. ? " .�a=r ............................
....................
�r�#g��rtt�e ,a$ f��am�li�nrr
ru Repaired
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or R pired ( )
by-----------
-at
7 . c
n . '
y Install
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No......................................... dated-..............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CrWSTRUED AS�t GUARANTEE THAT THE
SYSTEM WILL UN TION SATISFACTORY.
DATE............. Q ..........................•............. Inspector--•------ 4'VVQ-9--- ---- - A
. --• .....................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Gv ...................OF........ `j"r i�car
4 No.................)�" FEE ...... a..........
Ulaposal Works TDnnotnuivan rrmit
.� - , ,
' Permission i hereby granted.........._ � °�.�:..:::..........�*'' :__�'_�= �~'� .*'---------------------•---•-------------------._....---••----.....
to Construct (so ) or:Repair ( ) an Individual Sewage Disposal System
at No...Aca-r__ �. -'�---r&. %_.. 32EL4A,-_&A ----- `/ ------------
Street
as shown on the application for Disposal Works Construction Permit No .__1ZI,'l►Dated...-------
..............................
.......
Bo t t
DATE-- . ... "..;�.... ......
F M 1255 A. M, SULKIN, INC., BOSTON
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LEGEND
EXISTING SPOT ELEVATION Ox0 ���'��' s� CERTIFIED PLOT PLAN
EXISTING CONTOUR --- p - - - '
FINISHED SPOT ELEVATION 0 / Pv'F ' LET' G CAPT J3ELZ_ 4n1y � qNE
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FINISHED CONTOUR 01,� El
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APPROVED1 BOARD OF HEALTH IN
v,•
DATE AGENT SCALE: �r = 90 DATE , 71i1,11£'S
�'LDREDGE ENGINEERING CO. IN
CLIENT I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB NO. 8309'1 BUILDING SHOWN ON THIS PLAN
CIVIL LAND DR.BY: A -,A • �, CONFORMS TO THE ZONING LAWS
ENGINEER SURVEYOR OF BARNSTABLE , MASS
. ���' --.712 MAIN STREET CH. BY: Iz 3 E .
4DT
Ly�HYANNIS, MASS. / ZSHEET— OF E REG. LAND SURVEYOR
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/s•PctJ•'T• SEPT/ TANK D/ST, Y WASf/Eo 57-.•rE
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IN4ET .SEpT/C TANK 4-8FT, � /z FT. ZU4M. •i C 7>UWLArJON,
OUTLET SEPT/C 7ANK `{7.6 FT,
1xz, T O/STR/D!/T/GN BOX 4 7.4 FT. GROUND 1tiG47ACA 7AALE
OVTLETD/STIT/A0r/ON BOX 47.z- f7 SECT/O/V OF
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LEACH/NG P/T ai161�LATlGN
DES/GAY C•R/TER/A Jt.4LE : %s' _ /=o'
o�o o my. N A � FT.
i DINtWS/oN FT.
JV4'MSER OF. DED+ROOMS 3 D//►9E11/S/4/d G 4 PT.^7 ^�
'SA R&4GEp/SPO.SRL UN/T nNOA'E SOIL LOG
7707A4L EST/NyiTEO FLow 3 3 o G.41.1,pAY SO/L TEST. Ar! SO/t 7L=S7-02 .SD�L TEST
VUAIMR 01- L•L'ACN/JVG P/773 / I-E-LEK
S/DELrACgIAAG PER.PJT DATE OF JO/L TEST
.JOTTOM LZ4CN/NG pER P/T //3 • D - Z z RESULTS IV/TNESSED jr .PA C l VL_o N
�OTrtL LEACH/NG AREA Z 6 a FT. L COLAT/D/►� RATE�E/ 1 E`ss /►l/JK//NCH
S�. FT. J�#tCOLAT/ON Ie.ATE l�2 7 `/� �✓ M/N.//NGN
q. SvL3sort Z-,0 zESE�vE LEACH/NS ARE/ 2 6 SO. FT.
• 2= _ lZ� soiL -T�sT � - 4srai
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___ �LO CATION(35 � C ( EWAGE PERMIT NO.
co . �e llama, La vim, �6 '� `z z
VILLAGE
C e ,-�(v "t(q I m
INSTALLER'S NAME i ADDRESS
`"s ,s- �)t i SC,a�� �'st �%
1
B U I L D ER OR OWNER`
Ce"lmtV 'v �k
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED q 10 gs
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