HomeMy WebLinkAbout0025 GOFF TERRACE - Health GOFF TERRACE, CENTERVILLE
A= 171-103 T
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No. 42101/3 ORA
ESSELTE
10%
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171 - 103
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No. / Fee�2
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
0(ppYtcation for Mi5pool *p5tem Cougtruction 3permit
Application is hereby made for a Permit to Construct( )or Repair( jean On-site Sewage Disposal System at:
Location Address or Lot No. Ce� ul\` Owner's Name,Address and Tel.No.
S Gc)T A-Pu(cc.ce . /V1vc hV - s'&pF4v
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel. o.
CC>
tK\
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 gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Noyre of Repairs or Alterations( nswer when applliicable) /A.(,��1 � �0 ( P U(.Vyl 'Ct� 4 �^7"
�`` C.
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 y this Boar f Health.Signed Date _ `7
Application Approved b `
Application Disapproved for the following reasons
Permit No.��1 �- 2 Date Issued
I
No. 01A '_* Fee
�i
s• THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplication for Mioaal *pgtem Conztruction Permit
Application is hereby made for a Permit to Construct( )or Repair( 0�"an On-site Sewage Disposal System at:
Location Address or Lot No. Cw\lQ Owner's Name,Address and Tel.No.
r p1,
Installer's Name,Address,and Tel.No. �S-„5 q Designer's Name,Address and Tel.- o.
SCp�-,\ �- l-c-W 11/_`, 1
a�A •k 7 �s
Type of Building:
Dwelling No.of Bedrooms _ Garbage Grinder J�U�
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
Description of Soil
Nopre of Repairs or Alterations( nswer when applicable) Xa? OI `n
S_t-5-CSv CA C.
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 isst&d by this Boar f Health. ?
Signed Date
Application Approved b
Application Disapproved for the following reasons
Permit No. � ,.• Date Issued
———————— ---------------------���. ��..
THE COMMONWEALTH OF MASSACHUSETTS
t
PUBLIC HEALTH DIVISION=`BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced vl')�
by nr_(N kk- P^- <=t.-_,jti /, _ for
has been Xnstruqfed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ',- date f ., _ �-
Use of this system is conditioned on compliance with the provisions set forth below:
I
"f
No.
r
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
ligogaf *pMem CowAruction Permit
Permission is hereby granted t �n A ti `C't�-�.�
to construct( )repair( n On-site Sewage System located at C' ��j�rc -�P_Tcx, ce_
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to , y +
comply with Title 5 and the following local provisions or special conditions.
All construction mustbe completed withintwo years of the date below.
Date: s� � �+"dr Approved .'/
'SiNGLr-- FAMILY
Wo GACZBAGE 6ci:INo�2 lob' _
pAIL%? FLoW s 110 A 3 - 33o G.PP ►03'9 1
SEPTIG TAaJK - 330x15a% -- A95G.P0
usE l o0o GAL. �► �r jvp
w.5Po5AL. PIT vsE IOoO GAL . C � t
i BOTTOM AREAS . lac 5tF• . .
So 5.F X 1. O R. 0'0 6.P P' ¢ O 10 a Z
-toTA l.. p1s516N * .¢25 &R D• PQcpetEv 0
t3'
-TOTAL pA i I-Y FLOW = 330 G Pd lo�� nj F*vuoATioN N
Io ATE 8 1",W ZMIN oPLL65S � °3 I
j PER•C®LAT IJ R
40 3
kA,f'c /S./90 �f
WILLIAM ,�ram• � ALkN %•�•
W C. 1 W. " s — io4.7. T.v
$o N Y E y �JrNr�{
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M Cr_-evrIFIC•so PLOT PLAN
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LoCA-T_IO1J
Wo 5C N".4 Ot VATE 3:11718,3
ND/G / �' T o K SNo vYN PLAN RED 62EN GE
N�,2Czow GoMPI-`(5 1nlITN'THE 'S I o�L1N E
AUP SE,TQo•GK R.6Qv126MEN'f> oF'fNE
-TaWN of 81�QNSZ�.g�Nv I� +4oT=
55
LOCATED •WIT IIJ TH6 LOOD PLA
DATE-.1 BAxT6Qe hJ`(E INC.
REG I g-t6�6V'6Aw D S u MY FaroeS
?4115 PL.Q►J I�� W T gA,jr--D w Am COSTE2.VILLrr A MASS.
'lw5T9uMEN*l' SV ZVC Y 4-TN OFFSETS Suouo
......- IoT DG- Val".''ETC+ C7C'Tt=-t'_MI►�C 1_�`'�' L.IIIC�� APPLie AtJT �Q^Dfo/�TE. J�550.
L O CAT ION ., SEWAGE PERMIT NO.
G 'hF
VILLAGE
INSTALLER'S NAME i ADDRESS
BUILDER OWNER
A icdc=a S°
DATE PERMIT ISSUED L? - Ile-3
DATE COMPLIANCE ISSUED 2®
.0r
n
�
36'
o a, _
TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE. �,'� `� '� ASSESSOR'S MAP&LOT/?b- /d 9
INSTALLER'S NAME&PHONE NO.CC CM;:n, C
SEPTIC TANK CAPACITY �R C)C-)
LEACHING FACII.TTY: (typeRQe2s4r (o)(b �,"� (size) (J
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: L� S r('1 (_COMPLIANCE DATE:2!/J[,, r5 6
Separation Distance Between the: ko C.;,cAv" �?e-� I5—'b%-J
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility RIA� Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) �� �l�C Feet
Edge of Wetland and Leaching Facility(If any ands exist
within 300 feet f eaching facility) Ak Feet
Furnished by
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�............OF.... ...- ........................
Appliratiun for Disposal Morks Tonstrixr#iun 11truti#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..
Locati n•Address or Lot No.
W Owner � ..... l C �dr .�!�. .... ...
�.� •............................................Iastaller........................................ ... `-•-• Address t C ......................
Type of Building g/ Size Lot A_.1 A_lz .-Sq. feet
U Dwelling No. of Bedrooms................3.... .....Expansion Attic j)1 Garbage Grinder Q�
Other—T e of BuildingNo. of persons............................ Showers — Cafeteria
p" Other fixtures ............................ .
W Design Flow..............f�-; .....................gallons per person ter day. Total daily flow......... ............... gallons,
WSeptic Tank—Liquid capacityl4iP..gallons Length ..... Width.L{_- _An." Diameter................ Depth--- :. ..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft.
3 Seepage Pit No......:i........... Diameter.....S.......... Depth below inlet.....6,.........
Total leaching area 2 P.C?...sq. ft.
Z Other Distribution box ( ) Dosing tank ( t t I p
'"' Percolation Test Re Its Performed by.. n 4'� _ ..� ��` > Date... �..�lp-`.�?--?......T
,.a Test Pit No. 1.....Z......minutes per inch Depth of Test Pit......`.. ...... Depth to ground waterG7.�l��•.-•.1Z.
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
M ..........:.................................................._............-•••--........ ....... .... ----------- -.. •---.._.
0 Description of Soil...... 1.... is.A -. l�s?.� .� ��...-. - -fir 1�' --...�� ?......
, �........ 1 _r :._.-.�:��.....------- ` "� --•-•-•.................
w
UNature of Repairs or Alterations—Answer when applicable.........................................................................................0.....
.................................• ••-••---•-•-•---•-...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITL M 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 board of health.
/i
Signe .......................... ..• f .1,...( I ........................ .....--•--................_....
Application Approved By..................... -� �Daa�
._ -- ---•-•--•--•---•----••-•----••----•--•- ....................Date._...---•-----
Applieation Disapproved for the following reasons:..........................................................................................................---
....................•---••-••.......................-----•--•-----..............-•------.....•-•--•.............••----•.........-•-•--------------------.............------------..._...------........._
Date
PermitNo..................................................._.... Issued-....................................................._
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............OF..... AZ.Q..=-i'.1a.t t .
Applutttion for Disposal Works Tonstrurtion Ilrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
_ Location Address - or Lot No.
W Owner . I / Address q
..................•---...................... -----------•--..........._....•-------.............. ...............................l�- � � •t �./�......................----
Installer Address _
Type of Building . n- Size Lot. `.:�:. ..�. ..Sq. feet
Dwelling�No. of Bedrooms.............. --.--------------.-----Expansion Attic )_ Garbage Grinder
'04 4 Other—T e of BuildingNo. of persons............................ Showers — Cafeteria
04 Other fixtures
W Design Flow............... ;?..................._.gallons per person per day. Total daily flow..........1' Ions.
WSeptic Tank—Liquid capacity���?� ._gallOns Length ....��..... Width.!-_..!_Q._. Diameter________________ llepth .:.. ..
x Disposal Trench—No..................... Width.....I............... Total Length.................... Total leaching area...................sq. ft.
Seepage Pit No....___.�......_.... Diameter..... .......... Depth below inlet_............ Total leaching area.2. 042...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
a
Percolation Test Results Performed by... ! r - `t ..`__l ._� 5 1�� ✓{ Date....':...!c�-. ......r
,.a Test Pit No. 1��.....minutes per inch Depth of Test Pit.....J.a•..... Depth to ground water*/ ..lJ,'.r..
f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
va -••--...----••••-••-••••••••..............•----•--•..........•-•-•---------.......---... .......----- . •--..........._.......
Description of Soil•••• ----- .. 1 ------
a`f..' .
. : ......... •--.......-•----.......... . . t
W
V 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 b issued by the board of health. GG '
Sign ...... ............ ....... ............................
Date
Application Approved By............. I. ...-• -----
•^-------•---. ........................................
Date
Application Disapproved for the following reasons:..........................................................................................................---
.......................................................•---•---•--•-•-•-•--...------------...--------•--------•--•-----------------------••----.............__....-•----••-•--••-'Date•---•----•--
PermitNo......................................................._ Issued......................................................_
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............I..................I.........OF...........................................................I.........................
. Trr#if irate of Tomplianrie
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by..................
e_............--•------------------------...............-•-------•---•----------......................................_...._.._
Installer
at................. •-� ..3._..r�`�1"'% :........... ....C..... ..:c.........---•---•----•--•-•-----...-•----•--...........-•-•---------•-•--•----------
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 ............ dated................................................
THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D A GUARANTEE THAT THE
SYSTEM WI FUCTION SATISFACTORY.
DATE.-- ... .�1...... .............. . Inspector...... ......---...................................0.0........................
....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...OF.......................... .
Dimling' arks Tonstrixrtion tIrrmit
Permissionis hereby granted.....-----••••..---------- .< .-•--------------•-•-•---.............----......................-----•-•---.....___--
to Construct Repair�, ) an ndividual Sevtra a Disposal S stem
atNo......... .. ... , .._.... .................... 1�.. ..---------•--........--••--•---......-•-..........._.....0......
/�' Street
as shown on the application for Disposal Works Construction Permit No..................... Dated..................................0.......
........... •. .........................._...--------
DATE.............................•••••..... Board of Health.-.
FORM C-1255 CITY& TOWN FORMS, INC.369-9708
StN�� `�wAMtLY - � BEDszooM �
tAJa GARBAGE (�t?aND62. lo�`� _ _ I is . O 0 ,
DA►L�( FLOW 110 x 3'6 33o6.P�? �03.9
:I SEPTIG TAQK = 330x15o% 2A996YO
U51= 100o
ot5Po5AL PI'r u5E Ivoo GAL. x lv � 9
BOTYOM A2EAr .. YO �F• 'o t
5O S.1~ x I. O �'o G P c�'. . + 10'�
-ToTA 1- c> 51GN :. 42-5 G.P TN PQoPo .4 4
-ToTA1.. FouUoAToU Z3�
Ion• N N
j pap Col RATE] I''IN 2MIN O�Lt�SS 1n °3 `��
• � �T3 .I.
��P` of M�s�s i5 0
,./6
d= WILLIAM GJ e� ALAN op
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s; C. �' ( W. J Ip¢.Z T P oG B MtK• _ID�'I — — _ _ o I
N Y E •JGNF_S
A No. 193349�
e • �CT�3TEPyOQ- ` �'r'Ci�f�C;,cr !�'..a(�f .. ._ _97.� a?!bE � er � is%�Q� RivE!?ENS � ../Otl. 3 -� � .
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N6.RBo1.1 GOMPL`(5 ln1 T-NRH Si�o D1t,lE�N LOT 3
'Auo SE�MAGK
-TowN of ►s t4orr- FLAN C�4C Z�S �6 55
LOGp.TED •WIT 11J TN6 LOOD PLA
DAT ea i
•• BAxTE2e tJ`(E iNC.
Tw5 PLQ►J I,i KIOIT BtvSr=D Id AN O6rQ2.VILLrr MASS•
I •I)j,5T•R•uM6N'l' SVeVG-Y 4-rH DP%�15ET5 6uo�t,�
MoT (3G- Val"".r,TG`r C�GT1=•t'-MI►�C= Le-l" 1►II1G�� APPLIGA►�T �Q^��A"c I�S50.