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Home My WebLink About0096 GOFF TERRACE - Health 96 GOFF TE. RRACE � 170-084 CENTERVILLct r r UPC 12543' ' No.53LOR_ o�oo�CONSJ�� HASTINGS,&IN �12'--106 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISIOW TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migogar *pgtem Congtruction Verrnit Application for a Permit to Construct( )Repair X)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. lJ Owner's Name,Address and Tel.No. CZ�t ' Assessor's Map/Parcel/7 y) _ D q nac 09 a 4 Installer's Name,AddreA 6181.OANCO Designer's Name,Address and Tel.No. 350 Main Street N J 1+ W. Yarmouth, MA 02673 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 Flow .' 3S25— gallons per day. Calculated daily flow 33 G 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) l/l S 1A•(( (— 3 o X 7b 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 issued by this Boarrd'o e Signed Date 02 Application Approved by Date '3 Application Disapproved for the following reasons Permit No. V —ly 6 Date Issued - l U � � a`No: 6 � Fee J ' r THE COMMONWEALTH OF MASSACHUSETTS "EnAred in computer: PUBLIC HEALTH DIA" =TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pprication for ;Ditpont *pgtem Construction hermit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. �} U E' (— Owner's Name,Address and Tel.No. Assessor's Map/Parcel oaq r (�e,/?e"v�/(L CPu/cl� �� Ov �pJ Installer's Name,AddressAn&'BNCANCO Designer's Name,Address and Tel.No. 350 Main Street R1 W. Yarmouth MA 02673 ., Type of Building: Dwelling No. of Bedrooms Lot,Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures a Design Flow ✓ ?S gallons per day. Calculated daily flow 3 3 gallons. Plan Date Number of sheets Revision Date 'title y ` Size of Septic Tank Type of S.A.S. Description of Soil a Nature of Repairs or Alterations(Answer when applicable) T/7 S Y,4 t( (- /� • ,?��X 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 issued by this Board of ea 1ST Signed 1 Date o) Application Approved by Date 9 Application Disapproved for the following reasons Permit No. 19 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance fTHIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( l-'Upgraded( ) Abandoned( )by X ✓? Ail li at 14-)J o tw r .'/ een constricted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this p , t shalll t be construed as a guarantee that the sy"tb will function as d(ey igned%N C Date 1I /,/ `� � � �1 / B Inspector . a'7 �L �.` , i . No. / —( d;(� . .-------------------------Fee �^U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpool *pztem Construction Permit Permission is hereby ATted to Construct( )Repair( pQ Upgrade( )Abandon( ) System located at l e:& v (��/ � l� Le- 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 t be completed within three years of the date of this pe ' Date: !�// Approved by 1/6/99 NOTICE: This Form IE-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, J 1, 61-1 n t?0 A , hereby certify that the application for disposal works construction permit signed by me dated 3— concerning the property located at �i y �-e/`f • C2•�1��• 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. ✓• There are no wetlands within 100 feet of the proposed septic system ✓• There are no private wells within 150 feet of the proposed septic system �/• 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 not 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 not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: / A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation a S• 3 +the MAX.High G.W. Adjustment.01 DIFFERENCE BETWEEN A and B a SIGNED : i J DATE: [Sketch proposed plan of system on back]. q:health folder:cent > ,. .. �,2.G�1� 0 0 TOWN OF BARNSTABLE LOCATION 96 7- SEWAGE # VILLAG /a Af if Vd ASSESSOR'S MAP &'LOT A ® � y S . ,INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 S'i?PTIC TANK CAPACITY 11Y,' i LEACHING FACILITY:(type) AP4G1Y (?//4/-,&-e(size) 6?✓) j3/ 3t DC NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER / DATE PERMIT ISSUED: DATE -COMPLIANCE ISSUED:' 3--1 7 9 ` VARIANCE GRANTED: Yes No 4 251 ' �X1 i �.xtz. _LOCATION SEWAGE PERMIT NO. VILLAGE A`INSTA LLER'S NAME i * ADDRESS R U I L D E R OR OWNER �?,�//Cke �Ci�fi1e S L GATE P MIT ISSUED DATE COMPLIANCE ISSUED I I 17l J I �v 0J1 I 1 No. -/ '...... � .r FE$................./... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH �1 AT - 4---/- ` ................................a7 .Wh ..........OF` . ... Appliration for Biiipml Works Tomitru.rtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Te .............. � .--- ;..:roc C � 01.1 � .... 1 V. Location-Address or t No. �—. Owner Address a 1... .................................................. c �:�_�Zti..1Z�1_.._�_=.. A L: Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms........_ ..............................Expansion Attic ( ) Garbage Grinder (0) p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ---------------------------------------------- W Design Flow.....I_li_Q..............................gallons per person per day. Total daily flow.......33__.....................gallons. WSeptic Tank—Liquid capacity a .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 ( ) Dosin tank ( ) J '—' Percolation Test Results erformed by 5?4j^n±_��x_I��._ �4.16�k.ty...____ Date....D/s.,?L_1-2___�___. 1.4 ;;��,��ppa� ------ Test Pit No. It.-T ._minutes per Depth th of Test Pit____________________ Depth to ground water_.�B__�� F'� 1.4 P P (s, Test Pit No. 2................minutes per inch Depth of Test Pit_____________:______ Depth to ground water-_______________________ x •---------••-------•..... ---- O Description of Soil•'4a_` _.__ ____•__________________________________y®! -___ __ _y_Y................C ------t N --- V ----•••--•-------------•---•--- �l �'a c�'4d r..--•--•----..._ ..........................----7-Z ----- •------•�►Ii 1�t2.1_�d:Yk P4_6 0--•--------------------------••-----•-----------•----------•-••------=-•--•---------•----------••-- 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 iITl.is 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the board of health. 000, ig = :-:• --------------------- - - D Application Approved By-s-•---= ....( --- -- - l /�-�'t,�— V.2 � `------- 1 Date Application Disapproved for the following reasons:-----••-----------------------------•-------------------------------------------•------•--------------•------•-- ..----•-------•--•-•---••----------------------------------------•---•-----------•------•-••-•-----------I----------------•-•------•-------------------------•------------------•-•-------------•--•_.... �j- Date Permit No......................................................... Issued_.......7- { ................... ----- --•--- Date ...No.-- FE'13 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .4,N S 7 4 4 /.......7PtAd,__N...........0 F N.A ....................."__4. ................................ -Appliration for Disposal Nurks Tonstrurtion ramit Application.is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: IZZ ..............GFE...��Jia�r 6:44-Tavilk............ --------------------------------------- ........ V. LT.................................................. Location-Address or 'Dt�NO CV ......... . .... Jfy Address ...... . ..................... A..... .....................Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........I.............----_--------_Expansion Attic Garbage Grinder (0) P-4 Other—Type of Building ............................ No. of persons.........._..........__._... Showers Cafeteria PqOther fixtures -----------------=.......................................................-------.................................................................... Design Flow.... 0.............................gallons per person per day. Total daily flow........1.3..0.....................gallons. 9 Septic Tank—Liquid capacity.J.P00..gallons Length................ Width....._.____..___ Diameter b------------ 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 ( ) .4 f I 10.11cy..&N t a /L Date.... Percolation Test Results ..,,Performed byTRI.,.......... /7 --Po.4 C/L Test Pit No. 114�.!T.minuicsper inch Depth of Test Pit.................... Depth to ground water... 11 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.:.......__........._... .............................. ...............................;............ L-------------------------------------- ------- --------- 0 Description of Soif-.f........ .................Enz .....4 ............................................................................................................................... ........4 VA L0.8---------Aft............... ------------- ....... ................................................................................................. 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 T IT 12 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. .................... Application Approved By.......... ... ........... ............. ------------------------ ------------------Date------------ Application Disapproved for the following reasons:_ .......................................................7.................................................... ..........................................................................................................................................................................................I.......... Date PermitNo---------------------- ------------ Issued............. --------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH WW 7- a . ........................... 1C............................. ............. ........................Oir....... %T rfifiratr of Tompliaurr F�r �O THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed or Re`g4ired by..... ................................................................................................................................. ------- - �_,O-n--T----------U-Vj Instal . ............ -- ------ ...............................at..... ....... 4_f __.: , I ................... has been installed in accordance with the provisions of T Vjj��State Sanitary Cedie a d in the application for Disposal Works Construction Permit No... ..................... dated-. . .............. 'FIE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU4D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ..... ... ... ....................... . .....:_ pe THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF.... . ............... ....................... .............. not_..... No FEE........................ Permission is hereby gran ted.... AlcA ................. ............................................................................................ to Constr&t-'( Or Re it an Ind'viUual ewage D kA.T_ .0 :, Cat No.— e.....f ...........444(m.............................:- --------------------------- Street 7f as shown on the application for Disposal Works Construction Per 0...... F...............................4ZAI..................... �,_k 4--------- _-_�..................... .......... Board of Health DATE.._7 Z!�7)?.................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS S,y�r� •,/,-�/� 2 si��T3 r � 9 � I I �► v � I W I 01 $ \ t AS q �4 EL. 4 �q4J "� t N', 0 RZEV 7--P vG � EX i SrN 6- /6,/SZ sq, GT. FnuN DAT1oN° v # 4S.3z Zo, E1.43.0 \ Fvrj Ps lFp- � pT 44 G8 ce. 41.2 aq,Z,3 i \ NoT�— ELEVAT oNS B/JS6p o�/ ASSuH6D DATvH EDWARD E. KELLEY CERTIFIED PLOT PLAN al,M AQI s'D, MASS. 02637 LDCATION cEivT,wictE' , MASS. SCALE ./"'-.30. . . . . DATE T�v.E.z/.&*';V 01.1 PLAN REFERENCE .B4�-,1n/6-. 40T'*/¢. . . . . :c�Ft�tn rnH ^'.. ` S)VO►NN oN 9 PGgN i Xey o F � �vSEcTi.oM 2 Lulv,CdE/ZT /yiGGS ' . .. . . . .. . .2 75 . . . . .. SS . . . . . . . . . I CERTIFY THAT THE .Ex/ST/!!�!.. unl.4flTO�al LoT SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF 9?9R lS7 8ZC. . . . . . . . . WHEN CONSTRUCTED. TN0Qn/7—oA/ DATE f^'�.Zi./57�. PETITIONER: /�/y�r,NN/5� /"f.9S5, e REGISTERED LAND fSUfRVPOR TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS e 4' CAST IRON 12"MAX. 12"MAX. '�'"�'�•� • PIPE (OREQUIV. 4"ORANGEBURG(OR EQUIV.) )- MIN. PIPE- MIN. LEACH PITCH I/4'�PER. PITCH 1/4 PER.FT. PIT o,° PRECAST o' NVERII • Q LEACHING EL .-y.7.. INVERT INVERT ? . e `e' PIT OR SEPTIC TANK j.�3 DIST. �,T- ''� EQUIV. o INV RT EL.. BOX ELF..7' ; .•: �oe?o .. .. GAL. INVE T a 0: �� o; EL.....•.3c? tp INVERT v wW O• �:. 3/4"TO II& EL....•.... WASHED LL Ui STONE DIA.----►-� Non/E PROFILE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE PRELIMINARY SOIL LOG WITNESSED BY : DATE. �1?7�. TIME. .j-,3o l . PAL. . �'ef / . . . . . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 P�'. ENGINEER ELEV. . .4. -07 . . ELEV. .. .. . . . . . . 11\4MR DESIGN DATA NUMBER OF BEDROOMS . . . .3 . . . . . . , 3Z TOTAL ESTIMATED FLOW . .3V . . GALLONS/DAY BOTTOM LEACHING AREA SQ.FT. /PIT SMvA SIDE LEACHING AREA 5. . . SO.FT./ PIT GARBAGE DISPOSAL NYP�e.(50% AREA INCREASE) FiNE TOTAL LEACHING AREA O0. SQ.FT S/hvD PERCOLATION RATE MIN/INCH LEACHING AREA PER PERCOLATION RATE 447;?. . SQ.FT. AP-WATER WATER ENCOUNTERED NUMBER OF LEACHING PITS .�P/T W/TN, TIIMa APPROVED . . . . . . . . . . . BOARD OF HEALTH / ?'oF.57Dn/6 oN ALG S/DO'S. �«SG 70AdSf of•S7'�!v�.PE�, PiT . . . . . . . . . . . . . . . . . DATE . . . . . THOMAS E.KELLEY CO. AGENT OR INSPECTOR ENGINEERS—SURVEYORS 346 LONG POND DRIVE // SOUTH YARMOUTH,MASS, OF N4SS 02664 OF M4SS TH MA �i J �4-+Z�, G �. . . EDP fi z, No 2:1J)0 FGIST �/�N7a!�, ;��/✓��. . . �c�sT�y,�4� O�Fss/ONAI.��O�� PETITIONER !�?As.s. . . �o suc.