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HomeMy WebLinkAbout0030 MONOMOY CIRCLE - Health A0 MON M CIRCLE, CENTERVILLE No. 42101/3 ORA ESSELTE 1o% (D 0 0 0 0 ` No. /i'� Fee a�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es ftplitation for Mispo8AY *pstrm Construttiun j3Prmit Application for a Permit to Construct( ) Repair(t� Upgrade( ) Abandon( ) ❑Complete System E ndividual Components Location Address or Lot No. 3C)AA0N©q%j ctfq e. Owner's Name,Address,and Tel.No. CkN Vier 1 - - Assessor's ap/Parcel i C.,j 14 1 iw Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building (c^s (�44ja No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3`30 gpd Design flow provided 3gCj gpd Plan Date Number of sheets k Revision Date T Title Size of Septic Tank IijS}jti? Type of S.A.S.A)5-00 tC� sA-(o T Description of Soil Nature of Repairs or Alterations(Answer when applicable) N-t� cinrrti�r(� weft,, 4 t Sig C4!S rc A, 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 Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. !2 0 2 ( - 1 Date Issued 71 _ 14 , 1 g 1 4Yyr No. 'Fee Q Ur.- r' THE COMMONWEALTH OF Entered;n computer: y ,•. Yes PU;BLIG HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplication for 30isposal*pstem Construction i9ermit NJ Application for a Permit to Construct( ) Repair Upgrade( Abandon � p (I') pgr ( ) ( ) ❑Complete System Individual Components Location Addressor Lot No. MONpmkt Ctf( � Owner's Name,Address,and Tel.No. .l Assessor's Map/Parcel I Q (&( �� ► 1,, Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. r 10.k stow,, iJc, :�;'og_Woo t55 s �Gs�rs Type of Building: DwellingNo.of Bedrooms ^� 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ((` 'bf*%4-iq N No.of Persons, Showers( ) Cafeteria( ) Other Fixtures r Design Flow(min.required) gpd Design flow provided 3gCj gpd Plan. Date,_F 1.9"Q 12a2_n Number of sheets \ Revision Date Title E Size of Septic Tank Type of S.A.S. f�eAO-3 a -to (.64/►�P(C Description of Soil x Nature of Repairs or Alterations(Answer when applicable) c kkom�) % sic-, r.!S nCi oe,,A\ Date last inspected: f. 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 Certificate of Compliance has been issued by this Board of Health. Sign6 E Date Application Approved by ,. Date l . Application:Disapproved by Date for the following reasons Permit No. 2 0 j Date Issued if /j/2 s r THE COMMONWEALTH'OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(v) Upgraded(` ) Abandoned,( )by A ,jLArNoA 1 r&: at ',;Zn Akr,NOM V C,dcl jO ('P fP( d 11 a has been constructed in accordance with the prr-o�visions of Title 5 and the for Disposal System Construction Permit No.,;�0�f 1,25 dated ��/r 3— S Installer a► ,/ Q 6(0j.�r.3—E4 C Designer dr� /uIG�Ci n] #bedrooms 12 Approved design flo 3Q gpd The issuance of t1lis pe 'it11shall not be construed as a guarantee that the system w°: M.c t•n as de ed. C Date d Inspector ►V / 1 i ....�....e- _..-._. .---------------.-.-.f_•-�•�_+_`__.......'-_•------._._ --------_,-----------.-.---.----- :_._-_._ _._._-._...�,_. _.... No. l� '� d f ` Fee Od THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal e6pste Construction Permit Permission is hereb anted to Construct - _...:Y granted ,_. . �. .(•- ) ....-.Repair- ; ��I=" Upgrac(e(_ ) -Abandon ,System located at �n Moxy)snot! r s,(C)C' re-14F/VI I-e r 9 and,as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be cbinpleted within three years of the date of this permit. d Date ' t f a .` Approved by . �F' ].1.V r r Town of Barnstable aF Regulatory Services °s Thomas F.Geiler,Director _ MAW = Public Health Division i67q. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date:C ae .'1! Sewage Permit# It021--/Z9 Assessor's Map/Parcel Installer&Designer Certification Form r _ _ Designer: R � Installer: C Address: �i� �1/I�lilxL '� Address: 0 "Llpx 7Tv on (a e St—C-Ux4 was issued a permit to install a (installer) r septic system at 001ZL rltr based on a design drawn by �.� (adcjfess) 11A 1"'i0(,&-0j dated.P�-,AO-042,-)o (designer) certify that the septic system referenced above was installed substantially according to the:design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils ' were found satisfactory. I certify that the.septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system):but in accordance with State&Local u -'.%+ions. Plan revision or certified as-built by:designer to follow. Stripout(if rp- --cted and the soils 'were-found satisfactory. OF MAS DAVID y Insta is Signature) M a 11 4 c TOWN OF BARNSTABLE LOCATION -56 eflae2m C SEWAGE# --20A VILLAGE ASSESSOR'S MAP&PARCEL /M"/4'I INSTALLER'S NAME&PHONE NO. Z),4 /�/�r,✓,Ja1n/G SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 2fc—o0 c2II N/OCX#mj (size) /1,S3)C9 9- NO.OF BEDROOMS .3 OWNER /riSS DNS. - PERMIT DATE: COMPLIANCE DATE: G / Separation Distance Between the:` y0 6 GJ O _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /fi 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 &,),J ��G ® AC1C of hlo�s� sec . i -60 © .. . t �y r3z TOWN OF B STABLE 1 LOCATION'n �� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) :S t M 1\P y j I �SM L (size) 3 EN-aya-- NO. OF BEDROOMS BUILDER OR OWNE r PERMI TDATE: h-`'f COMPLIANCE DATE:L S 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 "Gvf f% Az 4q;G 53 ,o PAO, �� ASSESSORS MAP NO. 19 No. —Z PARCEL NO: Fee"z-✓ e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Ziqu ar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address orLot Owner's Name, ddress and Tel.No. 3 t Yn �� irnA-� 'EX)WA CR\ Assessor's Mal) arcel Inst is Yam ss and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( Va' Other Type of Building WLWV`� No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature,of Repairs o terations(Answer w eh, ap licable bD . o 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 prov' 'ons itle 5 of the ' nmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee d this B and f Heal Signe Date Application Approved b - Dates Application Disapproved for the following reasons Permit No. Date Issued r' —Q NOL r.. • o gas,►.+.+ 1 .,.'3i d� No. .� THE COMMONWEALTH OF MASSACHUSETTS Entered in tcomputer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS � . ZIpprication for Migool *pgtem Con!truction permit Application for a Permit to.Construct( )Repair( )Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name Addresg and Tel.No. fy� Map/Parcel Insta�llerr's Name Address and Tel No. Designer's Name,Address and Tel.No. �y Type of Building: i ?, Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( 0A Other Type of Building A,3LX No.of Persons —Showers( ) Cafeteria( ) Other Fixtures ja Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil I Nature o Repairs or ) �i�oftL.terations(Answer when applicable 6 k) 4—.�, 1 r r , 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 prov. ions,ITitle 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee �ss ed this Board of�Hea /7:4/ Signe . Date Application Approved b Date Application Disapproved for the following reasons C Permit No.��� .� Date Issued ✓ :� l��--li'`�' i - --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance II THIS„IS TO CERTIFY, that the.On-site Sewage Disposal System Constructed( ) Repaired( )Upgraded Abandoned( )by at AA an 1 11&as been constructed in accordance with the provisions of Title 5 and the for DI sposa ystem Construction Permit No.1>s dated Installer .ii e 4e" Designer 07 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ) �i �' �1"1 Inspector �. (f --------------------------------------- NoiZ 9 Fee ' r i t THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5po5al *pgtem Con0truction Permit Permission is hereby granted to Construct( )Repair( pgrade( andon( ) ti System located atr1 M u 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. j: Provided:Construction must be completed within three years of the date of this rmit. ', Date: � *` Approved by ..e TOWN OF B STABLE ct LOCATION SEWAGE # W:LAG N��t �' ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY U) LEACHING FACII.ITY: (type) (size) 3 NO OF BEDROOMS BUILDER 0 OWNE PERMTTDATE: �-�' COMPLIANCE DATE: S 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by I . A- 40/* l/ � = 55 F q0f a� i t 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 , lq� concerning the property located at �30 Al mow , vr2 meets all of the . following criteria: There are no wetlands within 300 feet of the proposed septic system • There are norprivate 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. D SIGNED. ATE: 9 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE MWMBER [Attach a sketch plan of the proposed system.,Also if the licensed installer posesses a ceriifled plot plan, this plan should be submitted). k f � � � � , �� l� (���� L_ _'Uv � ' ,� 1 � ' -.. ....... �xµ'-�av,..�-. nsrt°!!"'�=+.J.�:...,_r.--a:...�.�.�.--- .. wu..�rv-rwr�...x•w - k; 190 _�_ ' }` i c t rr {,'.i 3�'� F`?�!irtlrll?i f?(c } 7t;Wil fl � C)f Health Rf gi 3 j f3 ^t'' [�'t� G...-. °C./ �' ✓�� .,._. �+,'' .. ,` r' a, :1 t... t_ U « r'l 3iS St a!ict _ system a: sari 5„ziEl not ue� ir14t E ;. ; ' " ' ,,� �: , i:a ,. wrmir from the a�#l+i �> , , e c.� �!�. tag-`-7.` , %+ es appro a, flf i iv it . d 3ti �.. ify the lo—r3 ien 0" Jt'iyS. War f le,S �' <----� ( .... v y� =•� ,,.r--..�} '1.����� C.�°'f t aY,! • ..- �---- —-W11 _ _ 1 , "<t�iiL{i1•Ja"sF,'�l�i: '�� `+l-,�,-,'.4C `�'j)/r��. �e -zl � ^�] • [,�.� a'`� �y' C_bi'•lilt_F t i�;:,• , i i,. ir`Std�.a�sr.,r�. �° ' { "tf-,$ �✓ �� ... - `�'�"'" 4 ,�[ l f,�� L-t". J` Y ■ -, '1.`� ��t i`"�,;-' •i `-T'•''[+ t- 'ia t' t _ .�R F P� r t ?S .t1H' iPSL l: feet;)x i . �j i hVlt: sewer it ji ;. U£' 3 iY.0 4! ... 2 a - _ - •--- 7 d 10 lc _ �:c,,,.t,< �_»� ;�- 1".e distribution box s h?li E.y� ievd,; ail . :pink,c_oonections iz 0 i : ,d for a roperty ling' ai itlUrh ,.•r for any t7�;1£'.'. t 4_. �p �'irf 1 :pfiS��It!t!'r itl= lrt. : stem iilstatlatior�. f ._..._ �!J , 3`, � / ¢) �{u 1i (N L f art 1 f 1 ..i t; T+:,'it! 1 •i'T t.�% ! ' . ?i..rS�ii' �' 20 i at/a_ r. shall be p; 0�i , . ._� �. .. . .. _�: �•.a ` ex yti g eact t g t _ pin r;ed and€tEi. air?� :� i,;:ar;,�l per Tide V _ ��r� •�1,' J �r 'n i , n .t fop ,t• �- r T• V '' nr'1/1+/ T ti , s C +� CE'a5"i)olf5+ aY1Cl C;`iT i7r31l8tcd �GiE;within the tt t a I t> �' �� / `j dh:s, >,iui.ment pr,tcAd:!t p 1 C. rr! P S �` t ti ate , withr if <rc £t if t3�''it;1S. !�() „.,. prs d AS .=E be .' f" t_=ean 5a+i:f per iF ;j c •s: C`�1.�/,'r•,J� [ � ��t/"'t+l � � `} !sP."7`�C`fifll}'i�:,tiZi ar' .._ .., , : wateru r sa G ///'� v7 t � � •' : s r��i__e lirir:•. .�v+r_t +es fffss�.:n� V (�,^,,( •�1C'P.VCu� VdIT1? c�C �+?.1' 'tilafatt:e %i^(: : S/C. WitE' Z�4 i?t j"P '.�.�-Fti P.e }eps.. T a s>iri lc I!3r. _.... _. r s (! ;Stem is rtot ' gtE , ! ._., l garbage g(inder e�:.;` It i to bc. mt t .+� r,,:._l�t c.r•1 tr i �t:t'(Ifitr�i ;•' 1 w'�r' � - - ----- - ra sa{ter! i;, re.x). r. Clt c `•ort arot.'I' a Y,�t•.•, .,.-+{_''_�...{(..._i�'�:ow .... j .,�.�!S __. •......� +.,,, �... i r-i• ` � r �: �- •' :`i.�'�.:�t.l i•�S Ci t,f fir?{ i` .. - . : !' �.Q Ss J%'� l E' W i ! •� _y_� Jtt'Ct rS� �� r��i C 1 i' ?Stt?i"! _art be «y mcecrngTitl4?•'. } ..,i,rements. t 't f`"" ' l (iiC)i?E`rtV of bedtoomS ani" tgn flow. instollatic'; of 1he optic sy..tem as proposed and Ece pT :'!lent for the(1Q57L i` fit r. i be f�t?;�med a,�,praa.-ij o nc-- d .';ion £i0tf'.r9el �J the prt(>�'.� ±�t!' r, _rft Of. _ 4 �V f a,l, i C> -rt, pia1 dt; expire wi the expiration C r ion(if eta fermissue--' ' ,! j!r1° ts;.' r,t, 'iC3Y} fCl ? ppla!t prlL a{EClt .'s{:ni, Wart PXJi PiwY11Q ?( ' ". -- } r• l1 '�.. "� :a C .��✓r I d for tale I Is-Al - _ _ --- DAVID MASON "A4 jgAF t� t� ��..16tf '` J Yt 05ti _l !' 1 /} . . � -- } 4 . .,,ram ! - -► "�, j J, - 6 TF­ , �� !k{{ � _..,n.>.n;:•<....�..rnr_:..:.----+:aa-aarcas�.y.,..rrfcs wr.,-.-:-r... _.:-� .....s- -. -:•y�.,w.�:v.•�a.�far.a•.ov:z...-_,..-�.�•., , .-t.... - Gn•�^t u J ""„�P"FY"_'.'P*t/�"Y't1•R'.J1'?:•nT>:if:MMY.`W ...._... .. .. _ - ....._ ._,-.... ,. , kk.. .:... '.:.w:+:i:iYir-A•.t[3i6�QM4i+W'+.'inl.Y�.:.w>. �XY�.�...�N:_a.:..:.`.. -- _ ru,,,®a t .. Y.-CtQ!._kd..Rr..Y.+C4::;•Y."......... .... > iu.>.,.. >.V"..vVGa^!.iC�v✓..x J��LG"'.k.x w'�'i:, _ .,.. ��.'T.. 'S....•+�.,-0lCY<•�. u+a .. ..... - �::•��/l:.i•i....oeN x..s..r-.:�:Y:.•c:]:.... ®�.r..._.«...-.:..-'tvu:n.naMaM+dda'as.,.'tMiEtSCSSs•,.a n. x�.a�t 4k..ss vr�+rw9.a-.Yiew+rarta n..t^* _.• •-