HomeMy WebLinkAbout0054 MONOMOY CIRCLE - Health 54 MONOMOY CIR., CENTERVILLE
A=190-198
I do—tital)
UPC 12543
No.53LO
HASTINGS, MN
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I
No. ;a ��'�j Fee
THE COMMON OF MASSACHUSETTS Entered in computer:0
—Iqb
WEALTH
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes
ZippYication for 30igpogar *p!tem Construction Vermit
Application for a Permit to Construct( )Repair( 14grade( )Abandon( ) D Complete System O Individual Components
L�a'on Address or Lot No.
�Vls e, ss and Tel.�N�t
�'� �c1tS`c�c�n � P Assessor's Map/Parcel Q a) �� �,` �•,,,, (\ V� p �
Insctallr le�s Nam s and Tel.No. A , Designer's Name,Address and Tel.No. -
"77r4l:?11
Type of Building: ijb
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
Other Type of Buildings No.of Persons Showers( I) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank f 0®0R14 L_ Type of S.A.S.
Description of Soil
�.
Nature of Repairs or Alterations(Answer when applicable) ��
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 Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been is ed b is Bo o e h.
Signed Date 7
Application Approved by Date ,C=7—9
Application Disapproved for the ollowi g reasons
Permit No. Date Issued
No. cl ( t % Fee-�
'* THE COMMONWEALTH OF.MASSACHUSETTS Entered in computer-
Yes•
PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
Zip'rication.-for. Migpzal *Votem Construction Permit
14
Application flor a Permit to Construct( )Repair( P1 pgrade( )Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. r
N ��cJ ^n�/ Q�Q Kum, �c ,vL v:�
Assessor's Map/Parcel +
Installer.'s Name r
r,.A1,d es�s,a�nd�Te_l.N,o�. � x � Designer's Name,Address and Tel.No.
i
"7`?1 i
Type of Building:
Dwelling No.of Bedrooms �p Size s .ft. Garbage Grinder
.. 9 g ( )
Other Type of Building �?� No f Persoxis Showers( l) Cafeteria( )
Other Fixtures
E,
Design Flow gallons per.day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or,Alterations(Answer when applicable) (Z i
a
Date last inspected -""
A Ck
greement: - t
" �
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance.has been is ed b Ni
Boat�o h.
Signed. � w, ( t` .'i Date 7 '7
Application Approved b � � f- �'
PP PP Y � Date X", '�.•�'7
Application Disapproved for the ollow g reasons
Permit No. ��
t �� 7. Abate Issued' I.
--- ---- ------------ Z�-----------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
j a
w Certificate of Compliance
THIS IS TO C. TIF,Y,that the-@ssite Sewage Disposal System Constructed( )Repaired( LYUpgraded( )
Abandoned( )by
at 5 R ' has been constructed in accordance
with the provisions of Title 5 and the for isposal System Construction Permit No. 9� '>, dated
Installer Designer
The issuance of this p it shalI4� be co7truued-a guard tee that the systtel3 will=-4uncti n as designed.
Date ''" / Inspector
No. j Feed
{ THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
�DiOpo5ar *p5tem Construction Permit
Permission is hereby granted to Construct( )Repair(' Up rade( )Abandon( )
System located at ��`�
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 be completed within three years of the date of this permit.
Date: * e` 'i Approved by
r
TOWN OF BARNSTABLE
LOCA':10 — SEWAGE *
VILLAGE � ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. �4 kC .CMS �In l Grg%j
SEPTIC TANK CAPACITY
LEACHING FACILITY: (ty� (size) 1��
NO.OF BEDROOMS :.� �p e ��C,.% 2
BUILDER OR OWNE �1�ITt``LIB qt ' jS�`�
PERMTTDATE: COMPLIANCE DATE:
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
a r i
II -/
S,c
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
hereby certify that the application for disposal works
construction permit signed by me dated 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.
1 �
SIGNED • . - DATE:
LICENSED SEPTIC SYSTEM 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].
.�r
5
9
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r
CO)
O
�w
i
TOWN OF B STABLE
LOCATIO
SEWAGE #
VILLAGE \ ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.�O S Q 6)m A-f�� 'jQ C12Lf
SEPTIC TANK.CAPACITY
LEACHING FACILITY: (hype) (seize)
NO.OF BEDROOMS K2
BUILDER OR OWNE �C( WI [S`,6
: PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
'Maximurn 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
- -- . . .
r /
w
3 ,P�— /f
No------------------------ FEE.....Z4..............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF H ALTH
... . ._ .... OF. :............
for Bi_q oiial Worko Towi#rurtion Vrruift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
SYstep at.�`,��
----------------------------------------•--•- ............... ............................... ------------------------------------------------....--•-----------------------•---•-•-••••----...
Lo tion-�Lo tion-Addr r L No.
Owner Address
---------- --------------- --------------------------------------------------------------------- ------_------- t ...............................------.
Installer Address
UType of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms-------------------------------------__-----Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ___--a.__.._.__
--------- - -------- .................
Design Flow___ _________________ ._.,,.,�_.,,_��_$$1llons per person per day. Total daily flow------------._______._________..............gallons.
WSeptic Tank�Liquid capacity`v-!"gallons Length_______________ Width..__--.-.._.._-. Diameter__-.--_----_-__ Deptll-----._-_-.-----
x Disposal Trench—No..................... Width....__._._.._.. �_ talLe�Vk, . Tal leaching area_._.....____..._____sq. ft.
Seepage Pit No.. --.--- Diameter- - �. et__. �1'otal leaching trea-------_----.....sc ft.
.
z Other Distribution box ( ) Dosing tank ( ) P C '� 7— � Z— Z 1
a Percolation Test Results Performed by--------------------------------------------------------------------------
Date.............._---_---------------._..
Test Pit No'. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...--------_---.-....__-
r%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
------- -- =
j 1 t----..... . -------- ------------------
Description of Soil -------8 f ------- j ---- -- ------
zx --------------------------- �'- ---- \
-------------------------' ----- 2
U Nature of Repairs or Alt rations—Answer when applicable.-.__---.--------------------------------------------------------------------------------------.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The under 'geed further agrees not to place the system in
operation until a Certificate of Compliance has been issued b bo rd of health. 2
Sig ......... . .... ..r______� ....... ....... ..............................
.. Date
Application Approved BY ---- �....----- ----- --- - ` 7. 1� ------
Date
Application Disapproved for the following reasons-------------------------------------- ----------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ate
Permit No........................................................ Issued.- -�------` - ....
Date
t
<+l- -„
No..---.. ..� Fas "...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
XpVlirtttion -for Moporittl Workii Ton.5trnrtion Vrrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
--.....--•-•--------"---------••---••--"---------------------------------------------------------- -------••---------•--------•----------•--------•....-•----•-•----••--------•-----•---•-----------
Location.Address or,Lot No.
e
Owner Address
Installer Address
Q Type of Building Size Lot-.----__"___________________Sq. feet
U Dwelling—No. of Bedrooms____________________________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons.._-___----_."---.--_---_- Showers ( ) — Cafeteria ( )
Other fixtures ------------------------------•- -
W Design Flow............................. "lions per person per day. Total daily flow............=_.. "/__ gallons.
W . Septic Tank-Liquid capacitv_`.�4" allons Length---------------- Width---------------- Diameter---------------- Depth._-...____----
x Disposal Trench—No_ ____________________ Width .. Total Length---------- _.... Toal leaching area--------------------sq. ft.
Seepage Pit No.................... Diameter----.1__!>-?t.. )� ITelfiw 'rt� �..-`` ._�Yotal le ch" I� are" sq. ft.
f v � y g : _•-7 ------
z Other Distribution box ( ) Dosing tank ( ) p ,b • C
aPercolation Test Results Performed by-------------- ........................................................... Date---------------------------------------
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water-..--------------_--._..
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._..............__.--...
a' ---------------- -------------------------- - ------ •. l =--••--... l
D Description of Soil------------_--ut ' s�`"-' _.... G
' _.. .
----- --- -•--------
UW -•---•------ ---------------\ �h --- -- ------------------"----------"---"------•-"------.-.--------------_-.----""--"----------------""-------•-""----------------•----• .............
Nature of Repairs or Altera tons—Answer when applicable...............................................................................................
----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI 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.
Signed......
.. r _ ...��°�
f, .c: = =
v
--------------------------------
Date
ApplicationApproved By.................................................................................................. ---------...............----------------
Date
Application Disapproved for the following reasons:--"------------------------------------"-------"--------•--"-"---.""--------------.-------•-.-------.-----------
-----------•----------------------------------------------------------------------------------------•--------------.....---••---•---•-••-•-••---•--•-----._...........----------......_..----....------.
Date
PermitNo.......................•----••••------------------------ Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF 7ALTH
.................1....�Y !^N\O F..................... .Lt.�fN"L............................."-
(9rdif irate of 010ntplittnrr
y THIS IS TO CERTIFY That t Individual Sewage Disposal System constructed ( ) or Repaired ( )
----(
nstaller, "
......: {
has been installed in accordance with the provisions of Article�x`j of The ' ate Sanitary Cod s described in die
application for Disposal Works Construction Permit No ---------------------
�... __.___ dated............. ........�_�.._. _._.J.._..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ^ 2 Inspector -)J� -- ------------------•--------------.--------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE1L�;IH
/ vim, L U�—t.
.... .....r ... �UF................
No.. FEE...----•-•----..._.J....
Dinpoittl Vox p Qlon trnr#ion Vamit
Permission is hereby Ogranted.................::>-'- --- lr-------• --- -�•-�-.......................................................................
to Construct ( ) or air ( ) n Individu ewage Disposal -System
at No................
Street ��
as shown on the application for Disposal Works Construction Permit N ?_...__....1..____- D ed--_._-"-.--._/.............................
✓ / Board of Health
DATE------- �]� ------------11 6�---------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
PLOT PLAN SHOWING LOCATION OF BUILDING
IN
CENTERVILLE BARN STABLE MASS.
FOR
ALAN E. SMALL INC.
SCALE: I" =60' DATE: SEPT. 3, 1975
CHARLES N. SAVERY INC. REG. C.E.a L.S. 712 MAIN ST HYANNIS , MASS.
.y.
36 37
.1 0 0.00'
1
I~.O T 5 4
115)000 S.F. -0
0
O
53 0 c 55
//. N
Dwelling
19'+ Z�'±
+; +1
mE M
1 00.
MONOMOY CIRCLE
I herby certify that the Suilding exists
on the ground as shown on this plan and r��'`;H o►d `��
is in 'luordance with the zoning NOHEHT
requirements of the Tuwn of Barnstable. F.
Registered L:nd Surveyor f a��� F TE�� �.
'r� �URYC�.J`,q,
THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED FLOOD PLAIN ZONE. {
72238A I
A
l PLOT PLAN SHOWINGI VOCATION OF BUILDING
CENTERVILLE -BARN STABLE MASS.
FOR
ALAN E. SMALL INC.
SCALE: 1 =60' DATE: SEPT. 3, 1975
t
CHARLES N. SAVERY INC. REG.. C-E.a L.S. 712 MAIN ST HYANNIS , MASS.
t
36 37
l 00.00'
L-OT .54
I5,00o S.F. 0
0
� o
53 0 t 1 i 0 55
Dwelling „y
19 20'±
6o.2'
+,, +t t
co I�
m in
100.
MONOMOY CIRCLE=
herby certify that the 5uilding exists _
on the ground as shown on this plan and w�"-
ordance with the zoning • �E' Ad't
1$ IR its, ROREHT
requirements of the Tuwn of Barnstable.
a -4 MIKlS +
1 t Registered Lind Surveyor � ���\4I FTf.�•
THIS LOT IS NOT LOCATED IN A FEDERALLY DESIGNATED FLOOD PLAIN ZONE. I
72238A