HomeMy WebLinkAbout0163 POND VIEW DRIVE - Health 163 Pond View Drive
Centerville
A = 228 031
IN
UPC� 34 � •
�atu�ab MR
29 17
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No. a Fee .
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
�� 01p�plicatiou for Mtgotal *Votem �Conotruction Permit
AAplicatin for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Nomplete System ❑Individual Components
Location Address or Lot No. i(03, pwc) Owner's Name,Address and Tel.No.
Assessor's Map/Parcel __T \Q d�its✓
i
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
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 r3 3D gallons per day. Calculated daily flow 13 C 4� gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil _ S
Nature of Re airs or Alterations(Answer wh nap licable) � Sl f�W M cS
1) G u
i
Aifl—
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 C e and not to place the system in operation until a Certifi-
cate of Compliance has be y t �^ c
Signed i Date
Application Approved by — _ Date —
Application Disapproved for the following reasons
Permit No. /76 Date Issued
Fee
Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
k _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS } Yes
2pprication for 0igool *pgtem Congtructiori Permit
ippifi3n fora Petmit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components
Lcjmtion Address or Lot No. e(QG PWD V��tf��- -e-�c� Owner's Name,Address and Tel.No.
A
}. Assessor's Map/Parcel CN`� ��,tom?.. M�N-5
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
e. `t
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, �ue 30 gallons per day. Calculated daily flow �(4;r gallons. -
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 5-6/D 4---VAV--V Type of S A S Ca IX-('T s.A---'VtJ40L
Description of Soil
Nature of Re airs or Alterations(Answer when applicable) =r SFAA t S�
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 C de and not to place the system in operation until a Certifi-
Cate of Compliance has bee,"ssTe-Tby[fiisX-ogird-of H-eai y
C
Signed - Date -t
Applicattoh Approved by ''a Date
Application Disapproved for the following reasons
Permit No. / 9- 176 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS A, ,
BARNSTABLE, MASSACHUSETTS
y
Certificate of Compliance
THIS IS TO CERTIFY, that the Qj4 a Sewage Disposal System Constructed( ?�OepaireQi u)�pgraded(V)
.Abandoned( )by t0--C
at o t,,O 0'e— cd lea EL true has been con cte�'in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated I.
Installer Designer
The issuance of t 44/perm. shall not be construed as a guarantee that the sygte'' wiill function as de�gned'f
Date � �7 6 Inspector -7t ,'f A� �/ � �7 ✓ r�l/I � / �( i�
-----/-7—/---------------------------------
No. /p f—/ /(� Fee -�—o.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migpogaf *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Re air( )Upgrade(Abandon( )
System located at f ugtf �e
v
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.
q i
Date: y��/9/ Approved by �- .
1/6/99
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)
Ie, � c)IU� ; hereby certify that the application for disposal works
construction permit signed by me dated `b--I—1--t9 ----, concerning the
property located at �3 Pd Vl meets all of the
following criteria:
v 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
"ere are no private wells within 150 feet of the proposed septic system
"ere 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
p�ethod 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: F
A) Top of Ground Surface Elevation(using GIS information). �� o
B) G.W. Elevation s +the MAX.High G.W. Adjustment.31 = a t0
0.
DIFFERENCE BETWEEN A and B
�1
SIGNED : DATE: ��
[Sketch proposed plan of system on back].
q:health folder.cert
z
) . �� _
+- .'n
� �
V
,.M
� T
TOW OF BARNSTABLE ; r
LOCATION oy 0y� -UU /;7 xZ SEWAGE
VILLAGE��� ��� ASSESSOR'S MAP& LOT aa�^
INSTALLER'S NAME&PHONE NO. n c t ro e S-F Lt 7 7,?- 0 6
SEPTIC TANK CAPACITY /j c c,
LEACHING FACELITY: (type) 79d TGa S' (size)
NO.OF BEDROOMS
BUILDER OR OWNER ; V
PERMTTDATE: 99 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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
I
JAC Ji
6�cy�
-CJ-
A
/7 3 /3
Board of Health _
Town of Barnstable .f.
P.O. Box 534
Q�I � Hyannis, Massachusetts 02E01
No...lJ.0.......J..... F�s...aZo.......-••--......
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF \HEAL.TH
.-----....7Ou+-)7.................OF... gr116 .bl�............-----.........................................
Appliratiun for UiupuuFal Works Ton raxrtiun 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
�l.. ....................... .•-••••••-••-•....•-•-•----•••••--.....--••-••------••----•••---•---•------.....-----•---•-•-•----
Location-Address or Lot '�io.
-T�Ior�R3 �1. Qn a4r.4�n 5-------------------•......-- �!�3_. �! �c,...C�4+�e[__.�It,...............................
Owner , Address
A Q cA 350 Main 5f c 16�mAk
Installer Addre s
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 ( )
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. I.................minutes per inch Depth of Test Pit......--...--....... Depth to ground water-...-....-....-.---.--.-
Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....-.-..-.-------------
Q+' -----------------------------------------------------------------------------------------------•----------
-------------------------------
-------------------
0 Description of Soil........................................................................................................................................................................
x
U
w
x --------------------------------------------------------------------------------------------------------------------------------------------------------tt
N ture of Repairs or Alterations—Answer when a licable..1-0.00...� -_.--- tQ_AWsKr-.D-Bo�c (blto
Pd_----•----•---•----•--•--•---•----•••-•-•---•-----•••--•••---••-••••----•-•-•---•••--•-•--•-•-------•------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i I= 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
AA three board of
health.
Signed .. ................................. �:1.841•-•--------
/ Date
Application Approved By................... ....-\—D...... - --•--- ...............P n--- = 8i
Date
Application Disapproved for the following reasons:................................................................................................................
.....................•---.....------•----••----...-•---------..........-----------------------•--••---------•----•---------•-•---•••-----•••----•••------••--•-•--------------.........................
e Date
Permit No......... �l......
L/ -�� ................ Issued.
Date
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
No.-.11f?.`_-.L. :� Fps.. .'.-................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 OF.
A11V irFa#ion for Dispaii al Workii Tonatrur#inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair (*f ) an Individual Sewage Disposal
System at:
.. 3 fig, III �, i- .1C .....� ;�r_
Location-Address or Lot '�o.
1 r-1 ra v ern. r r Ifs �C lie I t— I( ('- .f
.....................•_•.--•----..---------------.....---..._---•--..................-^--....... ---.....=--.---.......----•---------------•----------•--------------------------------------------
r Owner _ Address
Installer Address
UType of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers
a YP g ------•------•-•------------ P ( ) — Cafeteria ( )
04 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-..-__-_-_-_____.-------
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---_-_-.___-_-_-----_--.
P4 ---•------•----•-------••----•------------------------......................................................................................................
0 Description of Soil........................................................................................................................................................................
x
V ---••-----••--•-----...---•-••------•••----••---•-----------•---------------------------•......----•--•--••-•--••-•----------•-•-•--•---------••-••-----------------------••---------•------•-•-----
VW ---------------------------------------------------------------------------------------------•------- -•----------.........---------------...•-------------•-•-•---•----•-•-•-----•-•---------•-........
Nature of Repairs or Alterations—Answer when applicable__:_-.:? --_': ' - 7...........................................................
I( -,I
-------------------------------------------------------------------------------------------------------------------•--------•-•----•-•-•---•------••------------•-----•-•--------•--•-••------.....-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TT T L
p 5 of the State Sanitary Code—The undersigned furtt:er agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed------`= r -`
Date
ApplicationApproved By.................................................................................................. ........................................
Date
Application Disapproved for the following reasons---------------------•------•----------------------------------•----•-----------•--------._......-----.....------
..................._.....................................................................................................................................................................................
Date
PermitNo......................................................... Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
1 / BOARD OF HEALTH
�y ......................OF....!.:.....:........ ..!E=
dw
Tatifiratr of Trrntphatta
THIS IS ,M O CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by....................._:.. -------- ---- ...... ....................------•---------••---------------------....---- .._..
Installer
at-••---•-•-- l` c1ti �¢�1` &L'_( ------
has been installed in accordance with the provisions of TIT' 5 o [The tate Sanitary Code as described in the
application for Disposal Works Construction Permit No--------- '_!-C?!i.k..... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.......... �:...1<Lj.. Q.D........................... Inspector.....--------........ �.
N THE COMMONWEALTH OF MASSACHUSETTS
¢ BOARD OF HEALTH
!J - `T I h r».....................OF.---�` l�
N O.. .�.�'.. FEE...---••............
�isp�a�,pt1 nrk� �nn��rtilan �eranit
Permission is hereby granted /!' ..................................................-............................................
to Construct ( ) or Repair (��an Individual Sewage Disposal System
atNo................ ------. fs. �....9A-X..........�-ey,T-0. 2 ......................................................
Street ���
as shown on the application for Disposal Works Construction Permit No_______ Dated..........................................
' ------------------------------- j.. - ------------•------••---------•-•----------•---•-
Board of Health
DATE.................. .....O.-e...................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS'
TOWN OF BARNSTABLE
LX)CATIOi � _� �/d4�a�Qv�'�r,�� 4(if— SEWAGE #
.'ALLAGE �,-� ��^�� �0� ASSESSOR'S MAP Cz LOT
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY
LEACHING F ACILITY:(type) G,z Ile y (size)
NO. OF BEDROOMS PRIVATE WELL O PUBLIC ATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
✓may
(�Zwr
�. TOWV OF BARNSTABLE
-'- ^N _ /43 P dNo 1/1 &Gtl k-?k - SEWAGE # V'l
frII.LAI-7 i��� ASSESSOR'S MAP& LOT
;INSTALLER'S NAME&PHONE NO. mt`n Ci4r2 e. S 1 ± r C 7 7001- O 1;
SEPTIC TANK CAPACITY /s G
LEACHING FACILrrY: (type) z y l Z 7'"T-aa-�� _(size) /Jk I s
NO.OF BEDROOMS
o BUILDER OR OWNER O
PERM TDATE: COMPLIANCE DATE: Y Lim
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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
flcsr��-
607 c .
Gj
�)2.- `''
143-IL i�
TOWN OF BARNN�STABLE
L ATION 1/ �a n�(�,'y., /,�LSE'_ SEWAGE# epee/Z
4LLAGE_ [f-,,/-, ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY /41t7i
LEACHING FACILITY:(type) �rs�/ir (size)
NO.OP BEDROOMS PRIVATE WELL O PUS ATER
BUILDER OR OWNER / ,,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED-
VARIANCE GRANTED: Yes No
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