HomeMy WebLinkAbout0032 SEAN'S CIRCLE - Health (3) 32 SEAN'S CIRCLE, CENTERVILLE
A=170-057.008
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No. 42101/3 ORA
ESSELTE
10%
6 O O O
I
I
TOWN OF BARNSTABLE
LOr,xrio. 5z �e`e✓ U� C SEWAGE # ��17_�sf
VII.LAGE L�� /���/' ASSESSOR'S MAP & LOT
IIv'.�'�ALLER'S NAME&PHONE NO. /�
SEPTIC TANK CAPACITY Clad®
LEACHING FACII.PTY: (type)
NO.OF BEDROOMS 3
BUILDER OR C74/� ��
PERMITDATE: 1?'/7 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 J
within 300 feet of leaching facility) /v Feet
Furnished by
.-z4 3A
Rear
gT
3
O 33 i
�lt�,
7
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for 30igpozat *p.5tem Construction Vermit
Application for a Permit to Construct( )Repair(/ )Upgrade( )Abandon( ) ❑Complete System R� Individual Components
Location Address or Lot No. C �'i�G,/� Ow er's Name,Addre s and Tel.No.
Assessor's Map/Parcel / �e�� ®���
Gee7�dUille 3 z �as : i/ le
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
A®1fa1011; 4roAsr
'77 -OeIZ
Type of Building: a
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/f-0
Other Type of Building e— e-e6e- No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow //0 gallons per day. Calculated daily flow 330 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank M Type of S.A.S. �T—
Description of Soil
Nature T
epai7 or Iterations(Answer when appl Able) cX05f,e�1 /��D�g/�r� !i f�G ,6:
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 b h' of
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
z 17a_
�j
No. �— Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
f.
2ppricatcon for Di!6pogar *pgtem Coriotruction Permit
Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System E� dividual Components
Location Address or Lot No. / Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
10//i COA31,
ti7 - 0
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/1K-0
Other Type of Building_��eCe No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow //D gallons per day. Calculated daily flow 3 3Q gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /0-119a Type of S.A.S. IsWV�Vl AClA /T
Description of Soil
t Nature of)Repairs or terations(Answer when applipble)
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 b i of
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
.41
Permit No. Date Issued
f —————————————————————————-———————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(certificate of (Compliance
THIS IS TO CE TIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( v)Upgraded( )
Abandoned( )byO/fd
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Ge/J5x Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as..designed.
Date / 4 - 9 Inspector
F —--- — -------- ----------------
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migpogal *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Rep 'r( Upgrade( )Abandon( )
System located at Z ✓`7ege 5 C%/�G e
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. 1
Date: 7�� Approved by
i
I,
Jc
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
I, /6�efl-Jr AO���l ; hereby certify that the application for disposal works
construction permit signed b me dated +Z 13h 7 concerning the
P g Y g
1
property located at �Z SL�II�?5 C%r�' �G� rU �. meets all of the
following criteria:
:�Tnffihere
ere are no wetlands within 300 feet of the proposed septic system
are no private wells within 150 feet of the proposed septic system
/Theobserved groundwater table is 14 feet or greater below the bottom of the leaching facility
r ere is no increase in flow and/or change in use proposed
There are no variances requested or needed.
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].
q:health folder:cert
TOWN OF BARNSTABLE
LOCATION F22 5L`��'�` C�rG�� _ SEWAGE #
VILLAGE LC� iw� ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) �i'lOG�G'i�� (six /�`5
NO.OF BEDROOMS 3
BUILDER OR OWNERS
PERMTTDATE: ✓a/A',�7 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �f 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
Lbl�'�
an-)�
710
LOCATION O,�SC 32. SEWAGE PERMIT NO.
V11LLAGE
C, FfI2V/LLF
INSTALLER'S NAME i ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
i
3� .
ar
yf� J
�cr
•
7 I 1.1 11
No.. .................... e. .,.. Fs$..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
l�v�
...... 0-W.1v...--- ...'OF.....�I�I I..S..f 3',G ....................................
Appliraftaan for Bhip sal Works Toustrnr#ion .ermit
Application is hereby made for a Permit to Construct ( Vl�or Repair ( ) an Individual Sewage Disposal
System at:
3�- .� J1L�l.'.�..... llf� C.� . ..- clll?,��s'�Y Z. ......................................4��- .�..�............................
/ Location,, ddress or Lot No.
•-•-- -------- �_.. --------------•-•-•-----•-------
O ner � Address
a E`fo 2 NorLos � NS7l �3t_C...
---------------•-••--•--------•-- --•-•-------••--•-----.........----•- - -
Installer Address
Type of Building Size Lot_al� �- 1....Sq. feet
Dwelling—No. of Bedrooms........... ...........................Expansion Attic ( ). Garbage Grinder ()VD)
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures .... - --•-----•------------------------------------ -----------------
�y
W Design Flow.........,1Z ..................... per l=p r day. Total daily flow...-----•....Y-a-!e................
WSeptic Tank—Liquid capacitysoc?o._gallons Length '_"- Width.-r��j-A." Diameter................ Depth .... ..
x Disposal Trench—No..................... Width............ Total Length.................... Total leaching area....................sq. ft.
eI
Seepage Pit No......../......... Diameter...x9..s......... Depth below inlet..... Total leaching area.6"'LOID..sq. ft.
Z Other Distribution box Dosing tank
4 Percolation Test Results Performed by..l N�q�n....1�t:.. .11�!�'+? J�................ Date._W`0, .�.czy..._.P2,31./17>7
Test Pit No. 1.G. _._minutes per inch Depth of Test Pit.....I ...... Depth to ground water..�1!N ......
(_, Test Pit No. 2..L. r..._minutes per inch Depth of Test Pit...lid....... Depth to ground water^AA.a.4r.....
•---••------------------••. •-•-••••.............•-•-•---....•••-- .....•-----•.................•-----••-•-------•-----.............._......•-•----••------
O Description of Soil------•.O.-=Z&F-.. e-0eyev..9�--.5,61,6 4570 5Y - ---....................
W
VNature 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 TITLI: 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.
Signed: = - - :..:. = _ `...:.
Date -,
Application Approved By---...`�. .��� �- 7.
Date
Application Disapproved for the following reasons------------------------------ ------------------------------------------••----•...••.. •••--...........---
.......................................................................................................................................................................................................
to
i
PermitNo......................................................... Issued_- --- /-
Date
h
� j
No...........�. ... ►- Fps......:�..}.•-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
° 0.W--eV.........._....OF.....BA-x11#.S:%-.464
�- Applirattion for Dispaii al Workii Tomitrurtion Vernfit
Application is hereby made for a Permit to Construct (V/) or Repair ( ) an Individual Sewage Disposal
System at:
----------------------------- 2�zr...9..........................
LocatiomT ddress 4 � or Lot No.
... .• .,_.i.......... ........................................ ...................... .......s............./.............
...
..........................................W ..... U E 1 o�i �e {L l� L.�1�el�t�:3 1 r�1�L�re s
a ......... ............... .....................
Installer Address
Type of Building Size Lot.-P.4CI-5/ .....Sq. feet
a Dwelling—No. of Bedrooms...........
_» .....Expansion Attic ( ) Garbage Grinder (VO)
Jl
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ...................................
W Design Flow-------- .�'aC57...... ..........gallons per j��er ay. Total daily flow............. ..............gallons.
WSeptic Tank—Liquid'capacity/,Oer&..gallons Length&..'4.`'`'.. Widthk�r'__,0 1'. Diameter..... ......... Depths_. 0..'r'
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................Sq. ft.
Seepage Pit No......./.......... Diameter.. .`...... Depth below inlet..... ....... Total leaching area"Zj ...sq. ft.
Z Other Distribution box t",—) Dosing tank ( ) 3 - ry,)
`"' Percolation Test Results Performed by. P.!4?AA_�J._....A .S115Y624P ............. Date../�''li.RCf�
aTest Pit No. I .x......minutes per inch Depth of Test Pit__-/A••_'___... Depth to ground water_.A?&+e�e4........
Li, Test Pit No. 2. :: .....minutes per inch Depth of Test Pit...?!--!........ Depth to ground watere,,.a W.d.......
a --••----•------------------------------•--......----------•----................................•---.........................................................
0 Description of Soil......... `'... .t ,f,�..9C....5el .5_Cf_a. ------------------•--------•-..............................................
V ........................................e�qf.r""._l. ram' 6f.....e�3�. Cf1._�G! .........S A,,4.-------"•-•--•-----------•-•-•-------•---------....---....--......
UW -•--------------------------- ---------------------------------------------------------------•--------------•-----------_....--------------------------------------------------------------------------
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 been issued by the board of health.
/S-ig�nred/-- -----1------�-----,--.---- -------•-•-• ---y-•->--�-........-----......--------------•- -•.------------.........-----•--
Date
Application Approved By....... -
—
-�
_ / •/- =?- ...
Date
Application Disapproved for the following reasons:...............................
...............................................................................
-
.........................................................................................................................................................................................-...............
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
... ............................................
wEnrtifirFate of TompliFanu
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
bY----------- OlZ 11Jn 1,j° Q S
at.............. Q'r` 5S PO{ C 1 fS C_L stalle A1'T�2U IL(,�
. -----•-•-----------•-------•--•-----•-•--•---•.....................•--•---....--------•---------------------------•---•-.....-----••-•------------------........----------------
has been installed in accordance with the provisions of �F' of The State Sanitary Code as described in the
application for Disposal Works Construction Permit NoA ...... dated_.'___` ...........:`�__%..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
61;v _
No..............rf........� �_ FEE....2'�---:::.......
Disposal-Works To-notrurtton Vanfit
'UiLo
Permission is ereby granted ------- - -------- -----.---............._...
to Construct ( V o, Rep it ( ) Mtn Individual Sewage Dis al
at No.-----�===P..?".... �' a (I IBC t.�........:_._. � 1 -I�l) 1l.l.C......-•--•-••--- ....-•-•------•------•--------
Street
as shown on the application for Disposal Works Construction Permit No........... Dated.... _ .............
d $oard of ealt
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
T�
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