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HomeMy WebLinkAbout0047 VICTORIA STREET - Health 47 VICTORIA STREET CENTERVILLE A = 148 043 C llll �,.EcYctFo�o UPC 12534 No.2-153LOR gOOST.CONSJ� HA8TING$, MN r I TOWN OF BARNSTABLE LOCATION SEWAGE #400 VILLAGE 1- .V/�if-'y� ASSESSOR'S MAP & LOT ���"U 43 INSTALLER'S NAME&PHONE NO.: /'titr SEPTIC TANK CAPACITY /5-00 Gs3/ LEACHING FACILITY: (type) cc,IT e 3 30'. (size) /0 r X 30 NO. OF BEDROOMS, . I' UII;DER OR OWNER - 'Po �L. . ...hi n / li w i PERMITDATE: 5 /;�Oa COMPLIANCE DATE: j Separation Distance Between the: Maximum Adjusted Groundwater Table and- of Leaching.Facility Feet I Private Water Supply Well and Leaching Facility=(If`any wells exist'. on site or within.200 feet of leaching facility) Feet i Edge of Wetland and Leaching Facility(If an wetlands.est Within 300 feet of:leaching facility)' Furnished by _ Fe et Old fl f l i t \"MC� ` zJ-3 3C� 6Y' 3�/ 11 � `�vlTcc y 3 Xu 1 zf TOWN OF BARNSTABLE ' --1I4CA_TION L� l�/C 2rh7 S/ SEWAGE # 0/- VILLAGE C�k��iPlij��� ('ASSESSOR'S -M-kP & LOT Iq rr q3 INSTALLER'S NAME&PHONE NO., L-I(C SEPTIC TANK CAPACITY 15-00 6,21 LEACHING FACILITY: (type) CyhC 33-0 , (size) /0 !X 30 NO, OF BEDROOMS BUILDER OR OWNER �E'o/Cr C�/ r r-Aiwi PERMIT DATE: 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 v-v 019 / 1 �,� 3a e F� 3yi xl 7t �� r J No. ���"� L/ � Fee Gal • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for ;W5pont *pgtem Com6tructton 3perruit Application for a Permit to Construct( )Repair(1/ pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S�"l T�/'� Owner's Name,Address and Tel.No. c.t,o��r� Assessor's Map/Parcel � S't / o C.e�.�c��%tl., L(a8- LA(0q Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. BZnio,�a S l Type of Building: Dwellin No.of Bedrooms Lot Size sq. ft. Garbage Grinder(N©} Other Type of Building 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 or Alterations(Answer when applicable) a(J 0 3 — Cu C-ce-c— 3 3 o C-P,r-v3 e2 s W t O S1U1v 5vrroL ,o•n, 3 nC u,-�_ 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 iss by this d of Heal Signed Date 4?9,/S'cZ DO/ Application Approved by Date Z"'�• ''' 1 Application Disapproved for the following reasons Permit No. zoo/.-z bl>,— Date Issued '` d �� ee THE COMMONWEALTH OF MASSACHUSETTS Entered in compute PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Digozal *pgtem Construction Permit Application for a Permit to Construct( )Repair(L')`Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel v,c C.,E ; /U Cc till L1 ,�� _ l� Elc le, c' f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: - D�wee lling No.of Bedrooms a` Lot Size sq. ft. Garbage Grinder(Nc) Other Type of Building 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 or Alterations(Answer when applicable) ,�1 ij ;7 5 C t`t� c .5 c: C `� ;;� i 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 Health. Signed Date,-'�R, 1-5-- DD/ Application Approved by r Date .�.- Application Disapproved for the following reasonsr Permit No. , 'd,�''`# r' Date Issued off 4 — ————————————-,————————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(k*')-Upgraded( ) Abandoned( )by_ at t 1' 1 t/ c c.. �; -4. i �:. i I } has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permi2To0A/ .,6,$,Zdated e? Installer C.\1, 1c Designer The issuance of this pe t shallnot be construed as a guarantee that the sy to Ill fuE�s,/641esigned Date �1 t L lnspector�� i ----.f�--- —,,.-----------------------------�— No. ,0,6 i Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS li$pozal *pztem (Con6truction Permit Permission is hereby granted to Construct( )Repair(1/Upgrade( )Abandon( ) I `+ System located at t 1�? �f , _:u; . ,a i- � G Po f c c k iI A C 1 ;IN, 411 and as described in the above Application for Disposal System Construction Permit lThe 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: 0. s'� s'9-e ,�'..w �.. �___. 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) h B ce VA 0..e c..l,`, s l of , hereby certify that the application for disposal works construction permit signed by me dated ;t=ffg, /S-aao1 concerning the property located at L('t Vi c i o 2. S-C. L e. t,e meets all of the following criteria: • This 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. J • 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 V • 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.jAdjust 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) �7 a B) G.W. Elevation +the MAX. High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED DATE: DATE: [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert WIN 3 S \Gxne- Y i3 ox O 1)(Z w� c 6&-kc c Firm. V..............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................O F................................................................................------.... Appliratiou for UhipasFal Works Tondrurtiuu Prrutit Application is hereby made for a Permit to Construct (l�or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. ......................_.............................. .•..---................................... ..•.....=•----•.............................- ---.-----•--•---•-----............•............. Ownerr - Address W Installer Address Type of Building Size Lot............................S f ,t Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinde Other—Type of Building No. of persons............................ Showers — Cafe ter P4 yP g -------••-----------------• P ( ) a' Other fixtures ............................ W Design Flow........ .........................gallons per person p� day. Total daily flow................. .p_.._._._..... s. WSeptic Tank—Liquid capacity—/000.gallons Length_._-�-f_--........ Width...: ..... Diameter................ Depth.....-.A/...._. x Disposal Trench—No..................... Width.................... Total Length...._j. .. .... Total leaching area....................sq. ft. Seepage Pit No..........J-------- Diameter...lQ°5�-- Depth below inlet._lea.e®.�...... Total leach in 5-p area... Q...sq. ft. �. Z Other Distribution box ( ) Dosing tank ( ) '`f �• '-' Percolation Test Results Performed by...X0.1 .......�L1� 2.-��...:............ Date.......�1." _� -•_-_-. .. Depth to ground water--- ,.a Test Pit No. 1__.1,.�.s�.minutes per inch Depth of Test Pit../�.�,�...... p gr �Q��__.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •-------•--------------------•--•---......--•--•....•-----••........._......._........----------•---......................................................... O Description of Soil-----� ,=!:----• -•---f --------------------------------------------------- x V ---.-------- W ---------------------------------------------------------------•-•---------.........----------...----------------------------------------------------------------------•--------------------------•-.--• UNature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------•--......_.....-----------------------------------------...-----------------------------------------------------------------------------------------...---........-- Agreement: e undersigned agrees to install the aforede ibed Individual Sewage Disposal System in accordance with the r isions of iITI.I of the State Sanitary e— T ndersigned further agrees not to place the system in er n ti a of Compliance has be s d b e board of health. J Sign ------•--- ............................................................ D--- ------- Aa ' Approved By ---- `--....-•------•-••--•--------•----•---...--••--••--•------••-•-•-• !?----_.... Date A plication Disapproved or a following reasons-----------------------------•-----------------------•-------------------------------....._......._........------ ................•--------•--••--•••••-•--••-•---.....--------•-••-•-------•--•----•--•--•............-••-••.._.....-•---•-•-------•-------•--•-•--•---•------•-----•-•-------•••------••----•--••-•••-•. Date PermitNo..............................................................................•-----•----•---••-•--••....... Issued........................................................ Date k1 r No.9'':�.. .411 ;V FEB............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................OF.......................................................................................... Appliratiou for Dispaoul Works Cfootitrurtiorc Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ......_ f C rO 12 T` sr.�T"%%��%...C........--•...........................�0�` �.----------- ----------•------- • - -- Location-Address or Lot No. ......................__........................................................................ ..._..••.........._._............••......._...................................................... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................. Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............_............... Showers ( ) — Cafeteria ( ) Q' Other fixtures .--•-••-•---•-------•--------- -- W Design Flow........ ............................gallons per person per day. Total daily flow................. 3.3-(...............gallons. WSeptic Tank—Liquid capacity, .00..gallons Length._)._...... Width__'7.'.......... Diameter................ Depth...-.K)..__. x Disposal Trench—No..................... Width........Y..._._.... Total Length.............]..... Total leaching area....................sq. ft. Seepage Pit No.........J......... Diameter..:�(,.�_'�� ..:.... Depth below inlet_ !.�. ._.:_.. Total lea® g area._ _ ___sq. ft. Z Other Distribution box ( ) Dosing,tank ( ) 1 > 6 °L/- 6•rP. �. '"' Percolation Test Results Performed by..Aj242.;....�JlEA76,:�.'3..--AX............... Date__....6. .��% �� ..._.. Test Pit No. 1_4:. %✓...._minutes per inch Depth of Test Depth to ground water_?OrA?:��6-_ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .........................................................•-•............... ................................................................................. D Description of Soil..... ;:�c ".. e.... � ' �� "✓�= ------�7..--•°� ---------------- U ----------------------- ----------- --------------------------------------------------------------------------------------------------------------------------------------------------- W •-•-•--------------• -••-----------•----••-------•--------------•-•-•-•-••-•••••--••-•••••••-•-----•----••-••••---------•-------•••-•-•••••••---•--••--•---•-•----•••---••--•-•••--•••••...........-•-•- UNature of Repairs or Alterations—Answer when applicable................................................................................................ •---------------------------------•-----•--•---------------------------------------................-----•----•---------------------------------------------------------•----------------------•--•...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with th ro,isio MIT 5 of the State Sanitary Code—The undersigned further agrees not to place the system in er on i'ficate of Compliance has been issued by the board of health. Signe.....-••--•-••••-•••...................•-•-•-•--•-••••-•.............••••••......••• •-•••Z...... .............. p >cation Approved BY... .•-- .......".....Gr----.................................................--------•--------- --;..'.�.�' ------' --------- J Date Application Disapproved or he following reasons-----------------------------•----------------------------------------------------------------------.......------ -••••••••••••-•-•••-•••••-•---••-----••-•-•••---•-•-••-••••••-•---•••••••-----•..............•••••-••••-•----------•--•-••••-•••••••-•-•--••----••••----•-••••••••-••-••-•-••••••-'_ ......------•--- Date PermitNo----------------------------------------------------..... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................I..........OF..................................................................................... Trrtifirat e of Tompliaurr �. T S IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) �i —= �I ---.. Installer at..... ••Z --------------- --------- has been installed in accordance with the provisions of IT-!— _5e State Sanitaryo ' bed in thee. �P�67 application for Disposal Works Construction Permit No......................................... dated................................................. THE ISSUA CE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE S A GUARANTEE THAT THE SYSTEM WILL �/fjlj r- ION SATISFACTORY. rInspecto ..../...... DATE..... THE COMMON,V1[EALTH OF MASSACHUSETTS (/ v BOARD OF HEALTH OF FEE........................ �- •`►�. �t'��o �t1 ork� �oa��#riion rruti� Permission is hereby ranted --•-•14............................--------- ----=----.........-•••-••-•-•.............---- to Cat ons c ) or Repair ( an bnd� ual Sev��ag. is s System •--••••--.....---•-----• ....:............ Street ,,,_ � �r as shown on the application for Disposal Works Construction Per .............. Dated.__-a 11.......... ......... .. , �_. 40 �: - Board of Health DATE --------- ...-----.....-......--•-•----------------------------- : FORM 1255 A. M. SULKIN, INC., BOSTON ,*,; L.'OCATION SEWAGE PERMIT N0. (oi vid,6 .PILLAGE --- , _ � ,���► �Q INSTA LLER'S NAME i ADDRESS d11. �ar2�v C h S U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� ZY11t; 0� 4-n1se—, 3�` To OF /-1=oU 'P //D --- -- --- -- /08 ----- - i 105.0c) , /c / 3 - ' o � .• kl F1 H E D' TONE q4 �8 - — - -- - - ------ e x rstrnc� ground Pr-o f•r le _—e— a— o—o — P. oPosecl c�rovnd P�ofrle HOB/Z. SC,9LE / _ /O ----- `SE C T O AJ V EST Sc �9LE / � _ /O' /E")XATNEHrIO/DL E f-C3L o L V Ef2�SP PTLO/G f� B/T(.H._E//L/ /2" OF Fri//5HED GEFaL) . scHED. 40 PVC. oe FLow ECJUAL 7z:) SEPTIC �r-r,rnirnurn �" Per �oof� I'- of %6 - �2 washscf sfone ��TANk-r pk I-/" --�" —/�11 �� —//l/- - • a o 0 0 e ► • O • O e D/ST BOX (o'dra. 6" Sump o ° p e ° yam ' /OOO Gi94.. SEPT/C TAAJJK' o-IC 3�4"_/�" o ° o Wa s)"e d s-f o ne ° ° . ° • o c ° • o 0 0 0(B LEACH P/ T 10, .I a5 LDE- 5 (SAJ TEST' HOL LOG B ED,2 0 0M HOUSE DATE : - 'J-c.3 \ TEST �• �E,2C ,Qi9TE ,2 A T E - GALS./D"q Y D A TciM S E P T/c T•A/v,e x /. 5 = 4`� -`_ # TEST HOLE / 7T EST HOLE c USE- : GAL. 7i9AlkL 101 J, iq Z X\ ` \ EFF DEGTf lob 6/DEIn//9LL 1� F• �� � ) = . G P �. /� O �.. TOTAL = USE. LEF�iCH F,/ T en 'zl, T/-bQ T THE B U/L D/rt./G T' C/V � � LG � L � A- F',2oPO5ED Ow THE GA2oUn/D �95 C C._ SHO (�/ti/ OA./ T7// S PLAN DOES c0NF0,21-? T-o -r"C- BU/GD/A./G SET- TOE / ,�T�� T BACK ,2EGty/�2E/`-MEAJTS OF' THE- -TOwAJ OF - C /'/ re Az V/ L_ C.._a E D Fo,e. L_ /S O Z' Z::) Q rt1 OF Aq ERErTM. /--l0l�/A/ Z>AT� : Un.JE i 9 03 — HI xo EVEREt' lr H HINCKLEY " 4*I�a 13230� I `7�Ya L L � n L' O OO - exrStrnq e /evafron BLDG. SE7-3 / (.17 ' o O O = �` U T Pr-Opole d e /e va-Fior, E QU/ eE/�E ti/TS ►�='i +"t'' Y Fq /"7 O - - - -- -- - ex /Sung contours S / de io APP20vED : —.._ —° °-- Pro/ooSec/ confOUrS BOA2D OF HEALTH