HomeMy WebLinkAbout0032 WHIDAH WAY - Health 32 Whidah Way
Centerville
A = 230 193
No. 42101/3 ORA
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1000
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No. R p Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIppYication for Migpool *potent Construction Permit
Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. 3 Z w�t�Ay f �,vA-v� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 3-o 101 3 e �f; 1 1� �/�-i/ ( /4s f}-3 S,4
Installer's Name,Address,and Tel.No. V I ) Designer's Name,Address and Tel.No.
d �2(� S A•,rE11A,.,� SQ Svc c e N� v a C c-e^.,L.7 ee
13a k 144 Z €6-eSTd<(2 c�2 S�rc�
�3;3 2/'7-7
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building Se 11- 2 No.of Persons Showers( Cafeteria( )
Other Fixtures
Design Flow �3 U gallons per day. Calculated daily flow Y 2 (' S�2 gallons.
Plan Date Number of sheets / Revision Date /10 ke-2
Title
Size of Septic Tank /ao !1 4llo.v Type of S.A.S. ZS 36a C4,,+vcr 6-0, p
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �Q D140- :e
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 d by t is Boar of Health.
Application Approved bytYDa e 1 Jr U
Application Disapproved for the following reason
r Prmit No. `� Date Issued d
4 '
pw / Fee -
No. ,a. ,r
THE COMMONWEALTH OF MASSACHUSETTTS Entered in computer: Yes
f
PU -LIG.HEALTH DIVISION - TOWN OFaBARNSTABLE, MASSACHUSETTS
0[ppficati, fo Miopaal *pztem Construction Permit
Application for a Permit to Cons= )Rep" ' )Upgrade( )Abandon( ) ❑Complete System Individual Components
Location Address or Lot No. 3 Z wk(J A if Owner's ame,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name Address and Tel.No.
r�/�c.
[/1 c 3 2 0 7
Za(O
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building l^'S e FA`t*� No. of Persons Showers( ) Cafeteria( ) �`
Other Fixtures
'tDesign Flow 33 U gallons per day. Calculated daily flow (� Z gallons.
Plan Date ' S /"°Y Number of sheets Revision Date
Title `
Size of Septic Tank o X Flo w Type of S.A.S.
u.°*Description of'Soil re
r '
i
Nature of Repairs or Alterations(Answer when applicable) lle C '/4 Q -e-
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 is by t ' B of Health.
Sign d Date
Application Approved by Date
Application Disapproved for the following reasons;
p � yd
Permit No. %�►�'� Date Issued
____ r __________________
t THE'COMMONWEALTH OF
'd•�„�,�'� . ' MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
' Certificate of Compliance
THIS IS TO CERTIFY,that ih�On-si Sewage Disposal System Constructed ( )Repaired(,(� ) Upgraded( )
Aban ned( )by �o�5 2 /c( J'al f 4� s2 icii c e /VCt
at e ' f� P`y _ has been constructed in accordance,
with the provisions of Title 5 aj the or Disposal System Construction Pem-gt No. ` Z5 V dated �I9��
Installer ,C30 r 5 j. �/c✓ �i 7` �y,J�.. .<< -Designer Lie ' r
The issuance of thi p rtit shall not be construed as a guarantee that the systt m-i.`t�� signed.
Date r 12 bb� Inspector T
No. -----------------------k.——;—Fee
- r
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
_ Migo5a[ *pztem Construction Permit
Permission is hereby, anted to Construct( )Repair(k' Upgrade,( Abandon( )
System located at Lq� (N�'D4 it �J /
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 conditio-nss'.'�.,
Provided:Construction must be completed within three years of the da a of f this pe -t
Date: 5 ` U L� Approved by
BRETT ELL'IS"' `''. ti` COMPLETE TITLEryV
PRESIDENT ;- DESIGN,&'INSTALLATION.',?
t - GENERAL EXCAVA_TION
CELLAR.HOLES.:., "=
cSan
�a¢t, eSE¢vjL �ae.
1.4 C JAN SEBASTIAN WAY
P.O.BOX 492
}FORESTDALE,MA`J2644 1 800-649 2010;,,-
508-888-2010`
TOWN OF BARNSTABLE (�
LOCATION �� �r (l�/ SEWAGE
VILLAGE - Oyr �l — ASSESSOR'S MAP & LOT R3U ,-P3
INSTALLER'S NAME&PHONE NO.&u&61' (Id FiFf 2-616
SEPTIC TANK CAPACITY, - 100® -e x c
LEACHING FACILITY: (type) �� U �' 1d1v� a S(size) 13 X 2--f 2—
NO.OF BEDROOMS 3
BUILDER OR OWNER fTGc re C- S S� S `�-
PERMITDATE: 5--Nr 1 D W COMPLIANCE DATE: 4`
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
b4AA.
f
TOWN OF BARNSTABLE
LOCATION ��' r� � ' (n/�. SEWAGE #O?OOV"!
VILLAGE �' !lam- ASSESSOR'S MAP & LOT E3d (_P 3
INSTALLER'S NAME&PHONE NO. u&47 k
SEPTIC TANK CAPACrN 100o -4e S 1-(,n
LEACHING FACILrrY: (type) _J �C, C ( r S'(size) 2-
NO. OF BEDROOMS 3
w
BUILDER OR OWNER
PERMTTDATE: Lf 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) 4 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist k/44
within 300 feet of leaching facility) Feet
Furnished by
w
'i
Town of Barnstable
dFTME Regulatory Services
Thomas F.Geiler,Director
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601 f.
Fax: 508-790-6304
Office: 508-862-4644
Installer&Designer Certification Form
Date:
Installer: I�b 'one
Designer: 1
Address: S2 v✓�c 2 Address: 60 Y— 2
—
Wi CA
On J (�I ���{ gv was issued a permit to install a
(date) (installer).
r ` .�� f g based on-a-design dr-awn-by-
septic system at-, /tJ a- Vl
(/naddress)
V dated
/ (designer)
I 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.
I certify that the septic system referenced above was installed with major chang orient
greater than 10, lateral relocation of the SAS or any vertical relocation of any comp
of the septic system)but in accordance with State&Local Regulations. Plan revision or
certified as built by designer to follow. � �� '
f
lees Signature) 1 7 Y+
(17esignu' i Signature) (Affix Designer's Stamp Here)
pLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIAr10E WII,L NOT BE I$ARNSTABLE UBLICHEALTH DDIVISION.
BUILT CARD ARE RECEIVED BY THE
THANK YOU.
Q:Healtb/Septic/Designer Certification Form
e,,5 1iJ
L0 -CA �ON � SEWAGE PERMIT N0.
VILLAGE
INSTALLER'S NAME & A'DDRESS
I UsILDER OR OWNER
'CIA �r C
cal, r
DATE PERMIT ISSUED 25
DATE COMPLIANCE ISSUED
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No..... 7 Fss -� ......
THE COMMONWEALTH OF MASSACHUSETTS
—, BOARD qF HEA
. .... ...............OF..... .... �.fS... /.
Appliration for Dhgvvii ai Workii (foutitrurtiun rumit
Application is hejeby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at:, "`. ...../ , /,1!�AA....../ , l/
nl. f,---
.........................................
... .......Location- dress or Lot o.
P
�..... .cam .... . ...- .!..__r-...%To....-.C�. 1....�r.l�La.. ............
Owner Address
------------•--•--....... . .................. -•--------
Installer Address
Type of Building -'$ Size Lot.�J .SS `..Sq. feet
aDwelling—No. of Bedrooms_-__.....sJ______________________________Expansion Attic Garbage Grinder ,(i!®
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtur
•-•• . .................•-----•------------.----..
W Design Flow_____......%,. :...................gallons per person per day. Total daily flow...... 20. ....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.
Other Distribution box Dos inj �J i
'-' Percolation Test Results ) Performed b ! -.'/&' .. _ �� /���
Y •-- �l!� __t Date. ...... .
Test Pit No. � 5.rr��minutes per inch Depth of'Test Pit.- /A/)�y r.... Depth o ground water.._._�j
LL, Test Pit No. {hCJ4tiinutes per inch Depth of Test Pit..F `:_______. Depth to ground water.__
a ...—•-•--- ............................. ' ---- _
O Description of Soil------ --
�_ .. .................... --�•-•----•------------•-•---......_...
.._:...�®c ...... �'-�-7°-� .ve--------------------------------------
�., --
x .....................................�--^.CP------- a�
U Nature of Repairs or Alterations—Answer when applicable.........................................................:..::.................................
f
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 hasAbDee . ued by the o dof health.
Signed. .---Application Approved By.....-••-•---•--••ring
.. ..•.. ---- ................................ ...
Date
Application Disapproved for the f o toasons:-----•--------------------------------------------------------------------------------•------a.t e............_
--------------------------------------------------------•-----------------------....------------.....------•--•••----••---•-••••••••••-•-••••••....--•--•-•••••••••••-----------•••••-----•--••.....----
Date
PermitNo......................................................... Issued_.......................................................
Date
n
""� 7 t. w 'F�s � .No.... 0�'
._ .. ....._
THE COMMONWEALTH OF MASSACHUSETTS 1 °r
BOARD HE T
C
AV;1liratiun fur Diipnoul Works Tonstrurtion r0mit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Systenj at:/
-----------------------0.................. - -----U�5... .........(I e c.......................................
�,/�`+' j location- ressLo
-• f-le e(el I:��::r.. .'.._...�� s!j _• ...................... r..��`t _.._..C1 01 f lw - jc....
..._.....
eJJ
' Ow et Address
a .........�- ----•--- .. ---------= ------------•----•--...--- ................ .... ....................................................
Installer Address
Type of Building '". Size Lot._4 �tq5 a.Sq. feet
a Dwelling—No. of Bedrooms...........
r?:.............................Expansion-Attic (114 Garbage Grinder �I(C)
a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fi, turs, ......... -
W Design Flow............ ....:. ....................gallons per person per day. Total daily flow...... ...................gallons.
WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................
xDisposal Trench—No. .................... Width.................... Total Length:.........:........ Total leaching area....................sq. ft.
3 Seepage Pit No............:....._ Diameter.................... Depth below inlet.................... Total leaching area..........I........sq. ft.
Z Other Distribution box ( ) Dosing ,�
a Percolation Test Results Performed by.. :..... ' .. ,.. .� ......... ......... Date...............
Test Pit No. 1 , 5 inutes per inch Depth of`Test Pit �... Depth o ground water...._.
4s Test Pit No ._�_�3.-�c inutes per inch Depth of Test Pit .�........ Depth-to ground water.... '...
- v .... .....................................
0 Description of Soil... 4��; .... S�3f
,f
U .............................. -•------.--••-
3 CA
U 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 TIT LE 5 of the State Sanitary Code—'.'The undersigned further agrees not to place the syst m in
operation until a Certificate of Compliance has bee sued by the d Qf health.
Signed ... ...............3.... * - _....
Application Approved By.................. . .... ... __
Date
Date
Application Disapproved for the f of ng reasons---------------••-------.............---•-------....-------------------------•--------------.........._....._.._
...........................................................•--.....-----------•-•--••••---...... ---••••-••-- ............•.. -•------.............................. .Date..........._
PermitNo..................................................._.._ Issued......................................................
-
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f
.........O F..... ....................... :
........ ......
Trrtifira ,orf Tuntplittnrr
Ty IS TO C IFY, That a Individual Sewage Disposal System constructed ( '` or Repaired ( )
by. r +
at.. + ..Cam... ... l.. ,�.............................................
has been installed in accordance with the provisiod of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..--.. -- " r_ ..__....... 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 0-9 HEALTH
No.... FEz......%., ............
Dispos Works9trnsl r ptt rrrmit
Permission is herebygranted.....:- .: " cc
0
------•--•- ..--•................•-•-------•........----...................•-----•--..................._.... .
to ConstrWt ( Red ' ( ) a Indro�du Sewage Dis oSal stem
at No.....C9--... W.4i t +� --- � ��'t 1 l?Q t�� ............................. ..........
...................................... ...
Street
as shown on the application for Disposal,Works Construction Permit No...�.�.�5 . Dated..........................................
PP P ,
..
�M`
-•------------------------•-•-..... -k..? ........._
DATE........... `'W .. � �4 �....................... Board of-Health
FORM 1255 A. M. SULKIN, INC.. BOSTON n
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$a �XTINA7 SPOT:, ELEVATION 0x0 / CERTIFIED PLAT PLANy
t p `�XIST.IN® `CONTOUR .---'.0 /
:� "118HE4 SPOT ELEVATION + (� \ �a.�t,�/
1E0 -CO N TO U R ----- 0 --�--- a. `:_�.- -- _ - e'E/�/T l•'�)L
{location, of any ,pxis'ting ;under:ound sewerage,
arsoth��,:.utilit�es>"shown on tr,is .plans appxoxr I ,s � `t z�A9k S A. 1��
`determined `from. records+ and%or verbai
The contractor is. responsible for theR�vis�o cl #J'
6' S.
ofi.-ihe exista.4ocations,:ini the field. . SCALE •'' � DATE
v. ,
�RE�G►E :ENf3IN�EERIAI@ CC�t IN G�,IENT:�.�.,,,_ I CERTIFY THAT THE PROPOSED{
t ;�_ J �. Q�'I BUILDING SHOWN ON THIS PLAN
} Iti1S'fR� RE019TERED OR NO,
'} .' �,q CONFORMS TO THE ZONING LAWS ,.
�' � 4 DR..BY " - OF BARNSTAB Es .
MAS
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/1/: PITCH
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S.Ef�T/C T.4 NK oX • • a i s' • • • + .•• •
18 •
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.� _ i, e • • • • • • i I.• • a
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. s--r . ' P. PRECAS r SS=�6E
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m &L EYAT/OIV S
/NY,ERT AT Bl!/LD/NG 4 G_b FT
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` 1JVLE7 .STEPTiG `T.4/VK 4s�. fT. _ E s
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/o fT O%i4lyf C��
4
L4 TJ N
OIJTtFT.SEPT/C TANK Cr
!/VLFT D/STR/EL?/ON BOX a`�5.4-FT SECT/ON, 4F GROL/NO MG9TE� T/�LE
! ;��/TLETD/STR/ tJy70N box `/S
SE•Iy GE DISPOSAL EY.STEA? TAX14ATION
INLET tEACN/NG p/TSd fT.
L EACH/NG Ia/T
DlMEN.StOAF A 3
.MALE.: 314' _ 1`-0� 6 .. .
D.E'S19;Al CR/TENIA o/M,�+vsta/v a t r•
� .N!/tl1TER Of. SEDr?OOMS 3 `
rtRBAGED/SPOSAL CtwirN_E SO/L BOG S•O!L TEST
TOTAl. OJT/M/4'rED FLOPS/ 33 y G.4L.pAy SOJL 7EST A/ . SO/L TEST P
VuMaEJP G►� 1.�AC1V/NG P/TS E[�Y. 4� D ELArko OATS OF SO/L T'EST S� I ��
_i/D/E L•�ACHING R�R..P/T Sf.,: FT. z RESULTS 1y/TNESSED JYPAJ GvJ.�C ter✓
i
JaTTO/+!1Fa•�CX/NG p1�R PIT �� a _ 2 PERCO,4AIWOlV I�ATlf / L.Ess M/Jry INCH
s . 7-07AL .4EACNlh'G AREA �—�So' FT. Svc o1L FWkC0L.AT10N RATE�2 TNT NMIH.f INCf!
?E3ER 'E,4CtIIN6 A'?E^ 6 5 f T Z "4
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No �� 7 7/ I -sr AV MA S
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rG 'i' cad ��sfGrs' °v� ��^ L. 3-S•Q 2 MAN a -Xy
JAL � ?iD S� TER OWC00417-EIeE1 t�/ENT" ? a BTz���R.tT. • b.. �
t� No G RovNOkyA
/(�/� QRO[JA/O y A7,--R..�T EL EY. JO®
ASSESSORS MAP :-- Z __ - -------- --
�
' T E S i HOLE LOGS
�'�� PARC
� EL :
FLOOD ZONE: , _._ _ ' C�_ .1 _.. _— SOIL EVALUATOR :�` �� �, '�-� G� ., NOTES:
,.-- WITNESS : 51-
T REFERENCE: _- - - ._.`_1 =�_. '' 7i'( --- - DATE: P=') �-. \
�-- PERCOLATION RATE::^ -- l+v�� ( 1) The installation shall comply with Title V and Town of Barnstable Board of
Health Regulations.
r�
2) The installer shall verify the location of utilities, sewer inverts and septic
3 TH- 1 - TH 2 components prior to installation.
3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot.
(7 2• 4) This plan is not to be utilized for property line determination nor any other
purpose other than the proposed system installation.
�Jl' ��p , _._. 5) All septic components must meet Title V specifications.
OCAT ON MAP � 6) Parking shall not be constructed over H10 septic components.
�'�' -- 7 The property is bounded b r
p p y y property corners and property lines as depicted.
Y�1 p
8) The property owner shall review design considerations to approve of total
number of bedrooms to be considered for design. Receipt of payment for the
plan and installation based on the plan shall be deemed approval of the
( number of bedrooms.
9) The existing leach pits shall be pumped and backfilled per Title V
Abandonment Procedures.
r17. U� t �. 10)P or provide S P g
roposed leaching is to be within 36 inches of rade ide venting or cut
grade as permitted by the Board of Health.
1 11)System components to be 10 feet from water line.
/��', 07 SEPT I C SYS:i~EM DES I GN
r �0 I�itr�, ,\ FLOW ES"7 1 MA T E
I� O 0 5 .BED" OOMS AT L�O GAL/DAY/BEDROOM -RFD GAL/DAY
-- __ -- SEPTIC I ANK
�Ir — �3 GA,'_/DAY x 2 DAYS - CAL a
USE L 3-2; >LLON SEPTIC TANK
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