HomeMy WebLinkAbout0076 CANTERBURY CIRCLE - Health 76 CANTERBURY CIRCLE
HYANNIS
A = 249 120
TOWN OF BARNSTABLE
LOCATION 76 CG&N `er Duals Gmc.� SEWAGE#e2 /nL- 7,6
VILLAGE ' 1 r t%A,V(,;1,5 ASSESSOR'S MAP & LOT Z Y�440
INSTALLER'S NAME&PHONE NO. i '�t�✓ ��C
SEPTIC TANK CAPACITY ��I 1 a 1, AO D
LEACHING FACILITY: (type) a1A-(A\C--i (size)
NO. OF BEDROOMS
BUILDER OR OWNER �i�-
(d
PERMITDATE: Z _ �'0 COMPLIANCE DATE: Z- I 0 I
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
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Mtgogar bpgtem Con.5tructton Vertu
Application for a Pemut to Construct( )Repair(V)Upgrade( )Abandon( ) O Complete System individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
KTer c,4 C��G
11 Assessor's Map/Parcel � l l� —Do �K.oLI U X-1 0
Incr�s Name,Address,an el.No. Designer's Name,Address and Tel.No.
J ova S Sv�CO
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow J gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1� 6-%t_,ci tiL�" � Type of S.A.S. Ca OAnT4Z_W L
P
Descri tion of Soil 5
Nature of Repairs or Alterations(Answ r when applicable)�"�4 ` � V ',V A,
�✓ ��`["(`�C (l v�(N 1)lfld�or(1�� �
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 vironmental Code and not to place the system in operation until a Certifi-
cate of Compliance has bee o ealth.
Signed Date
Application Approved by Date Z O
Application Disapproved for the following reas s
Permit No. '�'ZNy [e 6_7 Date Issued
TOWN OF BARNSTABLE
LOCATION SEWAGE #,% r�C
VILLAGE l ri, w ct� S ASSESSOR'S MAP &_LOT ZYC .
INSTALLER'S NAME&PHONE NO._- �rta✓ �,`��
SEPTIC TANK CAPACITY
. LEACHING FACILITY: (type) J� L��rq=TltGt (size)
NO. OF BEDROOMS
BUILDER OR OWNERd� t( ld
PERMITDATE Z �� ( 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 leaclung'facility)'
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300..feet,of leachingfacility) Feet
_
I ,
Furnished by
s;
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�: 4L A 3S
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No. /!/�`�.�— Fee S�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEi MASSACHUSETTS
Application for lk5pogar *pgtem Construction Permit
Application for a Permit to Construct( )Repair( vj Upgrade( )Abandon( ) ❑Complete System [Individual Components
Location Address or Lot No. CA KTc r.L f iC_'`JC(P_ Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Ipallees Name,Address,an�., �No.� Designer's Name,Address and Tel.No.
V.
1 J `UvI C, S►V���-- ay C1v."U_'t S
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures `t
Design Flow 3-30 gallons per day. Calculated daily flow —13 't. gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank ,u, sc01)C_-Ta MA.,_ Type of S.A.S. �^,"� c �� (�c< ,(Jlir j"I xC AC,
Description of Soil V X� U
Nature of Repaiirs_or Alterations(Answ r when applicable)�"1� �(i � t k(lC 1� �t t��i Ct~C V
2V 5%1 -.-S A,�Z IS'(
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 AthheEEronmental Code and not to place the system in operation until a Certifi-
cate of Compliance has beer slued-by-t�i . ealth.
Signed i Date
Application Approved by t Date OF
Z O
Application Disapproved for the following reaso s
Permit No. 6 Date Issued "Z O
-----------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CER�TI hat he On-site SewDispo al Syst m Constructed( )Repaired( )Upgraded
Abandoned( )by o r' S—,
at t 2 l mac_�_�
- C,_jiA A S has been constructed in accordance
with the provisions of Title 5 and the for Disposal 9,Tstem Construction Permit No. 76 dated Z
Installer Designer
The issuance of this perrpit shall not be construed as a guarantee that the syste^nw,*11 fu io as,, lesiigned.
Date / � Inspector ` �" `�7
No. C.AV G /.,t� -- -------------Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
�Di5po5a[ *p6tem Construction Permit
Permission is hereby granted to Construct( )Repair( V)Upgrade( )Abandon( )
System located at —7 G4_ c,,2h ir—\ CG-� a4i h t,
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 I t b completed within three years of the date of this Date: Z d Approved by
d
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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)
I� P �`s�S , hereby certify that the application for disposal works
construction permit signed by me dated o1-�-p , concerning the
property located at "](e C—tq&7�150buv, �yL:\�,-- meets all of the
following criteria:
vThis 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
-4 There are no private wells within 150 feet of the proposed septic system
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..[Adjust 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)
B) G.W. Elevation IM +the MAX. High G.W. Adjustment . 3.6
DIFFERENCE BETWEEN A and B 3 s
SIGNED-.,_ DATE: —O
[Please Sketch VT 6ed plan of system on ack].
NOTICE
Based upon the above information, a repair permit,wi11 be issued for bedrooms maximum. No
additional bedrooms are authorized in the future without engineered septic system plans.
q:health folder:cent
Town of Barnstable Geographic I?riorrna'.ion System May 6, 2016
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DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:249 Parcel: 120
boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:FATER,GREGORY&LARISA Total Assessed Value:$271600 Selected Parcel
1'=100'may not meet established map accuracy standards. The parcel lines on this map
are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.29 acres Abutters W ;.
boundaries and do not represent accurate relationships to physical features on the map Location:76 CANTERBURY CIRCLE
such as building locations. Buff
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-II 2y (10 ---........ .OF...........................................................................-----------.--
Appliraiion fair 4%ipaaual Workii Tuntitrur#ivn rrrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst a --C � --
.... ...--- .. ----------------------------•-•-•....._.--
Location-Add i or Lot No.
Owner Address kv
............ ..... ..C6d� .-:.� r�L.. :. .�C!................. ............._..................:..e" � �
I tallerAddress
U Type of Building- � Size Lot...� .....Sq. feet
Dwelling—No. of Bedrooms................c,,d......._....._...._...._ExpansionAttic ( ) Garbage Grinder ( )
A4 Other—Type of Building ---------------------------- No. of persons...--- ..... Showers Cafeteria ( )
Q' Other fixt s . -----......
Q ---------------------------------------------------------------- ---- ----
w Design Flow................. .. ................gallons per person per day. Total daily flow.......
gallons.
��"
Septic Tank—Liquid capacity- gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Widthg
d—Alepth
. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.._� . Diameter__-
below inlet.................... Total leaching area._._____..._._....sq. ft.
Z Other Distribution box ( -- tank ( )
aPercolation 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........................
W ............teww
. ................. . -• T---•-----------•-•-----------------------•-•-•------..--_--------•-----.ODescription of Soil--------------------•-- --------(. -.--------------....---------------------------------------------------
x
w
UNature 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 Article YI of the State Sanitary Cod —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been sued by the board of h - the
Signed.----- .......
' Date
ApplicationApproved By---------------------------------- -- --- ........................................................ ........................................
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------•-----. ......
..................•--•------•--------------------------------.....--------------------•-••------------.....:----------....----------------------------
/ Date-
Permit No...................................... Issued--3_
Date
---------------
N®.. v_ f ►-.-• Fri$............................_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OR HEALTH
...... ................ OF
Appltratton for Disposal Works Tottotrurtton Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
...... - ...................... _
a Location 1ddress r o ..
R 1 rr f r Lot No /
..`". ....... .... � ... `? .......,F.. ..... . .t......,ra ' ,1 c.:.�. +x
9�vnet J e? Address
...... c... t.X.a€? .. ;,..?. t:a...,.., :!............... ..��:..F' ��. .......................
n..,, Ipst4ller .- } Address r
U Type of Building '. ' , ",; Size Lot :ram„ ....Sq. feet
Dwelling—No. of Bedrooms ....... ; ...... ................Expansion,%Attic✓ ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.......s,:_=? ........ Showers ( ')�= Cafeteria ( )
Otherfixtures .•. -------------•---•------•-•-•----.-•------•--••-----------------------------...._.
W Design Flow........ `; `.....t 3 ^tgallons per person per day. Total daily flow........; ......................gallons.
WSeptic Tank—Liquid capacity.:_.. :_-:gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No. .................. Width ......... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.._.;_ ':` _,. Diameter_._,',',Y f._. b"v p g q•e th below inlet.................... Total leaching area.._...............s ft.
Z Other Distribution box ( aj"" Dosing tank ( )
aPercolation Test Results k Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.______________--_____
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-__-_-----_--_-___-.
Pr' ' .........................................................................
Descriptionof Soil. . ......... .... .... ................. .•...--• -•-----------•--------------•-------•--••--•---•----•-----•....................
x
V -••------•----•-----••••-•---•---.......--••-•-•---...-••---••--•••------------------••--•--•-------------•-•-------------•---•---•-•-•-•..............•----...-•-•-------
W
•------------------------------ ------------------------------------•-------------•-••..............-------•-------------_...._...-•-------------......................................................
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
---------------------------------------------------------•-•----.....----------------..........,,.,,,---•--••----••--•---•--------------•----•------•----•-•------------........-•--•-•-•--.......------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance witli
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 been4sued by the board of,health:
Signed.
0 fy..,. Date # .
Application Approved By................................. f-%.......
Date
Application Disapproved for the following reasons:---•-----------------•---•--•---•---.....-----••---.._..........-••-•-.......-•-•---•------•--•----•--•--....---
-••-••--•-------------"-•--.........--•--....----•-------......---------------•-••--•--.....------------------------.......-•---------------------•-----------...--------------•-•-•-•-•- .........
Date
PermitNo......................................................... Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF�IHEALTH �A q;
7
s>"" wi OF
`.- ............. ...yw..- .wu.. ..... ...... .....,e,......
�., Ta ttftratr of Toutphatta
THIS TO GTIF ,1 hat the Individual Sewage Disposal System constructed ( or Repaired ( )
- ;
„ .....................................................
+ .,,Installer
at. . ......... ....... :..._. ,__.... ...,: rK_ _ s"� .1_�_� ..................................................
has been installed in accordance with the provisions of Arti+le X1 of The State Sanitary Code s descr7bedn the
application for Disposal Works Construction Permit No_______ _______- _ . .__. ..___ dated.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTh THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................�..`/_E��. ................................... Inspector..-----.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
T, .
No.... f.i...... FEE...•...................ly'r�
X
t to Ft "x' onstrurtion Fautit
Permissions hereby granted.....-_. . j G
to Construe ) or Repair ( ) an Ir�divi4ual Sewage Disposal jS�ypte e,
--..........at No........ .. ` �"CC
......................... ..................... .....................................................
Street y -�
as shown on the application for Disposal Works Construction Permit No......................... Dated..... ` "
eft rn
board of Il.calth
DATE....... ? .. . '
FORM 1255 �•AOBBS & WARREN. INC., PUBLISHERS