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HomeMy WebLinkAbout0069 CAPTAIN ELLIS LANE - Health 69 CAPTIAN ELIS DRIVE.. t " HYANNIS ' '011 4 = 250° 102 , . " Q e TOWN OF BARNSTABLE LOCATION L9 SEWAGE # `,TILLAGE l-E 4 ►1 h t S ASSESSOR'S MAP & LOT GS® e/Q-) IN TALLER'S NAME&PHONE NO. Ae-10-0 L ecc SEPTIC TANK CAPACITY O O LEACHING FACILITY: (type) L( !h T, (size) NO. OF BEDROOMS -3 _ BUILDER OR OWNER PERMTTDATE: q COMPLIANCE DATE: ( ` 3" © O 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 a 7 Zs � � 1 TIN n J No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migooal *pgtem Cons tructton Vermtt Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 12/0 f 11 f Owner's Name,Address and Tel.No. Assessor's Map/Parcel cel // /�C- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. eL r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building s2 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3. 70 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank d Type of S.A.S. 9 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 411grroce 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 issue�jby t ' oar Health. q._^r Signed + � �- Date Application Approved by Date ? Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE # �?—d66 VILLAGE- 14 (4_G vi h t ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.��C L ear/ y SEPTIC TANK CAPACITY ( U O LEACHING FACILITY: (h L( ?Pe) (size) _1/ X NO. OF BEDROOMS BUILDER OR OWNER 06U r PERMITDATE: COMPLIANCE DATE: ( '( 3 " O U 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 E::• s� '� f i S D i J No. `'y y0—511/0.. -Fee J '' i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mioonl *rwm Congtruction Permit A �lication for a Permit to Construct Repair Upgrade 0Z)Abandon ❑Complete System ❑Individual Components PP> // ( ) P ( ) Pg ) ( ) P Y Po Location'Address or Lot No.to �P ' c l S 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.l! i Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other // f f. E Type of Building ��S No.of Persons Showers( ) Cafeteria( ) Other 1~+ixtures De X sign Flow gallons per day. Calculated daily flow gallons. 1, 'Plan Date Number of sheets Revision Date ` Title Size of Septic Tank 7U a Type of S.A.S. Description of Soil 0 r \ Nature of Repairs or Alterations(Answer when applicable) 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 issu by o Health. - Signed � t t B Date�� _O - Application Approved by Date `��T Application Disapproved for the following reasons Permit No. Date Issued ' -------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERY, Ze the n-site Sewage Disposal System Constructed( )Repaired( )UpgradedAbandoned( by P A t at �9 � f� T has been constru ted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 3 6 dated r �p Installer Designer A A A r4 fj � The issuance of this pe s aJl^ of be ca s rued as a guarantee that the y ate willTnctn/�as esigned. fDate Inspector Ai t�C� O ' l(�j v Not ejv-d S 3 6 Fee —————————————————————————— — Z —/v Z THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ' Migo!gal *p5tem Construction Permit Permission is hereby granted to Cons ct,( )Kepair(, )Upgrade( )Abandon( ) System located at Co 9 s 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:Conssttr�ue on must be completed within three years of the date of t ' it. (� A roved b - t� ' Date: pp y 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 P _ANS CONSTRUCTION _ s I, c L.gam.- - rn , hereby certify that the application for disposal works construction permit signed by me dated Q 0 , concerning the property located at Ze'O� l' ��ls 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. Z The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. ere are no wetlands within 100 feet of the proposed septic system 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 Zaf licable] he S.A.S.will be located with 250 feet of an vegetated wetlands the bottom of the proposed y b P P 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 +the MAX. High G.W. Adjustment. = Q DIFFERENCE BETWEEN A and B , t SIGNED : DATE: [Please SketA proposed plan of system o ack]. 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 ,_ram �-. _� `,-� �. �� 0 .� 1 �� (\Q� _] Lb'C QT I O N 5EW o C;E PERMIT M o. C-ag Ih1STNLL.ER• I.l&ME ADDRESS _<°a 1137- _ _7 7s= /3 BUILDER 'S Q &MF- ADDRESS Q -13 Y-F-F DNTE PERMIT 155UED DATE COMPLI &MCE ISSUED : `� �-- � � � a �.. W � � � �_..�� NO.........z 1't FE, ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA%," I ' o u/In..... .---.OF... ...-.. � .......................... Appliratinn -for BiipnStt1 Works Tonitrnrtion P.erntit Application is hereby made for a Permit to Co struct ( ) or Repair ( ) an Individual Sewage Disposal Sysra, -- --- - -- ---- Loca i dress / or No. t --- ------•. -----.... .. - ............................. W Ow p $ Add ess ................... .... ............�!� ��k!�.0. . ...................... �! • ..---•--••--------•-------- -}...........use Installer Address Type of Building Size Lot............................Sq.9), Dwelling—No. of Bedrooms------v�---------------------------------Expansion Attic ( ) Garbage Grinder p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria WDesign Flow Other 6.7 ......__....__gallons per person per day. Total daily flow............ .!l' _ __.-.-gallons. WSeptic Tank Liquid capacity`00_._._galions Length---------------- Width................ Diameter---------------- Depth._..-_--_-.-.._ x Disposal Trench—No. .................... Width._.._._____.________ o ength_----__-__-_-.k.. Total leaching area--------------------sq. ft. Seepage Pit No. ' Diameter..._.�1�'�..... . th`�e ....... .._ otal leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) r1�• �t° aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.__.--____-.-_.__.--_- �14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.__.-.._---.-_-__..__- R; I O Descri ion of Soi ...._.. .___._..-4—AZ tts_._ _ 7 ______.___ Z--- - - U ------- �J-G,Sna ��" eE'e: h�.{'11i( -�-------------------- UW ---------------- -�----- Nature of Repairs or Alterations when applicable----------------------------------------------------------------------------------------------- ------------------------ -----------------------•--------- ----------------------------------------------------------------------------------------------------------------------------------------------- --------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been Jssued by the ealth. ign ._ — .......•....._... - Date Application Approved By--..... -• ..... .. � -------------- �--....- 7 Date Application Disapproved for the following reasons:.................................. ............................................................................. ------------------------•---•---•---•----------------------------.--•-----=------------•---•--••-•--•------•--•---.----•--•--------•-------------------------•-•----------.---•------------------------- Date PermitNo......................................................... Issued-------------------------------........................ Date at Finc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ........ Z!/l7............OF........... 0 Appliratinn -fur Bi.ipnnttl Workii Tomitrurtinn Vrrntit r� Application is hereby*made for a Permit to Co struct ( ) or�Repair ( ) an Individual Sewage Disposal ----------------------- ----•-----------------------------------••-----•--•---..•-•--- ocati •: dress /� ♦ 0 or Lo "o. ,��,/ / Cv Own r _ / U—�tiL 1" t+r..Add esy s ......._..-•-•- -•-•-•---•-•----------------------------••----. ..-�---- [��--... ..--�-•--•--....--•-•------- Installer Address UType of Building Size Lot----------------------------Sq. fee Dwelling—No. of Bedrooms-------�� -------------------------------Expansion Attic ( ) Garbage Grinder Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fi. tures, g t// P P P Y Y g W Design flow. ........... : ....51___ .gallons er erson er da Total loll flow__.__.._.... �'"��..___....._._._ Mons. WSeptic Tank Liquid capacity�CO©gallons Length---------------- Width................ Diameter---------------- Deptli-......-___-_. x Disposal Trench—No- -------------------- Width--- Zot ength................. leaching area--------------------sq. ft. Seepage Pit No---- ---- _lDiameter......,L`�`o_ tlh e o e1.,1 1�'�__ otal leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank 7e aPercolation Test Results 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.............__.-------- Q+' -------------------------_--'-------- ' ------•---- ------------------------------ Descri tion of Soi =f Z2 I-J r / t `- = 1� = ..0 `4 l = i- -------------- m...... - -L- '.ld/ _ _.C° � %�-------------------- W _ VNature of Repairs or Alterations—Aner when applicable._.__-----__________________________________________________________________________________- ----------------------------------------------------- -------------------------------------------------------- ------------------------------------------------------------------- -------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the bua ealtli. Signe ----------------- •--•----�`-"",�•------- � ate Application Approved BY------- --......��... L P ...-- _C.--- - -- - ------------- Date Application Disapproved for the following reasons:--•-••------------------------ --•------.....--------------•-----•- --•-------•-••............---- ...................................................................................................................................... ------------------------•------.--------------------•------------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALT . . ...OF............ . ... ...�.. .. .. Trrtifiratr of Tomplinnrr THIS IS,-T, CE� .'lIFY, hat the I' vidual Sewage Disposal System constructed ( ) or Repaired ( ) by.....` <_ <���^• - -- --------------- ---------- --------------------------------•---------------. (J Instal)�r at.. ^ - v has been installed in accordance"with the provisions of _<\ %1 NI of -f l,4 State Sanitary Code as described •n the application for Disposal Works Construction Permit No._ Z�c . dated_------l_-_-- .�. .-�......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUf ,CJION SATISFACTORY. DATE........... ---------- ".'-- -----------•---•------------• Inspector---- .`_.. ............................... THE COMMONWEALTH OF MASSACHUSETTS 7 / BOARD OF EALTH No........... FEE... v ...... i� u �t1 k IT n rtiu$t �rmit Permission Weby granted____ ________ ------ �7...-•-----••-•------••----•-••---------- to Con str 't , or e�pair (��) ar n 'v' uai Sewa isposal System l at No..� �---- Ul ° -�-- (/ ----. ------ � Street �A as shown on the application for Disposal Works Construction Permit No. - Dated___ ---- - ----•-------- _ i �— -�-------------•--------------•-------- Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ass 7-.e, Vr-'^7-i 0__._____.__-__ To I/I4 SS. Er V/YVn MC'y►7cL , 7 '- /DDo 9G! rf,c -TawA e U ,' -tf-0� �o1�- 3 / 7. 36 /D7. (o " C,'-4 ,Ir. ZE-Z1 / S 4 PLAN ®F LAND ! 0 L 00. Y� i� 144,,A1.,'5-r19a MASS. OWNED 6Y *`tr OF Mqs ` i.�1h OF' FRANK CONERY 5 TRENTON ST. FRANK ��� �F/ FRANK HYANNIS, MASS. 02601 CONERY N I C7 CONERY REoisTcHrm ttity R a LAND su�evFVnR p No. 6232 p No. 6573 v SCALE t IN =241 FT- 144y 7, /,974 Sl!10E16Rp.�c�c� r