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HomeMy WebLinkAbout0070 HOMEPORT DRIVE - Health E70 r HOMEPORT DRIVE, HYANNIS A = 7 I I TOWN OF BARNSTABLE . LOCATION 70 ,r"o9grZ 06— SEWAGE # y V iLLAGE ���d�� ASSESSOR'S MAP & LOT2 J< INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /SUd (aN L LEACHING FACILITY: (typel&eIx,,71w) ('/ —(size) 1,11'X 30.X2# NO.OF BEDROOMS 'S BUILDER O O R PERMTTDATE: /•� 7 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) ��� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) )q Feet Furnished by /5ar' - � i O t � s, � w -,.., 4 : g. _'"'-- - No. � Fee v,f r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for 30igoaf *pztem Construction Permit Application for a Permit to Construct( )Repair(p/)Upgrade( )Abandon( ) 0�t omplete System ❑Individual Components Location Address or Lot No. �® 1"e� Owner's Nam ,Address and Tel.No. arm �h e, Assess�2or's jvla /Par/v Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: 77 Dwelling No.of Bedrooms�V Lot Size sq.ft. Garbage Grinder(_-410 Other Type of Building A&57yeWA5No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L gallons per day. Calculated daily flow v7 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) 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 oard o He lth. Signed Date Application Approved by - Date Application Disapproved for the following reasons Permit No. Date Issued . :'�i' �. , _ • . .v ..y ..Yy -.are. =,s/�'�-+A-,Y+wwtS..t"4 rrfl..+l. - -/°` 9� ,gip _ No � . - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered.in computer: Yes `'PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE., MASSACHUSETTS ZippYtcatton for Migpool *patent Congtructton Permit s Application for a Permit to Construct( )Repair( /Upgrade( )Abandon( ) DKomplete System EJ Individual Components . Location Address or Lot No. Owner's Name Address and Tel.N e. o. N Add rM 70 Assessor's a arcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms DD Lot Size sq.ft. Garbage Grinder( � Other Type of Building of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow / gallons per day. Calculated daily flow 3.3 e9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / ®d Type of S.A.S. e4" z; Description of Soil /V' '41.0 X Z Nature of Repairs or Alterations(Answer when applicable) 7—/2L1C 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 Application Approved byn2��eaDate /.? Y�f' Application Disapproved for the following reasons Permit No. 4W Date Issued --------D-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Comphance THIS IS TO CERTIFY, that the On-site a Sewa Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by �/- O 4Df7,S 7 at /j'I /" i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o � !dated Z0- Installer Designer The issuance ofthis permit shall not be ons ed as a guarantee that the sys 11 function as desrignede Date d am" G /^ Inspector1 .�, �-~7 Lg�� No. --�------------------- O� JZ� Fee , —d/mac THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ]0i5po5a1 *pgtem Con6tructton Verntit Permission is hereby granted to Construct( )Repair( f�Upgrade( )Abandon( ) System located at • ® lleRe 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:Constrssuc�tion must be completed within three years of the date of this`p 1 !t Date: 4.447 —Approved b 1� ���ll� o. i ! 1/"9 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) L k)61 X- ;,7. AVAlA//hereby certify that the application for disposal works l I construction permit signed by me dated /Z�2Zl/�9 , concerning the property located at 729 eAA9Wz 17- (600l': ��p�. -5meets all of the following criteria: W The failed system is connected to a residential dwelling only. There are no commercial or business s associated with the dwelling. Y 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 /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. V"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 Z,7 +the MAX High G.W. Adjustment. DIFFERENCE BETWEEN A and B SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder art . 0— LOCAT'ION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER l-1�t'1fF'y DATE PERMIT ISSUED Wo DATE COMPLIANCE ISSUED 7�� y � CD4UN7S� .,,.. A3P�� C�COOL /0©o Gil CC56P�D( ,�, C' .F.Rimo THE COMMONWEALTH.OF MASSACHUSETTS BOAR® F- HEALTH ......... W.)j......OF....... �•�/ �(,/ ........................... Appliration for Dispati al Marks Towitrnrtinn ramit Application is hereby made for a Permit to n�4ilv�� an Individual Sewage Disposal System at: � .. ......2 .-lC?, C� :.��-................................. ............... ... - -------------..........-------------........__ Loc ion-Address - - or t No "- Owner R.ffOio� C Ad ress Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_________________________________ _____Expansion Attic ( ) Garbage Grinder ( ) pay, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------------------•- W Design Flow............................................gallons per person per day. Total daily flow.............................................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. Z Other Distribution box ( ) Dosing tank ( ) - a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth,of Test Pit.................... Depth to ground water-----------------_------ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..............._........ ay� -` • ----•------------- O Description of Soil................. cr .. ---qrj -------------•------...---------•----------------------....--------- 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 TITU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issued by the board of health. �j Signed.. _ •_... n Si d / u . .. g C --J�Date Application Approved B --•-••••---••-•--•-•-•y ................••--------------------------- Date Application Disapproved for the following reasons:....................................................................... ................. ...................... .............................-------------------------------------------------------•---•--._...----------•-••••---•-••-••-••••-•••--••••--••••A•------- --- - � Date Permit No.. -... Issued. -� ------ ._....... Date ✓" ! �` ��J,� V u N ................-....... Fxs..7.1........_............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r T, � �- OF............................ ._....••----•-•-•-••.._.-.........._. , pphrtttton for Bts#nsFal Works Tonotrnrtton Prrmit Application is hereby made for a Permit t n�frb it (A an Individual Sewage Disposal System at, `��'((�� ............................................................. Location-Address or Lot No. /�y] y� COS /r .,s' /(✓�C t ��!/K/�/ /G /! i'/ Address a ....._ .......................................................................... .............•----•-------......_................._....._..........._..__.---.........._...._..... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms` --------_-----------------_................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Other fixtures . .....................•---- W Design Flow............................................gallon-,,#?er person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No_ ____________________ Width.........._......... Total Length.......................Total leaching area....................sq. ft. Seepage Pit No................ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ,) Dosing tank ( ) 4 a Percolation Test Results :. Performed by______________________ __._________ Date.................................. ,_..,-._ Test-Pit No. I............i_..minutes per inch Depth of Test Pit____________________ Depth to ground water_.__..._._.._:v__._..... (i Test Pit No. 2............:'_._minutes per inch Depth of Test Pit.................... Depth to ground ...........L........................--....-................................................ D Description of Soil................ . :1-_1Cf---/----`- x w _ --------------------------------------------------------------- .................. ------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable........../__2_____________________________________________________________________________ ----------------------------•-------------=--------••----•-•---•----•---•--._._.._......._..-•---------------------------------------------------------•-•---------------------------------•--..._•-•--- Agreement: The undersigned agrees to install the afore-described Individual Sewage Disposal System in accordance with the provisions of TITILE 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 =' = s 6 ......... ,t�>fel Date Application Approved BY : D .............................•-----------............_-•-•-••- Date Application Disapproved for the following reasons:................................................................................................................ --••-----••------------------------•--••_..._.__.._..•-------------•-----••--•-•--••--•----•--------...._--•--•--....__.....•-•-----------•-----------•---------•••----------------------•--••----....._ Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS -., BOARD-OF HEAL��T-H --••_:..o.... 7.....-..-OF......./ ....................'/•••�.... )1c...................... c ............ Trrttf trFatr of Tompli aisle TH-I 5 T RTIFY, Tat the Individual Sewage Disposal System constructed or Repaired JC S ' . .fit>t�/r /1 i% _Jl....y` f .....,...._i, Y P ) bY....................... s. nstal(er at 1..E ;�c- r..r .,t.� .../ T -/l�.....-:.;%r has been installed in accordance with the provisions of 5o The State Sanitary Code as�f�escrit2ed in the application for Disposal Works Construction Permit iV __ ________ _______________ dated....7__-_-___7,'......................... THE ISSUANCE.OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD,OF HEALTH 6/5 ..� ....................�:al.0....0F....... !.J .'" ° / l/�_... . .._... ......._ ... FEE................ Dtopogat orko Tonotrntton rrmtt_ Permission is hereby granted___``,' V /))�r r� !/�� -. �'�'�i-�''J to Construct (. or Repair,, ) -an--Indivi ual e gage Dis sal System at No..✓�._1 11/t_ - r 1 / .��r�J� -� ... ..... Street 7—2 Y I9�+) as shown on the application for Disposal Works Construction P • t No. _�;J Dated �......................._..fr...-•-•----- -•--. �.y. -------- ••r.........................._ Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ,2 a- -