HomeMy WebLinkAbout0041 KENNEDY CIRCLE - Health -,-.Kennedy Circle
267-050 Hyannis
' o
TUW1V OF BA.-IrIS1ABLE
1ILOCATION C/2 SEWAGE # ""��E
VILLAGE ASSESSOR'S MAP &LOT�4 7- ��'
INSTALLER'S NAME&PHONE NO. W L•14 CO" P SEPTIC TANK CAPACITY J S D O
LEACHING FACILITY: (type) t (size) low
NO.OF BEDROOMS
BUILDER OR OWNER aft.''
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
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ASSESSORS MAP NO:
,� PARCEI. to :5l�i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Avv iratinn for Diinvn!ml Wnrkw Tnn,itrnrtinn Vamit
Application is hereby made for a Permit to Construct ( ) or Repair )(XX) an Individual Sewage Disposal
System at:
...... 4-1 .Yanneci_Y...Circle T'�est -HXannisport '
De o TO V Leog�tiot -Address or Lot No.
............................. ••---------•---•--•-----•--•------------------•------------------
Owncr Address
W J. P .Macomber .Jr .
Ins tat Ier Address
UType of Building Size Lot............................Sq. feet
►.� Dwelling-1 No. of Bedrooms------------ -------------------_.-___-.._Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building --------------------_--.--. No. of persons.-.-_-.--..-.-..---..-_-._ Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------------------------------------------------------------------- -------------------------------------------------------------
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 ( )
Percolation Test Results Performed by........................................................................... Date.....................................
,.� Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water...--........--.........
�To Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water.....--..........----...
P4 ---------------------------------------------------------------------------------------•------------.........................................................
0 Description of Soil S a n-d_--ix.-.G ravel
x ------------------------------------------------------------------------------------------------------------------------------------------
U ------------------------------------------------------------------------------•-----------------------------------------•--------------
W
x ------------- ---------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable.-.-Omit caved in cesspool . I n s t a 1
---- - - --------------------------------------
50.0__.gal_1.on...t:ank.l.l--dis-tributi_on box .
- •-•-•-----------
Agreement.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has be is ued by the bo d of health.
f
Signed -.-` -- ...... , / %�!i 8/7/9 5
........ ....... ..... ... ..................
.:.. ................. re...........----
ication.AppB --.Appl : -------- �:Y ... _ ----- ----------e..... ............ .�.1........ �-.���
[e
.Application Disapproved for the following reasons: ......._............................_.:._..._------------------....
.......... . ..................................... . ..... ............................--........ ...... ........................................
...................... _.................
Permit No. ,a; .. T Issued ----- ...
...15— `
Existinf Leach -.,)it
New D—Box
omit cav d iZcessp .Neiv 1500 Callon Tank .
00 .
41 Kennedy Circle West Hyannisport Mass .
TTS
THE COMMONWEALTH OF MASSACHUSE
_ BOARD OF HEALTH
TOWN OF BARNSTABLE - --
+ &ffifir' ate of (11oraptinure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XXX)
by ---------------------J—P...M.e.c.omb.e r.....J.r..... . ...._._._-------------------------------------___....-------___.........._-----------........._... -- . ......._..... .......
lnsmilcr
at --------------------41_ Kennedy Circle_ West Hyannipport-----_.........
has been installed in accordance with the provisions of TITLES of '1„he State nvironmental Cod as described in T �{
the application for Disposal Works Construction Permit 1 '"�� dated . . '77.1_ 14,o j
THE ISSUANCE OF THIS CERTIFICATE SHALL NOYliE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ----- -------------- Inspect -
t
_
r THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
� TOWN OF BARNSTABLE
FEE..$ 30.00
......................
Permission is hereby granted.....LR-Rarzi tuber...`r•-----------------------------------------------------------------------------•-----...........
to Construct ( ) or RepairXXX) an Individual Sewage Disposal System
at No............41 Kennedy-- ircte_._West Ilyan-nisport
• • -- . .
as shown on the application for Disposal Works Construction,Pe/ij 4 a,"- -��ated.. "....... j/r�,._�
e --
... 2
--•.----- ----
Board of Health
DATE------------------ ........... ..........
FORM 36508 HOBBS-&WARREN.INC.,PUBLISHERS
3 y
4
' THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Alip iration for Diti-Vitiitt1 WorksC� � rnr inn rruti
Application is hereby made for a Permit to Construct ( ) or Repair I(XX an Individual Sewage Disposal
System at:
• 41_..Kenned-v._.Circle West IIvnnnisport' ----------=-----------•--•------••--••-••-.._....-•-_..._.
Lo pion-Address or Lot No.
Deo...Tovet
_...- •-•---•--••-•------•-••---•-••-•••--•--•---•-------- -------------------------------------------=--------•---------•---_-....._....-----....-•--------
Owner Address
W J.P.Macomber Jr.
a •--------••-•••---...----•---••----•-•--•-•--•. -••---•-------------••-•---------•••-------•----
-- --------------------------------------------------------------------=-=----------
Instalter Address
Type of Building Expansion1 Size Lot............................Sq. feet
Dwelling—X No. of Bedrooms-----------Z_____________________ Attic ( ). Garbage Grinder ( )
aa Other—T e of Building °' '______________-___
Other—Type g --__--_ No. o -persons---------------------------- 'Showers ( ) — Cafeteria ( )
Other fixtures ...............
•-.._ •••-•••------•••--•----•--•-••-----•------------------
W
Design Flow............... )..gallons per person per day. Total daily flow.__........................ ......gallons.
WSeptic Tank—Liquid capacity---------- pllons Length-----------__.. Width---------------- Diameter-----.---------- Depth--------------.--•
x Disposal Trench—No. .................... Wiidth ------------------- Total Length.................... leaching area.......... ft. .
Seepage Pit No-------- Diameter,..------- ---------- Depth below inlet____________________ Total leaching area..................sq.,ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by Date.......................................
Test Pit No. I................minutes per inch Depth of Test Pit_----------------- Depth,to ground water--------------:::.......
rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth'to ground water--
--- ------
_..__..._..
x
0 Description of Soil.........San-a & Gravel +-----------------------------------f°-----•--•-•--------•----.....---
U ----••••••••••••--...---•-•••----•--••---••---•---•••-•--•-•---••-•--•----•--------•-•---.-•••-----•---••---------••-_.. �.
W i ••-•----•-•--•-------•-••--- •-; --...----•------
W�ri --•-------- ---------------•--------...--------•••-•--•••----•----------------..-------•-••-------. ------- - _._...
Omit caved in cesspool rnstal:l ,
U NatureYof Repairs or Alterations—Answer when applicable................................................................................................
1-�150Q...gallon tank 1-dist bution h.o.x.
-------------•-----••---
4 Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the boatrd of health.
Signed --- -- ------- ------7Y...... / % - 8 7/9 S
• `rI ---- .. ....... .......... •�I ce
00
// p D�
Application.Approved By ....... 1 !`:. ��-.
------ --.. . ..
5 .5
Application Disapproved for the following rearons: ----"----"-"" -- .. _........ te
--"-"--------------- --------""--------------- _... _---
Permit No. --....1 Issued - •� ... � . ...
Da
•
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
I, Joseph P. Macomber Jr,hereby certify that the application for disposal works
construction permit signed by me dated 8/7/9 5 , concerning the
property located at 41 Kennedy Circle W. H y p o r t . meets all of the
following criteria:
• There are no wetlands within 300 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
SIGNED . o DATE: 8/7/9 5
LICE D SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER2 5
[Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted].