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HomeMy WebLinkAbout0010 WINDSHORE DRIVE - Health 10 Windshore Drive, Hyannis GREGOIRE REFRIGERATION I i t I 9 i TOWN OF BARNSTABLE LOCATION I fJ �/`� t�s4�c�� L1��_ SEWAGE # VILLAGE 14\/ < < ASSESSOR'S MAP& LOT22L.1UYL INSTALLER'S NAME&PHONE NO. 1�—EIA - ,4 SEPTIC TANK CAPACITY 10520 G GA Le. 620,0>K 0 LEACHING FACILITY: (type) Ll l (size) ! C S NO.OF BEDROOMS L"e-S U BUILDER OR OWNER - PERMTTDATE: a. - 3 2 COMPLIANCE DATE: Separation Distance Between the: 7 .Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /kFeet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ,��[)'�--f Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of Wching facili Feet y Furnished b '" 0 A � a Bays 61 �1 -so No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Digpogal *pgtem Conotruction Vermit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � , Owner's Name,Address and Tel.No. Assessor'sMap/Parcel C,_ 1 (� p' >'La 1 _ 0 W a NJ Oc— 1"J Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 94 �n l Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 'k �S Type of S.A.S. Description of Soil Nature of Repairs or Alteratio s(Answer when applicable)-AOJ Lg a1�c.«' 1,.5� P' fc SAO-4 Cif®iG� tu_� �C.�..n —��,.(0�.� 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 this Boar Signed Date •3 7 Application Approved by Date n Application Disapproved for th ollowmg reasons Permit No.�7 - wf!y� Date Issued 'I TOWN OF BARNSTABLE LOCATION ' I y W 1`\V!(-Wr-C ��r SEWAGE # VILLAGE_aX"i 1 J-S ff ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 7\S SEPTIC TANK CAPACITY I UGC) GG,L CCU X C I� 1pct LEACHING FACILITY: (type) (size) _(f L - S GW NO.OF BEDROOMS 3 � (, U . f BUILDER OR OWNER o ` �- PERMTTDATE: a- �,3`� 7 COMPLIANCE DATE: w Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility `��Je f 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 Ching facili /� Feet Furnished by ; �AflQ 40 Ci hh x4Q Q a+ d s Q+ .. .. vw•S ..Gr':- '}� ,.,y..wr"'s in�h�"t .�S. �,j�.,1 sT4.,j�S,.:-rt,/ti„+i�.,+*... - ..r.....7i ` .w. .rT .C')'+`r. _. - -- . /�� No. _ Fee _ i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes i PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIpprication for �Digogaf 6petem Construction Permit Application for a Permit to Construct )Repair ✓ rade Abandon ❑Complete System ❑Individual Components PP ( ) P ( )UPg ( )Abandon( ) P Y P Location Address or Lot No. Owner's Name,Address and Tel.No. U /o c,.,;>-, s xe, p� �vb G o Assessor's Map/Parcel { tyap\1 f'n^tr" ` ^ ^ ' Installer's Name,Address,and Tel.No. / 75—�� Designer's Name,Address and Tel.No. �j j (u�'� vCALA.A i. { Type of Building: Gd to G 1 Dwelling No.of Bedrooms_ 3 Lot Size sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures f 1 Design Flow gallons per day. Calculated daily flow gallons. i Plan Date Number of sheets Revision Date Title Size of Septic Tank kouo ar,l.. 9� �Skk Type of S.A.S. Description of Soil i n P ( applicable) AjJ �«�'in�1 t � L.}) Nature of Repairs or Alterations Answer when a licable c' 1 t n �_1 t 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 by this Board PYfealth Signed Date j Application Approved by Date Application Disapproved for th ollo ng reasons i Permit No. C? _ �.� Date Issued ri --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE, MASSACHUSETTS 1 Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( 4pgraded( ) Abandoned( )by k )06 GT re G 0,,r-e . at > 1n ° t r has been constructed in accordance with the provisions of Title 5 and the for Pisposal Syste Construction Permit No. dated Installer SC 6A (-c-twr11C_ r e.C6R Designer i The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date , l L _ 61 '1 Inspector U ———————————————— ——————— ——— ———————— Q P � No. / 7— �a �� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpoga[ *pgtem Construction Permit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon System located at 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 must be completed within three years of the date of this permit. Date: . — I , —9 7 Approved by 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) hereby certify that the application for disposal works construction permit signed by me daJ / / , concerning the property located at r6 u�'\LCL rkj SQ meets all of the ! r following criteria: _ r Y} , 'L/There are no wetlands within 300 feet of the proposed septic system _l 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 !' \ ere is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: c2/1 3& LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. jxert r :f LOCATION ' ® SEWAGE PERMIT NO. dr.✓ / v�i�it,Lr�d�.2st �w VILLAGE ,ael AA, INSTA LLER'S NAME & ADDRESS B UI'LDER OR OWNER ZI ( DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i x 4 �j, � . �•. � �` e7 ��� _ ;� tSr, � �� �� y r. �. � _ ,� C� =lG►�1 _ btS,TA o - ►�.to GA223AG� �r�I+,tn�Z t7.4I Lam( F LOW I 10 -4 3 = SS C> G•P-D. 33o.r ISG % = 4-q5 G•PD. !' po O USte- l OGc, 64,L. r?lSPoSAL PIT - usE loco Gai . o ao � U/ALL AVE = tc)p S.P. PT (`� L KP• 15o S� ( 2.S = 3 1S v BdT AA sr--. T4.V L/ N TOTAL T7ESl6Kl = 425 G.RD. — I o -I-o•TQ t_ '-C) r-LA\.A/ PE}ZGDL&TlO LJ 'O'wr r : j"I1.! Sm l u Do tx-_Ss. 1 24 vd4 13a f R1WAK) AL 474 �. Stu (., „tt"« %•� ;j Top FNo LvAt d INV. y h Lj'pP� T>KT I W. 6;4.L. q G -Box GG Sepr+c I C> ,. 2 � INV. T-At4WL l 000 1�• Q s.� i ENV. 1• � GAL. GG.v 9G•Z LsAcH A a�trIZS PIT oc- W�ru Apo WAfHEp �Ra✓• C.f=C�TtF1CU pL.oT Pi.-.AW LoGATI)" lrty A,��3tS 12 �5•`5 uo s�Q,►.a 'iI- �aAT t�-`30-`#"? Sc.nL t=' �O w Peo Pm,el�) C. t cr:izTtt- 'T&4A7 TMG- , CWSL-UQL 5t-10--uQ I 4-i��t?t�t�1,1 ' Gc�tC�l_�f5 �/t't't-4 TNi::. �I DF�.Lt►•-tom LOl" Aub SEA- ;ne�G ��4UJQGAAE ITS O Twc. -TOWLj Or-- Ta�F~ A L A a C'ov eT ` `�loCot`o ll'30-71 t2EGlSt'CiZ�D 'I�iJG 5U2vE`lo1Z� TI-Il•S Pt_AW l,<, LAOT aAKGV Ot:4 AN OSTE2. _LG a IV(rLS�i� li•l�lt<':1:✓�Ct�1 T ��Ut=�lr�`C Tt{C UF4:S T�i St�Gwta ApPL-1 eA►-._ -r fr � / 3 L- w'e o TG v r� : M r Al t= �o C- t_I Ni s L...�1��i t t t7 c `D r t--o f `' _ No....... _ ... Fa$.............. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....�^C .v.........OF....IT. . 0iPIVL.:Jr............................................... Appliration -for Ui,ipoott1 Morkii Tonitrurtion Vrrm t Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a� .........................� .......=�---- Psi` --------------------------------------- Loc,�s�o_n-Add ss or Lot No. Owner Address a --------------------------------------------------- ---•--------- ----- - -----------•--------- - Installer Address � UType of Building Size Lot_.//c_ --qn--__._Sq. feet Dwelling—No. of Bedrooms..----__�----------------------------Expansion Attic ( ) Garbage Grinder per, Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) W Other fixtures ----A--- ---------------------------- W Design Flow..........L� ....................gallons per person per day. Total daily flow..................4 ...... --gallons. WSeptic Tank—Liquid capacity/Va:Ogallons Length................ Width................ Diameter.........-...... Depth---._-_-_--- x Disposal Trench—No- -------------_-___ � Width------------- Total Length..._........,.,.r�__.,.a.. Total leaching area-------.------------sq. ft. Seepage e Pit iameter,�_ri� � below inlet----- - Total leaching area-0-2 c. ft. z Other Distribution box ( ) Dosing tank ( ) ,67- "G I_J d' 7 7 aPercolation Test Results Performed by-------------------------------------------------------------------------- Date--------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..-----------.---.-_-. f7, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.--.------------------ r--•-.........../....-- --- -- ---•------ G - ----- - Description of Soil---------------------------� ' . . ----`----------A---------- ----------............. U •--•------------•--------------------------------------•-•-•••••-•--•-•------•---•---------------•--•••......•---. W x -------------------------------------------------- V 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 Article XI 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. /y Date Application Approved By------------------ ........ ...•-----•-- •• -ja�- . -. I.;.Z .3 7_7-- Date Application Disapproved for the following reasons:----••-------------------------------------------------•-------------------------------------------------------- -----------•-----•--------•------------------------------------------------------------------------------------------------•------•---------------•-------------•----------------_----------------------- '` Date Permit No.---..................................................... Issued........... � 7 -7l................... Date �. ���. ------------ --------- ............. NO.._._.._ ....... Ficu THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF. --------------------------------------------- Appliratilin -for M-4pofial Workii Tonfitrurtion VnIlift Application'is,hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: n....................... ... ........................... ........................... ............................... - ---- Loc ton-Addess or Lot No. w ........... ..... ........ .......................... ...... -------------------------------------------- Owner Address ................... . ................... .................................................... .................................................................................................. i Installer - Address U Type of Building Size Lot,//#._SP_P------Sq. feet Dwelling—No. of Bedrooms----- ------------------------------------Expansion Attic;- Garbage Grinder (/.0 eOther—Type of,.Building __.------------------------- No. of persons.......:.�_k----------------- Showers Cafeteria P4 Oilier fixtures .... ......qoAe_41—--------------_---- ------------------------------------------------------------------------------------------------------ ----------- Design Flow___-_ _-�, ------------_-----gallons per person per day. Total daily flow........_...__.._.1R. -P----------gallons. 9 Septic Tank—Liquid capacity-fe !?gallons Length________________ Width........._..... Diameter_-_-- .......... Depth---------------- Disposal Trench—No- -------------------- Width___ --__. Total Length-------------------- Total leaching area..... _--_-_sq. ft. Seepage Pit No_/O!CO" Diameter,%�.�e._&A.W below inlet.....i.........!k---- Total leaching are. ft. Other Distribution box Dosing tank 046' 1M- //-j-0- 77. Percolation Test Results Performed by--------------------- ----------------------------------------------- Date:--------------------------------------- Test Pit No. I----------------minutes per inch Depth of Test Pit_.-__---_____-____.- Depth to -round water_------------------_- �14 Test Pit No. 2----------------mirfutes per inch Depth of Test Pit.-.--_-._-__-__-____ Depth to ground water_..--..----_-_.-_----._. -------------------------------------- I �oe...... . .................. 4, 1.1�1' 1,_... ------------­-- - ------------ -- - ------ . ............... 0 ....CY---- Y Description of Soil---------i----------------- 7;;k........0 U ---------------------------------------------------------------------------------------------------------------------------------------------------------------------I---------- -------------------------- ---------------__--------------------I----------------------------------------------------------------------------------------------------------------------------7------------------------------------ U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------ ------------ ------------ -------------------- ----­------------­-- ..................... ------------------------------------------------------------------------------- --------------................... - ------------------------------------------ Agreement: p, The undersigned agrees to install the aforcdescribed Individual Sewage Disposal System in"accordance with 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 been issued by the board of health. Date Application Approved By---- 0.-------------- ...... _- ---- ----• - Date Application Disapproved for the following 'reasons:----------------------------------------------------------------------------------------- --------------------- .......................................................................................................................................................................................................... Date ............................................. Issued...................... ................................. Permit No i'� Date THE, COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............0 F. ............................................. %Ll'Intifirate of (tompliaurr. THIS I T-IFY, That the Individual' Sewage Disposal System constructed or Repaired by----------------- ----------------------------------------- -------------------------------------------------------------------------------------------------- Installer at-------c�lf,{7-""I�k..44���o�04---.Z�-?-I?.!------------------------ has been installed in accordance.-with the provisions of A e'A-% I of The State'Sanitary Code as described in the application for Disposal Works Construction Permit No`__&�AV­47............ • dated------ 7-7........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .DATE---------...................................................................... Inspector----.. ................................................................. 4,A THE COMMONWEALTH OF MASSACHUSETTS ASSACHUSETTS B9. D OF HEALTH , I _W . ..................... ............................................ No........... FEE../s............. T f omitrurtio "amit Permissionis hereby granted-------- ---- --- --- ---------------------------------------------------- .......................................... to Cons It-jact-jAw"J'or Repair an In. 'Aid ial Sewage Disposal System at No._ .© e... Vr..................................................................... Street X7- 77 as shown on the application for Disposal Works,Construction P N Dated-1- - -- - -- ----- ;Piyiii C�e ----------- ........... --------------:------------;,11------------- ------ 4..,d of Health DATE...... ------------------------ ......................... FORM 1255 HOBBS' &-WARREN. INC.. PUBLISHERS J,