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Home My WebLink About0007 KIMBERLY WAY - Health 7 KIMBERLY.�WAY b I� TOWN OF BARIxSTABLE LOCATION A c: - SEWAGE # 99,-DSO { VILLAG S.SESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �QL,( 7.35177/` SEPTIC TANK CAPACITY LEACHING FACILITY: (type) -L'P-y (size) 1 a x-2S )L 2- NO.OF BEDROOMS , BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: ; G 7 A 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 s 4 f � -�- $50 _— No>= Fee THE COMMONWEALTH OF MASSAC USETTS Entered in computer: 4Y. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for �Digooal 6pgtem Construction permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Ad ress or Lot No. Owner's Name Address and Tel.No. 7 Kimberly Way, ' lls, MY, Mike besisto Assessor's Map/Parcel , L r P 0 Box 308, C Ot U It , MA Ui Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville , MA 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil S and. Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system. T)—box and 2 chambers . 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 i d b th's Board Health. SigPforthe Date Application Approved b Date Application Disapproveollowing reason Permit No. !�jmj - ia Date Issued C-i $�=� Fee $50 fl THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 4Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppricatiou for Mi.5po!5ar *pgtem Con6truction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components L catio Ad ress o Lot No. Owner's Name Address and Tel.No. Kim�eri-y Way, -Mars-tQnr"`mills, MI Mike 1jesisto Assessor's Map/Parcel Q. f U l J_ P 0 Box 308, C o t u It, MA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville, MA 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 gallons per daO Calculated daily flow gallons. Plan Date :Number of sheets Revision Date Title . Size of Septic Tank t Type of S.A.S. Description of Soil Sand. e �( Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system. . D-box and. 2 chambers . A k 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 iVtpd by this Board o Health. /Sign Date Application Approved by Date Application Disapp oye' for the following reason i r Permit No. i Date Issued i ___ _ ----- --------=---=---------------- �f THE COMMONWEALTH OF MASSACHUSETTS Desisto BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY that th Qn-site a e Dls os 1 S stem Constructed( 1 Repaired (X )Upgraded( ) r� Abandoned( )by Wm. E Se E. ---Vlnson S pt 1 eyrvice at 7 Kimberly Way. Marstons Mills has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer Wm. E. Robinson Sr. Designer . r g / J..�.. 'N' f J !1 � rmi° f� The issuance of this e sha 1 not be as a guarantee that the syste will function as designed./ ned./ Date ! !` �'�/ 1 Inspector �� e`>v .YT�"I No. ---------------- — Fee $50 THE CO MONWEALTH OF MASSACHUSETTS PUBLIC HEALTH(DIUI§IO.LV`-�BAI STABLES MASSACHUSETTs- � Desisto lwigogal *pgtem (Con!5truction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at ' 7 Kimberly Way, Matstons Mills and as described in the above Application for Disposal System Construction Permit. The applicant reFognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructio s b co leted within three years of the date of permit.Date: "; 204M �]1 Date: Approved by / fie 1 ,. 116/99 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) j> William E . Robinson,SAereby certify that the application for disposal works construction permit signed by me dated �� -�/� , concerning the property located at x;� h P r ly Way, pear s t e ns M; , , 8 _ meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. soil is classified as CLASS I and the percolation rate is less than or equal o 5 minutes per inch. 11/ Th e are no wetlands within 100 feet of the proposed septic system _ ,Tti e aie no private wells within 150 feet of the proposed septic system ere is no increase in flow and/or change in use proposed ere 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: kj iTop of Ground Surface Elevation(using GIS information) B) G.W. Elevation + the MAX. High G.W. Adjustment . DIFFERENCE BETWEEN A and B 01, DATE: SIGNED : t [Sketch proposed plan of system on backl. q:health folder:cen rA i IV � G� 1 Y 5 7 LO CATION SEWA G.E PERMIT NO. oe VILLAGE INSTALLER'S NAIRE & ADDRESS 4ILew ® U I L D E R OR OWNER DATE . PERMIT ISSUED DATE COMPLIANCE ISSUED T, io v 43 N�� 7b w,✓ /C� . a... _ F�$...�°............_ THE COMMONWEALTH OF MASSACHUSETT'S BOARD OF HEALTH (9 W/ ... ......OF........... ApplirFa#inn fnr Dispos�al arks Tunstrurtinn Vrrutit Application is hereby made for a Permit to Construct (�,) or Repair ( ) an Individual Sewage Disposal System at: ................._. ...- -- - ........ ..... .......---•--•. ------•-----. --------•-•--•-•......------............. Location-Address or Lot Nc} -------------� ...... k: ------------------------------ --._ Owner Wa . Addres- . ................................. .. ....-. A ------------------------------------------------- --------- Sr Installer Add;.. d Type of Building Size Lo ........ q.1eet U Dwelling—No. of Bedrooms............. ..__.__._.._._----_--.--Expansion Attic ( ) Garbage Grinder ( ) '04 4 Other—T e of BuildingNo. of ersons............................ Showers — Cafeteria Q' Other fixtures -----------------------••-----......------------------.-•-------------------•-----•-•--•---•---•-------------------------.....--•--------.........---- W Design Flow......................5'._-`............_._gallons per person per day. Total daily flow.__..........�.�._.....................gallons. WSeptic Tank—Liquid capacityae�..gallons Length.�__�.G... Width.`�_.'1_0 Diameter----�:.'-_. Depth_..`` `.$ s x Disposal Trench—No. ••__---_---------- Width................... Total Length.................... Total leaching area....................sq. ft. ef Seepage Pit No........... ___-__-- Diameter.10._�:.G�_...__ Depth below inlet..�__- ..... Total leaching area...:n�.sq. ft. Z Other Distribution box ()<) Dosing to ( ) `-' Percolation Test Results Performed b ....... 5 _. 41 �0C_0/4-Date__..Test Pit No. 1........2....minutes per inch Depth of Test PitJZ.- p• � Depth to ground water.AjQJ'7 CTC10-M",f Gz, Test Pit No. 2......... per inch Depth of Test Pit.?�.`--f 4-.,Depth to ground water.____`_`_--•-'------- JV Pi f--•--------...... ..................:........ ................... �d •-•---•- aI•---------•--• ........... O Description of Soil-- � ?! � 0.................. ` Ct�ta�OSc� ! x U ---•----••-----•----•-...-------•--•-•---------------------------•-------------------._........----•-.._......---------------•-------••-•-••......-----••-•--•----..................................... 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 III U 5 of the State Sanitary Code— The undersigne rther agrees not to place the system in operation until a Certificate of Compliance as been issued by th �ofhealth.---- -- ......... .....•.. ........... .. _... --- Date Application Approved -- ------ ---••--------•-- :. ® j� ate Application Disapprove or a following reasons:_..----•-------•---•---------••--------------------------•---•-----------------------------•--•--------------- ..--------•--------•------••---•--••----------------------------••--------•---------...........--------•-----------------------------------------•-•-••--------------------•---...---•---•------...... Date PermitNo.......................................................- Issued_....................................................... �� Date ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD ((.OF HEALTH } .��-�----•------.OF......... ,1d9+ '/ C-7"., L- ... -------- Applirativat for Bispoii al Works Tomitrur#iun ramit Application is hereby made for.a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: wr Location-A ddress or Lot -l _ Owner Addre s "�`• ----------•-•-••••--•-••-------- �\ . _ -----•---------------------------- �' Installer Address Type of.Building Size Lo I . . '-------:Sq. feet aDwelling—No. of Bedrooms.............3........................_---Expansion Attic ( .) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixture -------------------•--•---------- . Design Flow....................:?...................gallons per person per day. Total daily flow............ ` .__._......._.._gallons. 9 Septic Tank—Liquid capacit}�-U..C,...gallons Length .....G.__. Width�___�!'�.. Diameter-_--:_______--_- Depth_`-�__..�.. .. Disposal Trench—No..................... Width.............._..... Total Length.....__r........... Total leaching area....................sq. ft. Seepage Pit No._-__-___�..._..... Diameterf t?..-.- -_-- Depth below inlet '.._`. ...... Total leaching area..' - f...sq. ft. Other Distribution box (K Dosing to ( ) ,r,� ,,,.rr�� Percolation Test Results Performed by......................... ° ' .+�` >SQ °� Date.../=..!!.._19 s� • •. Test Pit No. 1................minutes per inch Depth of Test Pit '.._:"_"° __ Depth to ground ........... it Test Pit No. 2-------- per inch Depth of Test Pit!-?.........._. Depth to ground water.__`.................... x p g, ••••••••--•;......--•-------••......• ;� -----•----------•--•---------- --------------------- D Description of Soil•J �C ......... tc? v r `-�` 2:6 -® /�� Eo c�-/.se .��ri .. x ---------•-------------•-•----------- ...................... W VNature 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 TITLL 5 of the State Sanitary Code— The undersl rther agrees not to place the system in operation until a Certificate of Compliance as been issued b `Elth. I ..;n _._ .......... Application Approve - aDat j ate Application Disapprove or a following reasons-------------------------•--•-•------.•...--------------•------------------------.............................. --•---•-•••---••••••••-•-•--••••-----••-•••----••••-•---•--••---••-••--•--••-----•--•-••-••-••--•--.._...••-••-•---•-•--•-•--••••••-•--••--••-•---••--•-•-•--••-•••••--•--------••--••-••---•-•••••-•-•- Date PermitNo....................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...... ......................................I..................I.................... Cnrdifiratr of TuaatpliFaatrr S T C , That the Individual Sewage Disposal System constructed O or yRepaired ( ) b ---•- - ............................................•...--•--•---------...... -^ - _- I taller at -•---- .............................................. ---......•....---•------------•--------------- has been msta�ed m accordance with the provisions of TITLE ' >of The State Sanitar Code as described in the application for Disposal Works Construction.Permit No. _._ _. ............. dated............._.................................. P Y THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A GUARANTEE THAT THE- ) SYSTEM WILP Fy 4CTION SATISFACTORY. I DATE.......y lG -off.................................................... Inspector :. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'f.... ............................................OF..................................................................................... • FEE.. ................... �i��u��a1 u � ��atu�aivat rratti� ; Permission is, reby granted... _ ......---•---•-------•-•..................•••...........---...... to Construct ( r= ' ( ) an D is-go y, atNo. ..-••-- ...................................................................... `-------------•----•----------•----•---•----------------•.............. Street- as shown on the a pE tion for Disposal Works Construction Permit No..................... Dated.......................................... . X Board of Health DATE ------••(((------------------•-•••-•••••.............. FORM 1255 A. M. SULKIN, INC., BOSTON - a 10/A.0 toa�a�n.LAN•P-,r L0-r 2Q " «• \ _ '� .� ace - :� ,y ptST•BOR �. r { - F 1p l000lanr,• Colic. -c®T S AD 1e0A 3 Brroa�aoM 4e R4 OF WALTER C\.� P. co C> �.• . OLDHAM #23207 ISTER.a a ° ` REGISTERED ` CIVIL ENGINEER � �e�.�► �� I.a.' :,,. � ` `• . D I SPOSA L . PL_ N�\� OF Mgss9c WALTER `-' SMITH, JR; #15128 GIST FSSIONALdE�G\ � Kj 4- k4 P OZ I T n /oz• S AV AI Wee •ate., cK H 18.75 0 ono GFr. DIAtit. _ 10o0 Q 0 4► Coi1G LEAGN�/J(� PST. f SeF+IC- TaK k 98 5 A 4a 4 A A 4 d A A Z fir. AA 92.o a e e BOT• PIT E ay 5 Ord 0�71zov"D-0,� To P50►L` i c��a�! ES !Cn N DA'r'A 14'A) IXJCW DR.O P TEST PI;RF'ORMED APR IL 't9 ; fgg4. l�E.DRooMS x Ito GPD = 3"30 C PQ LEAcwiplc, ��aa �. 0 GARBAG;e DISPOS AL SSE (000 GaL..SE:PrIcTAq+ go Top- 2F CAN PAC y I T P 5 S 00 �-0V I D F SEC, 1 o(-c 80TT0 Z I DE 5 -710 x (Q x 2 , 5 = 411 Z C, PD 5 n1 p 1 COT-L. CA F'A c I T y PR0 V I Pep S49 7 G P D iV �oT�-- D t5 POSA� J�jSTG F�a( Dom.�Ic�►� E D ( !� i AcCoRDA"CS v`1 ! T-A, PROVISIONS OP S or-7 T�4s : lamsS. ENVIROtdMENTAL Goi�� T Zo NEw-T-awns R C�' Co Tv rr . OIL S---RArA S eET TOWN OF BARNSTABLE LOCATION i SEWAGE # VILLAGE W AV ASSESSOR'S MAP & LOT01 INSTALLER'S NAME&PHONE NO. WM E "',J9:YJ -7-7S-Si 7'71 SEPTIC TANK CAPACITY I Goo LEACHING FACILITY: (type) QVV ! kds (size) i Z.3f a5 )t Z NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: / c/% COMPLIANCE DATE: �12efe 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 (JhGAL 6 e6 r�