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Home My WebLink About0058 KIMBERLY WAY - Health 58 KIMBERLY WAY COTUIT �J f r T BARNSTABLE LOCATION S'S SEWAGE # VILLAGE -rvt n ASSESSOR'S MAP& LOT 017 OS-�' INSTALLER'S NAME&PHONE NO. y7-7,01 YG/ ,Xw -�,t-4 D-. � SEPTIC TANK CAPACITY LLD LEACHING FACILITY: (type) ,�—S0 6v/ 1)r,/ (size)_39 X /3 NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: $—-2- "-— 9 9 COMPLIANCE DATE: Z 24`�9 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well 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 '1l'-i-,"., 0 o • h ¢� � 7 � �� i t �P�� : _ __.._ �,��ry w��, No. :; Fee C THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppfication for nigoml *pgtem Construction 3permit Application for a Permit to Construct(pair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. SS k—t;,,f 6 er 6449y Owner's Name,Address and Tel.No. C Assessor's Map/Parcel arty � Installer's Name,Address,and Tel.No. (�,f�-.4��!� Designer's Name,Addr s and Tel.No. CAV /01, it Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other I 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 Y. J. 5',/ Nature of Repairs or Alterations(Answer when applicable) CaZ 12.-,ti Glir�lfs ��T,l �i' Sioar-e /�v�dys9 2 " f t� �Sjt�rl� 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. Signe a L+ Date 8,•`1S''�� Application Approved by Date Application Disapproved for the following reaso s Permit No. — Date Issued Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH"DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0(pprication for �N!6paal *pgtem Construction Permit-- Application for a Permit to Construct(4-�rRepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.SB kt;v h er l y WV,4/ Owner's Name,Address and Tel.No. Assessor'sMap/Parcel C_oj'U/r ��%� 4—les-ely / Installer's Name,Address and Tel No. C�J%—O,5' Designer's Name,Addr ss and Tel.No. ✓es��ti !�-c j��or�a.S ✓os`e�Gr U->✓ /.�i��•�rs 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 / Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 94X% 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." Signe . Date Application Approved by /J ' Date Application Disapproved for the following reaso s Permit No. Date Issued ————————————————————————————————T—————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(l--rRepaired ( )Upgraded( ) Abandoned( )by Jn s Gam , at g = a has ear constructed in accordance ZZ with the provisions of Title 5 and the for isposal System Construction Permit No. dated Installer_ j_e_�j d-c 13yeeoS Designer o _ /v The issuan of this ermit hall t construed as a guarantee that the � 11 function a�es rei � g $ Date +tom r"" Inspect !/ No.-- _-- �———————————————— � ——Fee -_._..._ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwizpogar bp.5tem Construction Vermit Permission is hereby granted to Construct(4,4-Repair( )Upgrade( )Abandon( ) System located at f it6c/ j,.a T 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 conditionsS Provided: Construc o�nust p ed within three years of the date oermit.Date: Approved bye's 1 w ' b 116199 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) I, Jbs�p� �� r�o. hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at $ �Ci�� /� Gl/,�y rai/ meets all of the following criteria: failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 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 •�ere 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. 14 The bottom of the proposed leaching facility will not be located less than five feet above the mammum 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 ma.�dmum 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 . 51 DIFFERENCE BETWEEN A and B SIGNED : b/2�¢�d�2 . /�%>�v1 DATE: [Sketch proposed plan of system on back]. q:health folder:cert rapo rx'Sr� p000 L i '� TOWN OF BARNSTABLE LOCATION 18 �, �� ci/v Cl Q y SEWAGE # g 9-•SyS- VII.LAGE ��rirT ASSESSOR'S MAP & LOT. 7 INSTALLER'S NAME&PHONE y SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS !` BUILDER OR OWNER ! PERMITDATE: %- — �� 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) Feet Furnished by ------ it _P. yy LO CAT ION?��7 .SEY0IAGE PERMIT NO. VILLAGE ll�� (20 TU INSTALLER'S NAME ADDRESS I 0UILDER OR �0 R DATE PERMIT ISSUED DAT E `C-0MPLIANCE I S S U E D 42 �, 1 1 '' �r `�i � v1 �`'� � � t .r . . ,. -- NOO-./-' (0 '► r�r' Fmc......`...................... �v• THE COMMONWEALTH OF MASSACHUSETTS B®ARD 17 HE T ,� lirttfiun for 3�iupuuttl urki Tunutrartiun Prrutit Application is hereby made for Permit to Cons .uct ( or Repair ( ) an Individual Sewage Disposal System at: ^ .... "''� :.. �-f/ ' ....... -••------------------- �u ........... catio -A dr t No. ............ ..� � ................... .......... ... ..... W ........... •• O .._. ................... .••-• .......................... ....................................................... Installer Address Type of Building Size Lot...(' �. _Sq. feet U Dwelling—No. of Bedrooms............. ........................ Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons.....................--.--.. Showers ( ) — Cafeteria ( ) a' Other s ------------------------ `'� W Design Flow........... .... ..........................gallons per person per day. Total daily flow.... 4 ...................gallons. WSeptic Tank—Liquid capac .gallons Length................ Width................ Diameter--.............. Depth................ Disposal Trench—No. .tf�}._._........ Width.................... Total Length................... Total leaching area....._/____ sq. ft. xSeepage Pit/ � 1l4ameter......k-..... Depth below inlet....6........... Total leaching areaY sq. ft. Z Other Distnbu- tion box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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........................ O Description of Soil......�__'��.. .. ...._:t..`' L _.. _ __ W -� - v� Q............................................................. .„ t .... ..... . ....... .................... 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 iITLL 5 of the State Sanitary Code—The un r igned further agrees not to place the system in operation until a Certificate of Compliance has been ' sue y th oard of health. - Signed....._. . •• .................................• 1 . . . ............. to ApplicationAppr ve . .....................................................:................................. :, 7= =--------••- Date Application Disapprov f o the following reasons:----•...............................•--•-•-------------•-----....---•--••---••-•--------•......••-----•__•----- ..••-••••-•-•••••••••-•••....•--•••--••-••••-•••-•--•-••••••-•----•-•-•-•.........-••---.....•-----...............•••......................••-••......----•-•--••...•••••==••••••••-•--------•-••--•••--- Date PermitNo......................................................... Issued....................................................... Date Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD I-IE /... .........OF...................................... Appliratiun for Di,ipusal urki .� nutrurtion rrutit Application is hereby made for ermit Con ruct ( ) or Re ( j Individual Sewage Disposal System at: /� / f2_�ti td - �/�i 9 /s /� t No. ..........D, /— -•- ---••--•-,} A- ............................................ Installer Address d Type of Building Size Lot_______. _U.=_.."..Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Oth ' es ......................... ••-• . . W Design Flow........... .. ...........�..//. ......_ gallons per person per day. Total daily flow---_........................................gallons. WSeptic Tank—Liquid capaciev .gallons Length................ Width................ Diameter................ Depth................ x Disposal Tren h—:�a �� .. Widthp/________________ Total Length___......_.__._.... Total leaching area..(:/2 -- sq. ft. Seepage Pit, 1......Diameter.._...g..__...._ Depth below inlet.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................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........................ 0 4 ... . . _.... s ......................................................... Description of Soil •-- --...--••--•--------------. ------------------------------- - W -------------------------------- •••-•••-•-•-•----....._...---••--•••--•--••---•••-------•----•••••---•.--•-•••---._...•---------•----.----•--•••--..... -•-----•--------•---- 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 TITLE 5 of the State Sanitary Co.e , The un rsigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssue y th board of health. - Signed...... ......... ••---=.................. --- __._;.. Application Appro d /�_ .--•....................•-----------•-•-•------------•................_ -------------- - -- -----.....---- DateApplication Disapprove or following reasons:............................................................................................................... ---•--••-----•---.---•--•--•-•-•--•-.......•-•-••----••--•---•••-•-••••••.•---•-••-•.._......•-----•...............•••---•----------------•....--•--••.................................................. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOA R D;eF iH ET'Al- ...... . ..... ......................OF..................................................................................... Tatif iratf of Tompliatta THIS IS TO CERTI hat tM Disposal System constructed (' ) or Repaired ( ) by................ ..... -•- -------------------------------------•--•------------•------- at................. ..........•-----------•------•-------------... -----------......------.•...........---•-•------------•------•------•------•....••••••........ has been installed in accordance with the provisions of TIT Lj•5 oegState Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-------------------------_...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................1.2 .... Inspector...... ✓ ...-•------•---------------------------•............--•....----•--- THE COMMONWEALTH OF MASSACHUSETTS BQARD F H L L / 2 4t 5U , y (� 1 ....... ......t!..` ................OF..................................................................................... sa: _ NO.......C; /........ FEE........................ Biupos aT�Mlg Toni rrutit Permissio� i�ereby granted ..... ........................... .........•••-•-. ............... ................................................ to Construct V) r/ air Indiv'. al ..wage D'vtr S st at No. "� c eet ..--c- .11 as shown on the application for Disposal Works Construction Per .nit'"No ................ Dated.......................................... �j Boar3 of Health DATE...... ... ... .... /-... •--- FORM 1255 A. M. SULKIN, INC., BOSTON -• :�r F.AMi►-Y • Np 'GgRBAG6 �jW►.ID6R � . I . 3 P P - - • /.b.7� 5EPT%C TA► K v5E- l000 DI:5Po.i��-- . i'�-- USE Goo GAS- 13z. .5. FXZ . S _ 3.�vG•� n. �, I. goT-ro� A2•EA - i I�s• �=, � Z 2, G,o� _�w,� , •DES 115 `+L+3G.P,.p. I�"(aTAtr- I=LIC y -:= .33o G•P, P 1.T f 1 t''►cv ?MIN o�. is 5 5 �' - ��• I: Ala. 7 PV- lac WILLIAM C. DAVID Rio N Y E v. s C. v Cl; ltiA1N 1 No 19334 O u t4c. 29975 7e��p`� �'� r V( ' /°ma's R , Top FNu -ram�r fl HOL�s-� G / ^ ��-^ INV.9y I/. _ loon� INV- o.�MF,Svb7 INS. GAS . &�g t i 6vG> D u K 51<P I Z ; G-v�� I.GFI N�, /B•li TANK •.�. w,• •'.;j. /it/ ro/1E INY• INV. I • �� II • �I 9y S i Ca ZTIFIGP P>.oT .? 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