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HomeMy WebLinkAbout0224 MARINER CIRCLE - Health 224 Mariner Circle, Cotuit A= 024-136 I TOWN OF"BA.RNSTABLE LOCATION ZZ /%f//fie- SEWAGE# .9 7'"�? . VIILLAGE Cf�7y1��3` ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY � 000 L_ LEACHING FACILITY: (type) gleo (size) 6 X le') , NO.OF BEDROOMS 3 J BUILDER PERMIT DATE: I/—3.e COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S¢ 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 j� �v Feet within 300 feet of leaching facility) Furnished by — -- 1 ® VJ of M b c No. u V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Migoml bpztem Construction Permit Application for.a Permit to Construct( )Repair( V)Upgrade( )Abandon( ) D Complete System ElIndividual Components Location Address or Lot NO. Owner's Name,Address and el.No. Assessor's Map/Parcel (e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7/J Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(114* 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 Natufe of Repairs or Alterations(Answer when applicable). �� ��� /If Ire alnew 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 is B of Walth. _._.. Signed Date Application Approved by Date c/--327 Application Disapproved for the follo g reasons Permit No. 7— a O Date Issued ............. J� No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSEfTS Application for Zi5potal *pztem Construction Permit { Application for a Permit to Construct( )Repair( IKUpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ��GI�(/f�j�/�Q/�j //G C Owner's Name,Address and Tel.No. Assessor's Map/Parcel ff/Wj Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �Z Dohs , Z/ v Type of Building: Dwelling , No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(✓�� 1 Other Type of Building ��� Ce No.of Persons: 4 Showers Cafeteria( ) � Other Fixtures `, d Design Flow g [ 'p F'. y. ed y g //� ea er da Calculated dail. flow 3�D allons. Plan Date Number of sheets kRevision Date Title t Size of Septic Tank 6.Fype°of S.A.S. { Description of Soil .. .• .,. �- Nature of Repairs or Alterations(Answer when applicable'' ) �������� i f Date last inspected: y 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�byt B. .• ;fe;alth. .... ` Signed Date � Application Approved by Date V- 3 a 57 Application Disapproved for the follow' g reasons Permit No. 7` a.D Date Issued j THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance f, THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( a/J Upgraded ( ) Abandoned( )by at 27- 41 Aa'r'/aer G/ G le has been constructed in accordance with the provisi ins of Title 5 and the for Disposal System Construction Permit No. 77,20 '7 dated ' Installer t �rG' © / C��l✓�` Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date S1 ! Inspector \� i i —— ——————————————— ———————--7 / —————— No. �3 — I/ G L��3C/ Fee r THE.COMMONWEALTH OF MASSACHUSETTS j PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopotar 6pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( �Up ade( )Abandon( ) System located at Z 1 ns'4 111)zh fr 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. PY g P P � Provided:Construction must be completed within three years of the date of this permit. Date: 3 Approved by `1 1 F'iAi W Genf G►PApo' _ .._.._... , vd�e Tif�v•c z � ov,B�t I•f7 ■ 42Y.$ I, R p IS T 13 o x ' or c IP t.O • Q 4 G I'll,7i�"Iv[ollljpl�� i Isi 0,00 ` ��,�.�V\\\M .. � J III .. n n�' �t:/���-•�� Ts ' •� •f, � j ,; � yam• .. 7 lr:�•�A3 f %;�r '• � - '� �,�•/'�A'Y 7�.. "�`•$�,�• �./ /•� .. ` d s� `��f, r it NOTICE: This Form Is T® Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A IDISPOSAL WORKS CONSTRUCTION PERMIT MTIIOUT IDESIGNEID PLAN hereby certify that the application for disposal works construction permit signed by me dated yf lz e/� 7 concerning the property located at meets all of the following criteria: /71 ere are no wetlands within 300 feet of the proposed septic system There are no private wells within 1-50 feet of the proposed septic system The observed groundwater table is l;feet or greater w g gr r 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: ?Ae-7 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]. q:health folder.cert rG • TOWN OF BARNSTABLE Z �/� Gj/PG�� SEWAGE # I7�ZDT LOCATION Z _ VILLAGE Cv f(,fl ASSESSOR'S MAP & LOT 07 /36 INS.TALLER'S NAME&PHONE NO. Ai PZpio 4f) 4 yML 7—V 9399 SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) (size) l NO.OF BEDROOMS— OWNER 3 I/ BUII.DER OR �6//� PERIviITDATE: —30 J�7 COMPLIANCE DATE: Separation Distance Between the: S•"f Feet IvlaaiIIiwm Adjusted Groundwater Table and Bottom of Leaching Facility Privafe.Water Supply Well and Leaching Facility(If any wells existAL_ Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist �J Feet within 300 feet of leaching facility) Furnished by . iqyj i O AM: � ss 9 t►•tb� LO CATION SEWAGE PERMIT NO. ,v� ,41ILLAGE INS A LLER' AME ol i - ADDRESS 0 U I L D E R OR OWNER DATE PERMIT ISSUED /—);z DAT E COMPLIANCE ISSUED ,. �� ,. b �� O � ��. I b � � �����`% 0-7f4 y THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...................OF...... ........................................ , pphrFa#ion for DhipmFal Works C umtrur#ion Prrmit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: � ..�.��.,.!�i .. .. L .... •-•--•--...... � Y .../4.4. <.. ..............••. ......�...._..� •-•.-•-- JJ��� Lo Add J 1 t o �"SL....� ............................ ••• •.... . ••.. •••• . . ._........----••-••............................... Owner. ...... ....Address a4a -- .......... .......t................................. Installer Address r Type of Building Size Lot.. y,_+ ....Sq. feet ,-, Dwelling—No. of Bedrooms............... ..........................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building ............................ No. of persons._.______&______________ Showers — Cafeteria a' Other fixtures ................................... W Design Flow:......... 7 7 ...................gallons per person per day. Total daily flow....... -..•___---..------_..---gallons. P4 Septic Tank—Liquid*capacityA07gallons Length.`-_.-f--... Width..'Y.___..__. Diameter................ Depth................ Disposal Trench—No. ................... Width.............._..... Total Length.................... Total leaching area....................sq. ft. r Seepage Pit No---------/......... Diameter....... ......... Depth below inlet...`; ...... Total leaching area`--sq. ft. Z Other Distribution box Dosing tank ) '-' Date..Percolation Test Results Performed by._...__ __...��! �__ _____ ___ ______________ _ �._���._.._...__.__... Test Pit No. 1_._._ %Z-----minutes per inch Depth of Test Pit.................... Depth to ground water...G PL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..�i... 9 •---•-•--•---•----••--•--•--...--•.........................•--------..........................................--•.................-----••-••••-••-•-•........ 0 Description of Soil................. ............. v ................................................ �...eie . ......._........._._..........__..._._......._......__.._.._...._._._..__...._............_.. 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 iI`:i.:,---: 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 hZbard,of.health. S•gned---- .... --------•••--------------------- --7_1V�0 Application Approved By..... ..Gate Date Application Disapproved for the following reasons-------------- ---•-----•---------------••-----•---•-•-••-----------•---•--.....--••----•••-•-----.............. ...........................•---•-•-•--------•-----....-•-------•-•--•------------------•--••---------•--------------------------------•------•-•-----•--•------•-----••-•---•-•--•--•-•......--......... Date PermitNo......................................................... Issued....................................................... Date NO....... ..L_.... Fzs.......... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ ... ---.OF.... .... ci ......... Appliration for Dispos al Works Tonstrurtiun runtit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ........ Loc ion Addr s_ t No.. ........................ ............................ _«r... , - .--............... � Owner r't'sC?. (1 =•°• =!1 ....................... .. ===•f lit!!S? Address .... A Type of Building Address ing Size Lot_J�;( i'____.Sq. feet V Dwelling—No. of Bedrooms................ ........................Expansion Attic ( ) Garbage Grinder ( ) aOther,' Type of Building ............................ No. of persons............ Showers ( ) '= Cafeteria ( ) Otherfixtures ............................................•......................................................................................................... W Design Flow............ .........................gallons per person per day. Total dal flow.....:_- ��_........................gallons. 04 W Septic Tank—Liquid capacity .gallons Length __ _..... Width-_-...... ..C=-.__.. Diameter................ Depth..... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......... ._..._... Diameter....... ...... Depth below inlet._ �_ ..�..... Total leaching areat,6- :;;E q. ft. Z Other Distribution box (/ )' Dosing tank Percolation Test Result5# Performed by....... Test Pit No. 1.... ......minutes per inch Depth of Test Pit.................... Depth to ground water. _...Ct� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water,&_e_... - -c a ••-•-•-•---•-•---•----•-•-•........•.................•---...........---..........---••--•••--•---•----•---....•---._........._.........---•••.....-•-........ ODescription of Soil................ y................------------r-------- ......._.....---••--------------------•-••-----------••------....----•--•--...-----------........:_._..-- V ------••----- ✓Y ..:/ calJf�. ..... W --------------------------- -----•-•-•••----- U 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'ITI 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. Date Application Approved By._.. / (, t '� r.. "� ' Date g Application Disapproved for the following reasons--------------------•--•-----•---•---------------------------•-----------------•-------------------------•_..._ s -......-•-•----------------------•-•------••-•---•-•---------........--•---------•-•-------•-•--...------•-••-----------•-----••-----------•-•-•...-•••----••-----•----•-•----••-•--••••-•--•-•••------ 1` Date PermitNo.................................................... _ Issued-_..------•-------- •-- Date--------•--._..-•-- ............... THE'. COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1?4 � LI /. ...............oF.......... . :..................................................................... Tn#ifiratr of Toutpliattrr THIS IS TO.C,ERTIFY, That the Individual Sewage Disposal System constructed (,N or Repaired ( _ by...... ''=� ...... < .,./rt: _r ;a--•----••.......................... ...............•-• ------_______-------_-_-......__-----•--•--_--____________-------- / Installer ,r� _ _•. ------------------------•-• ...................•............ has been installed in accordance with the provisions of J��1LF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nt4ev..__40.7___________________ da.ted__.:7''A_4'6 .y_...__..__..___.__.• THE ISSUANCE OF THIS .CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ I•ispector__---________-------------__-'•__-•--------•-----__----•--•-----------•----•--•---- , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Nok/?7 ............................................................... ....................... FEE... ±.....:!.. r... Disposal, Works nntrntion rrntit Permission is hereby granted 1._ -•--- 2 .....•-•-_- 691t .-......-•-•-----------•---•-•-----......-•...................... to Construct 0111) or Repair ( ), an Individual Sewage Disposal System at No / /` ,t� _ �'' ...-•................. J'_,�__ ��'c--••___. .• w ..'- �Street`--- as shown on the application for Disposal Works Construction P t N Dated..._7.................Jf--•----.--.--, - -----.•-_-• - DATE.._" ._ '..°.....�.. .................................. Board of Healt _ - ------------ FORM 1255' HOBBS & WARREN, INC.,,kPUBLISHERS ""�' w c.« �'� � �— �lA/ISN �r•p/1,DL���_ � ��N15'ff �a1C�plC �'►dNA�'W G1PATld� - • — — - • o v t 'r.4 N K _ .Lwo QYQK f�iT n G 2 Y r Togo a f Fi v Am- i __.._.��-^----. fcry • p j ' ec�oo�,�__ f D 3 T i 13 o x T • + ` a ° ' ' ° 11 j r ��� ome r sV4,1 r z • Ili�" �' ��� � � . . ..fir � �•c�' �...... _. _._._-------$-��-- =.,�..,,..,„,� �_ *: - •s � j do Aa Mad riAVI leg IV, CJC 7�o r �/AwrG� 7 Co� (f4cv ' -;eucr/dA/#AeRasWAN �fX:,, O m/d► ` ` L/��� L..i.K.� /iJ V IG0 SS c�