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HomeMy WebLinkAbout0450 MARINER CIRCLE - Health 450 Mariner Circle, Cotuit A= 024-090 _ TOhN OF t g MSTABLE L44`7- / f LOCATION ��C� i �'//11��5` G/QGa('-e SEWAGE # `�7- VILLAGE G� � t• ASSESSOR'S M,A,P�&LOT INSTALLER'S NAME&PHONE NO. ��� SEPTIC TANK CAPACITY /12 g6>0 LEACHING FACELrrY: (type) �4'.�; ��C X 2! iy zep� NO.OF BEDROOMS .3 BUILDER OR OWNER R A � PERMTTDATE: L—'07 -7 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) /G Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by y; 42 eA rk I No. 9 -7 fL� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[pplication for ]Dizpo at *pgtem Conztruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components LocatiorQAAddress or Lot No. Owner's Name,Address and Tel.No. ` Assessor's Ma /Pazcel eo f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /D Type of S.A.S. Description of Soil Nature f R-ep-ai/r�or Alte• ti �(Aer when applicable) — X 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 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by t is B d eal . Signed �-� �^ Date —7 Application Approved by Date Application Disapproved fort followi reasons Permit No. / Date Issued TOWN OF BARNSTABLE i/Cil L1A (e SEWAGE # 27- tl LOCATION ASSESSOR'S MAP & LOT VILLAGE INSTALLER'S NAME&PHONE NO. P r C� `Q 6>v <� SEPTIC TANK CAPACITY / Cx� ze - LEACHING FACILITY: (type) T--�•------- NO.OF BEDROOMS 4(/etV �;f BUILDER OR OWNER PERMTTDATE: -7 COMPLIANCE DATE: C, Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet �w ry on site or within 200 feet of leaching facilitywetlands exist , / Edge of Wetland and Leaching Facility(If any N� A, -e— Feet within 300 feet of leaching facility) Furnished by G l-QA C-h `T.Q1-2lVC" V l2 2A,2 AA � -mil = -�► �� � � � 00 No. 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for �Ngpogar *pztem Con5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Ma /Parcel t/" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 -3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title fe Size of Septic Tank ,lD Type of S.A.S. Description of Soil Nature of Repairs or Alter tions(Ans er when applicable) — x 2.�Z r Date last inspected: N`_ 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 ith 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by t is B d eal Signed Date Application Approved by Date - Application Disapproved for tIGyfo`llowiA reasons Permit No. % 7 _ 9/ Date Issued ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed _�)Repaired( )Upgraded( ) Abandoned( )by 410 0 /IU / at _ 44S y fZ(,e�.2 !rlJi�'/1 S �i.2 c.- 4�� '�� has be n c nstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - 9 ed Installer v Ic- /n'l 0 r? +0—) Designer LIZ The issuance of this permit shall not b construed as a guarantee that the sy em will nction as designed. Date "j - 1 7 Inspect No. 7— Fee T Cq•Ill�p'll NWEALTH OF MASSACHUSETTS PUBLIC HEALT ©IV""ISION - BARNSTABLE} MASSACHUSETTS Mopogar *p5tem Construction Permit Permission is hereby granted to Construct( )Repair(._Upgrade( , )Abandon( ) System located at ,ue<S Ci/Z C_v 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: Z G — S`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 PLANSI 1, , hereby certify that the application for disposal works cons uction permit signed by me dated �2 — Z y- , concerning the � property located at � ��` " meets all of the �� �,t 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 • Where are no variances requested or needed. SIGNED : DATE: �' 2' �� / 7 LICENSED SEPT C 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]. j:ccrt � J �J - AJ r LO Cy ATAG If SEWAGE PERMIT NO. !PILLAGE INSTALLER' - NAME 4k ADDRESS R VILWN OR DATE PERMIT ISSUED DATE COMPLIANCE ISSUED _ - b �� s� �� 9- v 7i I J � No79..1�. ---- Fsis............................ THE COMMONWEALTH OF MASSACHUSETTS /. L . BOARD OF HEATH eiv ..... .............OF.....Safe.00..W10coL ............................................... Appliration for Elhipasal 19,arks Tonotrurtion Famit Application is hereby made for a Permit to Construct G� or Repair an Individual Sewage Disposal System at: /, a ...............jze� ............... ..........zo�...................... ................. ... ...............; 0 ................ir........................................................ ,lLocation-Add Vi-t No. ---------- .................................................... . ........I... ..... &&d).......... ......I ............................... Lner, Address "e.......... .. .. ............. ............................................... ­_ -------- ..........................Y.s;a��-.r Address - ---------0 Type of Building Size Lot...JnQy,_A� _..Sq. feet Dwelling—No. of Bedrooms......... ...... ........................Expansion Attic Garbage Grinder Other—Type of Building No. of persons............&........... Showers Cafeteria a Other fixtures ------- ........................................................................................................................ ------------_------ Design Flow....L...........J—.37' ----gallons per person per day. Total daily flow............�V.0..................gallons. W r * Septic Tank—Liquid capacitv./ zallons Length.-S.-fV. Width--- Diameter................ Depth................ * Disposal Trench—No.................... Width..............._.... Total Length.................... Total leaching area....................sq. ft. Z t Seepage Pit No-----------/------- Diameter....... ...... Depth' below inlet.... ..i.... Total leaching area._.,..0_s57'_sq. ft. Z Other Distribution box (/) Dosing taA Percolation Test Results Performed Date.... ........ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water---A.-.10...&14.. Test Pit No. 2................minutes per inch Depth of Test Pit.___._.............. Depth to ground water.-o4.K.P................. .........................................***'*------------------------- ­ --- -----­--------"--------------**............. --------- 0 Description of Soil.................. ------------------------------------------------------------------------------------------------------------------------- ................... ........................................................................................................... - ---------*--------*-----­ ......................................................................................................................................I................................................................. 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 TL ILTI LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has I been ued by tVoqd of health.. 7P Signed.._..-en A*.A�.. ................................... ApplicationApproved By................................................................................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................................................................................ Date PermitNo......................................................... IssuedL.'AL/e .............................. Date ,U7)f THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH Appl nation for DiSpoii al Marks Tonstrnr#ion 11nmit Application is hereby made for a Permit to Construct (.)tom) or Repair ( ) an Individual Sewage Disposal System at• ............... ��` ✓ f ; IisG �... .�-? 'ez: .. r:._✓ ....... .... f Location-Addres —7 / r r Lot No • ....... - -- ..... ..., .... ner Address i1 Installer Address UType of Building Size Lot... ...¢�. %4�__.... . feet Other—Type . Bedrooms - ........................Expansion Attic ( ) Garbage Grinder ( ) a Dwelling YP o. of Bedingms; c ?l ca;c, ._.. No. of persons...........t ............ Showers ( ) — Cafeteria ( ) dOther fixtures ---------•--•••--•-•---•---•--------•---------------•-- -----------------••-•---......--•••••....................................................... Design Flow.................:7: __,_......_.....____gallons per person per day. Total daily flow---------- ...................gallons. W • WSeptic Tank—Liquid capacity-( !..gallons Length_7-..'V_ .. Width. .'#�."�.. Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area_._.....___..._r_sq. ft. Seepage Pit No........... ......... Diameter....... Depth below inlet...Z _______ Total leaching area._JZ ;a- .sq. ft. Z Other Distribution box (/ ) Dosing tank ( ) '-' Percolation Test Results Performed b ....:�-'�t�_:j......`........���t�, Date....�.5;/ - a Y ....._..._. Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..,/'_-..6 o-(,,_ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.e n•..KK-etii-. a' ••-•-•........-•-•-----•-•--------••----•--------------•--------.................--••--•----•----•-•.......................................... ........ .. 0 Description of Soil------------------=.......................e:..........................................................---............................................................. U .................................................-l�l!r ------ fl.__..c?�—•--........-•--------------•-•-•---....-•--------.........--•-----..................-----------•------------ 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 TiTL y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Signed <7 rr•--=..-- -------....��:_..:�J_ ,�_ • 'Dat_ /� Date ApplicationApproved By.................................................................................................. ........................................ ate "h Application Disapproved for the following reasons-.........-------- -_--------_-----------------------_--------------------------------- D ._._... .......................................................................................................... _.'$__.._ - - ----------------•-•-•------....._.-•-----•-------------------...Date a fiti r , Permit No.................... ' Issued. - Data .............•---..._•-•--- THE COMMONWEALTH OFF MA,SSACHUSETTS - ��� BOARD OF 'H'EALTH °nn .'... ...............OF...../ 'f�4� c. .....................a......................... C�rr#ifirtt#r la �.f�ant��i�nr�e THIS IS TO CERTIFY, That the Individual Sewage Disposal Systerr'l constructed or Repaired ( ) by...... .---7 --.--•- ., Installer at_... ........f� ......................................... .t ..........._ I.t..r. fi -------------- has been installed in accordance with the provisions of�T j ohe State Sanitary Code as described in the application for Disposal Works ,Construction Permit No____ .__.- ..If.................. dated.... `" ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED ASf A GUARANTEE THAT THE SYSTEM NAIL FUNCTION SATISFACTORY-: x DATE.......... I Spector.....__. a ....... ................................................... ......._------------___................................................ THE COMMONWEALTH OF MASSACHUSETTS � BOARD" OF HEALTH o �;4: ....... ..:-.........OF .��d� .J.. ....�.....................................Y. N .... - FEE ........... Dispsat Morkp Tonotrurtion ramit Pe rmiss>on > hereby granted...... rc-_._ !? ^__--•- ---- `-._.. f� -------------------------------------------- --- to Construct ) or Repair ( ) an Individual Sewage Dispogi System at No ....... ._. %� - t�....._--.. .................... $treet---------------------------------- 1 as shown on the application for Disposal Works Construction ....on P it N :_.__ Dated.... .w...................f_........ ............................._ + » Board of H DATE. --- .....-(--•----•-•. -•-•---•-------------------- .. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 • 1 �4 (- rilvesN arAre Cr4+ht'hF G;q'gve - - i p vL�AE TA A/K z '-'d o vER I01'T To c F F"4u vo. y t t � i`�`"�' raj'�^�. `✓X. 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