HomeMy WebLinkAbout0621 PITCHER'S WAY - Health 621 PITCHERS WAY, HYANNIS
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TOWN OF BARNSTABLE
LOCAI OR & 21 el-lc h k T WA�/ SEWAGE # w9n ,
VILI:AGE �4j d ,44� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 4!n& l h V cc � c
SEPTIC TANK CAPACITY j`o y
LEACHING FACIL=: ( ) /al I7-/IA OP S (size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE: 10
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
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No. , 7 , Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS �\
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01pprication for Migaar *pgtem Construction Permit O
Application for a Permit to Construct( )Repair( )Upgrade(Z)Abandon( ) El Complete System Individual Components
Location Address or Lot No. 1/ p Mc_ ✓S Owner's Name,Address and Tel.No.
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Assessor's Map/Parcel ^ ��
Installer's Name,Address,and Tek No. Designer's Name,Address and Tel.No.
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0�7 5 7
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 y gallons per day. Calculated daily flow C7 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank i�` ,_10eO �i u Type of S.A.S. C;C a -�
Description of Soil �� �3—W ,
Nature of Repairs or Alterations(Answer when applicable) ti
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 en issued by ��,ea�
Signed Date a_62:
Application Approved by Date 1n ,:6
Application Disapproved for the fofilwin reasons
- l 1
Permit No. r/ � � � Date Issued
`a •: gyp_ ;/ / � :,,,,_. '� l ``..... _
Fee
x No.
tHE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
-. Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS_'
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01pprtcation for Migpogal *pgtem Congtruction Permit \V1
Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) ❑Complete System LVJ'Individual Components
Location Address or Lot No. 10/76 KS 4c41 Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel,No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No..of Bedrooms 7 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 K C7 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank gse-,, 4Lae A oc Type of S.A.S. c e f
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) k 5- 2
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 een i—ss-u-edT-y-MrpBcWd:ii�' alth:
Signed Date le'65
Application Approved by Date. J g -
Application Disapproved for the fo ' win reasons
Permit No. Date Issued
--
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (tompliance
THIS IS TO CERTIFY, that the Qn-.site Sewage Disposal System Constructed( )Repaired ( )Upgraded(C11111,
Abandoned( )by 5 -
at < lc has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated
Installer Designer
The issuance of this e h not be construed as a guarantee that the ate will fu�ctio as igne % / '
Date 'L . Inspector -✓'
----------------------------------------
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migpogal *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon
System located at C.c
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: P1 Approved by
�'T s. yr d7 tis
li6i99
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
I, a Tt' .1, hereby certify that the application for disposal works
construction permit signed by me dated /�`�` � concetnina the
property located at ���� /�iJ'U�o„S ��'�✓ , meets all of the
followinc, criteria:
"• The 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.
There are no wetlands within 100 feet of the proposed septicsystem
There 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.
•/The bottom of the proposed leaching facility will not be located less than five feet above the
(/ ma.�imum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
method when applicable]
_,11if 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:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation ��/�(/' the MAX. High G.W. Adjustment . /i
DIFFERENCE BETWEEN A and B O r
SIGNED : J DATE: &
[Sketch proposed plan of system on back].
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TOWN OF BARNSTABLE ~a'
- LOCATION SEWAGE # 2
VILLAGE ASSESSOR'S MAP & LOT —
INSTALLER'S NAME&PHONE NO. 61_)Ce P _� T
SEPTIC TANK CAPACITY
LEACHING FACELITY: ��Ad r0'!!C C (size) //X
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
C'.
Private Water Supply Well and Leaching Facility (If any wells exist r
qlo
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
may_
Furnished by
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LOCATIO SEWAGE RMIT N0._
V LLAGE
INSTA L ER'S NAME & ADDRESS
B .UYLDER OR OWNER
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DATE PERMIT ISSUED -- 22
DATE C0 M P L I A N C E ISSUED
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THE COMMONWEALTH OF MASSACHUSETTS
Application is hereby'made for a Permit to Construct (/-�®r Repair an Individual Sewage Disposal
Sy75t a,
Installer Address
Sq. feet
Z Other Distribution box Dosing tank
4ztA ----- ------------:dd
6,��-- ----- ----------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
--------'—`---'-----------------------'`---'—'-------'--'------------
' AXrcco=o,:
The undersigned agrees to install the oforcdcnoribcd Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Oode—]he undersigned further agrees not mplace the system in
| operation until a Certificate of Compliance has been issued by the board of health.�Si;ne ---- --- --- --- ...14-6 / ^
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---------'-----'---'''-'--'-----''''---------------—''''''''''''''''''-''''—'''--
No. ----•-3- ................_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH,
Appliratinn -for Di-q wial works Tonstrurtion Vrrulft
Application is hereby"made for a Permit to Construct (!�-)o Repair ( ) an Individual Sewage Disposal
System at:
== r' •.� ' ------f /,r,/,Z✓� "ark._���.�r�.�.
---------------------- --...._.ess------------. - - -- -- - ------------ --
Location-Address J�/ or,.Lot No.
_.___.._._...______________ ______________________'_._._._ ......................__.....................
N r Owner! � :. Address
a ..........................: ...f.-r'� ... .-_-------�-. .....!�� .�f--�l..t?...... ..................................
-
� Inss tall--er / Address _
UType of Building Size Lot_ ___________---- _._S-.--- . q. feet
Dwelling—No. of Bedrooms------- -------------------------- -----Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons_____-_._.____-_______-_.._ Showers ( ) — Cafeteria ( )
Q' Other fixtures . _�-`�-' :`='
d -----------------------------------
-------------------•-••-------•-•-----•-------------•---------------------------••----•--------
W Design Flow............ t______________________gallons per person per day. Total daily flow_.....;:<-Q.0-__-___--__-_-_-.... _-gallons.
USeptic Tank—Liquid capacity.!-2-_- gallons Length---------------- Width................ Diameter___-__ ------- Depth---_---__-._.
xDisposal Trench—No..................... Width-------------------- Total Length--.--_______. . Total leaching area..----_._.__---._..-sq. ft.
a'f-
Seepage Pit No--- l ._.____ i rn > - ...... De th�licl'ow rrl�et rE'`__ !•-- =Pota1 leaching area._' ,')__�"-_--sq. ft.
Z Other Distribution box ( �)f Dosing tank ( ) /0G �a - G- /j'7'
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Percolation Test Results Performed bY---------- --------------------------------------------------------------- Date---------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water---------...............
G� Test Pit No. 2................minutes per inch Depth of Test Pit-.-_--_-_-.______ - Depth to ground water__....---_------___.._.
O -------- --------------E--------.------------- --------------- ------- ---- -------------------------
xDescription of Soil . - ; ' lL '-!< ,PzG ------- ---'-- -------------•------
U •---------------------•------------------------------••----•---------•------•--••-•-----••-----------•----•-----•-•-----•---••-----•---.--.•-.---------------_--.-----------------•---•-------•---------
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 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.Signed, /
•--•---------• -- •-•--••------ -------•------------ •--
A lication Approved B ; _. .. l _ Date
PP PP Y •r ---------
Application s ff r
Date
Application Disapproved for the following reasons:-----............ ----------------------------•-----•-••-------------•---• •------ -------Da.---------- ----
----------------------•------------------.......-•--------------•------•----------------------------------------•-----------------•.-•-----•------•-----.------•-----•--------------.•---.-----•--.---•-
,,(� Date
Permit No......................................................... Issued-------��1- .- r` �---•--•---
Date
c THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,/
..........�. .-.O F.. .................................
�rrtiirotr of %T1111utlionrr
THIS IS TO CERTIFY,,That./the Individual Sewage Disposal System constructed (.,� or Repaired ( )
y...- -•---•-•--------1-- --------
1,nstaller
at....... �J•' .-r_`s-JJA�,............. ------- "'
-------
has Keen installed in accordance with the provisions of Ar icl� XI�of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. �..:�1 "...............•_. dated....-./-.-.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE (� Inspector. ----•-- --------Y�------
: ---------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
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No........../}----•- FEE.......--...............
Diopotitt! ork Co�ctrrtioit� rrotit
Permission is hereby granted......... -... .. .........., , �= I�
to Construct or Repair ( )-an Individual Sewage Disposal System77/_
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/ Jos ,/r� �.' ✓'t' /'Z-t:'4::-�---. Street.
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as shown on the application for Disposal Works Construction^'Permit No.._-____�.j__ ..�j Dated......ol. ...........
Board o ea h
DATE-------------------------------------------------------------------............
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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621 PITCHERS WAY !1 &CONSULTING
HYANNIS,MA.
qg P.O.BOX 383
'c .If i I EAST FALMOUTH,MA. ShaWnS bd@SI. n@^ all
(508)495-2881 p g ley O.0•C�I11.