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HomeMy WebLinkAbout0049 AVALON CIRCLE - Health I�r49 AAALON CIRCLES OSTERVILLE 145 j 063 - - --- No. _/�CII*>-- Fee 7VYe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftphfation for Zisposar *pstrm Const union 3permit Application for a Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. (49 Ptundon C.j Owner's Name,Address,and Tel.No. —V6 GO- oralea-ua'!1� kyc e. Morcor�e 11 aka-l�i�S't-• Assessor's Map/Parcel /45 0&3 WIQ_6�- bfr MIEN OISoi Installer's Name,Address,and Tel.No.�Sb Designer's Name, ddress,and Tel.No. Gar-616Z_�' ��Skt��ton:Inc 44*—_r Jlvs+rsr N/ MCLMtO�n Vh4;115 _ IMA oac�Y� 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank e_X;Sti jM 1 0CZ_�q rd- Type of S.A.S. '--Y Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 C an to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date l�� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. c — '®P d— Date Issued No. 9.0/ 1 .. 1 � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�— Yesy PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliration for Visposal 6psteltt Construction permit Application for a Permit to Construct( ) Repair(J�) Upgrade( ) Abandon( ) ❑Complete System ®"Individual Components Location Address or Lot No,49 FAL)alpn 0-1 C? Owner's Name,Address,and Tel.No. SZ-) Assessor's Map/Parcel / 3 U)raj� -\0&r0 p• 01501 Installer's'Name,Address,and Tel.No. S1U$-7/l- 9v9� Designer's Name,Address,and Tel.No. ��narsknh�, 1M�li5 . 1r�1r/� o�YS t , Type of Building: v Dwelling No.of Bedrooms Lot Size, sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures `Design Flow(min.required) gpd Design flow provided 'gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank e-Ai S f i YL U r C Type of S.A.S. C_.>(• Description of Soil J Nature of Repairs or Alterations(A,nswer when applicable) 10,f, r . 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 C �anode to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. of Signed �-�` -".-."" -,-., Date Application Approved by Date Application Disapproved by Date for the following reasons 1 ,Permit No. a 7 "''/ d -'"" Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(;)Q Upgraded( ) Abandoned( )byr at 9? Ai)n +r�rI -(� { -.,�. ( (-L- -has-been constructed in accordance -with the provisions of Title 5 and the for Disposal System Construction Permit No�_/7'fS L) dated 5 / %0- / 7 Installer E�jt�� c,�U i.2 t t,t�.C�ije- C/1 n C Designer P� K n 'L4 #bedrooms 3 ! Approved design flow %JF gpd The issuance of this permit shall not a construed as a guarantee that the system I "11-funct'ornass s g 4d. Date , .l� 2 Inspector , __________________ No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 60stem Construction Permit Permission is hereby �grfanted to Construct( ) Repair(!t�(� Upgrade( ) Abandon -7 9 14 ( ) System located at J C}n C 1 re and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be/cpmpleted within three years of the date of this perm Date Approved b� TOWN OF BARNSTABLE LOCATION t f'S 4 lL,�L!��lL �(2.. SEWAGE # _jY j VILLAGE ASSESSOR'S MAP.&LOT -INSTALLER'S NAME&PHONE NO. k" Lear �I SEPTIC TANK CAPACITY /D On LEACHING FACILrrY: (type) 1FI I d � Z (size) .NO.OF BEDROOMS BUILDER OR OWNER Jc A a 4—cvedAZ ' c PERMITDATE COMPLIANCE DATE: Separation Distance Between the:. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet j PnYate Water Supply Well and Leaching Facility (If any wells exist I on site or within 200 feet of leaching facility) O Feet Edge of Wetland and Leaching Facility(If any wetlands exist :::..within 300 feet of leaching facility) i w f Feet Furnished by. r { I 6 U j TOWN OF BARNSTABLE LOCATION SEWAGE * VILLAGE . V1 "`-ASSESSOR'S MAP-&L:OT INSTALLER'S NAME&'PHONE NO. _ � lr SEPTIC;TANKwCAPACI'TY I:EACHING FACILITY(type)�,st" - NO OF BEDROOMSF BUMDER=OWOWNER PERMTTDATE `'.^ """ - COMPLIANCE DATE x s Separation Dtstance Between the:, Maximum•Adlusted Groundwater,Table to'the Bottom of Leaching Facility, b _ Feet Private'Water Supply Well and Leaching Facility (If any wells-exist on site or within 200:feet'of leaching_facility") Feet Feet Edge of Wetland and Leaching Facility(If any wetlands exist- within 300 feet of leaching facility) Feet L Furnished by r: ,��, � "_ � �- �' � ��' �- ;�, i �� � "'�o� V ,. _ � 5 �/ Xt No. "'P Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for �Digoml bpztem Construction permit Application for a Permit to Construct( )Repair fl*�Cpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t� /t} V A Leg`1 Cl—' f OXjner's Name,Address and Tel.No. IJ&A nta rCOA e , Assessor's Map/Parcel IyS' a(o� 4S ° 't A 11-a4ovi Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �� ��e �[4 4L - 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 Nature of Repairs or Alterations(Answer when applicable) IFX C-a_v q.. ('a A F 0 e L 42cz C, V►- /�fri / L f S 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 issu Ub�tBo Of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued iK—. �—'� 9 �y9 �w No. Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Roplication for Migonl *pztem Construction Permit Application for a Permit to Construct( )RepairJpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q c( V L-o ti CO_' I O�n�s�Name,Address and Tel.No. Assessor's Map/Parcel ( V l�J Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �1 KZ. 4 Qr rslLJa. t� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) } Other Type of Building e 4 H 6 No.of Persons Showers( ). Cafeteria( ) Other Fixtures Design Flow sa 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 - C p.fib i xkl" w Nature of Repairs or Alterations(Answer when applicable) �-�(cce v Q T !O r U te L G k t'►! 3 /4tA_Yi I.-t Date last inspected: a Agreement: , The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system Q' 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 issu by t is Bo S f Health. / Signed V Date V` 4 ' Application Approved by JAZZL, F Date (5 G� Z- Application Disapproved for the following reasons Permit No. .�' ! Date Issoed iK- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance AZI THIS IS TO CERTIFY,that the On-site Sewage Disposal S s em Co structed( )Repanre Upgraded( ) Abandoned( )by at ? has been construe& in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 -3 Y C7 dated (b — - Installer Designer "` —---•---. - ) The issuance of this pert shallilot bQ�co}astrued as a guarantee that the system i 1function as designed. Date �I �/ a Inspector- No. f No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS X"'Ui5pont *p.5tem Construction Permit Permission is hereby gran ed to Conspct( )Repair)Upgrade( )Abandon ) System located at � /7_C ( ( �C. � //0 J 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 rmit. - Date: 6 — f� Approved by c7' sue', 10/9/97 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 ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated L( , concerning the property located at q 'q /A-y a Co k meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility • 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. • If the proposed leaching facility will be located within 250 feet of any 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 Elevation(according to the Engineering Division G.I.S.map) DO B)Observed Groundwater Table Elevation(according to Health Division well map) 2d _ 3 © SIGNED: DATE: I LICENSED SEPTIC SYSTEM IN TALLER 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 I G��-eye �'�k-- � t �� ���: 17 No.......- ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEA T1-I '. :............OF................. ....... ... .................. Appliration for Ili4pnsal Works Tonotrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Re air ( ) an Individual Sewage Disposal i�f em .. N-----. .. .' .-•------------------••-----.... .......----...---... ... ............... ------- ocatio ` - ocatio Addr s r or Lot .... ........ =....... ................................. ................ ... .S�`.'---- .... ...................................... ner • Address a . . . ......... ........... BLS............................... ............... I ler Address dT of Building Size Lot............................Sq. feet . Dwelling�o. of Bedrooms____. :--.____-----•--------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............... No. of persons.*........................... Showers — Cafeteria Q' Other fixtures .................................. ----•--------------.-•--------•--•--•-•-•--•--•--......--•---.... ................................... W Design Flow................... —.gallons per person per day. Total daily flow.....-3 ......................gallons. WSeptic Tank Liquid capacity ._-----gallons Length................ Width................ Diameter................ Depth................. x Disposal Trench—No. .................... Width_.. ............. Total Length................. . Total leaching area....................sq. ft. Seepage Pit No---------��- Diameter........ Depth below inlet............ . Total leaching area..'?.o/...sq. ft. Z Other Distribution box ( ) Dosing ank Percolation Test Results/ Performed by----- ------------------------------------------------ Date... --................................ aTest Pit No. 1.__( .....minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil------------------ x x U Nature of Repairs or Alterations—Answer when applicable............................................................................................... L -••-----•-------------------•-----------------•-.........._......•••-••••••••••••••.................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of SITE 5 of the State Sanitary.Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued y the and of.h — / Sign �y-_-_ ....... '.................... ------- Date Application Approved BY •----- -----• ..Cd ....................................................... ...... -...r.. Date - Application Disapproved for the following reasons------------------- --- -----•-------•------------•--•--------.... -•.e.............. ...................••-•......------................--------------•---------••---•--...--•--•-----.....-----•--•-------------•-•-------•--- -----•---•--•-••-------•-------•-•---------------------•-- Date Permit No............ :....._.. Issu .`..................................................... Date No........... ,,s:..... Fss _............... THE COMMONWEALTH OF MASSACHUSETTS ,..._.� BOARD F HEA TH ..... .....OF......... ,t '................... Appliration for Dispuuttl ork's onotrur#inn rrrutit Application is hereby made for a Permit to Construct ( ) or Re air ( ) an Individual Sewage Disposal at: ............... ................................................ ocatio ddr r or Lot ... ... .... .............................. ............. ....................... ner . Address a _._......... r "..............4 ..... . .... .............. .... ........ I "'t Address T e f Buildinj ✓?� Size Lot............................Sq. feet U Dwelling of Bedrooms......... .................................Expansion Attic ( ) Garbage Grinder ( ) '04 4 Other—Type of Building .............. No. of persons_........................... Showers — Cafeteria a < Desl Flow_Other fixtures ••--•••"-'-' llons er erson er '� . W ign ..... ..... 5 P P P d$5'. tal daily flow,.a....r .. - ...-gallons. WSeptic Tank 4Ligui��tpacity.•...... allons Length................ W3d't�f_:.............. Diameter................ Depth................ xDis iosa!ttench—No. ...... ........... Width... . ........... Total Length.._....-•._....._.yyTotal leaching area....... .._..__ sq. ft. 3 Seepage Pit No..._..._...y...Diameter....._.... -_- Depth below inlet_ r_'...e_..�l. Total leaching area.._."' �_lsq. ft. Z Other Distribution box ( ) Dosingril ( ) aPercolation Test Res is Performed b jj .... .... .... Date.....At--------------•.-----.-----.. 1.4 Test Pit No. 1......`+,, ..minutes per inch Depth of Test Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•---•-----•----••-••--•••_.... ............. .....------. ���► f �+ .... O Description of Soil---•------•--- a.' ';' --- ...... s...- V ------------------- --------- --------- ----------------------------- -•-------------------- ----------- -........ •----------- •------ .------- -------- -------- ---------------------•--- 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued y the and of hea Signe . 1 1117 Application Approved By......... in. .. .................... flrtr!j •-•--_... Date � Application Disapproved for the following reasons: --------------•--•--•-------------------......--•--•----------------••-- -•-.....-•..-•---- --........••-•-----•..............................•----•......------------•--•--------------••-----•--••.•--•--_.........._...._...._......•---_..•---•----••--------•-•••------•--...--•-••......------ Date PermitNo.................................................... Issued-....................................................._ ? Date THE COMMONWEALTH OF-MASSACHUSETTS BOARD F HEALTH v..Y ........... .:OF.... ................. -� / (9rr#ifira tr of Tompliattrr THI$ IS T CER t the In h dual Sewage Disposal System constructed (Repaired ( ) by ! ...--•-- . -----• ............................. ........... st has been installed in accordance with the provisions of T F 5 of �e State (Sanitary Co e as described in the application for Disposal Works Construction Permit No.__...__ _ dated_................................................y v. _'S .._...----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CQ:NSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY., DATE................................................................................. Inspector..........................................----......---........---•----....._..._---- THE CClyMONWEALTK�OF MASSACHUSETTS ' ' � BQARD �HE T7f ........�..........OF....... .... ................. f'...'- No.........�..J��.. FEE........................ Disposal jar (94 inulinrc Prrutit Permission is he granted •-•_.... ' to Constru t or pair an ividu ear •Disp/ tem 7� y► . atNo...... ,� ._...Leo. .-.- •fli - ---- --------------------------- Street as shown on the application for Disposal Works Construction Per] i ��S�"�q• ` Board of ealth ---•-- •--•...................•---- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) mA , �- I / �C(J L DATA 1 CJ!�..y=-t_C:_ G=%-;�.....1 L\-( - _ _ .- _✓t�L�'v.'�•4. `ice ._ - !� ' ' A.f, ..1• i��..l Lam( 1`l_OUC/ � 1,�.> >. �� �^� C..F'•v. � ��-3�"('IC `("La,.1k = �=_1i.1 (�-i. �", �•c1=��: (.F?� ,� ,��•�rr. _. 'r _ Ui£ l CC%Li '6b t_ io l j�C�,Q:_ F�tT t_.35t= I(?r-',�• i� .._ .. '•y L= - - � ~�'�. /� i�.�. �a__,`,`f-' Lr2r, t f'rr'L^M Jt_l • r .. .:; � �� - _ _ � is -; - � ,.-_ - . �Ct t TDP 1-UU • . ... ,�f?f,e `,1--Pam _; :i tuv- .?-"; ..fi'✓vim I Iw. Gti�. a. 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