Loading...
HomeMy WebLinkAbout0071 BAYVIEW CIRCLE - Health 71 Bayview.Circle Osterville A = 142 —090 a' No. i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPrication for Moogaf *raem Cow6truction Permit Application for a Pemut to Construct( )Repair(1�)Upgrade( )Abandon( ) e Complete System ❑Individual Components Location Address or Lot No. 7/ 6�lv/e ti AC`e— Owner's Name dress and Tel.No. Assessor'sMap/Parcel Q��. ��y,�� � � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -7 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 d gallons per day. Calculated daily flow g41,0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 7 ���d 411mc 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 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B o ealt Signed Date 71/Qe Application Approved by _ Date — Application Disapproved for tfVfolloViing reasons Permit No. Date Issued / ,� Fee�J THE COMMONWEALTH OF MAS9AC1 USETTS Entered in computes: Yes PUBLIC HEALTH DIVISION -.TOWN OF BARNSTABLE., MASSACHUSETTS Application for jDie;po.5af *p$tem Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) 'ls'Complete System ❑Individual Components t Location Address or Lot No. 7/ ��t/�/f�/�/ lL' e Owner's N����ress and Tel.No. Assessor's Map/Parcel 1 0 y/ l v/11-�' / t Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �` BDr��Gfl�1 Co�s� J Type of Building: / Dwelling No.of Bedrooms '7 Lot Size sq.ft. Garbage Grinder Other Type of Building_- e5/ .e ee 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 ©D �Ie Type of S./AI.S. /D ,✓' y�XZ Description of Soil � 7 �'�D wl-dc IfeC��/9�isS ti Nature of Repairs or Alterations(Answer when applicable) 72 t1e Z� 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 t is B d o Hea Signed Date 7111W Application Approved by y rs• Date Application Disapproved for thYfollo4.ing reasons ._ Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CEJ�,TIFY, that the On-site Sewage Disposal System Constructed( )Repaired(V )Upgraded( ) Abandoned( by at Q U ui e'llele ®.S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated Z.0-9j;f- _. Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste funct'on as estgn,d�. Date --3 r) Inspector ——————————————————————————————————————— No. O 'u �O I AI 4- ao Fee J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mwigpogaf 6potem Construction Permit Permission is hereby granted to Construct( )Repair ✓)Upgrade( )Abandon( ) System located at 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 permiitt.. Date: -7 Approved by J x, 1 f- wo U119/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OSKETCH AND APPLICATION FOR DISPOSAL WORKS:CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) &f�l'�D'l�/' hereby certify that the application for disposal works construction ermit signed by me dated 7 �g . concerning the P ., Pi meets all of the located at �� �� l/�'� G���' � �i�''�ll� property .. , 10 -lowing criteria: =here are no wetlands located within :oo fee:of:he proposed feat ning facility �ihere are no private wells within ::o reel of:he:r000sed_eCdC sv<<e^t There s ao Mcr ease in ow and cr;:range :n'1Se fCDOsed i here are no variances requested or needed. /If'zht: arocosed ieacain� :ogle .Junin 0 eel it any a iaras. :he crGm ,r �e . rquosed leaching ac-iiry-61 ,� r ! . rc [e�..5s:Ilan :ourtee:: grUu.-1aVv.'Cr motreievadowi, Please complete the following: A)Top of Ground Elevation(according:o the Engineering Division G.I.S..map) . B)Observed Groundwater 1aoie Elevation(according to Health Division we.-'I map;► SIGNED: ` DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER Also if the licensed installer Cs a certified plot plan. [ARK*a sketch plan of the prop pain tbisplaa should be wbmdced]. ,��r aZ I c• o � �•-- TOWN OF BARNSTABLE LOCH ON 7/ SEWAGE # y� VILLAGE a.S ASSESSOR'S MAP & LOT l�1� Qe INSTALLER'S NAME&PHONE NO. BG'�70LOf �O�'s1' 77/-f3py' SEPTIC TANK CAPACITY /3'0�' G. j LEACHING FACILITY: (type) .� Lf-�� �6� (size) NO. OF BEDROOOOMMS---�? BUII.,DER^�� :`O: LR � �Fir��•�L c� PERMIT DATE: 7— � 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 ,/ Feet within 300 feet of leaching facility) Furnished by 30 ff&` ,�O O w- e �p`b o U<n r TO OF BARNSTABLE f �. 0 90 LO(' N SEWAGE # 1 A Qd1..0 VII.LAGE ASSESSO 'S MAP & LOT - DNA NAME&PHONE NO. � Nat* SEPTIC TANK CAPACITY L>>/-yC2;.¢ 4�0 ' x 5 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 41 V//G.. 12,o 60 &113 ., BUILDER OR�WNER C.CJ PERMITDATE: 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by oo Idk V i i TOWN OF BARNSTABLE 6 LOCATION �� �Q�U/� C1�7��`� . SEWAGE # VILIrAGE a5 fely11le— /� ASSESSOR'S MAP& LOT lYZ �AV INSTALLER'S NAME&PHONE NO. Xel-h;�100` 77/-X3-A^ SEPTIC TANK CAPACITY LEACHING FACIL=: (type)<. (6� (size) NO.,OF BEDROOMS— BUILDER CSC OWNER �F.�a;���►Lc( PERMTTDATE: �' —Z � 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 2001feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by c - s O O ' l ' 4 2 THE COMMONWEALTH OF MASSACHUSETTS . BOARD F HEA TH ;. o � .. OF ApplirFation -fox Uhip sal Warkii Tutu#rurtion Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal 1 ... . a - r a ion-Address or Lot No. Address Installer Address Q Type of Buildin Size Lot............................Sq. feet U Dwelling—' No. of Bedrooms______________ -------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _____________________ ___ No. of Pei-soils--------._._---_-____-_-__ Showers ( ) — Cafeteria ( ) G, Other firtures .--•----------•--------------------------------------------------------------------------------•--- .................................... allons Length Width--------- Diameter------- Depth---------- Disposal gallons.W Design Flow ............ :.... gallons per person per day. Total daily flow---------------------------------------- W Septic Tank�Ligti• cit�R. g- g 1 x Trench—No.:................... Width._..____. ____ _ Total h__ ----- Total leachingarea____.._.____-_-_-.-s ft. Seepage Pit No.. . ____-- Diameter-- l- --"� h Dwn e .-----._ to leachi trea------------------sq ft. P . :r �. 1. Z Other Distribution box ( ) Dosing tank D aPercolation Test Results Performed by------- --------------------------•-------............•••. ......•--•• Date--------------------------------------- a Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water-.._____.____._.--_-..-. f14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..........._._-____..--. i Description of Soil------------------- .--•-•-. s' -- -C� --- -------------------- - U -•-•-••-------------------------------------------- -------------••-••---•----••-•---•--••--••-----•-...---•-----•--------------------••.....---....._..--•-•-••...-----•------•......----•----------- 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 Article XI of the State Sanitary Code—The undersigned"further agrees not to place the system in operation until a Certificate of Compliance has be seX, r of health. igned /ate Application Approved By----------- 9 Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------=--------•--- ---------------------------------------------------------------------------------------•-•-------------.---------------------------------------------------------- ------------------------------------- Date ...... Issued...... --_--- 1........................ Permit No......................................................... 9 - � ate .. _' '-- ----------------------- -i No....... 5.... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD F 1-6EA `TH, _.� ' ° ------- OF.---- ..:............ ..- . / .... ....... ..... Appliratirru -fur Di_qpuiittl Workii Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System r � i '�' ' pf�j�f C Imo{! ...a..:' ----_'-_-- P------- ----- --------- •-----------•- -•`••--------•--- -.. �--''----=---••---- ----- ---------------••----------------•------- �C canon-Address / or Lot No. `de Address -- a ------ ---------' ' .,__1 _. . -��` '' ............ ._.._. Installer Address UType of Building«/ Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------/---------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q, Other fixtures -------------------------------------------------------------••----------------------------------------•-----------•--------•--------•-------------- d W Design Flow___________�__,,-'" ................gallons per person per day. Total daily flow--------------------------------------------gallons. W Septic Tank—Liquitrcapacity /'V' gallons Length................ Width ---- Diameter._.._-..--.--_-- Depth---------------- W Disposal Trench—No .................... Width Total Leta tl _.-_ Total leaching area--------_----------sq. ft. a.P Seepage Pit No-------------------- Diameter..! _ epth b.01 winlet........... leaching area_______._____.__.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) -4; Percolation Test Results Performed by------- ------•---------••------•----•---•------•---------...--•--•-•----. Date------------------------------------.... Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.---.---.----..--.-----. xq Test Pit No. 2----------------minutes per inch Depth of /Test Pit.................... Depth to ground water-_.--.------.--._.--.--. pyF _- _-T........................................................ ... �:._..._. ._..__._._.____ P - Description of Soil f- - ----------� ..G; ,....... , U --•---•-----------------------------------------------------•------------------------•--•---------.---••-•--•-••-•--•-----------------------------•---•---•-••----P-------------------------------- 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 thgoboard of health. f gfie y..- �j ` i Date Application Approved By-...... -- t / = �2 l .. ,. Date Application Disapproved for the following reasons:............................ ------•--------------------------------------------------------•••----•------------ --•--•-----------•-----••--•-•----•---------------------------•--•--•-•••---•-------....------------------•-•••---••------•----•-•••-••••-••------•••-••--•-------------------------------------------- Date PermitNo........................................---------------- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � .......OF............ .... ...tea .#. wrtifirate of Toutpliuua TH S 'S TO CER".IF , That th Individual Se isposal System constructed ( ) or Repaired ( ) 1� / Installer at , � e F` " `''s'' fP?A yer _.t ?......... .......•--•----•------- has been installed in accor nee with the provisions of Article XI of The State Sarnitary Code s described in the application for Disposal Works Construction Permit No------------�_c0 ---''�-------------- dated-- ��� ............. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A G ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS „� . BOARD Of HEALTH �i��u ` 1 fur.k,� (n,a�t�t� rtivat err it b ted___ ..___Permission h � � , .................................................. to Const 4Af r Repair ) an Individual SeNjage ispo a System f ?/ f `Street �+ as shown on the application for Disposal Works Construction er t No.___ .. !"t _i ed..- ; f. Z-.......... Board of Health DATE.----. -- ---- -------------X-------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS D W. MARCOTTE•CONST. CO. 104 Stoney Cliff Road Centerville,Massachusetts 02632 ' `�. e A 617 775-4035 F i. _ ILI €, ` C4 14 + ti ' � • 6 ode �,�� ��,--,,----••--++ ����F `y�f'. • . f f �,� `'".�3y.xr �• (3� T t 4 X tifi lil oq', C 47 ••,.+ �..— `awl, � tt.' PdP .- �. �. t� t. �,d 7"�•i'�'Oq {{.�i It'Q.�' 1.''.. '1� 1. 4.1 I It : Pf . O_2 LZ_ -vE.N/SAN W. s t n k *af t+y P yA[ *',y C} ,I j d" .•. ._r'Ls .�J��N-'�ItH,/ �_ r_l.rr�E^-_V_L.Y ) ,A;'.;5. x - -'.y.:. .• S- .r+w .r!.. »,'.: +m.�+}•.�aw4c,.�ws .spa...d. __ - .::,-L' 1s vP'r"Y w T.T.: