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HomeMy WebLinkAbout0014 GALAHAD CIRCLE - Health 14 VALAHAD CIR. ,OSTERVILLE A �PIAflafl Q R P 0 a ' P I ��jj** ff TOWN OF BA/RNSTABLE LOCATION I y (� ylAd///aJJ 6/le—le SEWAGE # 24W—1�Q7 ILLAGE D'S,'&'r111Z11! ASSESS.OR'S MAP & LOT/�lS�`O7G� ^INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1,0061 4 C LEACHING FAC1Lr1 Y: (type) rvo CIt ewe 4 C �,562 (size) )P "142 " NO.OF BEDROOMS 1. BUILDER O �W�NEPERMITDATE: 3— ,,�ZVO COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 FaciIIty(If any wetlands exist within 300 feet of leaching facility) /9 Feet.' Furnished by L'�Gt 00 70 No. � lg`] Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mtgpozal *p!tem Conztrurtton Vermtt Application for a Permit to Construct(dR p ' ( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /� /� �� /� C'�^le Assessor's Map/Parcel '7 �'OS nn1/1)e �iG Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms i? Lot Size sq.ft. Garbage Grinder Other Type of Building > P i5e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow Jv gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type Type of S.A.S. 2- —5-0-12 9aZ �cs Description of Soil: ZZZ 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 b this Bo of Mealth. _ l Signed Date 25 Application Approved by Date-A -30 Application Disapproved for the ollowtng reasons Permit No �_�9'7 Date Issued z 70 No. L Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zlpprtcatton for Mtgpool *pgtem Con5tructton Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /,y 6 4f/l / j Owner's Name,Address and Tel.No. Assessor's Map/Parcel O<Jc Installer's Name,Address,and Tel.No. /[� / Designer's Name,Address and Tel.No. BD/'tvlol�% Cod/s� Type of Building: Dwelling No.of Bedrooms L? Lot Size sq.ft. Garbage Grinder Other Type of Building PSf e`IGtF' No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow l/42 gallons per day. Calculated daily flow _34J gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �X l.`s �i'JQ �d�/' Type of S.A.S. 'Z -/ ©V5 Description of Soil Nature of Repairs or Alterations(Answer when applicable) ll'*4 �'�/ a 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 Bo of Jjealth. ll Signed i. Date Application Approved by Date A —_2) Application Disapproved for the ollowtng reasons Permit No.�`Z�� rf 7 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certtftcate of (Compliance THIS IS TO CE TIFY,that the On-site ewage Disposal System Constructed( )Repaired( V Upgiaded( ) Abandoned( )by at 41i&Y 4/11 L° has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 24-no- 19!7 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date L/ . ),g2g,P Inspector --------------------------------------- No. 91&% 17 /S=0�(/ Fee r� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS M-5pogal *pgtem Con5tructtou Vermtt Permission is hereby granted to Cojistrugt( )Repair( Vilup ade( )Abandon( ) System located at al (f/ G E 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: C, oc e Approved by 1/6199 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 PLANS) t L ��de��y-; J90/'�/'0/,hereby certify that the application for disposal works construction permit signed by me dated 91A9-106, concerning the property located at / y �aladlly GJ� meets all of the following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business es 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 septic system +' 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 I/There are no variances requested or needed I/The bottom of the proposed leaching facility will not be located less than five feet above the P Po g ty _ ma.,dmum adjusted groundwater table elevation.,_[Adjust the groundwater table using the Frimptor lif ethod when applicable] 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. DIFFERENCE BETWEEN A and B SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder.cen s- • # _ V �Jp �Jl/ c 1� �L ; . r x • „ a.. F. pit+1. `L - .. x ,�fj LOCATION //f . SEWAGE PERMIT NO. 7 �l 1 VILLAGE b' INSTA LLER'S NAME i ADDRESS 00 R U I L 0 E R OR OWN ED ' DATE PERMIT ISSUED ��7 -- 74 DAT E COMPLIANCE ISSUED e � I t 611 No ...........� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....--_-------..OF.... ................................ :._..._ App iration for Uiipniia1 Works T.mutruriion Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Sysat-,! ( .� .. .-----•--- - -...._. Loa n-A ss or Lot Owner . a �. -----. . - I taller Address Type of Building Size Lot.4_Q0 0T Sq. feet Dwelling—No. of Bedrooms------------- --------------------------Expansion Attic Garbage Grinder 04 Other—Type of Building -----------------------•-•-- No. of persons---------------------------- Showers ( ) — Cafeteria a' Other fixtures ...........�. -------------------------------------------- =` Design Flow....... _ �llons per person per day. Total daily flow------ ��P...... ,P D....gallons. fx Septic Tank—Liquid ca acity./404t..gallons Length......... Width. ____.___. Diameter__._-__.._ Depth................ W x Disposal Trench—P'�To. ��JvVidth..... :............ Total Length............. Total leaching area.......____._.._j>..sq. ft. Seepage Pit No....... :........ Diameter--__-- ----- Depth below inlet........4F... Total 1 h- g area.�L'-l__•sq. ft. Z Other Distribution box ( ) Dosing to k ( )_ � ��W- '-' Percolation Test Results Performed b _. . . Y... ....Date.._ Y ... •-- Test Pit No. I................minutes per inch Depth of Test Pit-- ...... Depth to ground water------------------------ (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------._-----__---__. ----------------------------------------------------------------------------------------•... .... ......... -`� 9 --- Description of Soil......... ----- --------------- -- ---- _ 21 W --------------------------------------------------------------------------------- '= �� .:� UNature of Repairs or Alterations—Answer when applicable______________________________-.--- ---...ej.- `3'� r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT -c;.. 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 t e board health. -------------------•--••••--•-• ......3 ...V Application Approved By......./"'V - ------07 7- 7e. Date Application Disapproved for the following reasons-..........................7.*., ---•-•-•-•---......--•--...--------------••---•-•---•----••-••........... -•-------•----------------------------------•-----------------------------•-----------......------------------•--•-----...........................-----------------------------------------........... Date PermitNo......................................................... Issued.--- -ll` Z '....................... Date 1 r R_. 3- �• ...... .C.. ..._.. FEE.. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............:......OF...:.... .......: ... _ A pfiration for iiipniial arks Tonotrnrtiun rrmit Application is hereby made for a Permit to Construct ( or Repair ( ',) an Individual Sewage Disposal S)st.. .............••--•----- - --. ............a .............................................t a� Cl� Lo on- ss . �or Lot _ /J/. ..._. ...... ..--n ._. .. ................................ r I�! Owner y�/�ryJ{y ddress 't Er� staller a +;'" Address Type of Building �f,/Size Lot..._ --:--Sq. feet g— ...................Ekpansion Attic x/�/1 ar age Grinder (. a Dwelling—No.No. of Bedrooms..............:. p., Other—Type of Building ............. ............. No. of persons............................ Showers ( ) — Cafeteria a !Other fixtures. -- ...................................... ;� = ... d {' : :. gallons. W Desg>} :Flow.•... gallons per person per ay. Total daily flow--------- jj WSeptic Tank—Liquid; c gallons Length----- Width_. ...... Diameter __ t11................ DisposaTr`e Bch—r7o Width•................... Total t Total leaching area._____ fcsq. ft j See a e,Prt No .__.. Diameter -.. _-_- De tliAbel<ow inlet `:..� '� _ T area_. r.s ft. P g sue ' pj q Z Other Distributiddb6x?,( ) Dosmg ( D f w 7'—' Percolation Test Results Performed by. ate Test Pit No. I...... minutes po inch Depth of Test Pit-................... Dept to g oi> yaier LL, Test Pit No. 2._.... x minutes per inch ,Depth of Test Pit.................... grin water ... Description of Sglli� t ,a s 'gr W • ------'•-•••-•------_.... ..............................V < ............................................ -- ''- -------------------------- --- -- = . V Natureof Repairs,o teratons An _______ _ ____ ________ _____ w ._...._.._._......_ ......_(_...................... _..__......................................... .................... ..... ........ .._--.•----..........__....._ - ------ ......... .._..... ......Agreement: The undersigned agrees to install the edescribed Individual Sewage•,Disposal System in accordance witli the provisions of TI`. : 5 of the State Sanitary Code—The undersigned furl, agreesu `to p ace l e system in operation until a Certificate of Compliance has beeri"issued by e board health . .� �,, �Signe s t € Application APProved - r............. Date Application Disapproved for the f ollowang reasons:--------- ........... +, ' ............................ . -•-•----•.............•------•-•-------••---•--.....---..............-----------..._... .......... --........ ------------ __ i Date Permit No.-----•................... - Issued.....V.. . -�•-= ------•--•---- Date - THE COMMONIYV ALTH OF MASSACHUSETTS BOA OF, H.HEALTHT- 06.410 . ............ ...........OF.. ...... ...... ......... .......................... Ter# ar r of (�nntlinrr THIS IS CERTIF th I iv' al Sewage Disposal System constructed or Repaired ( ) by10" .... ------ -----=- -- --- -------.-.-------------------------------------- rat ?ar .......„....... '. f•- A'� . - ----•• ---••-••••--•---••-•-••-•------•--•-------------•••-•-••--........._--•-•- has been installed in acce with the provisions of TI 5 of T e State Sanitary C a esc ' in the . -io application for Disposal Works Construction Permit N ---- ..:.::':__l�.Cf.._....... da.ted.:_...__. ---------------- THE .:._... ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEWI'�WILC FUNCTION 'SATISFACTORY. F '` // -- �DATE..................•----- .. •-�..--------•------•-.._..... Ins etor...... ---------------------..- ...---- ---------------------•---........ THE COMMONWEALTH OF MASSACHUSETTS ,�9 BOARD OF HEA TH f ....................OF... r n No.................. .. FEE... . Mop a1 Vorkg 01I. #rn 'ern it Permission.is hereby granted...... ._. .. to Construct ( ) or Repair ( ) an Individual Sewage Disposal�ystem­ -----r at No Street r� !� as shown on the application for Disposal Works Construction Per _7,,o.__ .: _. ____ _ ted-__•---t�.__` ..._.___j.-'._.... ., Board of Heaith DATE.. ...... ....... =.. ••-•----- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERSr' " ;? , .}- t7411 �1 L L'.l_� lw Q•M'�z.(. -ti: "��-_.�w t�C:N\ ter, AwV.. � F'T It' TAti1K = ��C7r (Cj c/C?49r-26.F'D. �\- US�E-- lGCGC-, r;al_ . .2 ; r; �+.j C t 2 n'A L'EL"'GDIQTli��� C�GTE 1� ? Iu D2 Lk , •v1r' J .fi t ` 00 c� r 4 1 A 'TI✓5T To t"N't' u = lvo.o ��OI( (I& J si&1'TIC In A'•. iNV. -FAS4V- - I Don 0 W t Tt�-1 I� _ Q c> i , C_E 1� Ci {- �f T!-�,(aT• Ti �E_ xL•.`.{ l1 G Stic>�IIJ 1-1 IZ - G,t_ lC_L= e-1�.t;tW I'�I...T C�.•1.\i'�-•`!S W t"1'!-� -f t-1�� �I P G L_I t-lE:. � ��� `�� t A.WD 7L'T"1',ACI! r LPLc- ra n.°r t_ _ tt/r� �� �- I• � -r f ^,.� g!�.h-r G t�::_ !�, t,���C !�;�. 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