HomeMy WebLinkAbout0009 WEST WIND CIRCLE - Health WESTWIND CIRCLE, LLL
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TOWN OF BARNSTABLE
I:OCATION � ��i ��,Q cJ���e SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT 1 Z/—O!/.OZ5�'
INSTALLER'S NAME&PHONE NO. 'BOrfOLD � C4�lsr 7�/-93��
SEPTIC TANK CAPACITY IODp rfaC
LEACHING FACILITY: (type) _r dC16W1-i �S- � (size) 10'.V.09`/U
NO.OF BEDROOMS
BUILDER OR OWNER wd��Is
PERMU DATE: "� COMPLIANCE DATE: ,f-Ig- 0'
Separation Distance Between the
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility sf Feet
Private Water Supply Well and Leaching Facility, (If any wells exist
on site or within 200 feet of leaching facility) /1��i3 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) /I��/? Feet
Furnished by
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Vend
No. V � Fee
THE COMMONWEALTVF
F MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWNBARNSTABLE., MASSACHUSETTS
Zipplication for lhgool *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair( i')Upgrade( )Abandon( ) ❑Complete System L Individual Components
Location Address or Lot No. �^� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel C, /C^1 w Ill J
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Ile
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(p
Other Type of Building mo.of Persons Showers( ) Cafeteria( )
Other Fixtures _
Design Flow lld gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic TankJr50��P/ Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) r/,yle lee-oavlr
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 d of Health.
Signed Date
Application Approved by _ Date
Application Disapproved for the following reasons
Permit No. 1 Date Issued
#9 . - --7
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TOWN OF BARNSTABLE
LOCATION 11/,sSTGti/rl,Q SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLERS NAME&PHONE NO. BOr pLO ll`��4�"sT
7>/-�3�y
SEPTIC TANK CAPACITY L
LEACHING FACILPry: (type) - r �S
NO. OF BEDROOMS L1 (size)
BUILDER OR OWNER Willis
PERMITDATE:
COMPLIANCE DATE:
Separation Distance Between the;
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facili -s f Private Water Supply Well and LeachingFacilityty Feet
on site or within 200 feet of leaching facility) any wells exist
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
. within 300 feet of leaching facility)
Furnished by Feet
No. Fee
THE COMMONWEALT OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN F BARNSTABLES MASSACHUSETTS
01pprication for ni-4pont *pztem Construction Permit
Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System U Individual Components
Location Address or Lot No. Owner's Name Address and Tel.No.
/
Assessor's Map/Parcel t� �/f�C`e tv/ I J
o5�erui/l�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
7
Type of Building: /e
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder
Other Type of Building hle ,e1'ICCNo. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow � gallons per day. Calculated daily flow 2/40 gallons.
Plan Date Number of sheets Revision Date
Title _
Size of Septic Tank �'/S /�9 1J400'r�Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /�/� ✓� �✓\
Date last inspected:
r 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 Board of Health.
Signed ~ Date /
Application Approved by Y Date .
'Application Disapproved for the following reasons
Permit No. .^ Date Issued -
t
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
certificate of (Compliance
THIS IS TO CE TIFY,that t eh On-sit Sewage Disposal System Constructed( )Repaired(Upgraded( )
Abandoned( )by PD/'74�el �'re4:5; `.-
at 9 We,-9 GCW/IIZ7 Cll^ele 05 /'l -/, A ha �construe d m a co an
with the provisions of Title 5 and the for Disposal System Construction Permit No. ��tidated `"^ � �
Installer Designer
The issuance of this nermit shall, of be construed as a guarantee that the system will function as designed.
Date go, Inspector ,
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Xi! pogar *p5tem on5truction Permit
Permission is hereby ranted to Construct( )�tepair( Upgrade( )Abandon( )
System located at 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 usttbbe om leted within three years of the date of this t.
Date: �`' "�' Approved byS%
4+
i L/'I'
.W �'r
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)
klevXeffozee-1 , hereby certify that the application for disposal works
I, ;�
construction permit signed by me dated �!/vim/�r� concerning the
1e lllk� C�i'�� o� �L��le meets all of the
property located at 4
following criteria:
i/ There are no wetlands located within 100 feet of the proposed leaching facility
W/T ere are no private wells within 150 feet of the proposed septic system
There is no increase in flow and/or change in use proposed
2re 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 be located less than fourteen (14) feet above.the maximum adjusted
groundwater table elevation.
Please complete the following: / J
A)Top of Ground Elevation(according to the Engineering Division G.I.S. map)
B)Observed Groundwater Table Elevation(according to Health Division well map) l�
SIGNE
D :: -4 DATE: 7 /
LICENSED SEPTIC 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].
q:health folder:cert.
10CATION SEWAGE PERMIT NO.
VILLAGE
6454,,I/
INSTA LLER'S AM i ADDRESS
M �� e�d 7� ®let/ f
® U I L D E R OR 0 NER
1/1,740
DATE PERMIT ISSUEDtttt fo c�¢
DAT E COMPLIANCE ISSUED
® e�` Qt
a
1 �
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A/
No.............. ...,. a- . � ................ i
* THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Appliration for Disposal Works Tonstrnrtiun ramit
Application is hereby made for a Permit to Construct ('14"or Repair ( ) an Individual Sewage Disposal
SyWem :
- c ion-Addres or
QLAJ
,, �,, Owner J Address—
a ...... �,r_-ur -V"cu 1���r� �`�="-�F. yyy...•....----�Sk M�.✓� "�i�rf�f. ��+�
/ . . .......................
.........q: .....
Installer Address / B
UType of Building Size Lot..,/�ZFr..S feet
Dwelling—No. of Bedrooms.............--_---------•-____--_-___Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ____ o. of persons.........6--------------- Showers ( — Cafeteria (/ )
d Other fixtu e ---------- ------------------ r�
W Design Flow............... ----_..........gallons per person per clay. Total dai yyw..__.___......-'}__ _._D.............gallons.
WSeptic Tank—Liquid capacity./.&"gallons Length..__.. ___//____ Widt ... Diameter_.__/............. Depth................
x Disposal Trench—No..................... Width......_.jL ....... Tota Length..._.........._f.. Total leaching area_.___.. ........sq. ft.
Seepage Pit No.........I......... Diameter.......... ..... Depth below inlet......,._..... Total leaching area___�;,�..Zq. ft.
z Other Distribution box ( Dosing Atnk ( )Percolation Test Results Performed by.. /.J... Date......G/...... /
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..-......
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..._.
O Description of Soil.......
�...........................
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 iI11 LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been •ssued by the board,�of�ealthh.
w A
Signed..... .. .
Date
Application Approved By............ -•--------------------------- ..... ...........
Date
Application Disapproved for the following reasons:__...
--••-•--•---•-------------•--•--•-•-•------•--•-----•-••--•-..................--•--- -----__.......
...................•-----------------•-----•----•-•----------•-----------•---•--------------•-------------•---•--•----------•-----•------...---------•---•------------•-•------•-----•----------•_-•---
I Date
Permit No. �... .........-���---------•--...... Issued.. •----- ....
- - ---------- - --- ----- -
N ............. ` FRs............................_
S THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
m
ApplirFa#ion for Disposal Ivor s Tonstrurtion fumit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
--------------------- -----C'tw. ,�144�.................
p oLg�ation-AddresO
-- ... ......�Y___
or Lot No.
Owne Addr s ..............
-•�-
Installer
Address
U Type of Building Size Lot_/,f. J...Sq. feet
�-, Dwelling—No. of Bedrooms.........._____________________________Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building ,Q No. of persons........ ______________ Showers ) — Cafeteria ( )
Otherfixt r ----V.................................................................
Design
------
Flow............... per person p Jay. Total _ _______
_ gallons
Li ud ca acitYjG(_� gallons Length ______ Width_. ..... Diameter__ . ._.__._ DePthWSe tic Tank .
x Disposal Trench—N ____________________ Width___. __t.___._.___ Total Length........... �___ Total leaching.area .............sq. ft.
Seepage Pit No________ ___________ Diameter.____.__.. __-___ Depth below inlet____. ..___ Total leaching area_ ,�_ sq. ft.
? Z Dosing )
Percolation r1Test Results Performed by. Date....
ank ( f Date___ ° ^'"
Test Pit No. I................minutes per inch Depth of Test Pit....._____._...._... Depth to ground water�f
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water"' �f_
er
Pd
Description of Soil _ __.. 1 .. 1 �
U •-•••---•-••••--------- ----••.....--•--------•••••-•-•- ••--•--------.,......----.._.. ------•---•-------------.:.-----------•-------•----•-------...-•-----------•-•-•--•--------•--
W"
�"`"x 3 Nature of Re airs or Alterations—Answer when applicable U--� P PP
�ry : Agreement:
's The undersigned agrees to install the aforedescribed% Individual Sewage Disposal System in accordance with
the provisions of TITI.I -&-of the State Sanitary Code,. The undersigned further agrees not to place the system in
operation until a Certificate 64Compliance has been sued by the boar ollealth.
Si ned_f
b Date
Application Approved By........ ...............................
Date
Application Disapproved for the following reasons-..........=....................................................................................-.................
--.....-•------------•--•....---•-----•--.....__..... •- =`:..........................••------------•---•-•-••--•-•---•-----••-------•-•----•--•-----•-•-• a--••--•--•------
� D
-Permit — 4 � Id e�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD:.. OF .HEALTH I
...... .0F...... ...�... -• Y
CInrtifiratr of toanpliFanre ;
THIS I. TO CERTIFY, That n the Ind:vi ual Sewage sposal System constructed ( ) or Repaired ( )
bY-------- - .. '''b! ........._ •L'I_ .Li•' �'' -•-•---- --- ------ -------- ----
f Installe
has been installed in accordance with the provisions of TITLE, j of The State Sanitary Code s described in the
application for Disposal Works Construction Permit No.......Xq� _ lr dated ..._. _. _
THE ISSUANCE OF THIS CERTIFIdATE SHALL NOT BE CO STRUED AS A G A ANTEE THAT THE
SYSTEA+I' VYILL FUN TION SATISFACTORY.
DATE.......... . _. ........................................ Inspector.....__ .. ._ ... ,r..................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.
No....49�--1•-"_. 07
FEE... l_ ..........
Disposal orkp & #r ' per t#
Permission is hereby granted_. ,• AA `_.._ - ..
to Construct ( ) or�Repair ( ) a Individual Se,rage Disposal ystem
... ..............
Street
as shown on the application for Disposal Works Construction Permit Now......
_____ Dated.........................................
-
- -- ----•-------------- ______--
Board of Health
,,.
DATE.............-----•-----...-----.....------....---------......._.._.___......... -
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MAP SECTION PWFOEL LOT ADDRESS `
"`•..... N ,�"""' Eve is"i, _ _ - .
r
_.__ �risr C'ar./rout
PROPOSED PAELING LOCATION
DESla v cel7-eel 5D _ /�er,�xo G'avTdl�sG
PROPOSED SEN,4GE DISPOSAL, SYSTEM
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