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HomeMy WebLinkAbout0038 WEST WIND CIRCLE - Health 38 West Wind Circle, Osterville v o 0 i _l T TOWN OF BARNSTABLE41 LOCATION 8 (� � �'�"�• SEWAGE # D VILLAGE ®sw0 V 1( ASSESSOR'S MAP & LOT o2.1_ b 11-6c INSTALLER'S NAME&PHONE NO.Mt4z LIS4 - SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 144 X L rg 12 1 L� (size) Y�?rff NO.OF BEDROOMS—:?' BUILDER OR OWNER g- PERMTTDATE: ��°��'t�' ` � 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 t rr [� �.7s, {: 1£ A I V No. .a--.. ;.•��--�- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYiratton for Mtopooal *pgtem Col 5tructton Vermit Application for a Permit'6 Construct( )Repair(a/)Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot No. c�8 W'ESl LV I IU0 C t rc,� Owner's Name,Address and Tel.No. osTP-avvit� ,CY6 t c� Assessor's Map/Parcell ,� f — O l t s vd L/ J Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Z� &-e v 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 7)�3/,j gallons per day. Calculated daily flow gallons. Plan Date ? Number of sheets Revision Date Title ow Size of Septic Tank 1944 5T1� 1dQQ Type of S.A.S. �C.�e�D�� l L14; ZVf'0Z01S Q Description of Soil f�� Nature of Repairs or Alterations(A swer when applicable) � '�y1-�� p- Q nc �i2J+" CA" �r w d� �iu�e.�► 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 i ! Signed ssu Date17 Application Approved byC:MZ21� Date Application Disapproved for&Tollowing reasons Permit No. Date Issued —————————— ——————————————— --———— a _ Fee No. � �? ` •,''b d. l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUs—TT S 01ppYtcation for Migogal *pgtem Co gtructton Permit � Application for a Permit to Construct( )Repair(t0')Upgrade( )Abandon( )/ Complete System El Individual Components ..�1 Location Address or Lot No. W t rcAe Owner's Name,Address an 'd Tel �No. Assessor's Mapj?arcel , + 60 L/ Instal a's Name,Address and Tel No. Designer's Name,Address and Tel.No. VA Type of Building: f t' Dwelling 'No.of Bedrooms '.S , Lot Size sg.ft� Garbage Grinder( ) Other Type of Building No.of Persons - _ "`°" `" Showers( ) Cafeteria( ) r. Other Fixtures r - Design Flow L d gallons per day. Calculated daily flow ` "f gallons. Plan Date Number of sheets Revision Date Title `Size of Septic Tank �ST}. . � tong Type of S.A.S. t�G� -�l Description of Soil r- a Nature of Repairs or AlterationA swer when applicabl)' fr�-S i Vk-\` o} Q 01G �J,` il'y c,,.� [ �Ci-r vl j y-•�+ (,TJ c�Tz'l2 L `�tUN C oj 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 vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss t oal� t Signed ' A Date Application Approved by Dateod " Application Disapproved for(he following reasons r~ } Permit No. "� Date Issued Oyu/V ------------- ——————————————— THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE MASSACHUSETTS t Certif irate of (compliance THIS IS TO CERTIFY,that the On-site Se a e Disposal System Constructed( )Repaired ( )Upgraded(�) Abandoned( )by M i( r 1 C_ at c� C �t-L 2 U -Pzx Ut ( ,- s len constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "` dated ° t Installer Designer The issuance of this permit shall not be- trued as a guarantee that the system w�l fur�G'on as designed. t Date l ^ " 7,,/ Inspector -- _ No. ------------------------------Feel 90­77_ -7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mtgpogar 6pgteT1, onelructton Permit Permission is herebyanted to Construct RepairU rade Abandon j ( ) P ( Pg, ( ) ) System located at _ � L.y_e C and as described in the above Application for Disposal System Construction Permit-The applicant recognizes hi�/her duty to comply with Title 5 and the following local provisions or special conditions. A Provided:Constructio mus completed within three years of the d Date: Approved by oft it. r /? � �'f o r 1019/91 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 v�8 e� try G �- - meets all of the C 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 d• 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 n9l 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) B)Observed Groundwater Table Elevation(according to Health Division well map) t� V SIGNED: DATE: - ��� LICENSED SEPTI 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 �.� C7 D ,�. •. �, f�� r .,.-�_ .. ��a ,.,y;;,. ,.� �. . . ���' �� :; •i TOWN OF BARNSTABLE <'> LOCATION 38 � CCU SEWAGE # VILLAGE O S3�e�1 ASSESSOR'S MAP &LOT10�- � INSTALLER'S NAME&PHONE NO. .:. SEPTIC TANK CAPACITY 6 57 1 r:a. 14n� Cu D�1T1.rT' t :j. LEACHING FACILITY: (type) 9 T_(size) { NO.OF BEDROOMS i �:. BUILDER OR OWNER �. PERMITDATE: I "II' ` � 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 j _ --- - — - ------ - - - -- - t ' 1 3 .. { i •j ._ ._ it ,C r � 't. i r •r V0 C A T 10N SEWAGE PERMIT NO. VILLAGE �_ �;' �Savi I t INScTALLETR'S NA E i ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED a$ B :1 a Lo� �r !Fi i ,rr No................ r" FimB............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 11� ✓---OF..... .,G .c= -. ,,r.. App irafilan for Uiipniitt1 Works T. ustrnrtinn ramit Application is hereby made for a Permit to Construct (�}' or Repair ( ) an Individual Sewage Disposal Sy at Location dress or Lot No. Ow/nner . Address - a ••-----•=• - --•�r•t'�.'- •-----.. d'-i_ �../r�t y- 1.�-6•-. lv.' .....................4J-- ....... .' -4Y� .i'�.---------- Installer AddressPq UType of Building Size Lot._JJ.'f.._�_:_V..Sq. feet Dwelling—No. of Bedrooms___________ __ ,o__________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin yp g �e,�. _ No. of persons_._.___._ Showers ) — Cafeteria ( ) 1p Otherfixtures -•-----•--•------ ---_----- •---•--------------•------•-------------------------------------••--------•-----•------•--•-----•--------------------- W Design Flow..................... ............gallons per person per ;ay.;ay. Total daily P9w.........3-�_s_.....................gallons. WSeptic Tank—Liquid capacity._/�Mlgallons Length.....£--...... Width__. 4._._ Diameter________________ Depth................ x Disposal Trench—No_____________________ Width.......r.......... Total Length.............. _._ Total leaching area....................sq. ft. Seepage Pit No----------/......... Diameter......... Depth below inlet...... ........ Total leaching area... _X_?_sq. ft. Z Other Distribution box (_�) Dosing tank ( ) aPercolation Test Results Performed by.....APA�:i..... ._ Date________ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water____________________/___. f>~ Test Pit No. 2................minutes per inch Depth of Test Pit___ _ _�Q_____ Depth to ground water,/.V10.1!/.�_76_R nn a ----••-.... 0 Description of Soil----- _. _1._.. �' L _._ Lam_ �.f! d 1 /. d�.... e x U ----------------------- •-------- ----------------------------------------------- ----------- •--------------------------------------------- •-------- •-•------ ......------------------------ UW -----------------------------------------------------------•.•.--------------...------....-----------•---------------------------------------------••-------------- ......--•-••._......•--_.._. 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 TIT1Z 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 the boa�f healt . Signed �.. "._ ' �. - Application Approved By........................ •------ ---------------------------•--•--••------•........_...-- ...•-S'�jo Date Application Disapproved for the following re ons:.--•---•--•--•---•-•---------------•----•----•--•••-------••-•---••--•-•------•-•-•-••--•-•-••-------••••---•--- ..._...---•----------------•------•---------•---------------•-----------....-----•-----....--•---•------•--•---••-•-•-•----••--•----••-•-----•-•----------••----•••-••-•----••-•---------•----•••---•--- Date PermitNo......................................................... Issued....................................................... Date No!!._.........." .. r Fps... ."................. THE COMMONWEALTH OF MASSACHUSETTS BOARD {--&W- ....OF... Appliration for DWpaaal Warkii Tonstrnrtion rami# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal sys �,a.� Locatio ddressy Address do— or t No O ner ` • Installer Address Type of Building Size Lot_ l__.'X-,V_-_._Sq. feet ..••.I Dwelling—No. of Bedrooms__________ __ .........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Buildingp- _ No. of persons._______ ______________ Showers f� ) — Cafeteria ( ) Other fixtures - ---------------------------------------------------------------------- - --------- - -- W Design Flow_________________, '..____________gallons per person pertiay. Total ril w._-_._.33-_l�_-----_-•-•- ______gAlons. WSeptic Tank—Liquid capacity_ _gallons Length____-, ________ Width__ Diameter________________ Depth___________..__- x Disposal Trench—No_____________________ Width....... Total Length._.__.______._ Total leaching area_._________:__:_..sq. ft. r--- s ft. Seepage Pit No ______/._ ______ Diameter.........�---.--- Depth below inlet ._.� ._..._. Total leaching area_._ _� q. Z Other Distribution box (. ) ' Dosing tank .( ) Percolation Test Results Performed by. _ __:.,J j1� •1�/1 Rlsll�__. Date___ __, -^ ►-a -T 0.4 Test Pit No. 1________________minutes per inch Depth of Test Pit ............ Depth to ground water..........:............. �y.. Gr, Test Pit No. 2................minutes per inch Depth of Test'Pit_ ' ______ Depth to ground water,�llL7_ r!7J . _ D Description of Soil_____._.I C"_ _�_....V/ -------------------- x 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 i ITLE 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 the boar of health. Signed-- . _.... G= ApplicationApproved BY .......................................................... J -----••-•--- Date Application Disapproved for the following r ons: ............................................................................................................. 11 ------------------------------------------•--•--••----------•------------........._---------•----._..._...._.....--•------------------------•--------------------------------------•••• ---•••......•--- Date PermitNo..................................................._._.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALT (111'aertifiratr of Toutplittnrr THIS I TO CERTIFY, That the Individual Sewage Disposal System constructed or Repairedby ( ) .... .......... 9" �'!?� a Installer has been installed in accordance with the provisions of The State Sanitary C e"a escribed in the application ___________ for Disposal Works Construction Permit No _____ _____........... e' _Oe........................... ..•,,.THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C STRIDE® ARANTEE THAT THE SYSTEM WILL UNCT ON SATISFACTORY. r ( DATE................ ----- .................................... Inspector......... . ...... ......--........... --------- .................... THE COMMONWEALTH OF•MASSAC U ETTS BOARD OF HEALT 4 oF�.__:�2................ `1 Dispaasal Works Tanotrurtion I a mid , Permissio is hereby granted........"fh: __.: . .`...__`. ..• ............................. to Construct ) or Repair ( an Individu 1 Sewage D�isppo�sal System Street as shown/onthion for Disposal Works Construction Permit Now ated__________________________________________ ' Board of Health DA3° --------------•------••_-......_.._............... r t FORM 1255 A. M. SULKIN, INC., BOSTON V, s - f! ..Y '-1 f`" ,, ,r,, ...... ��i � � �rP•'r!"G• Gyr... V�f �� � ML:i1.."f ti..> ,.. ;F _.._ y_.t• l -' I - - ` 1 .- 94V-6i A.a_ L.,wrt. `: A ►1twJtMt?t� QP` �j a t . > . C ;,- ;; ;i ; , I - ��..1 1.r'.�-� Qr r-fi�4C'r.;ty►E. �.P�;.a!R'1✓E C>. i �� '• , � � '+ ,•.L�- P+I t�1E S "ft9 �►ts3 t> I.J T Nfc 'SY`.,T E►.�:, -:N A.i.L I . (+. ALl JEPT(tC TA14c Ot',v i�Et3JT n.J >i �C A+1U -_"•"70� � ----- ..1.__-' __��—, I •.r�.-1 .J�. 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EL€V asa nwr++ �'�T--""P' j�fT tc Tie.�_�tL s• � �' � � .. r e JE t tLO t MAP SECTION P,4RCE�,� [U! 4DDRE+S S i r� r CoAlr04At .� P POAP P EZ,UNG I.OC c;�E'/T�"�i� �� r�erift�ao 'r,�[ `�_'t' SE ,�TION - r� :yw Paf'Oi�"OSElJ SEf�Y,4G DISPOS,� , SYSTEM,+/vn�l�E.e OX I9►Es�.�caa�+� s © � � �►a'' Lccy.. 4 f'E�t s n of 5 "re &-o e ec,tis _ s • R'tY`.4?'Vi� L'L, T WEST ev' f IQJ L) I c,�A�t o.0 5 -•- �'E.� sacra r r*Cf/lrVG �t N rQ&1.e G 3 c. '/ cesw2 k`:+G PT•ID t� �T. F� J ' r°E .... �'Yet' �'k'CiG� >t=�P L�ACwtNC'+ ptT :N :z Oct J® (: S PA heat P 1 ! j rdt✓ I IV ,�,�r.�a,,. - �r �'' � _ ,. � a �. , E,pt.;: , 4 RT � �� � . Yr4�1��lc��.a f�i ,;e. 1° 5Ji", ►77rG t i it 7} `_; z " P !.0 y W5 {a; s�.4iF �►r,rg u'+tlss>Er 4D ' I�L..1Ct�"t"1 -`'�""` T,:,r _ wF► 4.ti 'vCyTEAO � f _ tiltA+WN +ft'a GMIcla s� � APPO $1 PLAN ?*0. Ati.�°�L- # ,e e 4 j