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HomeMy WebLinkAbout0067 WEST WIND CIRCLE - Health 67 WEST WIND CMIbSTERVILLE A- 121 011 033 TOWN OF BARNSTABLE LOCATION 67 alrir u/iod SEWAGE # 7 VILLAGE ASSESSOR'S MAP & LOT J of/-Oi3 INSTALLER'S NAME&PHONE NO. y77�035'9 �os�p�i D,c /7ar�r0.5 SEPTIC TANK CAPACITY lDDO LEACHINO_FACILITY: (type) 2 -,SDO 601 VIV u/��ls (size) 26'X /3 NO. OF BEDROOMS 3 BUILDER OR OWNER ffa4k4pal PERMITDATE: .5� -G 99 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 j Furnished by � w�-vi �� - -....:f` R '�..• � , � r 6� 'S'� — -> i i f�t j a f•�•5�' r ui�''s r ur�� C'irc�r; No. .v citi j� Fee =✓ �� C'i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippitration for �igpogar *pgtem Congtrurtton i3ermtt Application for a Permit to Construct(v�rkepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �'f ((/��j GC/r f!; Owner's Name,A dress and Tel.No. Assessor's Map/Parcel 0S,r pVi!/� 11&h pn ��41bh�,,-w Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r/0Scp4 U, es i , 1 �� 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank e Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answe when applicable) dIST �� 2'� SOO- �!�! �1 ali Ilg GritTli S`' 51�� P �4v�av�� 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 Board of Health. Signed — Datey- Application Approved by r Date Application Disapproved for the following reasons Permit No. Date Issued r TOWN OF BARNSTABLE LOCATION G 7 &/Csr u/rHd SEWAGE # VILLAGE ASSESSOR'S MAP & LOT/2L--0 033 INSTALLER'S NAME&PHONE NO. e/77-09 519 ,JoseP/i D� L�,nrr•.�5 SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) 2 -S00 Q."Y Wesh/ (size) NO.OF BEDROOMS 3 BUILDER OR OWNER HirG�6�h�/ PERMITDATE: �- -,G ,99 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 bye- H.L�.c-✓ i Al 0✓FrFly� Sl 4q i f No. � Fee THE COMMONWEALTH OF MASSACHUSETTS V Entered in computer: . ? Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for ;Digpogar *pgtem Congtruction Permit Application for a Permit to Construct(4-11epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. G 7 t(/GS r �!// G/Kfi� Owner's Name,A dress and Tel.No. Assessor's Map/Parcel 0sr� / 1111kb�rW I A/ o// 033 t, T C/ �/� D rF�✓, /� Installer's Name,Address,and Tel.No. Cy%h'-O-3 y 9 - Designer's Name,Address and Tel.No. T_r IV Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building -No..f6f 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 __ 5',rQy,•/ I Nature of Repairs or Alterations(Answ r when applicable) L'`l577%11 2- SOO- 61, 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 Board of Health. Signed Date Application Approved by 7 ✓� Date "5,-'' Gam` Application Disapproved for the following reasons e.� Permit No. r` Date Issued -` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed((,.+Repaired( )Upgraded( ) Abandoned( )by .5 c 3 S at 0 w a //I&as been constructed in accordance with the provisions of Title 51and the for Disposal System Construction Permit N dated---I Installer tiJ B 69 d iP7!-� � flgs Designer / The issuance of this of be construed as a guarantee that the(ystem,/will functtion as designedf�� Date � / ` Inspector !s�' �i ! n �l!, ��1� 0 --------------------------------------- No. /V at/ 035 Fee 4::�' � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpo!gaf *pgtem Congtruction Permit Permission is hereby granted to Construct( 4-Mepair( )Upgrade( )Abandon( ) System located at 6.7 L4,,' 0^ r 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. 4 Provided: Construction must be completed within three years of the date of t� it. Date: t y Approved b4 ' d x THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A , I / �C(�J- L DATA 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. I - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISMSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS I, 1os-c e �� s3rro5 , hereby certify that the application fr,,r disposal works construction permit signed by me dated _ S� y- �� concerning the property located at 67 Gr/a—ST kz14 6rGIF meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses 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. � Theerre are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system �. 6� There is no increase in flow and/or change in use proposed There are no variances requested or needed. + The bottom of the proposed leaching facility will not be located less than five fe::t above the maximum adjusted groundwater table elevation. (Adjust the groundwater table .sing the Frimptor method when applicable] • If the S.A.S. will be Iocated 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 maxinium adjusted groundwater table elevation, - Please complete the following: A) Top of Ground Surface Elevation(using GIS information) -:5011 B) G.W. Elevation (O'_+the MAX. High G.W. Adjustment .5 DIFFERENCE BETWEEN A and B SIGNED : .G�.� �.f.Gv� DATE: — Q [Sketch proposed plan of system on back]. a;he th folder.cent o Ew 5Tl�y ��pO O L (I AT ION SEWA � E NQ. ob 7 wPsi w,ti C �� e / - YRMIT 3 VILLA E � y / ,, II4STA LLER'SS N ICE i ADDRESS *a e ro / h Pu }>' SB ��ov7'h C)e UILDE R OR 0 NER coo a 7 - Sa. `-1, 11V4v h DATE PERMIT ISSUED V-9_Ir DATE COMPLIANCE ISSUED 0'� ,.,FJN No....... .`��....�`..3a Fxs ........................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliraa#ion for Disposal Workii Tnnitrurtiun Vanfit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: -. ation-Address n d or Lot No. own Address a ..........- z -e:�. � Installer Address UType of Building ,� Size Lot...,-S.V%.Q_..Sq. feet Dwelling—No. of Bedrooms.............y�.--_---.---_•----___--__-Expansion Attic ( ) Garbage Grinder ( ) PL4Other—Type of Building �E�? �4` No. of persons --•-----1------------- Showers O — Cafeteria ( ) Otherfixtures -------------n- - e ----------- ----- ----- --------- ---i----fl-o--w-- . . --v�-------- - .-.... - -••---1.--n--s-- .� W Design Flow............... -gallons prperson pe day-.- Total daly Septic Tank—Li uid-capacity Width... Diameter................ De th.. V/----�l gallons Len th_�Q{ ._ x Disposal Trench—No..................... Width.................... Total Length................__- Total leaching area....................sq. ft. Seepage Pit No.----------I------- Diameter......... . .... Depth below inlet...... __'...... Total leaching area._//_0J7.sq. ft. z Other Distribution box ( Dosing tank ( ) '-' Percolation Test Results Performed by._. �1_ fY �111.�a/jlC -_-•---•-- Date...... Test Pit No. I................minutes per inch Depth of Test Pit..................# Depth to ground water--- --------------- fs, Test Pit No. 2................minutes per inch Depth of Test Pit---- Depth to ground water �(s�!-- /y� P4 -----------•-•---------------------- ------••----------...........--- y- • • •.......--•--.....-•••-•-••••••••--•............-----....-••...... Description of Soil......... /_._LJC�-.L' .�L..(1�!�??...___5.!__ /�_ _.__. x c, 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha/bee issued by the board 4 health. Signed -......��F'��'�y� - .-, / D to Application Approved By..........................•----•...... �:.. f�p •--------•-- Date Application Disapproved for the following reasons-.................................................................................----•---••--••-----••••-••••- ....................•-•----...-•-•---•-••----------------------------•----•••--•••---...-•_.......--..... Date PermitNo......................................................... Issued....................................................... Date i No................_....._ Fes? .........._............_ THE COMMONWEALTH OF MASSACHUSETTS ' BOARDBOARD OF HEA TH Appliration for Disposal Works Tonotrnrtion Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ......... 0-�- ..3-- ----------- -----44 _...._... `__ _,C- . .-•-•- 'o"hation-Ad res ••- - Address ... Installer r Address / �y UType of Building Size Lot__1'__ �f_/� ....Sq. feet �-, Dwelling—No. of Bedrooms____________ __________________________Expansion ttic ( ) Garbage Grinder ( ) aOther—Type of Building �WA No. of persons--------- -------------- Showers ) — Cafeteria ( ) Other fixtures __________________ -- ••-•-------•------eg an ••----------- W Design Flow...... __ ___________________gallons per person p y. Total daily flow._._.__. .......... n�/ WSeptic Tank—Liqui capacity/gallons Length_/O.b..... 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.Z/_ __�'.sq. ft. Z Other Distribution box'.( ) Dosing a ) W Percolation Test Results Performed by.__ ,F�_ � 4,t'�/. ,A} ----•-----_•_ Date___ "'" _.:. _9 Test Pit No. 1................minutes per inch Depth of Test Pit----------.......t Depth to ground water.._ Ps Test Pit No. 2................minutes per inch Depth of Test Pit____ _w __. Depth to ground water______ .............7 W .- -- •- O Description of Soil......... _ �/� _.. = L-1• ............. ,14 x • •--••••--=•••--•-•--•••••-•--•-----•----•---•-...----•--_-•--- U ---------- •-----------------------------••--•---------------•----------------------- _--------------------------------------- •---------- •------------------------------ __•--------------------------- -------------------------------------- ------------------------------------------------------•----------------------------- ----------=-------------•---------•------------------------------------•---- 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 TIT1E 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 by the board of,health { Signed f —<F�-a.. ..:1z. A" � ------------ -•---•-•-•------- g ate Application Approved BY ". .`.-' - --...- Date Application Disapproved for the following reasons: - ......._..-,----------------------•-•----....-•-----••---------------------------•-•----•---•---------•--.---•-•------------•--------------•------------------------------•---------------..-----•------- Date i; Permit No......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �... '' ...OF....e... .... ......... Trrtifirab of Tnntpliattu THIS IS TO CERTIFY, That the Ind* Se age Dispos- ,System constructed or Repaired ( ) bY----------------------- .:.. at....... I ta1�1er ............... has been installed in accordance with the provisions of T I �5. of The State Sanitary Co e a d scribed in the application for Disposal Works Construction Permit No.__._.___ni,i�e✓................ dated__... J.�X . THE ISSUANCE. OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......:......... . -.......................................... Inspector... ............................................................... f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No ........_3_a.... .. - FEESJ................•- Disposal orks Tn strnr�' n �CrrnP,6't �.q� -. Permission hereby granted.------ .-.!.__ .�-- �---•------- -�-�r�==- C���- --- .._......---••....................•-•-•--- to Construct (:Ty-or,Repair ( ) an I dividual Sewa a Disposal Sys em at No.. 'tom .. _ , .: �"��;;�4.- �' :' `P '�.-t .... `Street VV as shown on the application for Disposal Works Construction Permit No_____________________ Dated.......................................... / ......•. <5?,./. DATE_ k1l .. Board of Health .• -----•••--...• FORM 1255 A. M. SULKIN, INC., BOSTON . - IL9V z 4z40 L.�) --AL ELEJ'. 941cr,a.Ja,.9 AC� MEActi: SEA L.E�r��.. 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S k�E ' C1 � _l ;• nct3 t ?' , 1!4ti"' s y>J t`l'i tL. ` �' l;AyRkwYND 1 Dr=V-iA" Ac c-A - 'ZK-l'x A >< 6 v 2,5 = 37 7 GP'Q Rix >� ,a37� ,�,' SCALE. DATE.. SO4EET 7^) iTQhl} CtiQ�;�. a.. <- 16x4tY �ra `3Gl 'Pl7 . /, ° ASNO TIE I/1!' l1�rjlaJB IOF1 g ��jry- ."«+�'•,"�..ViL.,I�►1 1 O�• o "y��` � T(JT•A� 4��..� �}� �'* - •..a �' .�.�"• DRAWN 13Y. C H K D B'i APPO.�S1y'. PLAN fto0 ff • d �S.;sr'i "7 I;i.- K ��v 1 S�I7•. 8�Cj� �o