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HomeMy WebLinkAbout0210 WEST WIND CIRCLE - Health 210 WEST WIND CIRCLE, OSTERVILLE A=121.011.020 0 TOWN OF BARNSTABLE LOCATION W,, ,l Cie SEWAGE # 9 0-TS- VILLAGE ASSESSOR'S MAP & LOT&/2/ —00646 INSTALLER'S NAME&PHONE NO. CF . a k - �! SEPTIC TANK CAPACITY 6-0 LEACHING FACILITY: (type) `one we(. (size) NO.OF BEDROOMS BUILDER O OWNER - J PERMIT DATE: NCE3 COMPLIA DATE*_�_3�_-5_—Y_8_ 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 within 300 feet of leac J g,facility) Feet Furnished by . ���k� l so, _ J, No. Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: + Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 1 + ZIppfication for Miopozaf *pgtem Construction i3ermit Application for a Permit to Construct( )Repair(1110,upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.:'L l O W Q-3T' I A-t_ Owner's Name,Address and Tel.No. tMTS'S 0s��,..1te, �et-- Assessor's Map/Parcel Instal'ler1's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building 9+&1k 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ocs'✓. Oy"Q— `tPeuy,��_ elQ + kon!? X -,0 2)<-� k-r•q 5477-C_ SAS fiet7 Nj 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 ued by this Board of Health. Signed Date 3 Application Approved b Date Application Disapproved for the following reason Permit No. '� Date Issued TOWN OF BARNSTABLE CATION I W sr [•i ,,JC SEWAGE # ASSESSOR'S MAP& LOT/h/1/ INSTALLER'S NAME&PHONE NO. i I►zY .-::-SEPTIC TANK CAPACPTy :':LEACHING FACILrry: (type) (size)t O 1< 4J k ...<:.NO..OF BEDROOMS_ '.:BUII.DER 0 OWNER f RERMTTDATE Q COMPLIANCE DATE:_ ".Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility'' i- Feet .Private Water Supply Well and LeachingFacility on Site or within 2W feet of leaching facility (H any Wells exist ' Feet Edge of Wetland and Leaching Facility(If any wetlands exist ;'within 300 feet of leac g f cility) Furnished b Feet S I s t � S Q t t. . No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 0 Yes PUBLIC HEALTH DIVISION -TOWN'OF BARNSTABLE., MASSACHUSETTS ZIpplication for �Digo4a[ *pgtem Congtruction permit Application for a Permit to Construct( )Repair(Poloupgrade( )Abandon( ) ❑Complete System ❑Individual Components " Location Address or Lot No.JQ_10 w CST 1 k C m.14 Owner's Name,Address and Tel.No. i_0T ssV Assessor's Map/Parcel / j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: a Dwelling No.of Bedrooms .-3 Lot Size sq. ft. Garbage Grinder( 44 Other % Type of Building S% a No. of Persons Showers( ) Cafeteria( ) Other Fixtures v 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 Nature of Repairs or Alterations(Answer when applicable) G+tl_ ov�,V_ Sep77G SAS te.r9 Date last inspected: k 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 is,%ued by this Board of Health. Signed Date .A Application Approved by Date Application Disapproved for the following reason Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired (V) Upgraded( ) Abandoned( )by (-4�el�Q Cor`�c�tvQro� at ILA o Wea W_ Is b constructed in.accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �' dated Installer ` Designer The issuance of this permit shall no be construed as a guarantee that the system willunction as designed. Date 3 - 5- - Inspector -- --=--------------------------172 —r No. Fee THE COMMONWEALTH OF MASSACHUSETTS t PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS '=i5SPoga1 *pgtem Congtruction Vermit Permission is hereby granted to Construct( )Repair( 016pgrade( )Abandon( ) System located at Z\o CJet' (i.) 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:Constru io ust be completed within three years of the date of th pe.� 't. O o Date: Approved by 10/97 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) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 2—Co G3 es`r meets all of the following criteria: . . ere are no wetlands located within too feet of the proposed leaching facility ere are no private wells within 150 feet of the proposed septic system . ^ ere is no increase in flow and/or change in use proposed ere are no variances requested or needed. the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will nQA 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) SIGNED: ca DATE: 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:sett voo CLOCATION SEWAGE PERMIT N0. L.ot 3' Lti/e5t WIAW Cf e �/~ `7 8(o VILLAGE o5leauflle - INSTALLER'S11 AM1� �� i ADDRESS BUILDER OR OW�ER so DATE PERMIT ISSUED DATE ; COMPLIANCE ISSUED 2-q 0 07el Lot Tr r"' 1 70 THE COMMONWEALTH OFUMASSACHUSEETTS BOAR EA TH ri T _ ....oF...�� .. .. .. ... ....�- Appliration for Disposal Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct (_�f`or Repair ( ) an Individual Sewage Disposal System at: , .......L41.SS T... :�, .--.0 L.X.e4r..------ ��_.---O.—Y-T_j6F 1kk1_�1f�....... .-. ocation- dd ess Lot N }�j� Ow/n _ j� y� f�.-/-�AedAdre�,n�f � Installer Address Type of Building Size Lot... -� ---Sq. feet V Dwelling—No. of Bedrooms..........: .. -Expansion Attic ( ) Garbage Grinder ( ) PL, Other—Type of Building p� . No. of persons.......4-------­------ Showers � — Cafeteria ( ) a' Other fixt es -- ------------ w Design Flow.................. . .........----...___gallons per person p� day. Total dail flow__._.__ _ _ __._.�_..____._...._.__._ga ons. �/ WSeptic Tank—Liquid capacity/W. gallons Length.1,0.6..... Width... ._.. .. Diameter________________ Depth_ --3.. x Disposal Trench—No..................... Width.......fi......._._ Total Length..............__. Total leaching area--------------------sq. ft. Seepage Pit No. --------I--------- Diameter................ Depth below inlet................ Total leaching area. //x.. ...sq. ft. Z Other Distribution box ( I) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,al Test Pit No. 1...........:....minutes per inch Depth of Test Pit_..f. -_ Depth to ground water.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit._N- ------- Depth to ground water._._.................... ---------- ----------- ................................... .. . .. Descriptionof Soil..................... ...u.�.------•- /-------•---------.....----------•-------------••-•-----• 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 iIT11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has/Dee.n 'ssued by the board of ealth. gned-- - li-e_4 - ApplicationApproved By--------- --- ------••---------- .-------------••••-----••.............---------••--- ` -•---- ................ Application Disapproved for a ollowing reasons-............................................................................................................. ...........................•----....-•------------------......----------•-------..........-----...........---•-•----------------------......--------------------•....................................... Date PermitNo......................................................... Issued.................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA�Tl -I ,, Appliratinn for Disposal Workii Tonntrurtion Prrmit Application is hereby made for a Permit to Construct System a -( or Repair ( ) an Individual Sewage Disposal / {�tr-�• t n p,��,r,,[yJ �.y�•' ,[("f� ¢yam• "]�! ��rw ...... LY:`'4•--:: --..YD :: ,r_ .js!-....C..�--�—""''•F••�- ------ r,Pc.a�".-.-." ,d..�.1r......... .r..1... �'�..�.�.�-�:Lr.::_..------ Location-Address % f ytt N/o. /� Own Address W 6 .9-0.... �.. .... ............... : ` . 'f- r 1� '.. 'f ' Installer Address �� i U Type of Building Size Lot_.1.��,1_.-G'---0_ ...Sq. feet I—, Dwelling—No. of Bedrooms.___.___3.............•-._--.-_--:_-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building; / ! !i_ No. of persons......-.--•_-_-----.--- Showers� ) — Cafeteria ( ) Otherfixtures- ,...--••••. .......--•---• �-----------------------.----•-•---------•---..............----•----... Design Flow............. .... ...............___gallons per person per dy. Total daily flow_______�;l_. lons. WSeptic Tank—Liquid capacity t gallons Length _ ...... Width_..___. Diameter................ Depth ... __. x Disposal Trench—No. .................... Width...... Total Length......_..._._. Total leaching area............_..._.__sq. ft. Seepage Pit No......... .--_______ Diameter.._.....v ..... Depth below inlet...... Total leaching area. ~ P .sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-•----••-•••••-•-•-----••-•-----------••---•-------•------•-•-•-•-•----- Date........................................ 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit. ......... Depth to ground water_.I-_Z.......... 14 Test Pit No. 2................minutes per inch Depth of Test Pit./.f�--4-`........ Depth to ground water' (J. ... D Description of Soil------------------- 1.� .-•----•.. . { x - --------------------------------------------------------------•- ----------------------------------------------------------------------•---------------------------.------ Nature of Repairs or Alterations—Answer when applicable.................................................................. l ----•--------------------------------------•------------------------------------------........------------••----------------------------------------------------......------------------------......_. 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 lloperation until a Certificate of Compliance has been issued by the board of- health. r lollowin ed.._ r. a r,,oG.a,?.._._ ` t`�"!!a� 1°"'... _....... 1 t Application Approved By-----Ze -•... ...........................•-----------•--.........------•--- .. Date Application Disapproved for reasons-------------------------------------•------------------•--------------------------------._...--•--.....------. ---------------------•-------------•- Date Permit No-----------=.................................... •-•--• Issued....................................................... Date i P R t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT , w +K (9rdifiratr of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by �. . ;,�.4�... + < _ �±!`l- _ ..........-- •....... ............... ------- /..... f - Ins l J has been installed in accordance with the provisions of TITLE 5 orf/�he State Sanitary Co as esscc ed in the application for Disposal Works Construction Permit No._� �f=-_2_��_..--.-_-__•----_ dated,.?, _ _?_ ...------•--••--....-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY. DATE........... ` -5 ..... Inspector 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C�15 a .. No. :..L..... FEE. S.................. Disposal Works Tonstrurtion Vanfit Permission 's hereby granted......... -------- - ' !1. _---------- :. Z .............................. t Construct (- ) orRe air ( ) an In ividual Sewag Disposal System street as shown on the applicatio for Disposal Works Construction Permit No.__ .......... Dated.......................................... j ..........................-....... -•-----•---•-------•••---•-•--•--_-•------------------------.---•-- / Board of Health �"r DATE ,. ........ ........................................ FORM 1255 A. M. SULKIN, INC., BOSTON G c"E IZ QL N OTE'S E LIEN= 4ct4 — .- �.�---_`-��-----.• - _ I �. --- --_ -••-,-:.-- ��--ALL E.L E�Gr. 9 F-k�,.✓:.� ArcF M E sa0.! 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DiSM V5eW '�. ® O (9 ; ------ __ "TyP1GAt_ v4a3hF1L_-S L-F ACN JIM6 P+r 7 MAP SECTION JRARCE4, LOT ADD/4ESS Pzzz 07- 1 1 4 I i J 1 LEG psMn PROPOSED PNELUNG LOCATION ,..-•� DES/GN -�/TES'/•�+ 1��_. �t4Po�eo Cavlali.G .;t�s PROPOSED SEWAGE PISPOSALC SYSTEM Z IIJuM a E� OF BEv.� tit S '3i EX/9TAr E`Fl/ rtQ�CF:T f�E:t3a/+/5 PE.C' �p,,Q,OaM ._..� , ,c:'xc .:' /'/Qp/. �oL�T ALE.//• c" `" . 6ALC o.US /fit' f�'C XvV t E>�O^f Y _.� � PLC PCUt.�lhw � fietY w'�`' t ��/ V r t 'r ZL£rACWIA1G �4n?r TF' ^ F'k'�P �`5c 7 L✓4ritn�c. PtT l D R t �.P(�f.�tGAAlT EliGl�1f�'EQ: j ' ' TLI O• COA,/ TRI.`F, 0.4 ,4eeov/ Et.4GjNeE21mG I Nc. 100 °o EX FI.A KI o rJ POE R f �1y,"�f.7j x" A 3 E. J ' o RAYMCND SCALE GATE: 5Nf£T Nu.1987 c ' h AS /VOTED '✓C t.. /5T E �` -•wry j 'f BV DRAWN CHKO BY APPD BY PLAN �tr3J