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HomeMy WebLinkAbout0239 PERCIVAL DRIVE - Health 239 PERCIVAL DRIVE, ,— `- �— s_ JE A=110-001.003 �"' ` 1 1 Pi I No. 4210 1/3 BLit ESSELTE 10% f TOWN OF BARNSTABLE. ` LOCATION �rs� 9 rP O ,x� §�.� SEWAGE # VILLAGE V e 4,rgt8�� ASSESSOR'S MAP & LOT 9 b A i> 00 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 14 (size) 4° NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: —7 -3.7- ?ff COMPLIANCE DATE:T1 ©-�� 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 leaching facility) Feet Furnished by i 73 No. Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE& MASSACHUSETTS 01ppYication for Mizpooar *p!5tem (Construction Permit . Application for a Pemut to Construct( )Repair( )Upgrade(Abandon( ) ElComplete System ❑ r Individual Components Location Address or Lot No.=--;1—_gC( b f" Owner's Name,Address and Tel.No. Assessor's Map/Parcel Lv�Y�Q1 Ovo k s, 10 O(D 1 1003 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r' Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow � 3 gallons per day. Calculated daily flow '' gallons. Plan Date Number of sheets Revision Date Title r Size of Septic Tank Sze< ST 14h!!�/ Type of S.A.S. 1 t Pc_d �� Description of Soil S Nature of Repairs or Alterations(Answer when applicable) cr 6,lr cS F S A Krems 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 t to place the system in operation until a Certifi- cate of Compliance has been ' d \ Signed Date Application Approved by Date 7-3-7* 99 Application Disapproved for the following reasons ti c� Permit No.__ / y�2— Date Issued 7 —X 7- No. '�0 'L�4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes I Application for Mi-4po.5al *pztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(A.Abandon( ) E1 Complete System ❑Individual Components Location Address or Lot No.�fit%(�('C•'% V( d r Owner's Name,Address and Tel.No. W`�W(Zy c> Assessor's Map/Parcel 110 00 1 r 003 V �J f t Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: „-• Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 7�C7 gallons per day. Calculated daily flow �J gallons. Plan Date Number of sheets Revision Date Title ° ` " t. . .; 1. Size of Septic Tank 'F_tf< S-N r r6 14 d w Ty e of S.A.S. 44+r Vn,(cj pc—o'r< Description of Soil 1A6, S-A"/0 r Nature of Repairs or Alterations(Answer when applicable) S U`'S j,P ul/ t <(r �.'� ( .S G Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal 3ysfem in accordance with the provisions of Title 5 of the Environmental Cod�andt e the system in operation until a Certifi- cate of Compliance has been i d-by-th7s-B, d Signed Date Application Approved by ' Date 7—Z 94" ' Application Disapproved for the following reasons s t Permit No. Z_ Date Issued 7 Z 7—9 Y 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 n r pt\c + at �:RP.2KS, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9r-61Yr Z-dated '7— ' 9 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date -.. Inspector ''"`+.`� ----- i( ----------------------------------- No. / "L/r Z— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �LL 1=i!6pogal bpMem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade,)V,)Abandon( ) System located at .��':. j�ke r 6 a y t� " 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. r Provided:Construction must be completed within three years of the date of this permit. /�6 D Date: -a7 ­6� Approved by—a 9.�_ <- 4 G`' f1 NOTICE: This Form Is To Be Used For the Repair.Of Failed } Septic Systems Only. ; d ♦ a . t -CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT ENGINEERED PLANS) I� here certify that the application for disposal works I �r fy > constlUction permit signed by me dated 7-`�-`��.�. , .concerning the �k property located at '�-�3 ru� � mats all of the following criteria: ve Than we no wetlands looted within 100 bet of the proposed leaching facility - bb There in no p f"te wells within 130 feet of the proposed"pie system There d no htaeese in now mWor dm p in on proposed �o• we no vaim oes requested or needed. � If the proposed leeching faeiihy will be beefed within 250 feet of any wetlands.the bottom of the >= proposed leeching facility will pa be located Ins then fourteen(14)feet above the maximum adjusted groundwater table elevation. Plellse eomplete the followings ' w A)Top of Oround Elevation(according to the Engineering Division O.I.S.map) B)Observed Orumdwater'hble Elevation(according to Health Division well map) '�f • 1 // `t•r STONED: DATE. • LICENSED SE C SYSTEM RMALLER IN THE TOWN OF BARNSTABLE NUMBER fAteaeA a stareA plan of tin propow/a VW&Also If rise 1kowd h"ller this Plan should be anbmhtedj. ves«s«a e.rrla.e oleo o �ha1d�Alan:uR t ,, i J J ti.� i i r 60 A1LYj21 3 �� fI24. 132 TOWN OF BARNSTABLE LOCATION SEWAGE # ' VILLAGE Wed" ASSESSOR'S MAP & LOT I fd— b n ! tea INSTALLER'S NAME&PHONE NO. ,Ssal, V f v I SEPTIC TANK CAPACITY rf LEACHING FACILITY: (type) H IdA&t (size) ! NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: -7 -1.7 1 ff COMPLIANCE DATE: 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 leaching facility) Feet Furnished by THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............Ire W.t�I...........OF.......1Ao2t�I,s�CF LE........... Appliration for Uiupuuttl Workii Tonstrurtiun Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: {' ................__...._. ..T.. Vr��...�Ji�l�lL..----.................... . ` . 7 i1 .Locati ti-Address or Lot No. ................. .1d�4 .......•....... ............................... ..•........................................... Owner Address a ........................... :'� .... --------------------------------- -----.-.--•-•------------•-•-------•-----•--••-----•.....*--.._.................... ............ Ins 'r Address �f(I _� Type of Building Size Lot... .` q. feet .-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) 'Garbage Grinder ( ) a'4 Other—Type of Building No. of persons........................ Showers YP g ----•--•-------••----------- P -•-- � ) — Cafeteria ( ) Q Other 1 xtures .•-------------•-•.._....._....-•-•- 1Z_. W Design Flow............... . .).....---.........gallons per der t�ay. Total ily ow.._........_. ' .........-•••••---......ga�lonrs WSeptic Tank—Liquid capacity Length .�a...... Width. ��.:. Diameter:............... Depth..... - x Disposal Trench—No..................... Width.................... Total Length............. _ Total leaching area..............rsq. ft. 3 Seepage Pit No..........I.......... Diameter......L.Z. Depth below inlet...—' .. Total leaching area��s�......sq. ft. Z Other Distribution box `� Dosing tank ( Percolation Test Results Performed............ by..�...t--•... ,�`.� �C... ..._,.... Date...��.r.�,Z}�..j. ,., ..,,.... ,.a Test Pit No. I.... minutes per inch De th of Test Pit.....(,. .... Depth to ground water..U0.I. rif Test Pit No. 2................minutes per. inch Depth of Test Pit.................... Depth to ground water........................ Pit .� E-•-----•--------------_--. ......M-�-f.........cf-- --•-•-----• _............... �n� O Description of Soil.. ..---. ?. .f W ........_-•-•- .......................... ...................................••...-----'.._..------•.' -- ........ .. .:f. ....................... ........• ••--....---••-••-•-..-• ........--••.... ------•.....• ......•-•- -•----• -l._����...............---...•......... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ •----••..............................................................•-----•--..................-----•-•---•-------•---------------••----•-------------•--............................•••••.......... Agr ement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I LL 5 of the State Sanitary Co e— The undersigned further agrees not to place the system in p� operation until a Certificate of Compliance has be ed by the b ryoj, altlh. Signed. •. . . ... .............•--:........... .........................._.... Date Application Approved B ' Date Application Disapproved for the following reasons------------ --•------.....----•---------...--------.........---•--------------...-•-•-..........._.....--._... •--•-•......... ...............................��._..�..�._...__....--•--•--......----......._..........--•--••------^----•------...........------•--............_....Date............_ PermitNo..........Q............1-------- ................... Issued....................................................... THE COMMONWEALTH OF'MASSACHUSETTS . . BOARD OF.-HEALTH ............. .W tN .........o F...... A2 'r&F 1. ... Appliration for Mipaaal Workii Tonutrudion Itrrmit Application is hereby made for a Permit to Construct ✓ or Repair ( ) an Individual Sewage Disposal System at: .. Location Address or Lot No. - ...Aa ....;R-w..(............................................... ......_^______'_____......._..._......_____ __........__________................ Owner Address a. a ..................................... ................................. ............------....__.-............------....--•-----•-----....------------.. ......._..... Inster Address Type of Building Size Lot... 5-�Sq. feet ., Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) a`a Other—T e of Building ............. No. of ersons...._......._.............__ Showers YP g --------------' P ( ) — Cafeteria ( ) Other fixtures .------•--....----•................ .--I. ... Q =-y w- ...... ____________________ W Design Flow.............. .. ...............gallons per.person per`day. Total daily ily flow--•------•__ _......__._..._gallons:, WSeptic Tank—Liquid capacity.../ allons LengthO.r...... Width �-_(.C).-. Diameter................ Depth.�_._. . x Disposal Trench—No. .................... Width.................... Total Length................._,.. Total leaching area..............�sq. ft. 3 Seepage Pit No..........I.......... Diameter......17:-:_... Depth below inlet.._T:..5.... Total leaching area2��....sq. ft. Z Other Distribution box ( Dosing tank ( ) ff ( Percolation Test Results Performed by._.'`Pa�1 L�_...�:..��- �'!........................ Date...��:!. 2�.!_�......... a �......_ t E W l Test Pit No. 1................minutes per inch Depth of Test Pit...... :..__ Depth to ground water...... ....... Gi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..................... ............. t.�...............t O Description of Soil...Q.'.'... .�.J......f: f.11• ••`J :i.� 1_:ca ...� i W ........•-•-••--'-••--- --------------------------•------------_--_--_------------........-__•-•---•-•--------------------- ...�.. -----•.... ------......-............ r , 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.TITL; 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been Jssded by the boird of healthE GSigned...-;/_l � .._.. . ........._. �� Date Application Approved By......... t`==` -- �� •-----•-------••----•-- ------- Date Application Disapproved for the following reasons---------------•-----•...------•......-•-----•-•----......__...--•••-------------...............-____........-- "-----•-------•.................'•'-•••-_..__...............____............'•••---_._................................................................................................................ Q�• Date PermitNo.......... ................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tatifirate of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 1- or Repaired ( ) by..........................•-••-•---'-----._......_..--••--...........---.....-•---..........................--'•'-----•-'•---•--...-•-•-•----._.... ...................._._.........._..... Installer 4- , ----- . -•--•-•----------------------•_•_--__-•---------_-.-•-•--•-- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......5K��-.4'mil....... dated_.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. `:) DATE.......................... ..... ` ..~_. ...................... Inspector.............--'-,._................................................................ -. .....,s..___ .__.,..-_-...,,.,.__w.. __,.,____-__ -....--------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `7 c/ 9� A.:.r......?:...........OF.............( ...,r::7. f ..: NO..............r FEE..,::::.._.............. Disposal Works Tonu#rur#ion ran fit Permissionis hereby granted......................................-........................................................................................................ to Construct (-,—/) or Repair ( ) an Individual Sewage Disposal System at No. L. ' ....... c`2'�° ?4 :.••a�a...JY....-----•........................... Street ((��C� as shown on the application for Disposal Works Construction Permit Now'Ij �/.. Dated..........................I................ ................•••-........------•-•...-----•-••------------------•.....----•-•••...........--••'-..-._ Board of Iiealtb DATE........................................•-•-•-••'......•................___.... t lz TOWN OF BARNSTABLE rcl LOCATION �p�- .,? A SEWAGE # VILLAG OT�Ib �!—' & INSTALLER'S NAME & PHONE NO.C-s SEPTIC TANK CAPACITY LEACHING FACILITY;(type) �/ �l 6'� �s ) I I No. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER IAA' l BUILDER OR OWNER i l U f fi �Of 1 C�r )lroe 1 DATE PERMIT ISSUED: (DI ZCI ! DATE COMPLIANCE ISSUED: �L VARIANCE GRANTED: Yes No _ N• • r h i r TOWN OF BARNSTABLE LOCATION + 2rcI SEWAGE # VILLAG� ��-(� 'Ii�f�'�I � ASSESSOR'S MAP LOT I f0 �/—� INSTALLER'S NAME PHONE NO. �9 ryr . SEPTIC TANK CAPACITY ao i U J LEACHING FACILITY:(type) L 67 65'° size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ,i e 1 i - OWNER f t L-Of 1 1 BUILDER •R • roe DATE PERMIT ISSUED: 0 2q `IR DATE COMPLIANCE ISSUED.: VARIANCE GRANTED: Yes �a H e I 1��miimnmmnmmmtmtnmmnmmmmnn► nmmnmrtnmmtnttmmtriimir n I ititittiliiitit►iiittiiiliitiiiiiittititiiitittlithliitiitit1i11iitiiitiitHtii)itiiittititiimtiitmiittitfiitiifiit(ittitTil//if ENVIROTECH LABORATORIES _- 449 Route 130 Sandwich, MA 02563 (508) 888-6460 CLIENT: G.C. Inc. ADDRESS: 5 Great estern R LOCATION: Lot 22 Percival Dr. S. Dennis, MA 02669 W. Barnstable COLLECTED BY: D. Mucke - SAMPLE DATE: 3/2/89 _ TiME: 12 PM _ DATE RECEIVED: 3/2/89 EE Existing SAMPLE ID: ET 444 JOB.#: g Well WELL DEPTH: 87 ft -� . RESULTS OF ANALYSIS: EE Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 H p 0pH units 6.0-8.5 Conductance 6.90 umhos/cm 500 Sodium 143 mg/L =_ _ 20.0 F_ Nitrate-N 19.5 _ mg/L 10.0 Iron <.03 mg/L 0.3 Manganese .65 c mg/L 0.05 Hardness mg/L as CaCO 3, 500 B Sulfate mg/L ~ ;~ 250 Potassium mg/L ;! 20.0 _ Alkalinity mg/L 200 _ Chloride mg/L 250 r Turbidity NTU 5.0 E Color APC units 15.0 Background bacteria COMMENT: Iron level is not a health hazard. YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETE S XXX . ❑ TESTED.TED. � DATE Y4/ �ll1t!llUltlllUUllll!!!llUltttt!!!!!tllltItllltltilltltttl!!!W!!!1t!!!llttltlltlltItItltlillltUtl!lllitlltltittlltttt11it1tititi1t11tUtltltitlillttlUltlt�tlttlltltllUlttttlllttltltlllltllttt � ` lUt!lttUltlttiltUltltltttlltitlt!(til�\ 1 iTiititiiti111111iiililtiiiiiii)mititii�iii{pfiiiiff(fff f iiiiiliiiiifi(lliiiiiiiilfifi(itii(lllilltiiitiliif ENVIROTECH LABORATORIES _= 449 Route 130 Sandwich, MA 02563 (508) 888-6460 •L € CLIENT: G.C. Inc. �- ADDRESS: Great estern LOCATION: Lot 22 Percival Dr. - E S. Dennis, MA W. Barnstable COLLECTED BY: D. Mucke SAMPLE DATE: 3/2/89 _ TIME: 12 PM DATE RECEIVED: 3/_ 2/89 SAMPLE [D: ET-4 44 JOB #: Existing Well WELL DEPTH: 87 ft RESULTS OF ANALYSIS: c Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) Eii 0 pH 0 Ei pH units 6.0-8.5 Conductance 6.90 umhos/cm 500 � Sodium 143 _ mg/L 20.0 Nitrate-N 19.5 mg/L 10.0 Iron <.03 mg/L 0.3 Manganese .65 mg/L 0.05 Hardness ►ng/L as CaCO 3, 500 _ Sulfate mg/L 250 Potassium - mg/L 20.0 Alkalinity mg/L 200 Chloride . mg/L 250 Turbidity NTU 5.0 Color APC unitsBE 15.0 Background bacteria 9 COMMENT: E Iron level is not a health hazard. 1` YES NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PAR X3X . 11 AMETE S TESTED. �! �,•� ��( rill,� DATE 3 4 i1J11l1lUlll!!1Wl1!!1!tWWlllUW 1!1 Ull!!1!!!UlIU1111111111111111U111111Alltllti! �11 I 11111t1111t1U1111,lA I 111t1!i,llllJlWl�,t1U11J11tU!!J(!lllllll!l11U1! . 1111t1l1!!!lUll!!!!U!!it!lUUlllltltlUlllllWl11111111W��� ' i J, Go rJ L. 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