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Home My WebLink About0033 ARBETA ROAD - Health 33 ARBETA RD. HYANNIS T. p Y ip „ • ° 4 ` - o v � � .. c a C ° - c u. - " o a In � ° `� TOWN OF BARNSTA,sBLE LOCATION -79 Ae,E74 VIOa�/ Y SEWAGE # 40O VILLAGE �/yZOn/`J ASSESSOR'S MAP & LOT?6 —/7-3 r r INSTALLER'S NAMF.&PHONE NO. SEPTIC TANK CAPACITY /7 o .LEACHING FACILITY: (type) gairu,�s (size) Y /64lJ, NO. OF BEDROOMS / B ILDER 04016 PERMITDATE: Z Z—O( COMPLIANCE DATE: V'—Z-F d 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 anNwetlands exist within 300 feet of leaching,facility) Feet Furnished by O n 0 4�0 No. /-'Ll Fee y " 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfication for ]Sigpooal bpgtem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5� �} P @ "g Ow am//e,Ad s and Tel.No. !S Assessor's Map/Parcel s N Address, id ate. ^^ Designer's Name,Address and Tel.No. 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) s' /3 Z G Date last inspected: Agreement: The undersigned agrees to ensure the construction and mai enance of the afore described on-site sewage disposal system in accordance with the pro ' ons of Tit e o Env' nm 1 Code and not to place the system in operation until a Certifi- cate of Compliance h e ssued o S Date �� Application Approved by A Date Ti O Application Disapproved for the following reasons Permit No. 200 l—�� Date Issued l—Z L 0 r No. Fees / Entered in computer: . •.- THE COMMONWEALTH OF MASSACHUSETTS Yes/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ✓ Zipplicattou for ]Digpogaf bp!6tem Cottgtruction Permit -Application for a Permit to Construct( . )Repair( )Upgrade( )Abandons( U ❑Complete System ❑Individual Components t Location Address or Lot No. Ig e� .�. Ow er--'� e,Add sand Tel.No. Assessor'sMap/Parcel Ins��Name,Address, d el. o._r, n Designer's Name,Address and Tel.No. 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 /-5 -0 0 Type of S.A.S. Description of Soil CM t4 Nature of Repairs.or Alterations(Answer when applicable) 2- '�U G Q�t.•e ) tr r S�U� U l3 Z G � Date last inspected: Agreement: The undersigned agrees to ensure the construction and mai tenance of the afore described do-site sewage disposal system in accordance with the pr v�iSio"ons of Title o En'v_��onrn n 1 Code and not to place the system in operation until a Certifi- cate of.Compliance ha .ssued i 0 1 ly. R S C Date— Application t Application Approved by Date gK Z7i O/'�11j Application Disapproved for the following reasons 1ky� 4 tIe# c a Permit No. Date Issued —LL - G THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C-Ei2T-IF-Y, t a trax) n-site ewM!�,kz sposal System Constructed( )Repaired ( T')Upgraded( ) Abandoned( )by S #V1 v C at • .11 a r ke�A OUti i S has been constructed in accordance with the p�ovisio V615"..0 e 5 an the for isposal System C struction Permit No.241V - �/�� dated Installer X S�� -for 0,0 Designer The issuance of this ermit hall not be construed as a guarantee that the sys 11 f fit, S designed Date �o ZS' d 1 Inspector - No. � . Fee THE COMMONWEALTH OF MASSACHUSETTS T PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Digoai *p.5tem Con!6tructiori Vertuit Permission is hereby granted to Co strugt( )Repair-( Upgrade( )Abandon( ) System located at Y, 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 ust b completed within three years of the date of this e t. �J^✓' F D� Z Date: Z �� Approved by -�S- X ( 3Xz LT 5/25/01 NOTICE: This Form-Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, ffoa-A—el , hereby certify that the engineered plan signed by me dated c O/ , concerning th property located at meets all of the following criteria: • This 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. The applicant may use historical data to conclude this fact or-may conduct preliminary tests at the site.without a health agent present. There is no increase in flow and/or change in use proposed �`• There are no.-Variances requested or needed. �6 The bottom of the proposed leaching facility will not be located less than fourteen I (14) feet above the"maximum adjusted groundwater table elevation. [Adjust the- groundwater table using the Frimptor method when'applicable] jPlease complete the following: A) Top of Ground Surface Elevation (using GIS information) B) G.W. Elevation + adjustment for high G.W. _ 41/ i DIFFERENCE BETWEEN A and B o V . SIGNED : DATE: O NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:percezmp " o (J T �l b Z . TOWN OF BARNST LE LOCATION i SEWAGE # 4-o -/w 'S NLkP &LOT ?6 7-3 VIL LAGS--04Mk;90�� 9 YiV7nIJ ASSESSOR INSTALLER'S NAME&PHONE NO. ea—Ii . SEPTIC TANK CAPACITY LEACIUNG FACILITY: (type) (size) NO. OMEDROOMS BUILDER PERMITDATE: COMPLIANCE. DATE' : Separation Distance Between the: Makimum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply W611 and Leaching Facility (If any wells exist ri Fee on site or within 200 feet of leaching facility) t Edge of Wetland and Leaching FabiLity If Any wetlands exist within'300,feet of leaching facility). Furnished by Feet 0