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Home My WebLink About0028 BUMPUS ROAD - Health 28 Bump�S`Road Hyannis A= 310-035 f 1 R h Si No. 77 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for �Digool *pgtem Congtruction Permit VP Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components ocation ddress or Lot No. n ` �t ,� Owner's Name,Address and Tel.No. Asse s s Ma_tep/Pazcel3t O a3 �I �—r re In aller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. `C 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 /5_Z�0 Q 6 3 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 's Bo, d of Health. p C Signed La_ Date Application Approved by 4ZLDate — r Application Disapproved for the following reasons Permit No. Date Issued No. / Fee �� •�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application for 0i.5pozar *pztem Construction Permit Application for a Permit to Construct( )Re)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Coca n ddress or Lot No. Owner's Name,Address and Tel.No. 2 �ph �„s RcP ° � AsseSso s Map/Parcel k o r� 2 t v� 31 o c�r � ,J �e�v ( Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: - Lot Size s, ft. . _.. Garbage Grinder Dwelling No.of Bedrooms q. g ( ) 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 t Size of Septic Tank l sf>0 063 Type of S.A.S. AT Description of Soil k n + Nature of Repairs or Alterations(Answer when applicable) LJ 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 Envir°onmental Code and not to place the system in operation until a Certifi-, cate of Compliance has been issued by is Bo d of Health.Signed Date 7p -2_0—9 Application Approved byW&WD��_ Date _ Zv " Application Disapproved for the following reasons Permit No. Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - A Certificate of Compliance THIS IS TO CERTIFY that the On-sqe"Sew a Disposal System Constructed( Repaired( )Upgraded-( ) Abandoned( )by ( ; at 2 C. c. 1 w--s as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7— e dated — 2 G Installer Designer , The issuance of this p shall onstrued as a guarantee that the sy ill function as q s gne, kf Date Inspector �� 1/1 a �� r V F u — -- — -------------------------- —No. Fee e THE COMMONWEALTH OF MASSACHUSETTS 3 (9_d 3 S" PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigogal *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( Upgrad/e, Abandon( ) System located at 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 must be completed within three years of the date of this permit. Q Date: / _2�'"/� Approved by C �.� t- y 1/6/99 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 PERIIUT (WITHOUT DESIGNED PLANS) - , hereby certify that the application for disposal works construction permit signed by me dated q 0 "'? concerning the property located at fir{ 13 U p 64j Jeco meets all of the V 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. • There are no wetlands within 100 feet of the proposed septic system • 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 • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the ma..,dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(1.1) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the NIAX. High G.W. Adjustment _ `> DIFFERENCE BETWEEN A and B > 1 SIGNED : DATE: ' (Sketch proposed plan of system on back]. q:health folder.cen Q r7 ) � Q r0 1 n TOWN OF ARNSTABLE 4/111 �__LOCA N 2' `4qg vs SEWAGE # ` VILLAG a#I n 1.S ASSESSOR'S MAP'& LOTi INSTALLER'S NAME&PHONE NO. ��C �� L��s^ IF0 2 5-3 L SEPTIC TANK CAPACITY JCO d LEACHING FACILITY: (type) �"�C (`� f C+I (size) NO,OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: C `'�O - COMPLIANCE DATE: 7 — '!2-I Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Z� Feet Private Water Supply Well and Leaching Facility (If any wells exist e o leaching facility) Feet on site or within 200 feet f g ty) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) t-one Feet I Furnished by e-6,f i L . Ct, o. z YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1.st Fl.; 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate,that is required by law. ti t '. DATE: il-/y •� Fjll in please: yrsa � APPLICANT'S YOUR NAME/S: C'�cv/N 1 BUSINESS YOUR HOME ADDRESS: -W ��6rlSs i�( r, yL/YAIJL� fYcl. TELEPHONE # Home Telephone Number EGG CB o"If 0,9 NAME,QFCORPORATION : . e NAME OF NEVI/BUSIf�IESS Fec , C TYPE OF BUSINESS IS THIS A HOME OCCUPA�'IpN? YE5 IVO ACIDRES5 OF;.BUSLi11ESS� =. MAP/PARCEL NUMBER [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules.and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSID-NER'S OFFI E This individual hEA Ef/eillin infor edl n p rmit requirements that pertain to this type of business.MUST COMPLY WITH HOME OCCUPATION ' VU RULES AND REGULATIONS. FAILURE TO Au herized na ur COMPLY MAY RESULT IN FINES. OMMINIT Q, yt 2. BOARD OF HEALTH This individual has be formed of e errmit r irements that pertain to this type of business: prized Signature COMMENTS: 3. CONSUMER AFFAIRS LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE LOCATION a�'F &U Mea Y 5 01 SEWAGE # VILLAGE k1-1 Q 4 0 ►5 ASSESSOR'S MAP & LOT3�2 INST,ALLER'S NAME&PHONE NO._ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS �� 6.,' BUILDER OR OWNER J"P Gu C. an q/7C e—5` PERMITDATE: 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