HomeMy WebLinkAbout0072 CHESTNUT STREET - Health 72 Chestnut Street
Hyannis
A = 309 051
N
a
o °
°
° a
e
a
TOWN OF BARNSTABLEC
LOCATION C //�tl I /�E�%- SEWAGE#,2aC)I -
VILLAGE 1�A0�1.S ASSESSOR'S MAP LOT
JNSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type p (size) 2,5 X 13 X Z
T�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC /WATER
BUILDER OR OWNERj� U/ '
DATE PERMIT ISSUED:
DATE, COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
_ _ _�
s9
�--- ��
M
a� w
m 1 ./ � � .�.� / �
O ' � % v. I
O � �,
r
� � I `
,� �
` ,
it O u
..
�`{y I � `
:� � i t I
/ � - - — --
_ _ � —__�
��� �
f
— — —
r1 �R g
0
- 1//
No. � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0ppfication for Oigpoal bpttem Cow6truction Vermit
Application for a Permit to Construct( )Repair(grade( )Abandon( ) 11 Complete System ❑Individual Components
Location Address or Lot No. 702 C of hU f- s-1 Owner's Name,Address and Tel.No. �1
Assessor's Map/ParcelnSTA� I�aVJr n v
Installer's Name,AddresswIdeg'CANCO Designer's Name,Address and Tel.No.
350 Main Street
W. Yarmouth, MA 02673
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)
l . 3 o a . S- ( A-,"5 ` hvt-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 Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Hea th.
Signed 1 LDate Q l
Application Approved by a Date
Application Disapproved for the following reasons
Permit No. Date Issued
}
No. Tee-so
THE COMMONWEALTH OF MASSACHUSETTS µ Entered in computer: '
"ter Yes
— PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pprtcation for Mtgpozar *pztem Con6tructton Vermtt
Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. ?'J C �fhv Owner's Name,Ad/dress and Tel.No.
CT _ / 1r13fA��c
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. ( Designer's Name,Address and Tel.No. j
Type of Building:
Dwelling No.of Bedrooms= Lot Size sq. ft. Garbage Grinder( )
Other ,Type of Building No.0of Persons Showers( ) Cafeteria( )
Other Fixtures
-De 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 ;-
P ( applicable) - -j-51A �1 ( �Sd 0 F,4 �. S' 1
Nature of Repairs or Alterations Answer when a licable
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 He th.
Signed r-> Date CP `�� 0
Application Approved by a Date
Application Disapproved for the following reasons V v
1
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(fertiftcate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( upgraded( )
Abandoned( )by e,
at h u-1- V4 el i S ha b constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. �" ted
z�
Installer Designer
The issuance of, s eft shall not be construed as a guarantee that the system will function as 4esigned
,Date � � al! uy Inspector n&"f
1
-- -----•—�_------.---------------
No. /�ft� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS '
'=tgpo!5a1 *pttem (Construction Permit
Permission is hereby granted to Construct( )Repair Grade( )Abandon( )
System located at T �Si'I v eS /�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
��must a comp/Feted ithin three years of the date of this
l e it.
Date: !/7 1 Approved by */ 1
Y 1
•� ^.,1 i .1 .4f
1
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 PER-TWIT (WITHOUT DESIGNED PLANS)
I, �•� , hereby certify that the application for disposal works
construction permit signed by me dated (�2 o� 0 1 , concerning the
property located at 7a CAeSh-y�' S 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.
• 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 maximum
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(14)feet above the maximum adjusted
groundwater table elevation,
Please complete the following: 3 l
A) Top of Ground Surface Elevation(using GIS information)
B) G.W.Elevation 3.(c. +the MAX. High G.W. Adjustment.
DIFFERENCE BETWEEN A and B ( .
SIGNED : v DATE: O
[Please Sketch proposed plan of system on back].
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:cert
.�
Y
I
• � �
'I
9
t
TOWN OF BARNSTABLE
LOCATION n2 � t1 I /�E2��% SEWAGE
VILLAGE 1� �.Z.S ASSESSOR'S MAP 6i LOT 0 vSl
INSTALLER'S NAME & PHONE NO. rA & B QkM 775-6264
SEPTIC. TANK CAPACITY
LEACHING FACILITY:(type (size) 13 X Z
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER dQU5:2:2 I�Url
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:_ ' Q/
VARIANCE GRANTED: Yes No
r '. •�
s� 00 �
a
AfM
TOWN OF BARNSTABLE
LOCATION UT SEWAGE # 'FtV- 4'0' 0
VILLAGE�.�t l/V CS ASSESSOR'S MAP & LOT ,309L--
INSTALLER'S NAME & PHONE NO. >ea122V44f77
SEPTIC TANK CAPACITY �®46
LEACHING FACILITY:(type) (size) <; ,X /D
NO. OF BEDROOMS PRIVATE WELL OR BLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: 9/�90
DATE COMPLIANCE ISSUED: 9 �G
VARIANCE GRANTED: Yes No.
J
��
a �
ti �
r
ro
ti
a
�� � �
�` x v
� ��
� --- ................ -
Q THE COMMONWEALTH OF MASSACHUSETTS
/ r BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrnrtion Famit
Application is hereby made for a Permit to Construct ( ) or Repair K an Individual Sewage Disposal
System at:
G �s`7ir Jc� .... ......-....... S •Z4�............................................
Location-Address or Lot N
Owner Address
,Wa sG2�UGU 27_ C,Gec ?' 7!- ..... 5
ac�
Installer Address
-VOL
UType of Building Size Lot-,, ............:....Sq. feet
Dwelling—No. of Bedrooms__________________.......-.____.--___._...__Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of ersons____________________________ Showers —
(� YP g ---------------------------- P ( ) Cafeteria ( )
PaOther fixtures -------••----- - ----------------------------------------------------------------------------------------------•--------
W Design Flow_______________�S__-_._...._____gallons per person per day. Total daily flow..............c30................gallons.
WSeptic Tank—Liquid capacity.l4:V.gallons Length................ 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..................sq. ft.
Z Other Distribution box ( • ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1________________minutes per inch Depth of Test Pit.............._----- Depth to ground water.........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •------- ---------------------------------------------------------------•--.........---...----•-------------._.-......•••--._.._.__.....--•-•- --------
Description of Soil----------. --•---- .... sr:aw_------:--
x
W ----•------------------------------------•--•------•-------------------------•----•----••••----------------------------------••------------•-----•-....................................................
Nature of Repairs or Alterations—Answer when ap�plicable__ s . __ GL_.__Q7�f/'`�+'l,Gy�,JcSS�bOL
U 1� lCk?a
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliant as been issue b e board of health.
Signed ... L�" ..... �, .. --�Q.....-..
re
Application Approved BY -e-- . ��— !n/C ....
e
Application Disapproved for the following reasons- ----------------------------------- -------------------------------------------------------------------------------------------
...................................................------- ------------------------------------ -------------�--------------------
Permit No. �!?.-- d... .. Issued .... - ------------ --
Dare
THE COMMONWEALTH OF MASSACHUSETTS
�•i �F BOARD OF HEALTH -
TOWN OF BARNSTABLE
Appliration for Uiipnsal Workii Tnnitrn.rtiun Vamit _
Application is hereby made for a Permit to Construct ( ) or Repair (>Q an Individual Sewage Disposal
System at:
Location-Address 7 or Lot No
- -
LiU57 .
...��?i.---••--- � -•--- O...�si ..................... ............................G .S i � �c�.v�s
.... -----
owner Address
a --..... c..G.�Uc.... .....--•--c-..�" ......•------ __ G .........31'.. ...... Y2 2sr us r i�t�s,6��L
Installer Address
VType of Building Size Lot..Z��-----------_'-.Sq. feet
Dwelling—No. of Bedrooms..................." .___.._...______.Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures .
W Design Flow................� 5................gallons per person per day. Total daily flow--__-__••___--. '_...._.._..__..gallons.
04 W Septic Tank—Liquid capacity./gallons Length----------_--- 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.......:_._.......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water_.--__________---_--_
G-14 Test Pit No. 2................minutes per inch Depth of Test Pit-_.___--_--___•__- Depth to ground water........................
O 0 -..--------------------------------------••-------•---------------- -------------------------------------•---------------------
escrption of Soil------..... - / ------ .................................................` a /
_ � /� '1
W
---------------------------------------------------------------------------------------•---------------------------------------------------- -----------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable.__G.E N_ __ %G..._-_ v 2t=G1 1---G'F.5.�1 C
/OD� -.......ice"------ ......5?r.!.,L_---------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of'Compliance has been issue by.-the board of health.
Signed -G-------------�5-8--------f-------.......................... `r1 Q......
D to
Application Approved BY ..........-.... �� �ti yr— `_%'---------
Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------- -----------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------
ppDare
PermitNo. --------f p---" o--------------------------- Issued ------------------- ....................-
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Tontlatian e
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by % Or2`TG-1C�2�'7 -----�=D ........................ --------------- ----- ----...........------.......... ........ . .
Installer
at ................ ........................ S7ii -U7"----- 5_/:---------------------- /.. J /.........................-..--------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ....../lJ `7r6 -------------- dated ......................................--.--.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.... - ---------------------..................... Inspector ----- .. ?..-.........
f
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No. O.:.. �J FEE. �J-�....
Disposal Work$ Tnn#rudinn rrnti#
Permission is hereby granted............... 6<_�-�_66.� ..._..Z. � .............................................
to to Construct ( ) or Repair (-'s<-) an Individual Sewage Disposal System
at No.......................... 27 -----1_. S7�tJc� '...ST------- -------�'�. JA,4�
Street q //!!
as shown on the application for Disposal Works Construction Permit No.!ll_._k\ 2—___ Dated..........................................
/ - �� Board of Health
DATE.
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS