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Home My WebLink About0020 CRAIGVILLE BEACH ROAD - Health HYANNIS A = 288 003 I I 0 TOWN OF B STAB - �+ . , LOCA?6-ii EWAGE # VII LAG!:' ASSESSOR'S MAP& LOT J =' INSTALLER'S NAME&PHONE NO. P'4 Co SEPTIC TANK•CAPACrrY qaL `', p LEACHING FACILITY (ty (size) e r) 1!(a NO.OF BEDROOMS J ( I BUILDER OR OWNE PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum:Adjusted Groundwater Table and 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 w fib? { _ �` A� No. ! Fee 115-Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ves PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Mtopoal *pgtem Construction Permit Application for a Permit to Construct( )Repair(✓fUpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a d /q q v (L f3C Owner's Name Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No. d & B CANCO 350 Main Street W. YaFmeuth, 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 /S60 Type of S.A.S. W .. + S-�dyi 2 Description of Soil Nature of Repairs or Alterations(Answ when ap licable) 1 Siq �/ I — /$oU i4� Se -Cc_ -tog A) � ��-is r tCt« cols A;,l e-e".r 0 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 H all . Signed Date Application Approved by Date " Application Disapproved for the following reasons Permit No. Z Date Issued I -, TOWN OF B STAB E, . EWAGE # LOCATION. ASSESSOR'S MAP &LOT` VILLAGE r(, INSTALLER'S NAME&PHONE N . r� SEPTIC TANK CAPACITY �" LEACH NG FACILITY: (ty� (size) i�f NO.OF BEDROOMS J �' BUILDER OR OWNS ' N COMPLIANCE DATE: PERMIT DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) exist Edge of Wetland and Leaching Facility(If any Feet within 300 feet of leaching facility) Furnished by r �5z i _ J- No. `.' Fee Ves THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Mi9;po.5a1 *pgtem Construction Permit Application for a Permit to Construct( )Repair(VI-Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a O C/A V ({ �?��(` tdIv. Owner's Name,Address and Tel.No. Cp� Assessor's Map/Parcel tti+� u rye S v Installer's Name,Address, Designer's Name,Address and Tel.No. 350 Mpin Street A rl W. Y_arrmutti, MA ON73 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 /,SOO Type of S.A.S. X,L c Sid~t e Description of Soil Nature of Repair's or Alterations(Answ when applicable) 1 v O / Se/�✓ c C 1 Ai I Ce S1- d o 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 Heal Signed I Date Application Approved by Date Application Disapproved for the following reasons Permit No. 7 Date Issued 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 at 2 ; has been constructed in accordance with the provisions of 'itle 5 and the for Disposal System Construction Permit No. dated Installer Designer I �! The issuance of this pertit shah otbe construed as a guarantee that the syste ail function as desig e�� V j /1 / 1• Date �� Inspector <<'1� �;? 11 R v t/ No. -- 3?� - - -----"----------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *paem Construction Permit Permission is hereby granted to Construct( )Repair( ✓3 Upgrade( )Abandon( ) System located at ��, , b1�1( 12 o X.p hCy ,L f 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 p mit. Date: Z �9 Approved by I ASSESSOR'S MAP NO. PARCEL ( � LOCATION SEWAGE PERMIT NO. lZC VI L LiG E .INSTALLER'S NAME i ADDRESS e U I L D E R OR OWNER 0 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED gyre o�� s to Ib f u • fb r • - r • 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 PERMIT (WITHOUT DESIGNED PLANS) I, J C,ann.6y\, hereby certify that the application for disposal works construction permit signed by me dated (o - 3 ` T concerning the property located at Q o C'a:�„1 �{ �c �� meets all of the 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 mammum 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, 106 ht�4 y yt Please complete the following: P g A) Top of Ground Surface Elevation(usingGIS information ) B) G.W. Elevation +the MAX. High G.W. Adjustment . _ DIFFERENCE BETWEEN A and B SIGNED : J O ^^� \ DATE: [Sketch proposed plan of system on back]. q:health folder:cert i ( � C goo 0 1 w