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Home My WebLink About0031 FERNWOOD AVENUE - Health 31 FERNWOOD AVE. , HYANNIS A = 289 105 TOWN OF BARNSTABLE LOCATION d` SEWAGE #WOO — VILLAGE t5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. iNtwom, SEPTIC TANK CAPAC rT)0 . LEACHING FACILIn:I(t pe) ZC0 � Z�x ItCJ�x�, NO. OF BEDROOMS 3; BUILDER OR OWNER t5(3;—E PERMITDATE: 84--2,Wh 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 V v r qwg_ -1, p No. C Fee r/ THE COMMON�Vt=_ALIiH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for �Di000ai *potem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. F�f(1 Own is �� i�Name,Address and Tel.No.' ' " -n r-1r Assessor's Map/Par a —� _ ( _16C(IIJ Installer' ame,Address,and el. �.Q Designer's Name,Address and Tel.No. Type of uilding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow_ I� gallons per day. Calculated daily flow �2-')'6 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 000 Type of S.A.S. 48o 6fa-L Description of Soil Nature M�IAC s or Alterations(Ans a whe applicable C `t �rtc 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 bee ' sued b H Signed Date d� Application Approved by Date lug Application Disapproved for the following reason Permit No.7 r?,o Date Issued r� No. _ l Fee _' / THECOMMOrl9NFAITH OF MASSACHUSETTS Entered in computer: LIZ ,,. Yes PUBLIC HEALTH DIVISION -TOWN y OF BARN TABLE., MASSACHUSETTS t, ZIpprication for Migaar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/PaI�L(,n71► (}(} -_�l` (�LLX CJGIe' Installer's Name,Address,and Tel.No. a gner s Name,Ad ress and Tel.No. lam. � TDUC1�°'S f�cL�'�OnSMx.��n a 11PGcK �'' S�,tNi°s , Type ot1 W u dingt Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures A Design Flow 171 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Da e Title Size of Septic Tank , nttirl �S Type of S.A.S. r G 6A 6 t 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 th and o Health. Signe& Date e Application Approved by Date Application Disapprove fo e followtn r asons Permit No. zezv Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of ComplianceR F THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by t at has been constructed in accordance with a provisions o Title and the or Disposal ys em onstruction Permit No. dated Installer 1 ,. n „r Laz. Designer i The issuance of this permit shall not be construed as a guarantee that the ys m will function as designed. / � �, - / �✓ Date �'� � l Inspectors--'i�" �i -?rl No. Fee THE COMMONWEALTH OF MASSACHUSETTS Z —/C) S' PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS wtgpoar pgtem Congtruction Permit Permission is hereby granted to,'Construct( )Repair( Upgrade( )Abandon( ) System located at rl� , IIAIIA s l( v 1 / 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. J ► Provided:Construction musebe completed within three years of the date of this pertrut. Date: Approved by ' r N 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 MWAM—��\,,tjN�Uherebycerti that the a lication for fy pp disposal works construction permit signed by me dated �� , concerning the property located at 1 �r 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: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W.Adjustment. o _ DIFF WEEN A and B SIGNED : DATE: [Please Sketch propose p n ystem 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 ` ,�.� �' --��/v �� , � Q _ �� c r c� n .. _ 'g ', sir' y V � — i f 1 1 i TOWN OF BARNSTABLE LOCATION F` SEWAGE #ZDCYJ _ VILLAGE_ A`f a kIkV v5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPAC b � LEACHING FACILITY: (c p3e� 1X ZZ � m5 Zen 1�o f NO. OF BEDROOMS J BUILDER OR OWNER ip, PERMITDATE: c�a:2-= 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet .57 'S 51 1 5'S5 L ?g`4 iS 10 MM qV ) �NI :�V3A SON ._ t,� `__J\\ (v � �� g � � o � 3 L � � a � � `� �� ;---_ _ � .' � J �� - �_ rJ � .� '-� � � -� � � i -- � � I � ��