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Home My WebLink About0067 FIFTH AVENUE (HYANNIS) - Health 67 FIFTH AVE HYANMS1 A 246 126 i 6 1 k "I{ `I a h TOWN OF BARNSTABLE ®O� LOCATION 1;'— ,LTA -11.Ye, SEWAGE # VILLAGE , ,/�� .!aX-7 — ASSESSOR'S MAP & LOT t INSTALLER'S NAME 8i PHONE NO. /27 (n11,ok,e feh-11 "SEPTIC TANK CAPACITY %S O U LEACHING FACILITY: (type) IV 1/iCA 1/ :)IeS' (size) %:!�7 ice'' t NO.OF BEDROOMS BUILDER OR OWNE PERMIT DATE: COMPLIANCE DATE: f 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 . ^e ti n. No.t '��' �'�^�O Fee J-6 � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Wgpo , Y *p5tem Congtruction 3permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) nomplete System ❑Individual Components Location Address or Lot No. tv Owner's Name,Address and Tel.No. Assessor's Map/Parcel 2 b 1 Cp 1— �GC v tC�C.#Q Install is Name,Address,and Tel No. Designer's Name,Address and Tel.No. D-`GH e__S� -t tv L S 1U L)%S 5C. -} t Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 11 Design Flow !A 7 gallons per day. Calculated daily flow L-1 q 9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I:St ) S.T, Type of S.A.S. JA cSA Cs,jAT%-rt ��e Description of Soil: Nature of Repairs or Alterations(Answer when applicable) S-yxy— Al x_ Q—a 6�e2 l+�Lo CA JQ Li'(to_ L-E� Cz&� 0-c-c- C `A-, c{15'ro tie— . d I/V 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 ha n issue y and o ealth. Signed Date Application Approved by Date 9,7— Toy Application Disapproved for the follo ing reasons Permit No. 'Z4D -S 3 0 Date Issued OY TOWN OF BARNSTABLE I ` LOCATION i��t, SEWAGE # AOO� VILLAGE It-7- ASSESSOR'S MAP & LOT r INSTALLER'S NAME&PHONE NO. 1,171- C� iI SEPTIC TANK CAPACITY I a. I LEACHING FACILITY: (typo) /',-/ %TiC.`I/'d/�S' (size) NO. OF BEDROOMS BUILDER OR OWNE PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facil?ty Feet Private Water Supply Well 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 i iNn No. Fee �? THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rp-p1tcatioIt fbr Mt5po!g r *p$tem Congtruction Permit m 1 S Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) �,Co p ete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel �`tj--1 �" ✓�'�GtPV Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. i Type of Building: Dwelling No.of Bedrooms_ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i t' t Design Flow � y0 gallons per day. Calculated daily flow (A 4' gallons. Plan Date ' Number of sheets Revision Date Title Size of Septic Tank 1 15 tTn S _, Type of S.A.S. t S&�r Description of Soil • t Nature of Repairs or Alterations(Answer when applicable).i A ati K Q (Z[6C� t 1 S1 If;� f`f�t 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 h men issued by'ft oard ealth. \4_ Signed Date Application Approved by Date 7- 20y Application Disapproved'for the following reasons Permit Nov"S 8 Date Issued 0/- - ?.ate.✓ -- ----------------------------�='-' 1----- -y THE COMMONWEALTH OF MASSACHUSETTS iRNSTABLE, MASSACHUSETT& �� ` '7) Certificate of fo"rnpYiance THIS IS TO CERTIFY, that the On-site Sewage;Di posal System Constructed( )Repaired ( )Upgraded(V•)� Abandoned( )by at �'� �^ 'r�I,-e__ has been constructed in accordance with the provisions of Title 5 and-the for Disposal System Construction Permit No24-&-'O` 3 V dated 7 - 7- -uro . Installer >: '- Designer The issuance of this permit shall not)be construed as a guarantee that the yste will function aslidesignel. Date Inspector / V r'v d ' �!�/1 !�l V'1 �.��✓ r ————,——————————————————————————————————— No.Z't!"7YtJ 3 0 Fee � 6 '�- 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS ; U C } 'Wi5po5al *pgtem Con0tructio Vermit Permission is hereby granted to Construct( )Repair��_6p`grade( `)Abandon( ) System located at o t c- 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 permit. Date: / � Approved b C 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. 4 ti CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT_WITHOUT DESIGNED PLANS). hereby certify that the application for disposal works construction permit signed by me dated � �� , concerning the property located at r"F A 4'-cl J(n 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 here are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed here are no variances requested or needed. •/he 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 61 +the MAX. High G.W. Adjustment./' DIFFERENCE BETWEEN A and B SIGNED : DATE: [Please Sketch propose 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 o� � ' � 0 �� 'I