The URL can be used to link to this page

Home My WebLink About0082 FOREST STREET - Health 82 FOREST,STREET,HYANNISPORT A;245-110. o 0 _ TaWN OF BARNSTABLE LOCATION r�-�Y '`Q SEWAGE # R:1-(0 1 VILLAG SV 0'417 / ASSESSOR'S MAP & LOT ' I INSTALLER'S NAME&PHONE NO. �i Q--C*4-6 JR'`t l,'1 C_ SEPTIC TANK,CAPACITY �'`�Q-D L )� LEACHING FACILITY: (type) [ -�6)L% L— (size) �� f l f11e(� ' NO. OF BEDROOMS BUILDER OR OWNER 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 - ' _� • �'. O o I o i ,; . . -. � ��, n � �-� 3� �.� .- � - �� L� . �� - _ �. � � , �, � :, .it_ . No. 4j"` Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZfppYiratton for �Bigozal *pztem Cowarurtion VCrmtt I Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Vomplete System O Individual Components Location Address or Lot No. ��.�Q r`e.S'1 STi _ Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0 1�'�_I �� ' �D Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. &dr-r- I 1W4 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r I ff-- Design Flow 41,40 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ( _ n`J \ Type of S.A.S. C1' Siti� �— Description of Soil Nature of Repairs or Alterations(Answer when.applicable) S Tc 1 To VL I All Lk 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 E vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b a Signed Date Application Approved by Date o Application Disapproved for the following reasons Permit No. Date Issued 3— 3 r 22 _ TbWN OF BARNSTABLE LOCATION 9 Q SEWAGE # QT IO VILLAG IV . ASSESSOR'S MAP & LOT — 1® INSTALLER'S NAME&PHONE NO. �� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) ze) NO. OF BEDROOMS BUILDER OR OWNER 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 Facihty(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �'ru I d O O c , �,J� _ ,. ti ,.-.•: --•...•... .. .... , -... _ �.- - •� ,.. `:" .�_,c,-...�.r�� _ ,ru;.., ,.- � �.r�M ,. _ „psi No. k/ 0 ram• ' Feq THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: l . ` '..PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS es ..Pricattbn for Migpogal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Pf6omplete System D Individual Components Location Address or Lot No. ��. f "'Q Y,E>CST /STI Owner's Name,Address and Tel.No. Assessor's Map/Parcel G f 5_-1 1 r V ` 140 Installer's Name,Address,and Tel.No. I l Designer's Name,Address and Tel.No. { Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures ` t Design Flow q '�t o gallons per day. Calculated daily flow "4 (a gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1�f7 l c Type of S.A.S. Description of Soil VY\O.L SIA Nature of Repairs orAlteiatiods(Answer when applicable) CTZ) S T t �4 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 E vironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b t ' o of-He*alt . G Signed Date Application Approved by % Date - S� Application Did'\ roved for the following reasons � . t Permit No. 9-� Date Issued 3- .3- 22 j -----=- ------------------------t------ __�THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance - THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded (V) Abandoned( )by � 0-C- Q at Y`e;-;l a(Z t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 22-10 dated Installer Designer r i The issuance of t 's ermi shal not be construed as a guarantee that the yste will ulncct' n as desig ed. v Date Inspector No. __/ / / ------------------ -------Fee ✓" . '�_. THE COMMONWEALTH OF MASSACHUSE S PUBLIC HEALTH DIVISION - BARNSTABLES MAS ACHUSETTS Zigogal *pgtem Congtruction �,,trmit Permission is hereby granted to Construct( )Repair( )Upgrade P Abandon( )\ System located at r=:Q-v'e-SI 5(_ \, I 11�=4 /Job 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. Provided: Construction must be completed within three years of the date of this pegrut. �' Date: Approved by _l9, ,`4 ,: 1/6/" 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) hereby certify that the.application .for disposal works e _ Y fY PP P construction permit signed by me dated 3 —�k`C�S concerning the property located at �704 " f ' meets all of the Mowing criteria: /. The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. V• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. /Tliere are no wetlands within 100 feet of the proposed septic system There are no private wells«zthi.n. 150 feet of the proposed sclitic system ere is no increase in flow:11d/or charge in use proposed There are&I variances requested or needed. D B �* The bottom of the proposed 1;aching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor ethod when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility wrill 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 t 0 +the MAX. High G.W. Adjustment. DIFFERENCE BETWEEN A and B 1 V SIGNED : DATE: (Sketch proposed pl of system on back]. q:health folder.art A i9 "\ ��. .r' .es�p Q r� ..��