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HomeMy WebLinkAbout0067 GROVE STREET - Health 67 GROVE ST. HYANNIS A = 309 073 A TOWN OF BARNSTABL.E � A Lf'n" aTION `�GROVL J-� _ SEWAGE # VILLAGE /Pr IJ ASSESSOR'S MAP& LOTjO —!?ZS IN'STALLER'S NAME&PHONE NO. 76M •S w-11-KEn SEPTIC TANK CAPACITY 1000 /,-'1L L ACHJNG FACILITY: (type) (size) 3 X 11 KZ t N'�?OF BEDROOMS_, BU-d.DER OR OWNER PERMITDATE: DATE: Senaration Distance Bev veen the: Minimum 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 beaching Facility(If any'wet?ands exist ,;�J• i within 300 feet off leaching facili ) :_ Feet Furnished by / 4,ArA-_ `' i -S 00 C CIO O th r ij�e -:r 4ti ! n I. No. �.. Fee , r `` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIPPiication for ;Diopogal bpeum Conotruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �- Owner's Name,Address and Tel.No. o Assessor's Map/Parcel TO � y Installer's Name,Address,and Tel.Wo. 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 Design Flow O gallons per day. Calculated daily flow 2 S� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Eel shm /Doe y41— Type of S.A.S. S �40s ,rr.6L71{rk toRs Description of Soil; Nature of Repairs or Alterations(Answer when applicable) l ti.0�I�i�/ rJ t'�a X `�c7 cy S 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 s Bo d f Health. Signed Date Q(o —2C Dl Application Approved by Date 6 — ZG_0 Application Disapproved for the following reasons Permit No. _Z AYV — Z Date Issued G Z 6 r_ 00,0 _ Now ry G ,~ s <� a`� � �� Fee r / Entered in Go uter: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0[ppricatfon,for �Digpooar 6potem Construction Per'-,T Application for a Permit to Construct( )Repair(. )Upgrade( )Abandon( ) D Complete System El Individual Components Location Address or Lot No. {� .G. Owner's Name,Address and Tel.No. j f Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -T!�3w►�s w�ILkrR yl-2y2 v 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 rJ gallons per day. Calculated daily flow `� S_ gallons. Plan Date Number of sheets Revision Date Title Size-of Septic Tank EXii JIme, loon yr1C. Type of S.A.S. 5 76 "-4 r+f0 S Description of Soil; qho Nature of Repairs or Alterations(Answer when applicable) lb t h 1=�L fR�► '�'dK S W N ' e� S'fOh e a �� � /2�2 u 2 � 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 s Bo d f Health. Signed O 7 A Date ©fi ApplicationApprovedby Date 6 — 16-0 L Application Disapproved for the'following reasons Permit No. -Z-4 y I—l(Z Date Issued 6 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 --A lzr E.S W AL k E/1 at 41 6 9 0y't S jt } f&&W�s has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No._Z4V/' Z S dated 6 — Z 6 - M0 Installer Sp N7 e S J..,/&_h FR Designer X/Ia The issuance of this permit shall not be construed as a guarantee that the systpoovill function as desi X. Date fnspect No. ! Z� --------�Q�-©��------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS li!5 pooal 6potem Construction Permit Permission is hereby granted to Construct( )Repair( AfUpgrade( )Abandon( ) System located at I 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 piust be completed within three years of the date of this p - Date: G Z G Approved by vs C( t a U6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH .--ND .PPLICA.TION FORA DISPOSAL WORKS CONSTRUCTION PERNUT f7YTTHOUT DESIGYEI}'PLA, SI 7-701M L6 'k18LkrA hereby cz-my that the application for disposal works consiruc—aan permit sigied by me dated_ 0( — Z conce.r-iunQ the propetry located at (� �J (r�ovc 51- Y(eAff1A.11( meets all of the fouowins cniena: • The failed sysem is coane`ed co a residendai dwelling only. T ae:e are no comme:cal or bttsiness uses assocated with the dwe!lins. • The soil is classified as CLASS I and [he pe:coladon rate is less than or equal co 5 minutes per inca. • There are no wetlands within 100 Fee;of the oro*rosee+ se-ptic i ne:c arc no private wets within 1-50 fee:of the or000sed seodc sae n • There is no incise in flow and/or c..iangt in use proposed • There are no variances"requested or ne-__a+ed_ • T nc botIOtn of the proposd Icacaing faclity Will not be located less than five fe_, above the tnasimtim adjusted gbundwamr table e!e•radon. (Adjust the--oundw-ate:cable rs:ng Lhe t=iunntor method when applicable) • !f[he S.A.S. will be located wiLl =_0 fee;of any veE>_tated wetlands, the b-o IT om of the proposed IeaCvng facHirf will not be lccated!ess than=pure_t(l4) tee:above the to -urnum adiusted_ E-ounQwa[er table e!e"/at'_on, Please complete the foll0wina- A) Too of Ground Sur:ace E?e•/ndon(using GIS intornation) I/a�_ [he `-i=h G.W. Adju5-Lrnenl D TTER ENCc. B E7;; ` and 3 22, d S ctit� D-_T-E 2J-0/ (Si:etc`t proposed olan of s:sent on backj. q:.^uLh CoIdc:- l i t t i_ a 0 is E Y -rA" YL fs` ..L>.y' " - z5 �`, ,-,,_*'" -� l '�"� s- rr�o- ,,• .: ky �y.. „y \yr ti ti q r.. ,, Z •..� 7 +J���( L�.�(� r vt Y:. :f� _ „�$L�— .. r. '?. � �.=t w V ri. '1• f r TOWN OF BARNSTABLE ;. LOCATION. 7 G R.o r!� s f ooI 60- SEWAGE # L : VILLAGE ASSESSOR'S MAP& LOT:�� INSTALLER S NAME&PHONE NO 74 M e-9 W9 L on SEPTIC TANK CAPACITY AL Wir :: r.. IS—T Zt— a '3�oTh4k.zF'fkr�, LEACHING FACILITY. (type) � ti.!7" lZ�eA.S (sat 1 X Z _ t� NO OF BEDR MS Y v BLIIT:.DER OR OWNER ._• PERivIITD�.TE : Separation Distance.Between the fi `Pnrate Wated1Suted�rW hand Leaclvno?~ac�1►ottom oanLe ellse z�stlitty Feet �k�Yi j P.l}Y S h` Y oti site gr;.withan:2p0 feet of leactung facility} Feet S Y Edge of Wetland and Leaching Facility (If any wetlands existf wittun 300 feet,�off 6a�ching f zli ) ` Feet 4 Furnished 6y: 7 t V l E 111 ( / FF kys jj ` T , _ i z • < Ot O TOWN OF BAR.NSTABLE LOCATION �� � p if1� , SEWAGE #_ VII LAGF_ M/5_� ASSESSOR'S MAP LOT fM INSTALLER'S NAME & PHONE NO.--- P3/LaS C'o u�r Jloa-� 3 4 SEPTIC TANK CAPACITY /OC14 LEACHING FACILITY:(type) l (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 0116AIC- BUILDER R OWNER 0/569 ( "d U �-- PATE PERMIT ISSUED: DATE COMPLIANCE ISSUED:r�_� _ VARIANCE GRANTED Yes_ No __ F oS � � _ , � 1 � ���. ' ,t� -a� . _�� __ - - ��� .y' �-_ .'' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applutttion for Disposal uAr/k ��a tnn �exnti Application is hereby made for a Permit to Con ((tact ) or Repair ( ) an Individual Sewage Disposal Y JJJ ��` . ...stem 7_�G: - US................................................................................................. ._..-----......---.....----.------. �/- Loc ion-Address or Lot o. '------------------------------------------- _�.. ...................................._..... Owner a Address �>� ....��ees.�--•-- ---------------- rr !2l�ll? �'d._...._....._.._..... Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms_-_---�-------•------___ -Expansion Attic (44 Garbage Grinder (4 ) Other—Type T e of Building ............... No. of ersons....___......._.._...._.__._ Showers — Cafeteria (� YP g ------------- P ( ) ( ) Q, Other fixtures ------..----------------------------•---------•------•-•----•-.._......._......--• ------------------- - W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic 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-___-----_--_--_--_____. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w' ----•------------------------------------------------------------------------------------------------------------ ------------------------------------------- O Description of Soil..................... x U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alteratipns—Answer when applicable---l-------t_ Cr races._.j_9_ _.._5" ....._...I.....5:rb:_...3;K a'0A- 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 issued by the board of health. z -- ' Signed . ----- ----- �/... ----✓. . ,// Application Approved BY //v ---- ------------ ----- -------- Application Disapproved for the following reasons: ---------------- ------------------------------------.............-- ................................................. ------------------ ----------------------- ----------------------------------- -------- ...............------- ------ ------------ Date Permit No. ----------------------- Issued ------------------------ ' Date f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Disposal - urkaTun� iutt rrutit Application is hereby made for a Permit to Construct X ) or Repair ( ) an Individual Sewage Disposal System at: U � � ��d �� RyA�11�� ......._------------ --- -... • • ......------ ------------------------------- �! Lo n-Address or Lot No. • :� --------------------- ----C 2.--6 .... ...----•-•--•---•------•-----.........-•---- Owner Address •---------------- - � Installer Address d Type of Building Size Lot------------------=--------Sq. feet Dwelling—No. of Bedrooms...... .............................Expansion Attic ( 4 Garbage Grinder (AP ) t_l - aOther—Type of Building -----.-•-_-_-__-___--__---- No. of persons___________________-___- Showers ( ) — Cafeteria ( ) d Other fixtures .............................................................. W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic 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 ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit-_______--_--..__- Depth to ground water........................ (L4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ ------------------------------------•---------------------------•-------.........---•-•••.....------.........................................................O Description of Soil...............................................................................-----------------------------------------.............................................. x t U --•-------•••••-•--•---•---•----------••-•----------•-----••--------------•-------•----......-•-----•----•--•--•------------•-----•------------•••----••••----------------------••-•----------••------- W --••----•--•--------------------------------------••-----•----•-----------------------•----•---•---•----------• ----------•-----•••• 1- ter, -D 3a� •--•...... V Nature of Repairs or Alterations Q..-Al fer n aPP� e-...�- c ini s ----------I.......................................................... vl�l ;i �`�? cav .: 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 issued by the board off health. Signed . - % /G'�� ................. ...... - Application Approved B - y _ . .. --------- ------------- YApplication Disapproved-for the following reasons- --------------------------_--------------------------------------- ----------------------------------------------------- ....................................... ------ -- ----�... . r Permit No. . ----- t-� ------------- Issued ..� -.1� I?ate .... Daie t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` TOWN,OF BARNSTABLE Ter#ifirak of TompXianre v�� TH- IS TO C RTIF a t e�Indivi 1 S s o l,Sysyer{� nstructed (X ) or Repaired ( ) by ....... -- O-- I aGeo t �� . ...... 0`36.------ -I.-- ------- .....1...... ........... .-------- ------------------------- -------------------...------......------ -- has been installed in accordance with the provisions of TITLE 5 f The S t nvtronmental Cod as der4b in the a lication for Dis osal Works Construction Permit No. dated ..... .....PP P . -- 6 ---.--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B,CONSTRUED AS A GUARA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. - p ....1..--`'1..�----------------------------------------------------- Inspector ._...:....- ( !- �,� '"""'- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEEY1. Permission Disposal Works Tun�sJttJu �mit ss on is hereby granted s-....�!�L_ -� r �� , to Construct ( )�� epair �j ) ann •victual Sewage Disposal, System Street as shown on the application for Disposal Works Construction Permit No � Dated..,?./z, DATE.................. _ _ 0..... Board i f deal°ti FORM 36508 HOBBS&WARREN.INC..PUBLISHERS i