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Home My WebLink About0005 JIB WAY - Health 5 JIB WAY HYANNIS ° A = 247 186 023 0 2 ° n G P e 1 ° 9 0 OFIME ro Town of Barnstable r a Regulatory Services &UMSPABLE, MASS. $ Thomas F. Geiler,Director , 1639• �0 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 5,2002 Customer Service Bureau Massachusetts Department of Revenue P.O. Box 7010 Boston,MA 02202 Dear Customer Service Bureau: This letter is being written regarding a septic system repair located at 5 Jib Way in the village of Hyannis. The system was in failure and as a result took out a repair permit on June 27,2001. The system was repaired and brought up to Title V on September 17,2001. Thank you for your attention to this matter. Sincerely, Q r Donna Z.Miorandi, Health Inspector Enclosure: copy of repair permit Massachusetts �EPARt4F�P De lent p Revenue P.O. BOX 7010 BOSTON, MA 02204 0001 oop ALAN LeBOVIDGE, COMMISSIONER ROBERT P. O'NEILL, ACTING BUREAU CHIEF JOHN T. PATRIQUIN JR 540 Notice 10589 OP 5 JIB WAY T/P ID 025 50 9849 HYANNIS, MA 02601 Date 05/29/02 Bureau CSB INCOME 4 Phone (617) 887-6367 025509849 1 Dear Taxpayer, The Customer Service Bureau has received your Application for Abatement/Amended Return concerning 12/31/01 INCOME. In order for us to act on your claim the following information and/or materials are needed: Letter from the Town of Barnstable stating that the reason for system repair was due to Title V failure of the existing system. Please submit the requested information using the enclosed address stub and window envelope. Also, include this letter or a copy of this letter with your reply. Please send the requested information to the address listed on the following page of this letter or fax it to (617) 887-6142 within 30 days. If you cannot meet this deadline; please notify the Customer Service Bureau at the number listed above or toll-free within Massachusetts at'(800) 392-6089. It is important to note that this is the only letter that you will receive requesting this additional information. If you do not contact us and/or send the information necessary to process your claim within 30 days, we will be forced to deny it. It is particularly important to respond to this letter since, once your claim is denied, you will not be permitted to file a second claim with the Department of Revenue on the issues related to this claim per Regulation 830 CMR 62C.37.1(4)(g)2. Sincerely, The Customer Service Bureau L J TOWN OF BARNSTABLE LOCATION SEWAGE # 37 VILLAGE IA-1/>w,.iiJ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �- SEPTIC TANK CAPACITY 6Al-L� LEACHING FACILITY:(type) y ta, Clboys (size) NO. OF BEDROOMS M3 PRIVATE'WELL OR PUBLIC WATER BUILDER OR OWNER Zbtmn �t��-��v�r� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � � � � � ��- � n _ 0 0 i . �� ' ) Q 0 � �� .. `NN . V' •J� y << No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicatton for Mtgozar *pgtem Conmrurtton Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Locationsre➢L t o Owner's NaWe,Address and Tel.N . elwAsses r' Map/Parcel � --� / i (� �sj ��iGGG VAT Installer's Name Addres ,and Tel.No. Designer's Name,Address and T .No. Type of Building: 22 Dwelling No.of Bedrooms J 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 9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. / Description of Soil Na re Re airs QrAlterations(Answer whe pplicable) //'�, S� . DSO \ -L'F P',n s.t c1_o S f Zr n c) ' 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 nvironmental Co nd of to place the system in operation until a Certifi- cate of Compliance has been issued by ' d of Health. _�Signed _ Date Application Approved by d Date�^ / �� Application Disapproved for the following reas s Permit No. I&V /— 37 Date Issued 6 !�._ !1'Y-�n,�-.Ii°"'7?+f''�� t��7�i��l�>H M��'?•zz F�c�:� {�•:��. ?r4 'qu eA '�ffl.�"..?Wih �P_J•��x.?'r"*.,�� ? .w zi i .S :r .•p � LOCATION �.��. .-.SEWAGE # 2ooi 437 } . .•. VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE.NO. LS(, is 3 �7n�l.M- f .• SEPTIC TANK CAPACITY I,SCX� ,ALL LEACHING FACILITY:(type) y ta., .C,.oL>s csize NO'. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER , BUILOER.OR OWNER flhn �P` rI casi� DATE:PERMIT ISSUED: ... : :DATE ., • COMRLIANCE•ISSUED:. VARIANCE-GRANTED: Yes No T r S d 4t No. 7i.� �^ Fee - ° THE COMMONWEALTH OF MASSACHUSETTS Entered in compute;: P�`FUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS= .r s Ztppliratton for Migpo�ar :*pgtem Conztrurtton Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Loc on ddres r of N� w�i Owner's Name,Address and Tel. o. - Ass e or' Mapes cel � � � ' � v TV- 7 6 Lod Install Name.Addre s,and Tel.No. Designer's Name,Address and L No. /Zd TTypkof Building: j Dwelling No.of Bedrooms Lot Size sq At. Garbage Grinder,O Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. M. Plan Date Number of sheets Revision Date , Title Size of Septic Tank X,5 0Q 4 Type of S.A.S. -Z /Y c' ?.� Description of Soil Nature of R _airs or Alterations(Answer when,epplicable) 5 '�y S 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 th Environmental CqdVand not to place the system in operation until a Certifi- cate of Compliance has been issued by thi and of Health. Signed Date G Application Approved'by Date 7— Application Disapproved for the following rea ns r Permit No. 7.flU �' Date Issued �O "" Z —0 ———————— ————————————————————————————— ` t ,THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (ferttf Irate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed ( )Repaired )'Upgraded( ) Abandoned(_�by 4 c at has been constructed in accordance with the provi�pns of Title 5 and the fo Disposal Syste Construction Permit No. — dated 6" T 7—0 Installer Designer The issuance of his permit shall not be construed as a guarantee that t e sysa will fu`tion as designed. Date cl 1 >>(�� Inspector C . V `L\ . ----------7--------- —-- ------------ } No. �01-4 13 7 G (//7-1,p6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �� /� -. Mtopaal *pztem Con! trurtton Permit Permission is hereby granted to Construct )Repair( )Upgrade Abandon( ) System located at 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 in st be c pleted within three years of the date oft s ermit Date: 2.7 6/Z Approved b co-v V4 � � t/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). hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at all of the following ciiteria: ` YID•y This failed system is connected-to a residential dwelling only. There are no commercial or business uses associated with the dwelling. V24 0 The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. V '• 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 - v : There is no increase in flow and/or change in use proposed N�" • There are no variances requested or needed. 141V • 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] V I • `If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed lo leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater.tiible elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation d b +the MAX.High G.W.Adjustment. DIFFERENCE BETWEEN A and B ,3 SIGNED: LATE: G 1 (Please Sketch proposed pld of system on back). V. 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 z f