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Home My WebLink About0092 KENNEDY CIRCLE - Health KENNEDY CIRCLE 9rHYANNIS A - 268 055 f � I i E � o ASSESSOR'S MAP NO.-��'ql PARCEL LOCATION SEWAGE PERMIT NO. VILLAGE N S_ T A L LE_R�S__�._._N-A • UILDE R OR WNER D A T D A V C-0"M-P"L I A N-c-E-rT 1-D .__.--. 4 � �. � .. 4b c� n c .C, 9� TOWN OF BARNSTABLE L�94 LOCATION SEWAGE # 2,V0 r VILLAGE ASSESSOR'S MAP & LOT ==� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ,�Sd LEACHING FACILITY: (size) NO.OF BEDROOMS BUILDER OR OWNER. h PERMITDATE: 00 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 ^s cam. r N G Y a No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppYication for Miopogaf *pgtem Construction permit Application for a Permit to Construct( )Repair grade( )Abandon( ) AComplete System ❑Individual Components K.. Location Address or Lot No. W Owner's Name,Address and Tel.No. Assessor's Map/Parcel fw "-;L6 6_0V (J Installer's Name,Address,and Tel.No. 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 r Design Flow 3,0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil s SK'yd Nature of Repairs or Alterations(Answer when applicable) r- cA�( 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 Enviro2ruptal Code and not to place the system in operation until a Certifi- cate of Compliance has bee is .. �(Signe a, Date Al Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE i LOCATION SEWAGE 0 r VILLAGE - ASSESSOR'S MAP & LOTJ INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY Sd a LEACHING FACILITY: (size) NO.OF BEDROOMS BUILDER OR OWNE PERMITDATE: fol COMPLIANCE DATE: D 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 j Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by FE r i * ; I � i, Y No. Fees THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pprication for Migaal 6p$tem Construction 3permit Application for a Permit to Con t( )Repair(�,*`)Upgrade( )Abandon( ) Ncomplete System El Individual Components Location Address or Lot No. �'a' �'d r` 4-V Owner's Name,Address and Tel.No. Assessor's Map/Parcel —G 1 Y� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -` Type of Building: Dwelling No.of BedApOs Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures rr__ Design Flow gallons per day. Calculated daily flow 3�A gallons. k Plan Date Number of sheets Revision Date Title _ Size of Septic Tank t�-� R) t ` Type of S.A.S. A 60 rrf ►7 V Description of Soil ' "" Nature of Repairs or Alterations(Answer when applicable) 9�� S.i` p` �-�"'►2 C� �.. Ca c IYO UC4...0�.'w,-cct Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system k in accordance with the provisions of Title 5 of the Environnigntal Code and not to place the system in operation until a Certifi- cate of Compliance has beenassuee by is oar 1t — Sig Date Application Approved by _ Date Application Disapproved for the following reasons Permit No. Date Issued U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 1 Certificate of Compliance THIS IS TO CER , that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Ab done ( )by 1 0_c APF �i %<1 c— at °�xl,ly K-G:�ti9 Cc rc.1'?.. k Itj, A-w V S vr"— Jhac�..�/een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Na '"1 I U dated n Installer Designer Al" It The issuance of this pe t s 1 no b, construed as a guarantee that the system.willfinctibn, s des gried. v Date �� Inspector ------------------------ No. Fee`✓C.� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miopooar Opotem uConotruction 3permit Permission is hereb granted to Construct( )Repair( ad ( )Abandon( )� System located at 9a� 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:Cons tru' 'o ttlt be completed within three years of the date of this °ermi Date: lm/ Approved by IZI/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 t WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the applicatio n for disposal works construction permit signed by me dated Af {—d , concerning the -)OL-�2- property located atAJ116 G�� 1 meets all of the following criteria: L--�is 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. here are no wetlands within 100 feet of the proposed septic system •/ here are no private wells within 150 feet of the proposed septic system ere is no increase in flow and/or change in use proposed • here 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] • f 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: G A) Top of Ground Surface Elevation (using GIS information) l B) G.W. Elevation 5-'0 +the MAX. High G.W. Adjustment. DIFFERENCE BETWEEN A and B 3 ✓ SIGNED : DATE: (Please Sketch propose plan o ack]. 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 T �r� ��I eo� � �l � �I