HomeMy WebLinkAbout0403 LINCOLN ROAD EXTENSION - Health 49-LINCOLN RD. EXT., HYANNIS
A=271.022t-�/03
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" TOWN OF BARNSTABLE �/
LOCATION A L'.Q� � �� SEWAGE# 7 9�3
- ASSESSOR'S MAP &LOT. 2/._a
INSTALLER'S NAME&PHONE NO. Fo� i tiJ O
SEPTIC TANK CAPACITY ,��U U
LEACHING FACILITY: (type) c " '�` S (size)
i
NO OF BEDROOMS 3 '" -
B L=DER OR OWNER
P.ERMI T DATE: L/"I 2� COMPLIANCE DATE: L/;r2'3
Sepazation Distance Between the-
Feet
Adjusted Groundwater Table and Bottom of Leaching Facility Fee
Pr vate,Water Supply Well and Leaching_Facility (If any wells exist Feet
pn`site or within 200 feet of leaching facility)
Edge•;of Wetland and Leaching Facility(If any wetlands exist Feet
within 300 feet of leaching facility)
Punished by —
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yo?j TOWN OF,BARNSTABLE
LOCATION Z Are-Ql A SEWAGE # 7 9 3 /
VILLAGE_ /`i i ASSESSOR'S MAP &LOT 7 I- 6
INSTALLER'S NAME&PHONE NO.
� I R.,f .�'
SEPTIC TANK CAPACITY Z cS'0 -0
LEACHING FACILITY: (type) Ste `"' "'' S (size)
NO.OF BEDROOMS -
BUILDER OR OWNER
PERMITDATE: /"/ `I Q COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ^ Feet
Private Water Supply Welland 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 6'C1�
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No. 123 •..� � � ` 6 '�L l `.. ', Fee $5 0 0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es YT
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PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01pplication for Wgpogal *pgtem Construction permit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 419 Lincoln Rd E x t Owner's Name,Address and Tel.No. 7 7 5—8 4 9 0
Assessor'sMap/Parcel Hyannis, MA Todd Coy 419 Lincoln Rd, Ext
Hyannis, MA 02601
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Service
PO Box 1089 , Centerville, MA 026 2
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 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 sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 septic consisting of
1500 gallon Tank, D—box, and 2 500—gallon leach chambers.
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 this Board of Health.
Signed Date `I- )S-It T
Application Approved by Date
Application Disapproved for Ve follbling reasons
Permit No. 7& - z C3 V Date Issued
No. %f3 V Fee $5 0,0 0
.THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ti,/
` Yes
PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for Migaal *pmem Construction Permit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 419 Lincoln Rd EXt Owner's Name,Address and Tel.No. 7 7 5—8 4 9 0
Assessor'sMap/Parcel Hyannis, MA Todd Coy 419 Lincoln Rd, Ext
Hyannis, MA 02601
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Service
PO Box 1089, Centerville, MA 026 2
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 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 sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 septic consisting of
1500 gallon Tank, D-box, and 2 500-gallon leach chambers.
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 this Board of Health.
Signed 2te ✓'-5k Date `1• ►5-9?
9
Application Approved by Date
Application Disapproved for a foll ing reasons ,
of CWA
Permit No. Date Issued
�yny1�. THE COMMONWEALTH OF MASSACHUSETTS
Coy BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired(XX)Upgraded( )
Abandoned( )by
at 419 Lincoln Rd, EE7t, Hyannis has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. Q dated
Installer W E Robinson Septic Sry Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as^designed.
Date '" Inspector fit tom. 1
No. C1 2r - Fee$5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Coy xi5pogaf *p2tem Construction Permit
Permission is hereby granted to Construct( )Repair.(.xN Upgrade( )Abandon( )
System located at 419 Lindoln Rd Ext
Hyannis, MA
Installer: W E Robinson Septic Service
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 by
P
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
ENGINEERED PLANS)
1, William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated concerning the
property located at 419 Lincoln Road Ext, Hyannis, meets all of the
following criteria-
* There are no wetlands within 100 feet of the proposed leaching facility.
* There are no private wells within 150 feet of the proposed septic system.
* There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
* If the proposed leaching facility will be located with 250 feet of any 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 Elevation(according to the Engineering Division G.I.S. map)
B)Observed Groundwater Table Evaluation(according to Health Division well map)
SIGNED:.x Acwl ,C DATE j� /�)
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998
(Attach'a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted).
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TOWN OF BARNSTABLE
LOCATION'L i n r /n RrA L��4-/ r SEWAGE # 6
VILLAGE g, ASSESSOR'S MAP LOT
INSTALLER'S NAME 6z PHONE NO. (/N- C e C-1 2 G ,7
SEPTIC TANK CAPACITY 00 G 4
LEACHING FACILITY:(type) eco c"',li �oU�� (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER , ,
BUILDER OR OWNER ):3 r d\ C
DATE PERMIT ISSUED: -
DATE . COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No I,/ —
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR®.. F HEALTI
1 �.__......OF...... -... _�--------------------
Appliration for DiupuuFal Works Tomolrurtion thrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
...... _ .- - ------- -------------- .................................................
/-(Location-Address or Lot No.
f0_koe_�........4 ..G-` - ---------------------•------------------------- ................. GstM_,e.-•
ner ^ Address
Installer Address
Type of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms________...................................Expansion Attic (tm) Garbage Grinder ("o)
1/� _______________ No. of ersons___._______.____________..__ Showers — Cafeteria •,�
Other—Type of Building ____ __p p ( ) ( )
Q' Other fixtures ----------=,�o.........................................................................................................................................
w Design Flow............................................gallons per person per day. Total daily flow..____..�- _,d_______._____.________gallons.
G: Septic Tank ...I Length___.,l`�_.____ Width__.0_.`.__. Diameter._ja2_.`.__._ Depth__!_/___.._-
Disposal Trench—No_ ____________________ Width_____ ....... Total Length.................... Total leaching area-------------�___._sq. ft.
Seepage Pit No. .Diameter__________ _____ Depth below inlet________........:. Total leaching area...../A?........sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
i . Test Pit No. 2................minutes per inch 'Depth of Test Pit.................... Depth to ground water------------------------
�+ ------------------------------------
------------
•-•----------------------........------------------- -----------------
---------------------------------
0 Description of Soil----------- -----------------------------------------•----.-.-.....----••-•--•-----------------------=--------------•-•-•-------------------------------.......•--..__..
x
------------------------ ---...------------------------------------------------------------...--------------------------------------------------------•-----._................................
U Nature of Repairs or Alterations,4ns-wer when applicable.______ .......�0_L/________.10____________________
_�i A1.571-1.--------- �i✓--------------------------------------------•--••--•---- ------------••--•-••••--------------•-••••--•--•••----•-•.....--•.....___-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of i i
p 5 of the,State Sanitary 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.
Signed - ----- -....-•-•------ --• ..._ _
Date
Application Approved BY - -•---- �7
-- ----------
D to
Application Disapproved for the f ollowi g reasons----------------------•-•-------•-------------------------------------------------------------------------••••--
.............•••----...••••---•--------•----------------••••-.._..--•--------------..........•-----•....--------------•-•-•----------------••----••-----•----•--------------••••----•--------------•----
Date
PermitNo......................................................... Issued-.......................................................
Date
MW
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F I- E T
ti . .OF.....:.. •---.... ..................
Applirtttiou for Di""sal 10orkii ( ontitrurtiutt 1hrmit
Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal
System at:rn 1
Y � / / ,
..- .. 7 -------------- .....-•-=----_v�I--.�-' ,r ...........---------------------......---•--------.
Location-Address or Lot No.
. J ..........7-- ............. ................... ............................
wner f Address
�- ;
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms...........................................................................Expansion Attic (mot ) Garbage Grinder �.o )
Other-Type of Building .__.j/C? _............... No. of persons............................ Showers (% ) — Cafeteria
Pa t` Other fixtures ------•-` 1....................................
d ;
W Design Flow----------_---------------------------------gallons per person per day. Total daily flow......... __ _4.......................gallons.
P4 Septic Tank—Liquid capacity L!2A.gallons Length.../2........ Width._6...._...... Diameter./D----------- Depth�Z_./..._....
W Disposal Trench—1�o................:.. Width__ Total Length.._._______.____.__. Total leaching area____.___._____.._.sq. ft.
T
x
Seepage Pit No.... ............. Diameter----- . ........ Depth below inlet................... Total leaching area___,t ..__._.___sq. ft.
Z Other Distribut o—box..( , ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I.:..............minutes per inch Depth of Test Pit.................... Depth to ground water---------------.........
.
G%, Test Pit No. 2-.=,............. per inch Depth of Test Pit..................... Depth to ground water.......... .............
----------
•--•----------------------------------------------------------
Descriptionof Soil------------------------------------•--....:-•--•--..•..----.......---•--.._...-----------•=--------------------.....................................................
x
c.,
x --------------------------------------------.--..................................................................................................................,.......................................
V Nature of Repairs or Alterations—AWwer when applicable_.._. _i t........A. k--------7- .....................
; -•--------------------------------.....................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T"=�.
p J of the State Sanitary 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 t
............
Dat �
Application Approved BY C/ >-----•••.. ' -- . . .. ._ .
.. ate
Application Disapproved for the f ollowy reasons:----------•:....-•-------------------------------------•------•-----------------•------•-----------------•-----
-----•...---••••••-•---••-------------•---•--•-.....-------•-------•--•-------••-...........-•-------------•-•-•---•-•--------•---•--•-......-•--•------------•------=--•-----------------•------------
Date
PermitNo....................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA T_
(ErdifiraIr lad (fumpltatta
THIS TO CERTIFY, )(hat the Inal id al Sewage Disposal ystem constructed ( ) or Repaired)_
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at.........-I J ............... ' -s= 'It'`^`--`'�-------- 1L----------.------t"1- �Copehs
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has been installed in accordance with the provisions of i T i-l��C 5 o- The State �nitary ribed in the
application for Disposal Works Construction Permit No _- -_________ __________________ dated_...____[-._ _._ ___. _:-�__- ._-___-•-•-••-
r
THE ISSUANCE OF-THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT YHE
SYSTEM WILL FUNCTION SATISRACTORY.
DATE.................------•-•----•--- -------- Inspector...........:...... ...................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR, F HE TH
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NL......................0 F....�.'Y ...........................................................� 4
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No = FEE.....
irr I �rk� tt mot'. n_ Z.rrnt '"
Permission is hereby grante ...../...........................................................................l 1.....................................................
to Construct ) or Repair ) an Individual.Sewage Disposal S st
1'v :e_ ................
Sheet
t UW
as shown on the application for Disposal Forks Construction ermit No Dated........ _ -..... ._ .
l�' Board of •-••----• •----•-••-•----••--•...--•-
�R Health
DATE--------------EEE-....----........................................................
FORM 12,55 HOBBS & WARREN, INC., PUBLISHERS _ -