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Home My WebLink About0224 LINCOLN ROAD - Health 224 LINCON ROAD HYANNIS 4 { A - 270 045 i 4 i TOWN OFy�BARN_STABLE LOCATION n� `f jam` % SEWAGE # " VILLAGE L,Ge%!ZiI S fASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO: C�6 / SEPTIC TANK CAPACITY ��./ LEACHING FACILITY: (type) h g d-a (size) t 4T 'NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: M t 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) J e W A-( Feet Edge of Wetland and Leaching Facility(If any wetlands exist '. l within.100 feet of leaching fac' Feet Furnished by - I � �- �� t - � �� 0 �� ' � g � �� . `� .�� ! S � �;a: i, �° t,�v J�, ��l _� �. -,� No. Fee �✓ //� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS -' - - 21ppYication for Migw6al *pztem Con.5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5.-5 if T j iu Owner's Name,Address and Tel.No. Assessor's Map/Parcel � 0 � � ��J qj'No J es S l C,Cc �� Installer's Name,Address,and 1.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size > �A q. ft. Garbage Grinder( )eV,4 Other Type of Building No.of Persons Showers( ► ) Cafeteria( ) Other Fixtures Design Flow p t�_o gallons per day. Calculated daily flow d U gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 'no0 G 4- Type of S.A.S. >�� s ✓�� c4 ' Description of Soil 1'11 G Cam, v Al g- Nature of Repairs or Alterations(Answer when applicable) 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 af Title 5 of the Wmironmental Code and not to place the system in operation until a Certifi- cate of Compliance has bejie�gb 'A s of eSigne C Date Application Approved by ate Application Disapproved o owing reasons Permit No. i Date Issued TOWN OF BARNSTABLE LOCATION C. l,V kl SEWAGE # �6 VILLAGE � : f� � 'U%S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� f�`/�r r -' 'a (size) C;0 47c NO. OF BEDROOMS y BUILDER OR OWNER J EL PERMITDATE: 6LG SP 006 COMPLIANCE DATE: Separation Distance Between the: jMaximum Adjusted Groundwater Table to the Bottom of Leaching Facility I Feet Private Water Supply Well and Leaching Facility (If any wells exist F�` on site or within 200 feet of leaching facility) 1 d- �W> Feet j Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching fac'.� Feet E Furnished by �-° No. �/✓ �0 _ _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC.HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS c 01ppricatiou for Migo!5ar 6potem Cougtruction Permit �• TApphcation for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. o`�,.off y /^v rVAN 0fd Owner's Name,Address and Tel No. p Assessor's Map/Parcel 70 / Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3vhto 10 P ley Type of Building: Dwelling No.of-Bedroom's Lot Size ��h s q.ft. Garbage Grinder( )/VGA Other Type of Building No.of Persons cZ -Showers( Cafeteria( ) Other Fixtures Design Flow a gallons per day. Calculated daily flow �° O gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank DSO o / Type of S.A/.S. 3 C ass,bPr r Description,of Soil Nature of Repairs or Alterations(Answer wheniapplicable), > Date last inspected: .A i. Agreement: ' � I The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio Tit 5 of the n ' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee ' ue b t ' ar o 1h . p Signed 'Date D Application Approved by O ate Application Disapproved for a following reasons � 3 Permit No. Date Issued y ,' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO FY,jt a thy/Qn-s't Sew D• §al SystemConstructed( )Repaired s!� )Upgraded( ) Abandone y) 0 f/Lf/ 1 III-) at ha constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer Designer _ 'A 1Y11 The issuance of tl�s:s e s tZet b onstrued as a guarantee that th s,ste kwilf�unctionQadev e Date &T g� Inspector, ® __ __ -----— qO 30—�—� --------Fee&O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS li!6pogar p$t (Con5tructiou Permit Permission is hereby!jtg t. ons ct ,.,)�I,te )U ( ) ba don( System located and as described in the above Application for Disposal System Construction Permit.The applicant re ognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons o ust be completed within three years of the date is permit. j (;j C, p� Date: �(/ Approved by ✓ I 04 r 1/6/99 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) I, Jo�M QOt F J , hereby certify that the application for disposal works construction permit signed by me dated d , concerning the property located at 2 Y /IU CIO as meets all of the following criteria: This 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. • 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 • There is no increase in flow and/or change in use proposed • There 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) • If 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: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation ,W +the MAX.High G.W.Adjustment. _ DIFFERENCE BETWE A nd B 1(19 SIGNED Q: .'� DATE: ® [Please Sket propo d p an o system on lac k1. 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 Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: �%Okc0n102 C"A LaIndsc��,-� BUSINESS LOCATION: MAILING ADDRESS: 070-zL1 L3AC.0(V_\ Rd llya,ln,�S MA 042,6 o 1 Mail To: TELEPHONE NUMBER: (Gps� Board of Health Town of Barnstable -CONTACT PERSON: P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: L4od9 ZCa4"e_4ak6-� Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO - This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(forgasoline orcoolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS c mrTl n rn � rl �' �O �,- (: m I Z 0 ! -1 r i m �Oml � c , � I Rrn �► I o I m l rn I- m l I I I ( l I P 6 `� r �' �-- , ' I✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAVOZ4 ..I . _. . ... . ... .. .. .OF....... ..0 � - ►v► 14 ApplirFatiura -fur Uiupuual Works Towitraurtivaa Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( an ndividual Sewage Disposal System at n ..-.- - -- --------- ....`.......................................................... Loca ion_Address or Lot No. , .G�-- '.�.. ............................... ................................................................................................. Owner .............................•-•----•--.....Address Install Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ________________-_--______ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------................. 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---- -------------•----•---•-----•-•---- ,a Test Pit No. 1................minutes per inch Depth of 'Pest Pit..------------------ Depth to ground water.-.__-.____--_-._.--.._. fi, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 04 --•-•------------------------------'----•---•---'•---._.-•--'-••------•----•---•............--•-••••......................................................... ODescription of Soil..................................................................................................................................................... ------------------ x U W ---------------------------------------------- -------------------------------------------- - f -------------------------- ------ U Nature f P.epairs or Alt ations— newer w en applicable..... ._�l^_.. ._ . . _ /_ '-- D_e?.D.... ... .. . ... .. -- -------------- - Agr ment: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n i sued by e board f heXh Si M '�?`t-i d=-- (-' .:'1.._... Date Application Approved By.-=• -- -------------------- -(J �� _--7`J� Application Disapproved for th following reasons--------------------------------------•-'•--------------•------..___.__._..._................Date--._..___..... ---------------------------------------- ------------------------------------ ---- PermitNo......................................................... Issued-----Le1V--------------------....................... Date No....... 3................. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration -for DiBpotial Norks Tonstrurtion Ppriffit Application is hereby*made for a Permit to Construct or Repair (/-)—an7ndividual Sewage Disposal System at: .......................................................... 11 Lee Address ddress or Lot No. i on-� -?,_.. ............................... .................................................................................................. Owner Address ..................... Owner .................................................................................................. Insta Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder a Other—Type of Building .___....................... No. of persons............................ Showers Cafeteria-1� Other fixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length________________ Width.._......_.._.. Diameter.._.__.._..._.._ Depth._.:--_-_.-.... Disposal Trench—No. .................... Width_____-_-_-___------_ Total Length._.........__.._.... Total leaching area--------------------sq. f t. Seepage Pit No_____________________ Diameter___-___-__-_____---_ Depth below inlet__.._.___.__._____._ Total leaching area------------------sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---- ..................................................................... Date--------------------------------------- Test Pit No. I----------------minutesperinch Depth of Test Pit._......__.___...._. Depth to -round water-..-----I--------------- rX4 Test Pit No. 2.......I.........minutes per inch Depth of Test Pit.--_-_-_____________ Depth to ground water.-..-._--_-------.--.__. ................... ......................................................................................................................................... 0 Description of Soil------------------------------------------------------------------------------------__-------------------------------------------------------- ----------------- x U ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W -----------------------------------------------I------------------------------------------------------ ---------------------- U Nature f Repairs or Alterati7o-ns—Answer when applicable------ -_ ,-- I- --- - ... ----.-.-./-.-.-.-.-.-.-..-.-. -------------------------------- - ----- t: - A mel The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees-not to place the system in operation until a Certificate of Compliance has b9ol-1)sued by tke board of health... S,93F.d ... .. ..... ........?---s Date 0 7J— Application Approved By____,:-.......WIJ. . Date Application Disapproved for the following reasons__________________________________"/ .................................................................... ................................................. ............................................I------------------------------------------ ------------- ---------------------------------------- li .— ( 6 1.%— — e . PermitNo........................................................ Issued..... ----------_ ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 07 HEALT OF........A. .. ... ..... .............. ��A L�T .. ... ....4 %:.Irrtif irate of Tomphaurr THI IS 4TCERrY, That the Indiv 4 ual Sewage Disposal System constructed or Repaired by ....... .. .... ins ---- ---- -------- -------------------------------- --- -------- ------ --- ---- ...... ------ ........... ------ ...... ------- - 4..... -------------- ---------- • has been installed in accordance with the provisions of Apet-F-TI of The State Sanitary CodAas described in the application for Disposal Works Construction Permit No----( ----------- dated'_ __ _74.7-7 3' N"W01--- - Id ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT, BE CON RUE S GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------ -------------- ----- ..&........................... Inspector.... ................................... .......................................F17 77 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT15jZ A, 0, ........ .......�- OF..........je..4::::&.�.. .................. ............ FEE.....2��........... NS*a, ..; ......5 ... .... Binpv.sal or 010 rurtion rrm.-----------------------""-•--------------_------ tot - ------ I_t .. -----------Permission is hereby grarited_�_� Constru;f ( L � Repair ( 4-ran Individual Sew Disposal ystemf ...........2--- ?I" 1(..... ......... at No.._jX__6(------�01� S trect ---------- I.... ............ ......................... as shown on the application for Disposal Works Construction Pit No._,w� 7j- ed.... ..................................... ---41e ---- ----- -In----- - -- - ------- DATE..../�......57— 7T_ Board'of '-eailth ..................................................... ----------— FORM 1255 H0813S & WARREN. INC.. PUBLISHERS