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Home My WebLink About0280 LINCOLN ROAD - Health aFo ,2,W LINCOLN RD. ,HYANNIS A =271 074 yi e ' i L� TOW/N OF BARNSTABLE l�o LOCATION) V p�'tt/��-s l`�- � SEWAGE # ' VILLAGE Zia / ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY,/61�>-' Q ' 1 "' 1 — �- �°�-b�`�� LEACHING FACILITY: (type)�b^ (size) NO. OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: Ll a. gp*--p COMPLIANCE DATE: -6,L4--- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If an ells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any w ands exist within 300 feet of leaching facility) Feet Furnished by b \�'�a�' �� G c -- . -- �R� 9 J S �: i ' 1 �f ti I No. ,� � � 1 ?, --..r .'`..• Fee �� 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZfppYtcatton for Mtzpaal *pgtem Comaructtou Vermtt Application for a Permit to Construct( )Repair(K )Upgrade( )Abandon( ) O Complete System El Individual Components �® l,p tton�ddressor)fnMZd Hyannis L1a.V1Cl. eArtg jr Tel.No. G UU lncolln Y .. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville 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 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. fr Nature of Repairs or Alterations(Answer when applicable) new Title-5 leach system, consisting of A D-box and. 2 concrete leach chambers with stone all around. 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 thi and Health. Signe l310 Date Application Approved by ® Date IF L-11 Application Disapproved for the following reaso Permit No. `= Date Issued TOWN OF BARNSTAB LE �. LOCATION aJ F O I—I A C.o l`l.%, SEWAGE # 00 VILLAGE /7 ASSESSOR'S MAP & LOT' INSTALLER'S NAME,&PHONE NO. b ti s S�d S 7 I9 SEPTIC TANK CAPACITY Z� of LEACHING FACILITY: �—g 'o� — S (type) L (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: ��— -8 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 an Vells.exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any w ands exist within 300 feet of leaching facility) Feet Furnished by 1 En _ �,t No. _ ...,.- .. Fee in computer: e � THE COMMONWEALTH OF MASSACHUSETTS Entered 1, z PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatton for ;Digpoga1 *pgtem Comaruction Verna Application for a Permit to Construct( )Repair OC )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components on ddress or of N ner's.N m ddr ss d Tel.No. g �� inc o in W d.. , Hyannis �`av n hArn Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms, 3 Lot Size sq. ft. Garbage Grinder( ) 1 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) new Title-5 leach system, consisting of A D-box and. 2 concrete leach chambers with stone all around.. Date last inspected: W 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 th' and Health. Signed. l i 0 Date Application Approved by ® Date a Application Disapproved for the following reaso j Permit No. "°"' Date Issued --------- ------------------------- a THE COMMONWEALTH OF MASSACHUSETTS Arthur BARNSTABLE, MASSACHUSETTS Certificate of Compitance THIS IS TO CERTIFY/thathe On-site Sewage Disposal System Constructed( )Repaired ( X )Upgraded( ) Abandoned( )by Wm. Z. Robinson Septic Service at 290 Lincoln R d . , Hyannis is ha b nstructed in accordance with the provisions of Title land the for Disposal System Construction Permit No. ated Installer Wm. E. Robinson S r. Designer 1 The issuance of this permit shall not a cod ued as a guarantee that the systemV��l 1functio/n as�d /signe �� {vlA Date l �'l Inspector ��A4� rf. .�. --5—W — ------------------ —_$_ o No. t / Fee 5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTDIVISION - BARNSTABLE., MASSACHUSETTS Arthur Xat dia p!6tWn on!9trurtton Vermtt Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 290 Lincoln Rd.. , Hyann i s 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: Constru io must/be completed within three years of the date of t s�e Date: Approved b / PP Y 116/99 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) T, W ill iarn E . Robinson,Srltereby certify that the application for disposal works construction permit signed by me dated fl , concerning the property located at 290 T i n c o 1 n I3 ,_Hya igig j meets all of the following criteria: • The 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 and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 00 feet of the proposed septic system There art: no private wells thin 150 feet of the proposed septic system There is no increase in ow and/or change in use proposed • There are no varian requested or needed. • The bottom of proposed leaching facility will not be located less than five feet above the maximum adj ed groundwater table elevation: (Adjust the groundwater table using the Frimptor method whe applicable] If the S. S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leachi facility will not be located less than fourteen(14) feet above the maximum adjusted group water table elevation, Please complete the following. A) Top of Ground Surface Elevation(using G1S information) B) G.W. Elevation +the MAX. High G.W. Adjustment DIFFERENCE BETWEEN A and B _ SIG NED NED DATE: _ 3_Q [Sketch proposed plan of system on back]. q:health folder.cm