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HomeMy WebLinkAbout0008 NEWTON AVENUE - Health 8 NEWTON AVE. , HYANNIS BSI X2? _ TOWN OF BARNSTABLE LOCATION ^` �O -34V6 SEWAGE # W n . � 17- ,LAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK:CAPACITY LEACHING FACILITY: (type) -Ary �L size) NO.OF BEDROOMS , 7 ©`� BUILDER OR OWNER PERMITDATE: 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 oc6A T 0 n jC n No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migozal *potem Congtruction Permit Applicatio r a ermit o C s ( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Lgcation Address or Lot 4o Owner's Name,Address and Tel.No. AJIVI Asso W/� r's Map arcel 1 A 7 /)Wrr I er' � Ad ss,and Tel.No.�, Designer's Name,Address and Tel.No. COp r0C4t oaf 1 NG �• ,e 17 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 �J�o gallons per day. Calculated daily flow i>S gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 2 bQ D Type of S.A.-S. 61 Description of Soil Nature of Repairs or Alterations(Answer when applicable) L��s Date last inspected: I � o _e Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provi02reN nmental Code an not to place the system in operation until a Ce fi- cate of Compliance has be lth. Signe f Date Application Approved by Date Application Disapproved f Permit No. Date Issued . No. !ieg THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppIication for ri.5pogar *pgtem Construction Permit Applicatio r a emut s ( Repair( )Upgrade( )Abandon( .) ElComplete System El Individual Components L�,gqcation Addi s or Lot No Owner's Name,Address and Tel.No. A Asse�sor'sMap/ azcel �� y / f r Ad ress,an Tel.No.,.--- Designer's Name,Address and Tel.IVo. 7�r?[ro, p'trvc ,oti, Type of Buildings Dwelling No.of Bedrooms � Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _ Design Flow S�U gallons per day. Calculated daily flow _� o gallons. Plan Date Number of sheets Revision Date Title ;. Size of Septic Tank 2000 Type of S.A.S. Description of Soil �s y p n ;Nature of Repairs or Alterations(Answer when applicable) F ,U iL1C W SI Z660 <VN ,f Date last inspected: Agreement: , 'k The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio the o the Envir nmental!'Code an not to place the system in operation until a Ce 'fi- -sate of Compliance has be issued�thiso f H alth 1 Signe 9 0 ' /9 �' o l S, Date 4 Application Approved bit 49 / Date Application Disapproved f r the following reasons, a Permit No, Date Issued ' ----------------------- ----- --------- - i THE COMMONWEALTH OF MASSACHUSETTS i % BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE t a Qn-site�wage posal System Constructed( )Repaired(�)Upgraded( ) Abandoned( )by (61 Al S ✓ c/G r w �w L at #� W °A' R V A)r o r has bepm&constructed in accordance with the prw� 'o 6 f Title 5 d the for��sposal Sy gm Construction Permit No. Rated Installer /� (OAu ✓w - , -- .�s;L Designer A� . The issuance of this e ,'t sh ll not be construed as a guarantee that the sys 11 fine io as,, si ��. ; Date Inspector No. � 9 ---�r���----------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migoar *pgtem Cons�truction Permit Permission is hereby granted to Co trust( ) epair Upgrades( )Abandon(//�� System located at Ale /� fJ u N/5 V"G r 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 cti n must be completed within three years of the date of this 't l,* Date: ? �D Approved by .�7 lc,,, 1/6/99 i 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) r I, SV WfirA-10C -S , hereby certify that the application for disposal works construction permit signed b me dated 4o -�/ ' DO , concerning the property located at 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 +the MAX.High G.W.Adjustment. _ DIFFE TWE A and B SIG D : DATE: b — 7^ 00 [Please Sketch pr pose an of system o back]. 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 Q TOWN OF BARNSTABLE LOCATION a -dye SEWAGE # �D©-39 VILLAGE ASSESSOR'S�IAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) r_ f -., ('size) ` ' NO. OF BEDROOMS BUILDER OR OWNER i PERMITDATE: 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 100 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 01 . ; Lott N. 9 j` I TOWN OF BARNSTABLE r LOCATI Al£l.,/ SEWAGE # VILLAGE % toc/f% ASSESSOR'S MAP & LOTAXI_/te q ;INSTALLER'S NAME & PHONE NO. A &` B CANCO 775-6264 SEPTIC TANK CAPACITY C r LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 'VARIANCE GRANTED: Yes No M o4 c No. ,W/ Fee ' THE COMMONWEA OF ASSACHUSE S Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migpogar 6pgtem Cougtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor s Map/Farcel �- Installer's Name,Address,and Tel.No. Designer's Name,Addres 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 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 Nature of Rep ' ltera ns(Answer wn ap li ab e)h f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system g �' g P Y in accordance with the provisions of Title 5 of-tq Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by is d of Signed Date Application Approved by Date Application Disapproved f the f owing reasons Permit No. Date Issued No. Fee THE COMMONWEA H OF I ASSACHUSE S Entered in computer: ' Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for M.5po5al 6potem Congtruction Permit ' Aptph o for a Pemt'�to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Atddrej� or Lot No. p Owner's Name,Address and Tel.No. Assessor'sM e 1 Installers lame,Addresss'�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 Design-Flow gallons per day. Calculated daily flow gallons. -:---Plan Date Number of sheets Revision Date Title y '—Size of Septic Tank Type of S.A.S. Description of Soil ,,,.mow^".,"✓' _.< Nature of Repai is�Alterat'ons(Answer wl�eIt ap licabl ) I- 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 Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by t .s B d of Signed Date Application Approved by Date 6 Application Disapproved fo the f owing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CER -!-' at t e On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by d r` — /) .r- at r ) o i , —+ , I11h onstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer I Designer 'i rA 1!! n, i %J f r The issuance of thispernu sha�1 of e c ns trued as a guarantee that the cyst ill un�ti/o�n,as esigried. . / r'�1� Date t' Inspector t f.� ! % r� " l. .; t �tf/to No THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi.5po.5al *p! tem Qfon5tructton Permit Permission is hereby grante o Co s ct( e •r��ade( AMAk System located at and as described in the above Application for Disposal System Construction Permit.The applicant recogni es his er duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons ion ust ebecompleted within three years of the date of e i Date: Approved byZ/�-� TOWN OF BARNSTABLE q q, LOCATION AIEZ✓ SEWAGE # j VILLAGE % ✓o!e% ASSESSOR'S MAP 6z LOT INSTALLER'S NAME 61 PHONE NO. A & B CMM 775-6264 SEPTIC TANK CAPACITY ?/�/ ' //L' C/9/) A f' LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 61 \ I� : I1 L f 1 �\ I ; s � I . r