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HomeMy WebLinkAbout0144 OLD YARMOUTH ROAD - Health 144 OLD_YARMOUTH RD., HYANNIS A = _ i l i I , //TOWN OFBARNS-ABLE 'LOCATION yo . v, r4 . SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 39y- Oc�(o INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �b��l r . C!J-!6 size �S tYlx V (size). NO.OF BEDROOMS BUILDER OR OWNER ���H�/ l�/� 1i1/1�9Y! PERMIT DATE: q—�Q - 7 9 COMPLIANCE DATE: Separation Distance Between the: L Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet �l 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 leachin facili ) Feet Furnished by �� `M��i�� r - 1 0 C! Y � 4 l� No. ?q Fee THE COMMONWEALTH OF MASSACHUSETTS WEntered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mie;pogal *pgtem Con.5truction Permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address orLot No. f Er�4 0 �/,apwavll� Owner's Name,Address and Tel.No. Assessor's Map/Parcel G 1 Instal is Name,Address}and Tel No. Designer's Name,Address and Tel.No. osiwjpl; 17z,(�i�1°'/n�dJ ,Io,S��l d-e �sa«"OS 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 Repairs or Alterations(Answer when applicable) l !lD [��l 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 Board of Health. Signed Date f 2 0 Application Approved by Date © — Application Disapproved for the following reasons Permit No. Date Issued q TOWN OF BARNS ABLE LOCATION ILI _r� —SEWAGE # 'S MAP &LO 05 VILLAG ASSESSOR 3. INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACIL=: Prev �1_45115_ (size) .(type) 0610Z NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE:, 0 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 Feet within 300 feet ofl hi faci Furnished by ----------- Ih _____�_ ,_ _____..�_ _____J L Y 11 11 No. �,P'l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mioaal *pgtem Congtruction J)ermit Application for a Permit to Construct( )Repair(4>Upgrade( )Abandon( ) El Complete System Individual Components Location Address or Lot No. J L,eS( o/j%N�y�vdy'�jAU Owner's Name,Address and Tel.No. Assessor's Map/Parcel �G�//9H/l�s C'40.01jr' reed�9/7/3' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ✓osc�� Dt Q,rar�^4 5 Josrpl, (7� 6AAP'OS Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) �a Other Type of Building No. of Persons Showers( ) Cafeteria( ) "Other Fixtures Design Flow, p y y gallons. g gallons per day. daily flow Plan Date Number of sheets Revision Date { Title Size of Septic Tank Type of S.A.S. Description of Soil SSE. Nature of Repairs or Alterations(Answer when applicable) 0 fl.,11 sr— '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 11-20— rl Application Approved by Date LO - '9 Application Disapproved for the:following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS , Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( upgraded ( ) Abandoned( )by_��� �� .9- oa 0ye a S at u has been constructed in accordance with the provisions of Title 5 and the f000rr Disposal System Construction Kermit No. w dated Installer ✓ �� Aeje s Designer f The issuance oft hisl)ermit shall not bte construed as a guarantee that the }�s�t , will function as des gnedr Date 1 1 ! Ins ector }'�1.� /�-- f. Cam' w No. _ ----------------``s. ` Fee THE COMMONWEALTH OF MASSACHUSETTS 3 Yq-6 PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS _Migogar &pgtem Congtructcon Vermit Permission is hereby granted to Construct( )Repair( 4)-Upgrade( )Abandon( ) System located at 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 it. (^ Q Date: lZ�/J 9 Approved by C"� g ,�1 ��• e �' air z tl6/99 "\ 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 1, ,,os��� /'� /4�`►rr�s , hereby certify that the application fc:,r disposal works construction permit signed by me dated z1 — -- Qq , concerning the property located at_/yy /cl /Z meets all of the foilowin eriteria: ZThe failed system is connected to a residential dwelling only. There are no corr:atercial or business 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 Lhe proposed septic.system ere is no increase in flow and/or change in use proposed l There are no variances requested or needed. • The bottom of the proposed Ieaching facility will n9t be located less than five fett above the nixamum 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 bortem of the proposed leaching facility will nQt.be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: 2 A) Top of Ground Surfa Elevation(using GIS information) B) G.W. Elevation +the MAX.High G.W. Adjustment DIFFERENCE BETWEEN A and 13 fit_J J r SIGNED : .c DATE: [Sketch proposed plan of system on back]. q:health folder.cut s e 12 l o •