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Home My WebLink About0048 PRAM ROAD - Health 1 ,48.-PRAM RD.. ,HYANNIS A ='268 048 TOWN OF BARNSTABLE _ LOCATION &Q,r? �. SEWAGE # 0000 9 VILLAGE_I AA1411 ASSESSOR'S MAP &Lyrs- i--w INSTALLER'S NAME&PHONE NO._ An,/.0 C-442 SEPTIC TANK CAPACITY /S e 0 4 LEACHING FACILITY: (ty ) /rV7"'I %files' (size) ' 11X NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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.. � �� `' �'"I� c ,� f,, o . �, T v... \ ' � �. .�Y _ f'I No. t�m Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for 3Di5poga1 *pg;tem Construction Permit Application for a Permit to Construct( )Repair( ).Upgrade( )Abandon( ) `Complete System ❑Individual Components Location Address or Lot No. P�(Gv w� -Owner's Name,(Address and Tel.No. Assessor's Map/Parcel 4-0_` f Installer's Name,Address,and Tel.No. V"1 Designer's Name,Address and Tel.No. fAt 0—CAV24? 5 e � \S `OLA5 &tc 014 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 "AA0 gallons per day. Calculated daily flow `18_� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. tom. 5;1 ,OTC-i Description of Soil 46e cJ� Nature of Re airs or Alterations(Answer when applicable) rA-STt �, �� a L-7 ivk 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 Envir mental Code and not to place the system in operation until a Certifi- cate of Compliance h issue y 1 Signed Date Application Approved by Date 2,2-D 6 Application Disapproved for a fol wing reasons Permit No. a Oct, -- 19 0 Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE # 000- VILLAGE ASSESSOR'S MAP & L INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: {ty (size) NO. OF BEDROOMS ---` BUILDER OR OWNER PERMI TDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and LeachingFacility Feet ty (If any wells exist on 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) Furnished.by Feet _. ... .. _ ........... ` Q 7r ►bL�'4 � , .57i�-' > ° . No. ! r„ d o.� Fee rf THE COMMONWEALTH OF MASSACHUSETTS Entered in comlputer:, es _ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0[ppYication for 3Digpo2;a1 *pgtem (Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 11 7 Complete System ❑Individual Components Location Address or Lot No. h ,/)� ,`y Owner's Name,Address and Tel.No. Assessor's Map/Parcel V D S'$. Installer's Name,Address,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 i lam{ gallons per day. Calculated daily flow t n:` ! gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. e eV Description of Soil - r Nature of Repairs or Alterations(Answer v,�ien applicable) .nT S .. y L7 K d Date last inspected: Agreement: I The undersigned agrees toerisure 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,3s ed-b Board o f th. - -- Signed Date� 7 Application Approved by Date Application Disapproved for fo ing reasonnsM 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(v-)•" Abandoned( )by - at has been constructed in accordance with the provisions of Tie an the or Dts osal ys em o s�ruct on Pert No. 0 ge dated Installer Designer _I � t The issuance of this permit shall dot be ct nstrued as a guarantee that the sy tem ill function as d s ned� � �� Date 1 �° ? Inspector / I�1 tt// /' . rfi ,--------------------------------------- No. Fees v a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Iigpogal *pgtem (Cowaruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(,_�andon( ) System located at d t ` & and asUd scribed in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to t comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed wittfl-I three years of the date of this permit. t` Date: I' Approved by 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) hereby certify that the application for disposal works construction permit signed by me dated �-�� C1?� , concerning the property located at `•-I Re, �� u 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 ZThere 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 licable] v If the S.A.S.will be located with 250 feet of an vegetated wetlands the bottom of the proposed Y I P P 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) `� 1 B) G.W.Elevation +the MAX.High G.W.Adjustment. DIFFERENCE BETWEEN A and B SIGNED : DATE: [Please Sketch osed plan o m on 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 L �±�- � CO O t�