The URL can be used to link to this page

Home My WebLink About0204 SCUDDER AVENUE - Health 204�SCUDDERI AVE. :;. HYANNIS'S t r i I y " TOWN OF BARNSTABLE LoZzATION Z0 I��a) /4"c U27 OL4.1; > SEWAGE # VILLAGE ASSESSOR'S MAP & LOT' INSTALLER'S NAME&PHONE NO.��/»� SEPTIC TANK CAPACITY -XZ LEACHING FACU-ITY: (type) ew4el/ZMMS (size) NO. OF BEDROOMS BUILDER OR OWNER ��C, •PERMITDATE: l 3U O A COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 y y q��`'l3 3 v+Y TOWN OF BARNSTABLE ,f LOCATION -401 3cOgle e� AV R-, SEWAGE # VILLAGEBA iQN, }gAWPJiS, ASSESSOR'S MAP & LOT INSTALLER'S NAME & 'PHONE NO. SEPTIC TANK CAPACITY 1500 qAk LEACHING FACILITY:(type) (size} 6�sn NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERJA-±f7ee BUILDER OR OWNER 7 1TEVC)U M, kL IJA ty DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: i VARIANCE GRANTED: Yes No r -$ w r� ? L ' o o v LIN o � Si a O a 1V �l I _ . No. 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,L MASSACHUSETTS Zipplication for Migool bp!5tem Con.5truction Permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot No.,2_0 5cu - a( r/five, Owner's Name,Address and Tel.No. Assessor'sMap/Parcel e�;qt_00 lnstaller'pVarne,Address,and Tel No. Designer's Name,Address and Tel.No. ,e,- F- r %5 t✓i 5 St c c�tS 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 3_7�-n gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank CKribc- ta?" STI Type of S.A.S. % G`1`— K� C7 Description of Soil . Nature of Reill I- pairs or Alterations(Answer when applicable) �I 1\[5 04 l�v ao k- i 0Cy-0 It 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 Env' ental Code and not to place the system in operation until a Certifi- cate of Compliance has o of Signed - Date '� Application Approved by c Date /11,36 O Application Disapproved for the following reasons Permit No. 0Z�� b Date Issued [ 0 r��-y�, �` l.l. ,I SJ {RSS Fee ✓ _... No: THE COMMONWEALTH OF MASSACHUSETTS;. Entered in computer: ,. Yes PUBLIC HEALTH DIVI�I'ON - TOWN OF BARNSTABLES MASSACHUSETTS ZIpplication for Misspogar *pMem Congtruction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete«S,gstem individual Components Location Address or Lot No. ?-045Gv004 r f}c,, Owner's Name,Address and Tel.No. Assessor's Map/Parcel 1�7�- o Installer ame Address,and Tel. o. 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 ~S ,� gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank 4420, Jcr SZ iT(c. j(77A7 ST, ,4jC 1 Type of S.A.S. 1 c ( `I L V Description of Soil im. sp, <<l�(Natur of Repairs or Alterations(Answer when applicable) 1 lal 5V icA A--G(C- Y A u_j2_ -Fw,_y2_.- r f c4 c' 4 r ( t/C t 0 C 1 �~� ( �vt. S J° �G- 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 b.,gge issued-4y-this.Board of Hea Signed --- --Date.. Application Approved by Date/ I 36 0 Application Disapproved for the following reasons Permit No. �� b Date Issued ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ', l Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewa a Disposal System Constructed( )Repaired( 1/�Upgraded( � Abandoned( )by o� _ s1"Ac,- —at t �O �. . , �✓ A _ tw. x k :µdi e has been constructed in accordance with the provisions of Title 5 and the:for Disposal,SystemtConstruction Permit No �?ab j--6_,& dated 1 1=;O )O 1 Installer Designer '} ` The issuance of this permit s all not be construed as a guarantee that the-syste will f tYtao w'as designe Date ... - t;i<Z »? 1.X,: < wk. 'lnspector ————— ——————.——————--------------------- No. '�00 1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Xigpogal *p.5tem Congtruction Permit Permission is hereby granted to Construct( Repair(t✓)Upgrade( )Abandon( ) System located at 0L, lzLt on i 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:Constructions must be completed within three years of the date of this permit. Date: 3i o/ 0) Approved by TOWN OF BARNSTABLE LOCATION Z0 SEWAGE # 7-e-VI-05S VILLAGE //yam„ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /.I/Jc' i SEPTIC'TANK CAPACITY LEACHING FACILITY:_(type) _j .yi /?/ TUC S (size) NO. OF BEDROOMS 3 i BUILDER.OR OWNER :W L4 . �j PERMITDATE: U U.1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table.and Bottom of Leaching Facility. Feet Private Water Supply Well and Leaching Facility (If any.,welis 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 S G V f E!s,if r. 4. 47 — r ' 1 ,[7,?c,< q,��"13 � ,3 �, 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) i4-�_s , herebythat the applicationcertify for disposal works construction permit signed by me dated , concerning the property located at C-,DJ2-,--. O ( 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. L/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. 6' There are no wetlands within 100 feet of the proposed septic system 0 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 s/ There are no variances requested or needed. ZThe 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 ,. �5plicable] (% 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) 6 B) G.W. Elevation w +the MAX. High G.W. Adjustment . \ to = 1p 1 DIFFERENCE BETWEEN A and B ( o 0 7 SIGNED : r DATE: [Please Sketch prop sed �nof m ste on bacl.]. 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 �I �� o � �: r