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Home My WebLink About0065 SUOMI ROAD - Health 65 SUVIOI RD. HYANNIS A -269 112' a ° i ;� a TOWN OF BARNSTABLE LOCATION IU44l' SEWAGE # V3.LAGE ,r9AvVj� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Y17- 034'q , ost�Li ��4s^s^oS SEPTIC TANK CAPACITY /SOO LEACHING FACILITY: (type) 2-e.5706t Poew GUT (size) 2 S X 9.3 NO. OF BEDROOMS 3 BUILDER OR OWNER fin �o�i9 PERMITDATE: G = 141- -?� COMPLIANCE DATE: G — i15 49 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 `e Edge of Wetlind and Leaching Facility(If any wetlands exist within 300 feet of leaching�facility) Feet Furnished by I r 9� i . t h rI No. — I Fee �d THE COMMONWEALTH O'F MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for Zt2;poga1 *pgtem Cow6tructiott permit Application for a Permit to Construct(t-)'IIepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (eS SUm o / 12el Owner's Name,Address and Tel.No. Assessor's Map/Parcel G p //2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 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 S Nature of Repairs or Alterations(Answer when applicable) Txi 5rol/ /fd0 GAl ,-SZ' f—S'Oo 6,y Hfe .z:11s Tl 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 � - Application Approved by e - Date !S 199 Application Disapproved for the following reasons ' —3 Permit No. �Y Date Issued 6 I*}Fij' Jv No. / � �� Fee '" - THE COMMONWEj►L`TW CF MASSACHUSETTS Entered in computer: Yes " PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUS TT Application for Migpoml *pgtem Congtructton Pert Application fora Permit to Construct(6�epairr )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. (%S Sum o/ K Owner's Name,Address and Tel.No. Ky��%s Sri 2/o"ix k i Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms' 3 i 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 glldrts Plan Date Number of sheets Revision Date `f `-- Title Size of Septic Tank Type of S.A.S. Descrip fim-of Soil ' r , Nature of Repairs or Alterations(Answer when applicable) Zti 5ryll /fo0 (//,0/ 461,d y',S/O al .2 J�Fs� Crary 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 t 's Board of Health. 3 Signed Date Application Approved by _ Date .19 9' Application Disapproved for the following reasons a Permit No. ` 3 EY Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of CompliaAre THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( repaired( )Upgraded( ) Abandoned( )by at s i ,° has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.;9? 33 dated Installer ✓o ,_ ros Designer J03wp! )g,"'a 's �J The issuance of this pe t s all not, e c nos f ued as a guarantee that the sy 14. w'llll.function' s de 'gned� / Date ' rn �I Inspector x I/�� -- 9(�— — No. / / ------------- ------------Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Itoozai *pgtem Congtruction Permit- Permission is hereby granted to Construct((repair( )Upgrade( )Abandon System located at 65' Sjt"o i /ZcI Nu.or►rr.,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:Construction must be`completed within three years of the date of thi it. Date: l el 9� Approved b J 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 PERIMIIT (WITHOUT DESIGNED PLANS) i I, t1 S cal ae &PA 0 5 hereby certify that the application for disposal works construction permit signed by me dated 4- /4- concerrung the property located at �S ,Siis��, , 122' 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. 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 rystem &--Rmre is no increase in flow and/or change in use proposed 6. ---rfiere are no variances requested or needed. C'" The bottom of the proposed leaching facility will not be located less than five feet above the ma�dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] 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 rnxximum 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 .t—z__ �d 7 D11TERENCE.BETWEEN A and B �d SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder.cat I _O 3 N � 15 VQ n� i PER 7 ✓" LOCATIO SEWAGE N0. /0 . 0/ 9 VI"LLAGE ;v INST L R'S N E i ADDRESS B U IL DER OR 0 N ER DATE PERMIT ISSUED �� _ 7dr— DATE COMPLIANCE ISSUED 6� �. i � .. , I I �,:. . I � �';'�. I :� a-... Y' i NoE FxR ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .7-r3 ........OF..... ........................................................... Appliration for Disposal Murks Tonstrnrtiun Vamit Y Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: I i je / ......... - --..... ... ._ ................ .................. .....•--•---_____-__-----•-••--•--•-------- ---•---------__----_--_--------------____ Locatioq-Address / or Lot No. .......... .............. ....................... .......... --............----••----•-----•--.......---•----... Ow r Address a , _._cff ......... ,_.. lt ..-----•---•--...--•-•-----•- --•----••--•-•.............: Installer Address Type of Building Size Lot............................Sq. feet - _, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures d -------------•----••-------•---•-------....------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity._.._._____.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank'( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit...................... Depth to ground water........................ a ------------------------------------••--••-•---------------•---..__._................._••-•--_--•-•-......................................................... 0 Description of Soil.................................................................................................................... ............................................ --------------------------•---------------------------------------------------...------•---------------------------------------------------------------------••-----------------------------------_..._. U Nature of Repairs or Alterations.;,—Answer when applicable______________________ __________ ____._.. __.. - ------- -------- _.. _.....__._.d/ 09 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL , 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health.. Sign ........- ! ......"�—._ �s '"' Date Application Approved By•-----v- � ��+,. �rG' ____-____--••----••- f�-/ �7 '... Date Application Disapproved for the following reasons:............................................................................................................. ---------------------------------•-•-•--.....--------------...--••-•----•--•-•------•--•-•-•------------------•-----------------•-------------- ---------------•---------------------------------------- Date Permit No. Issued / •--_/-G^ --•-•-- Date No.......... Ale Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ ,. .........---------•-•--.......------........................ Appliration for Disposal Works Tonstrnr#inn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat .. _ --•--------•••••--•..................... Lo Address .or Lot No. .......... .......... --�.�.o � .... -------------•-----••••..........-•--.._...._..... Owr _...•-•-••..............................•---Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g -•------••---•-•--•--------• P ( ) — Cafeteria ( ) Otherfixtures -----------------•---------------•-•-•----------------.--••••••••••••---••-•-•----•-------•-•••-.........-----•--•-- -•-••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter------.......... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet......._............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................... a ..--•-------------------------------•-•-------------•-•-------------•--•-----------...•--•-•--------...._..........----•-------__..........---•.._...-••--••. ODescription of Soil........................................................................................................................................................................ V W ---•-------------------------------------------•----------------------------------------------------------------------------------------------------------- -------------------------•--•-•••-.-- U Nature of Repairs or Alterations,-Answer when ap li e--.•------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT LE 5 of the State Sanitary Code—The undersigned further agrees not place the system in operation until a Certificate of Compliance has been issued by the board ooff�jiealth. y Sign t . `? /p'�-/ Application Approved By..... rf� �'61� --- ......................... ��t' i7 7. Date Application Disapproved for the following reasons:.............................................................................................................. ......................................•--••-••••---•••••--•...••-•••-•---------•••-••••••-•-•-••--••••--.-•••-••---••-•-••-•••••-••••-••••-•-•••--•-------••••-••••••-•-••-----••......•--•--••...__.._. Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA T Li ...OF...... ................ ........... .................................. 01rrtif irate of Toutplittnrle T IISJO CERT Y, t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.._. c1 . ..a n...-. . .. •.:...........................•.-•-.•._ ..__ �� ,,_ ` + ! ,In•staller at .......-Y'�a te~...............J7t �..p'_.. s+. T -f. - t-- has been installed in accordance with the provisions of T X � f The State*aanitaryCode as described in the application for Disposal YVorks Construction Permit Nor ..--. �-�............. dated.... '. '" ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. , DATE.-••--•..............................................................s •--•-- Inspector..................................................................................... t THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEAL r N 6Pa2— ........OF......... E.......... .......... ..._ ............ tapos urk Q tr ion Up�ermit - - C.i_...Permission ;s hereby grante __. !!_ _ _ __________ c ...._ to ConstVrepair ( n Indiv ual Se r e Disposal t }d vys�nat No.•-•f�- .... �/l2R _... . G �3 Q /� �! J �' ---------- ..-----....................... .•---••« � .�...... Street as shown on the application for II sposal Works Construction Per No. ............ Dated_._...--.�......................... GL, v`� /+ /Q .. �� Board of Health ` ..----...-•-•---...._ DATE. . ---••• . -•---•--- FORM/i255 HOBBSs&.WARREN, INC.. PUBLISHERS S ! a,-. •PANfI Sot �� c-r.r,4, � :•.. ,�. - -= - �rx.a-,. - ,, Iry Endslots.1. x P6 r, f . w�a I Roor. S3 ' Phone�lV y l Phana�Tv = 32•y,X 32" I Linen �► vim' r `ccm 1 u 7,d.,.c�;�. .. f 9/L 9in�r3 Cy - I AFT S3 , 0�1 i 9e UwN S� e)