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HomeMy WebLinkAbout0073 WALTON AVENUE - Health 73 WALTON AVE.,HYANNIS A=310-018 f h M 1 1 A +LOT--NO. : _ ADDRESS: 3 w L� c, OWNERS NAME: I` �C, icL.q . SEWAGE PERMIT NO. : NEW: RE FAIR: L� DATE F ISSUED:_ .®. r 7:9q DATE INSTALLED: V 1 NSTA.LLERS. NAME INSTALLATION OF: l -00 .' 1 WATER TABLE: , , FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE : 1� j ,�lj o 1 V O TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACELITY: (type) (size) 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 No. 3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3pprication for Migogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. —7- 11)a h 4W Q ` Owner's Name,Address and Tel.No. Assessor's Map/Parcel ( ® PJ H �t)^/ �(C_DI Q'4_9 Installer's amine,Address, �d Tel.No. 7 "�5.�� Designer's Name,Address and Tel.No. `1 �Yc� ev, w� Type of Building: Dwelling No.of Bedrooms —3 Lot Size d sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flower 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank O Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 is Bo==. Signed Date .-1) —9 ? Application Approved by Date 3 Application Disapproved for the following reasons Permit No. Date Issued /7 No. �; Fee THE COMMONWEA OF MASSACHUSETTS Entered in computer: LTH Yes) PUBL`-i HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS _ r . Zipplication for Migpogal *pgtem (CoYCgtructton 3permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 7 W Q! fo m 4U e kyp--, ' Owner's Name,Address and Tel.No. Assessor's Map/Parcel I o r I"� 4r�y if<C-�Q/` -j9 Installer's Name,Address,and Tel.No. 7 ! ©-S,5_.�y Designer's Name,Address and Tel.No. Type of Building: �. w Dwelling No.of Bedrooms Lot Size U 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 P Title Size of Septic Tank f SRD O Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigried.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 is Boa Aof Health. Signed,'zb_IL— Date "' ?"9 9 Application Approved by Date 37/12 Application Disapproved for the following reasons ti Permit No. — Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,;th tithe O, ` a Sew g Disposal System Constructed( Repaired ( )Upgraded( ) Abandoned( )by v . at 7 3 Cit/Q has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 133 dated 3117,1� Installer Designer The issuance of this permit of a construed as a guarantee that the system wi 1 function s gnec. vmr), a Date Inspector l��i I --------------------------------------- No. n—133 Fee AM{(O�WEALTH OF MASSACHUSETTS KbBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS et1-1ottgtructiott permit Permission is hereby granted to Construct( Re air( —)-Up rade( _ )Abandon( ) System located at 7 (,A,)Q I _ R.lq 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 p t. n Date: 31,J 7 �/ Approved by ��(y M 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 2— / 2 " concerning the property located at ? (7�G,11 Qc/ e 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. • 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: it `7 A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX.High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED : DATE: 7 [Sketch proposed plan of system on back]. q:health folder:cert � � �( � �"'' O E ��-=- 0 S S �y I ! it �. LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 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 Feet within 300 feet of leactung aci Aq pagsnun3 taa3 Furnished by unca snimnam Xur-ro tinrnea Burumm,r nus_nu�na _io a8m� laa3 3QI S 3S2I3A32i NO NGI.'..t/'I'It1ZSNI 30 ONIPI"G d laa3 :,kg NOI.LOUSNI rIVNI q 3'I4IV.L 213.m QE7 l :d0 t10I.Ld'riust1I S d J ka I � J 3WbN .s33'I'IdZsr,T /1 H 9 ( � :Q3'I'IVISNI 3,LyQ �b. o :(I3f1SSI aw �"Z :2iId3321 :M3N �' : -ON ZIHRi3d 30dM3S J .h y,J 314VN SuNM0 S G' Q SSMQQd • -ON ion 0 z 3' 9VISNUVEI 30 NAkOJ,