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HomeMy WebLinkAbout0350 WEST MAIN STREET - Health 350 WEST MAIN ST.,HYANNIS A= 269.157 D 1� a I� I 4 I h TOWN OF BARNSTABL a /�4E #, RATION 1 W e o L � SE A' VMLAGE— ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 42 � &;l SEPTIC TANK CAPACITY LEACHING FACILITY: (ty ) 4-,y J"i Z44&C>if-7 (size) VO.-'OF BEDROOMS w 3UIL.DER OR OWNER w . 'ERMUDATE: _COMPLIANCE DATE: ;eparation Distance Between the: ✓Iaximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet 'rivate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet 'dge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / ���� Feet ucru. v(� f I 0 1 i ,i V-71 . No._ e _ Fee THE COMMONWEALTH OF MASSACHUSETTS r ' 'E ered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for ligp�Upgr2ast(,,� bpaem Congtruction Permit pplication or a Permit to Construct( Re ar Q Abandon ) Co .pleteSy m ❑Individual Components Location Address or Lot � �`G Own�r's e,Address and Tel. vZ� � �" tell�.B Asses s Map/Pazcel94 q �a w1 ovi fez ue4w G onInst s N Address,and Tel o. Designer's Name,Address and Tel.No. w 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 2? gallons per day. Calculated daily flow 'l`� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank %55_ Type of S.A.S. 0 C Description of Soil ✓� - Nature of Repairs or Alterations(Answer when applicable) ' �- 4 4 C 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 untila>Certifi- cate of Compliance has y t is oar � Date Signed Application Approved by f0§;; Date Application Disapproved for the following reasons Permit No. Date Issued — ——— --- -- -- — — — -- -------- ,z� Fee ,6 THE COMMONWEALTH OF MASSACHUSETTS `IaAwd in computer: IYes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01 pp[ication for Mi!5 pog *pgtem Cott�truction Permit Application for a Permit Cons I( . Re ( Upgr4, )A andon( ) Complete System. ❑Individual Components LO C, tag � ��Q sf i r<�� � Location Address or Lot No. �W CX)0\r i y(�`'�r Owner's N e,Address and Tel No`� l Assesoi'M p/Parce Ins s Name,Address,and Tel o. Designer's Name,Address and Tel.No. 4 Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers 1; ) Cafeteria( ) Other Fixtures l`(`� Design Flow gallons per day. Calculated daily flow "�- ► gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank 'At�dT e 1 4 Type of S.A:S. r ab L Description of Soil C f,1/t VP y Nature of Repairs or Altera 'on (Answer when applicable) Date fast 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 bee ue by this 13oard*o // _ Signed. ' e Date (&d` Application Approved by Application Disapproved for the following reasons r' Permit No. d Date Issued r ——— ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS t, Certificate of Compliance THIS IS TO CER t n-siteewage Dip System Constructed( )Repaired( )Upgraded(�-- Abandoned( )by at ­20 U_xv v40-9-_ C�vt_"-'S, has been constructed in accordance ." with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer n Designer The issuance of this permit sh 1 not on strued as a guarantee that the yste .,will function as design d Date © ecr � � Insp to , ....��/� �/ ------------- No ----------Fee .r - .,Q IG%UV i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miopooar Opotem Conztruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade l_ 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 ust a com leted within three years of the date of 's Date: Approved by rT r i Y{ I �.. 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 y WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated D ^ � , concerning the property located at �; (dip p� ��� Q 19-a--� �T 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 ,•jPhere are no private wells within 150 feet of the proposed septic system here 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 pplicable] • 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: e A) Top of Ground Surface Elevation(using GIS information) 9 B) G.W. Elevation "rf�p 0+the MAX. High G.W.Adjustment DIFFERENCE BETWEEN A and B 0 SIGNED : DATE: [Please Sketch propose pla of em 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 1 �1!II _ o l e .� �` z TOWN OF BA.RNSTABLE LOCATION �� SEWAGE VILLAGE nip i ASSESSOR'S MAP & L j INSTALLER'S NAME&PHONE NO._L12C--//L2 -fir' I SEPTIC TANK CAPACITY LEACHING FACILITY: (ty .17441 5--�.) S (size) NO. OF BEDROOMS ,n i \ BUILDER OR OWNER V PERMITDATE: COMPLIANCE DATE: 20 Separation Distance Between the: -j 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 E R fir( C� ll r V' v' Make application to local Fire Department. Fire Department retains original application and issues duplicate as Permit. 4 "f APPLICATION and PERMIT Fee: for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: • Tank Owner;Name(please print) �'` A x/� ig-ature i aP yo9 or0 RAddress ,3y ly e s5 —/� 'n i i1 �/ Sneer I City State zip • • , Company Name Advanced Fnyeitrnnmen'tall CO:or Individual. vu�r Address ddress Pent P . Signatur ' apply" for pi4paturejif applying for permit) I ' .IFCI Certified r.; Other O I,FCI Certified.,t. O LSF# Other -7777777, Tank:Location.`- ~��'� waat i nt .uranni a ` -MA sreer.�ddress cIty� Tank'Capacity;(gal ns) Substance:Last:Stored - Tank Dimensions(diameter x length) Remarks: I 7Firmtran,sportingwasteAdvanced Environmental State Lic.# MV5083856100 Hazardous waste manifest# E.P.A.# I Approved tank disposal yard James G.Grant Co Inc Tank yard# nnf3 Type of inert gas Tank yard address w-• -o l l u o a,air;l l e-,• M�! I City or Town FDID# /�G�� Permit# — Date of issue - ---- - - - Date of expiration Dig safe approval number: 199915067 38 Z')(ftAAjjC)-jg Safe Toll Free Tel. Number-800-322-4844 Signature/Title of Officer granting permit HY 44 After removal(s)send Form FP-29OR signed by Local Fire Dept. to UST Regula, n Place, Room 1310, Boston, MA 02108-1618. RA 02 fXj '-292(revised 9/96)