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Home My WebLink About0057 WOODLAND AVENUE - Health 57 WOODLAND AVE. HYANNIS A = 269 058 �- l IC I li i 1 i TOWN OF BARNSTABLE ✓ LOCATION ✓7 W ooP iyo 4W SEWAGE #Z 0 VILLAGE +f'fyl�NlUI,S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.. A—F (2A91VC0 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ��S°Z1 q�� r+ �� (size) NO. OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: `rr - l S - ZOO/ COMPLIANCE DATE: �'f-Z 3 - 7.0a I 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 V0 r No. �� / �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z(pprication for 30i5poal *potem Com5truction Verna Application for a Permit to Construct( )Repair(grade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No.5 lice— Owner's Name,Address and Tel.No. [� K. Assessor's Map/Parcel ^��g^ K. j`Q 1 . / J I S, S+. p t Installer's Name,AddreshaigT9.LANCO Designer's Name,Address and Tel.No. 350 Main Street �I W. Yarmouth MA 02673 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 16)6D :t-".S K Type of S.A.S. X P/aW Description of Soil Nature of Repairs rAlterations(Answer when applicable) A 5 tA-L( (� • A0 >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 t e E ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B ealth. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No.�,Oz3z_ Date Issued ��—'� sy C 1 : _ TOWN OF BARNSTABLE LOCATION 57 W do V6r SEWAGE #Z �� VII,LAGE '`'f y6�N/U t 5 ASSESSOR'S MAP &LOT ZG INSTALLER'S NAME&PHONE NO. �' A)Co Q. zJJ � f_ SEPTIC TANK CAPACITY ,Y LEACHING FACII.TTY: (type) Z-5' L C4,*H6f (size) ZSS x 1'?/X 2- `� � NO. OF BEbROOMS 3 f, BUILDER OR OWNER PERMITDATE: `� / Z-Vo COMPLIANCE DATE: z - Zaa 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 §1'491��t,.(iONO, NO, 4„�y P��F ff,fE F��i�ti,.vr�l�y 1sY51 1 � z f , - c q-7 53 ; 140 No. � / ,G; . Fee V' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(ppYication for ;h5 pool bpg;tem Con5truction Permit Application for a Permit to Construct( . )Repair(-Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location(Address or Lot No.�G' G A N 1A.� Owner's Name,Address and Tel.No. y� Assessor's Map/Parcel l�Q} S ! Installer's Name,AddreA 41 Bl.GANCO Designer's Name,Address and Tel.No. 350 Main Street W. Yarmouth, MA 02673 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 gallons. Plan Date Number.of sheets Revision Date Title Size of Septic Tank /CJGD �'r�/ Type of S.A.S. P/UUp e<i; n 9 Description of Soil{ Nature of Repairs or Alterations(Answer when applicable) �f n 5�A ( �� • �%o X Soo S ( J/ t� S 1�ortR Date last inspected: Agreement: • . c, 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 E ironmental Code and not to place the system in operation until a Certifi- cate y acid Health. Cate of Compliance has been issued b this B ) H Signed �, Date "' Application Approved by _ Date Application Disapproved for the following xe,asons Permit No. /F-� Date Issued ,�� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the n-site S wage Disposal System Constructed( )Repaired( "TUpgraded( ) Abandoned( f)E�by at Gv0 r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Ns �Ql" dated �' ,��v Installer Designer The issuance of this permitjphall of be construed as a guarantee that the syst I fu ion,,a Date l 3 / Inspector No. v✓r ,%' Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1wi!5pozal *pgtem Conotruction Permit Permission is hereby granted to Cons ct )Re 'r( �-T Upgrade( )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 must be completed within three years of the date of thig$ermit. Date: ,''° :�6�� Approved p y�—��, 4 / f 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 W( ITHOUT DESIGNED PLANS) (AvtvL u. , hereby certify that the application for disposal works construction permit signed by me dated 44 ` 19 ' 1 , concerning the property located at S 7 OooS(Ad Ao-k- 9J , 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. he 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: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation db +the MAX.High G.W.Adjustment. DIFFERENCE BETWEEN A and B SIGNED : �/ �� DATE: _I vp—y l [Please Sketch proposed plan of system 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 �1 9L) �1 � O C 1 C1 I