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Home My WebLink About34-36 HIRAMAR ROAD - Health 34-36 HIRAMAR RD., HYANNIS A = ;1 1 i i i i TOWN OF BARNSTABLE r 1' LOCATION 7 i" de #/e/Y&L 1-9)b SEWAGE # 1 09 G7� VZ-L GE ASSESSOR'S MAP & OT ' � :,: INSTALLER'S NAME&PHONE NO. T e SEPTIC TANK CAPACITY 4 r-2� LEACHING FACILITY: (type)' (size) NO.OF BEDROOMS_ K t F BUILDER OR OWNER q 4; PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: T 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 t i/ mC--Aj � I No. � Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rppfication for Migw6ai bpetem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Womplete System ❑Individual Components Location Address or Lot No. —3(4p t tt p--cA-_vA44_r_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Vtki 0 PTI C 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 1-1`kO gallons per day. Calculated daily flow y g7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank L'$0� S�e p� L`T��G� Type of S.A.S. CQ IL. Description of Soil Q.o a-e_S� S AtjQ Nature of Repairs or Alterations(Answer when applicable) 1 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' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee ' Signed Date Application Approved b Z_ Date Application Disapproved for the following reasons Permit No. ZV, Date Issued -� `— ran "..�Yun'C��r� ' .t' +.. � YN - \ .. f+... Nam. ��. _..... -.r �.,... _ • v .+ �. .. • .. Fee 4cvn THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s 'PUB�I IC HEALTH DIVISION - TO.WN aOLB'ARNSTABLE., MASSACHUSETTS 01vuYication for OigogaY *p!6tem Congtruction Permit , Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) S4omplete System ❑Individual Components Location Address or Lot No. 3 4—3(c N',,r &r-v-- Owner's Name,Address and Tel.No. t. Assessor's Map/Parcel 2 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. vr Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) :x Other Type of Building No. of Persons Showers( ) Cafeteria( Other Fixtures Design Flow W`LO gallons peliday: Calculated daily flow 4 T7 gallons. Plan Date Number of-sheets 4 Revision Date -.Title Size of Septic Tank k`3'0'U S—ca0 C_-1 Av,(< 11 `Type of S.A.S. (4 0<c r4' _Z c,_�L Description of Soil eo 4'2 Nature of Repairs or Alterations(Answer when applicable) /TL M) S c JL d C -T A,-V— p_g q-�r �r t N`•e Lj ttiCo F. 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 issu t= Signed Date .,.Application Approfved b e" Date��/�`r x Application Disapproved for the following reasons Permit No. +, Date Issued ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(1/r Abandoned( )by at "� �.. c..n.tti� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d date ® /- � . Installer Designer f m " The issuance of this permit shall lot be o urged as a guarantee that the syst twill nction as desined+ / ' Date d l mil Inspectors r f �i � r ------------------------- No. Fee ,5 azij�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopozal *p!5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( Bandon( ) } System located at 3 t(t �o t✓ 4 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 t. Date: /�` �'.� Approved b � 77 f 1/6199 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) I, 01, hereby certify that the application for disposal works construction permit signed by me dated 16 —If S concerning the property located at #i r vrt C, fee meets all of the following criteria: JAZThe 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. 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 ere is no increase in flow and/or change in use proposed .r There are no variances requested or needed. ,9� i iie 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] 1/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) W-j 7- B) G.W. Elevation 150 +the MAY.High G.W. Adjustment 3,7 = DIFFERENCE BETWEEN A and B ✓� SIGNED : DATE: ! �J [Sketch proposed plan of system on back]. q:health folder:cert 9 ,� TOWN OF BARNS TABLE -_ LOCATION SEWAGE # VII.LLAGE_ Hy1I1 ,S ASSESSOR'S MAP& OT INSTALLER'S NAME&PHONE N0. Y SEPTIC TANK CAPACITY dD i LEACHING FACII:ITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: �.. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet ! Private Water Supply Well and Leaching Facility on site or within.200 feet of leaching facility ��any wells exist Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Furnished by Feet or 0 0 Y " F w a . N r O lz = o Ci � At Sr 3 .K p w 5 e ! � t .q 4,7 '1A✓t / 2-1 1-, No. ._56 6 FizB....5..."60........... .. ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .......... ------ ................................. Appliration for Dispaiial Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .................... ............................. .............................................. ocativ . io'K 'f A0 5 .............................................................................................. ................................................................................................. wn 0. _e.e AV ................ ..... ................................ ..........................................0...................................................... Installer Address Type of,Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder PA Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ...................................................................... < ----------------------------*----------------------**....... ------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter..._.._......... Depth-............... Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area.....................sq. f t. Seepage Pit No--------------------- Diameter.........___.._..... Depth below inlet................_... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit..........._........ Depth to ground water.........____._......... 44 Test Pit No. 2................minutes per inch Depth of Test Pit..._._.............. Depth to ground water..__._..........._.._._. 9 ............................................................................................................................................................. 0 Description of Soil......................................................................................................................................................................... -------------------------------------------------------------------------------------------------*----------------**-------------------------I-------------------------------*----------------- .................................................................................................... ..........................&..... ...& --------------------- X............... Al ns—Answer ---Z&A.�_ ".4 U Nature o R trrgtio -------------- pairs or en applicable. --------------------- ....... .... Agreement ....... ..... ............t.......................... ....... .... .................................... The undersigned agrees to install the aforedes ed Individual Se ge Dis sal System in accordance with the provisions of TITLE 5 of the State Sanitary C e— The undersign rther grees not to place the system in operation until a Certificate of Compliance has bee ' sued by t boa o iealth. d... ................ ............................................. .... ........ .......................... ��_�.._.... Application Approved By...... .. . ................. ...:4........ ... ..... .. .............. ...... I . Z�� follow% reasons:........................................ .................................................................. Application Disapproved for he ......................................................................................................................................................................................................... Date Permit No......................................................... Issued.. ............... Date „r. No.8n S _ _ FEs................�............... THE COMMONWEALTH OF MASSACHUSETTS * � ` BOARD OF HEALTH n�F .. ...........-OF...........,•.!C.r"'�� .-----------------........----- Appiiration for U,Wpos ai Works Tonstrurtion antit Application is hereby made for a Permit to Construct ( ) or Repair ') an Individual Sewage Disposal System at: - -• -_ _.......... ...................................................... ..........1........................................................................................ /� "-_j ocatiyn�r4ri;r g61. y�'* µ�6 �_7'rr or Lo N��/�/ .... __...y...._..`.".�...'.... ............................................. ..........--...................................................................................... gown W / IAIC_ /1/a �c AIGl.2 ..___....._.... .. A.............C._._......_.. Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of ersons...._..--................... Showers — Cafeteria a YP g --------•-•-- P ( ) ( ) 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................ ------------------- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..--.................... 444 Test Pit No. 2................minutes per inch Depth of Test Pit............--...... Depth to ground water........................ Q+' --------------------•------------------------------------...------------...............--•--................................................................. 0 Description of Soil--------------•------...----•------...------.......................-----------------------------------------......--------------------------------•---•----------.----- x U ............................-....................................................................................................................................................=........................ W x Nature o airs or A ions—Answer en a 1 cable -�'�'- .�_ _ / f� ![ U P PP 1 r ----- -----....•--•-------- Agreement The undersigned agrees to install the aforede abed Individual Se, age Dis}osal System in accordance with the provisions of TITIE 5 of the State Sanitary e— The undersigned rther; grees not to place the system in operation until a Certificate of Compliance has be sued byte board'o ealth. 1 d- ................. ............................................. ”_... ........ .........................._.... Application Approved By..... ......... --•----- - �- --- ------•-----. -• •� -------- Dat Date Application Disapproved for the f ollowi g reasons-------------------------------------------------------•-------------------------------------•-=-=----•-••_..... ----------•----------•---------------------------------•----•------------•--••----------••--------------•.......--------------------------------------•.•---------------------------- -----•-•--••-- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f9"t+? "-................OF...... .. ,....!........................................... -.i Tnrtifiratr of TouttpiiFattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......... � ......-•----•--------------------------------------------•---... ...---•--............----...------------•--...----••-•------...... Ins alter at.......................X-f----- --- ............... •------- ----•------ --•-- ---- -- , ------ has been installed in accordance with the. provisions of TITLE `" of The State.Sanitary Code as described in the application.for Disposal Works Construction Permit No...�e�J'p.�;,6 .............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FrCTION TISFACTORY. J . DATE.,F ..... ._. Inspector._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `a " '" 'f 2'w:...........OF........r,�. Ce� 4s ..... No..........................' 1 � FEE-- ................ �o utr.... ?Permission is hereby granted. A.--••• � �-------------•------•---------.......----................._...... to Construct ) or,Repair ( an Individual Sewage Dispo3?e S stem at No. ..� ---- -_�• ------ . ---- ..--•--.------. as shown on the application for Disposal Works Constructio t No..................... Dated.......................................... GHx, t ------------------------------------ Board ofoffellth DATE.........fd .................................. FORM 1255j•HOBBS & WARREN. INC., PUBLISHERS