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HomeMy WebLinkAbout0120 THIRD AVENUE (HYANNIS) - Health 120 T I A E. YNNNIS A C 1 TOWN OF BARNSTABLE p LOCATION LZ� �//�1 �fie� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT Zh -i! 7 INSTALLER'S NAME&PHONE NO. ����d// C®�cS �I/"Q✓?�� SEPTIC TANK CAPACITY LEACHING FACII,TTY: ( ) Cam - (size) L stze � NO.OF BEDROOMS BUILDER OR OWNER ` PERMUDATE: 7� � 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 i� Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ' ' ®� �� Q ,. 4� s � � ��� a �� : � � it �� � � , r , . . ., t ����� �� �' No.. U Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: jZ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Digpoml *p9tem Construction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) LJ Complete System ❑Individual Components Location Address or Lot No.� 9 1 Owners§I,ZTame,Aldresssagd,Tel.No. Asso �C lvjap�f e� ��� �✓� 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � 71 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/,�o Other Type of Building PLy45 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ll e2, gallons per day. Calculated daily flow �® gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /��©� Type of S.A.S. 7 —.S'—®® 5; ' 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 th' Boardof Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued r' No. ICJ Feed C THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISI OWN OF BARNSTABLE., MASSACHUSETTS Yes �~ 0(pprication for Migot' ,pgtetn �Congtruction eririit Application for a Permit to Construct Repair ��V `rade pp ( ) p (j/')' pg ( )Abandon( ) Complete System O Individual'Components • Location Address or Lot No� �© rQ°��_ Owners UameGA dress Tel.No. Ass -7o9 tp 4 ce-1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 6a/toGo�� C®Hsi'` 7 71-93 9" Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A�o Other i Type of Building.al No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ��� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date M � { Title Size of Septic Tank /S!©D Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable). ��`/� �° T 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 y this Boar of Health._—_�_ Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. `� Date Issued -THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ACertificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (VI"Upgraded( ) Abandoned( )by Dr ze"I;�"/ COpIS at has been constru led in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated "r Installer Designer /1 The issuance of this pml s 11 a� � si }b� nstrued as a guarantee that the will function as gn / Date c �9 Inspector THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs.MASSACHUSETTS Migotal *pgtem Construction Permit Permission is.hereby granted to Coy struct V )Re air(el"Upgrade( )Abandon( ) r System located at Z0 7` // � 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 t t. Date: Approved !f r l x O IC � v -r7,4-&2b c � h a V"9 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 PERWr(WITHOUT DESIGNED PLANS) I, ��� O®` ��-hereby certify that the application for disposal works construction permit signed by me dated /y/�� g concernin the property located at /Z�9 � 'd�� /� �`i17/9 yleets 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 ,1/ 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 I/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] Vlif 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: Q. 70 A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX High G.W. Adjustment.Z DIFFERENCE BETWEEN A and B 7. 7 SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder:cat dF t Barnstable Town of Barnstable UAmWcaCft + BARMABL£. + 1 r PAAM Board of Health roc ` 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. 7unichi Sawayanagi March 3, 2008 Mr. Art Pacheco Pacheco Construction Co. 720 Main Street Hyannis, MA 02601 RE �j2; 0..Third Avenue, Hyannis ' A 266=017 Dear Mr. Pacheco, You are granted variances on behalf of your client, Janet Police, to construct an addition at 120 Third Avenue, Hyannis. The variances granted are as follows: 310 CMR 15.211: The soil absorption system will be located seventeen (17) feet away from the bulkhead foundation wall, in lieu of the twenty (20) feet minimum setback required. 310. CMR 15.211: The septic tank will be located nine (9) feet away from the bulkhead foundation wall, in lieu of the ten (10) feet minimum setback required. The variances are granted with the following conditions: • An impervious liner shall be installed between the septic system components and new bulkhead foundation wall. The existing septic system components are setback the proper distances from the main " foundation. It is our understanding that only the proposed bulkhead for the new addition will encroach upon the existing septic components. Sincerely yours, ayn iller, M.D. Chairman Q:\PachecoPolicel20ThirdAve2OO8.doc l F1HETp� DATE: ZC6.0.1 O FEE: L► SS.I E n�u� 163q. REC. BY C�M A ` Town of Barnstable sCHED. DATE: . o Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Cannif,,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: f ' C Assessor's Map and Parcel Number: a(� 6 0 7 Size of o : O) , 4 (� �- v e Wetlands Within 300 Ft. Yes Business Name: No___X Subdivision Name: C-*> APPLICANT'S NAME: C hC C v Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSONAID Name: 2T C' �/ C-� Name: c-ck-6e r Address: 3 22 6 /eG ('Cch-f- Pn fal Address: Phone: 0e 3 6 9, l.—L,6`i Phone: 6—G L S5 7 i VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more (�space �needed) In C'Co�..0 I—, //l 4 C3'h �l Q- I b e:-c v411, s tT114G^ �C%- ACC- e S NATURE OF WORK: House Addition 00000 House Renovation Repair'of Failed Septic System 13 Checklist (to be completed by office staff-person receiving variance request.application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or,restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Canniff,D.M.D. REASON FOR DISAPPROVAL Q:\Application Forms\VARIREQ.DOC MAIL-IN REQUESTS Please mail the completed variance application form to the address below. Also include four copies of engineering plans, house plans, authorization letter, etc (see check-list below). In addition,, please include the required fee amount (see fees at bottom of this page). Make $85.00 check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 Checklist _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) $85.00 variance request application fee(no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, you must mail the required $85.00 fee. Please make the 'check a' able to: Town of Y q PY Barnstable. The check must be mailed to the address listed above. In addition, please mail four copies of engineered plans;house plans, authorization letter, etc. (see check-list below): Checklist Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ $85.00 variance request application fee(no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page � t I i Ir� �� � � } .P 2-10 a Z- / v I L©r i b�lz J �� i i`-bC G - , 1. 1 i o ' 14-7 'iLO� v 8 r I O T 7ZW-f .vim/ CERTIFIED PLOT PLAN LOCATION `���r-�'.s•/`?�cC EyANN/S}00/2T� 2a . .r� S//0TE - T.�s �/���-r / /.S �CA7Z� SCALE . ... ........ .... PLAN REFERENCE . 6GtarG LoT,S !�`7 ' -b is /21— /3M. 3 4- PC L 3 L iV�,0 t 4MWt (CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON; DATE L oo$ /203 � REGISTERED LAND SURVEYOR. f l _ 25�1 k) li c - LoT a 2 - hL T q o / i 9a' a `IUD 147 � Sa 2• ism a CQ• �J6. oc5 � ��, T 7aw,v w,ry CERTIFIED PLOT PLAN LOCAn0N Bia2vsrgac � AN�,so�-r N073-5 - Th'is 02®p&rz7y /.S LoCoqrC--b SCALE . .../ - 2c ' RATE FWl. ALDcsv zc.'A/E rC PLAN REFERENCE of 3. . . . . . . . . . . .. . EMN E Q sP, µ¢ KELLEY N N0. 26100 ,� IStE�'�� I CERTIFY THAT THE 'AL LACE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON, DATE Fe(3' /Zo Jr'�T�T $� --��'YV GST` 1 c&Z IC- fJ�' REGISTERED LAND SURVEYO , J r g 1 •�a !o'er c Nck 147 Io.t RW1 f C-A,1 i r rfG c3 G lees >' ST2�'C T T�w,v ur�y CERTIFIED PLOT PLAN !3�.s1�rac� fy.A LOCATION Ic/ar� - TNrs P120 �- /s LocAr SCALE .._ /.,_ 20 ' .. DATEo7Z v Z r!' PLAN REFERENCE . l3c6G LaTS. . 0 Al {CERTIFY THAT THEi'/S "' [��!�'�r ,•'G. . . . . , :x X SHOWN ON THIS PLAN IS LOCATED ON THE G IOUND , .P AS SHOWN HEREON; DATE ..CG? G? REGISTERED LAND su k i 11 �� q � O Z �I Y N G i s F � B Lill 9 a sv A Vh L; rb V'71 0%11) 16 A Ir t4 law o A VD 2ke ,try;, zz'54 1 CD It5 L 1. If) IL 1.0 all I-I I p� 1 TOWN OF BARNSTABLE LOCATION ZU /1 Il"P'� �'L � SEW 90;SD7 AGE # l VILLAGE /TyIP//i be A z ASSESSOR'S MAP & LOT A�—�/7 INSTALLER'S NAME&PHONE NO. J lW,?JLol,,`-I Z21/95,7-, SEPTIC TANK CAPACITY T S LEACHING FACELITY: ( ) Z-- (size) x� 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 CD v p � I N 2oo -7 Ue7?.;-''/ 31 C Z5�1 • LET �i�� 0 10P. And Zor 14 't /-1 DA/7r10A1 2�S7� ST2G—C-'T 7aw,v w CERTIFIED POT PI LAN LOCATION i?2.!sr�l.. ... jc�' /VQT� - Tths A2vpL-o�/ /-5 LoCATt SCALE . .� �- �a DATE / ``C:�6 PLAN REFERENCE . 9y E RD G� C E. KELLEY N / No.26100 �a r , ISTER�� f i CERTIFY THAT THE !G . . � L L SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON, DATE REGISTERED LAND SURVEYOft , + 1 V 1 ' r R a I I i { • f R I Y f f'- t '• 1 I ice,. � i I 1 � , � t ji I I : ' I { i 1 I : r : 1 1 1 ` , 1 .' ry - r r 1 1 1 r I s I • + r t t t + I 1 I '+ , 1 i I t 1