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HomeMy WebLinkAbout0019 HARTFORD AVENUE - Health 19 HARTFORD AVE.17 V MARSTONS MILLS - - A = 103 063 r �i TOWN OF BARNSTABLE LOCATION 19 �� �®�� V��� i SEWAGE #POD) :. VILLAGE 9i4fzSZom5 ��(,[ � ASSESSOR'S MAP & LOT Ga 3-�� INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 -SEPTIC TANK CAPACITY tX►S//- �db b c- I LEACHING FACILITY:(type) S� (size) X 1 X 2 . . w �'sTv.�E NO.OF BEDROOMS 3 PRIVATE W L OR PUBLIC WATER .l BUILDER OR OWNER I, o2oc DATE PERMIT ISSUED: C9 _Z " © f DATE COMPLIANCE ISSUED: L= 7" 41 VARIANCE GRANTED: Yes No Y ,� �, � r �� . .. , �" �, 31v�v ���. _ • r O ri l� r , � ..r �. �_ `. . _ -- �, " No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Miopogaf *pgtem Congtructioil Permit Application for a Permit to Construct( )Repair(vilu-pgrade( .)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./ Qj //,4 i LA e— Owner's Name,Add re and Tel,No. Assessor's Map/Parcel Q Installer's Name,Address,*&-SOICANCO Designer's Name,Address and Tel.No. 350 Main Street 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 Type of S.A.S. Description of Soil ✓ Nature of Repairs or Alte tn (Awhen ap cable) a i wl oZ 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 by this Board of aC'494a SignedDate 691 7 0/ Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued -,,.,.,cam"}" fi `.:. t TOWN OF.BARNSTABLE d _ r /CT. r> ` . LOCATION SEWAGE # �� DILLAGE � S��� ASSESSOR'S MAP &LOT,: INSTALLER'S NAME Cz PHONE NO.. A & B CANCO 7,75-6264 " - SEPTIC TANK CAPACITY tX� Ti` 'i LEACHING FACILITY:(type) �' �' �Lil /S. .(size) w v. :: P TE ORPUBLIC'WATER NO..OF"BEDROOMS4 � y ,i rx RYVA W L D �� BUILDER OR OWNER.:.���: ��C� t v O / DATE PERMIT ISS:UED.: ::. .`2 DATE °COMPLIANCE ISSUED• a/ " Pt VARIANCE GRANTED .Yes No j r y om 4 : 1 77t j 1 F .. "-- _ t jf , •^ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes ZIppricatfon for )Digpool *pgtem Construction Ve it, . Application for a Permit to Construct( )Repair(L14pgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 11A f 440 p CQ 0-2_ Own Name,Addre and Tel,.No. I oh /o� t e Assessor's Map/Parcel O , U Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. . ,Garbage Grinder( ) Other Type of Building 4, `No.of-Peisons 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 Type of S.A.S. Description of Soil Nature of Repairs or Alte ations(Answer when applicable) —,)WI 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 this Board of Signed s 1 Date b 7 0 Application Approved by Date Application Disapproved for the following reasons r Permit No. n14Vl Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( vl�Upgraded( ) Abandone ( )by �� u G U at A r f r ` w ha onstructed in a ordance with the provisions of Title 5 and the for Disposal System Construction Permit N ated 6 b Installer Designer r The issuance of this e t all not be construed as a guarantee that the..syste I func ' n esigae . Date Inspector ——————---———— ——————————--—— —————— —— No. _ Fee 5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopogal *pztem Construction permit Permission is hereby$Evted to ons Bt( /?�Repair( Upgrade( )Abandon( ) System located at / /`7�4� y(i' (�Q 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:Co struIon sl be co pleted within three years of the date of th' -ermit: Date: .9 1 I Approved by 6/ ° t �i ' tp 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) I, C1-+yi►1-dYJ , hereby certify that the application for disposal works construction permit signed by me dated 0 , concerning the property located at �y/�N d �-� 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 / 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 SurfaceElevation(using GIS information) B) G.W. Elevation 9=Fr—'# +the MAX. High G.W.Adjustment. DIFFERENCE BETWEEN A and B SIGNED : DATE: p� 0 [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 y Fi ti ..r 1��-'�� ���� r�'YL�/ a / / S � ,� ��� s� ..-� - �-