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HomeMy WebLinkAbout0400 WILLOW STREET - Health 400 WILLOW ST Q�E WEST BARNSTABLE A = 130 ,.'006 a a 'F P�P��1 �roa Pry a FPur�rE�so.� - y:aT 1 I-lFtSTtN Cr I-( u rau"v � -,ewti4r 0 - r i u _. a.F w o t •- _.\fix• --- gr,nG l.aovE .77-JI po W7Li-4.W' L4A iJp G r 3 l P""`s J l i YVJi � V J . Ice" TOWN OF BARNSTABLE LOCATION `i_©CO :� -�-o.� �� SEWAGE # ®U1-05 t VILLAGE W. -Af--n-S+A(p�J`, ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY ( SQQ &A I t " LEACHING FACILITY:(tirm) N) -epan 1TWOM-Awize) NO. OF BEDROOMS RIVAT WEL OR PUBLIC WATER BUILDER OR OWNER CD. �p iy�y�t--tom DATE PERMIT ISSUED: f , DATE COMPLIANCE ISSUED: 67 o i VARIANCE GRANTED: :Yes NO : A ! t f L tt 98 I � I _ r 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 DESK-'NED PLANS) hereby certify that the application for disposal works I construction permit signed by me dated .3 G--'�� , concerning the property located at q4 the following criteria: bo • 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. rgo 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 Q _proposed leachmb facil►ty w�11 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 +the MAX. High G.W.Adjustment. _ DIFFERENCE BETWEEN A and B y SIGNED: DATE: [Please Sketch p oposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for 14 bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert TOWN OF BARNSTABLE LOCATION �i0® i�-�-®�► 5� SEWAGE # t®()l"05'1 VILLAGE lam. � n� -,y�`pG`, ASSESSOR'S MAP & LOT INSTALLER'S NAME 6i PHONE NO. 3(o2 (a2� '� SEPTIC TANK CAPACITY t SQQ C (luv\ /�+' LEACHING FACILITY:(type) 1q) a-Cr� J-rTfl l"ize) J41 x NO. OF BEDROOMS RI A WEL OR PUBLIC WATER BUILDER OR OWNER CD (p C`A �Lr DATE PERMIT ISSUED: /-P �l DATE COMPLIANCE ISSUED: 2-6--01 VARIANCE GRANTED: Yes No v -- la, 39 �f � No. ��l o �— Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYfcatfon for 3Df 5pooaf 6potem Con5tructfon Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or�.ot% />L Owne�Narrf,Addres d,Ty�� !rU Gil/ J✓ ,-.* �—aC 1,�,.7/V Assessor's Map/Parcel Q ✓O4 i 1/40J Installer's Name,Address,and Tel.No. jg� '����' Designer's Name,Address and Tel.No. "S .�/� �.�/ 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 ��`T Type of S.A.S. S Description of Soil _( , A tf'/ 1/QA�J-1 , ,��L t _ XACT C' 1 plau7�i Nature_oPRepairs or Alterations(Answer when applic le) _L&_1 .r Cj0 3 I �?✓ T l 1/ ✓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 e Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t s oar -f Health. J Signed Date Application Approved by Date Application Disapproved for the following reason Permit No. o r/ Date Issued No. OS Fee -- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BAR NSTABLEstMASSACHUSETTS 0[ppYication for �Digaal *pztem Congtruction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Comple'''t�ett"""System ❑Individual Components Location Address or of or / � J Owners Nary�e,Address and er�rr Assessor's Map/Parcel 130 el Installer's Name,Address, d Tel.No. �j •��i1 �i Designer's Name,Address and Tel.No. fw Type of Building: .. Dwelling No.of Bedrooms Lot XSe I sq.ft� �j Garbage Grinder( ) Other Type of Building No 0e ns Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons Der day. Ca ted y flow gallons. Plan Date Number of sIt "s Revision Date. Title + ( el Z -�— Size of Septic Tank �— Type of S.A.S. S jF Description of Soil l6you^� — L4 Nature of Re y appli le)---� e 57 v -Date last inspected: � 0�41--- 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 T�Jhenvironmental Code and Wnot to place the system in operation until a Certifi- cate of Compliance has been issued bf Health. Signed Date Application Approved by Date Application Disapproved for the following reaso s Permit No. f U Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Coance THIS IS TO CE FY rthe 06t Sewage l Sys m Constructed ( )Repaired( )Upgraded( ) Abandon �)by vD at �'�'� iL > has been construct d in accordance with the provisio f S d for Disposal System Construction Permit No.�/—O S79 dated 3/ �' Installer �� G .dam, . Designer The issuance of this perm' sh ll not be construed as a guarantee that the sy ill f n=pjssig Date Z Inspector OVA- Ze ------------------------------------`--- No. / O Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS U Digooaf *pztem Conztruction Permit Permission is hereby gr t.d to Con�ss ;ct/(,�Repair( )Up gr e( ) baandon System located at � lrl/j/!!� t /t'/t 0 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:Constru pion Tust be completed within three years of the date of this t. Date: 3 Approved by �"" 1,q' / C �.�.. ' 'ct/A+s ,Q�. i;.• ` r.� R i - f x,a 7" E ;�.,- e�S +,X f! �f#:sue - -----, 'T-'� Tom__-�._.--..__!_..-..:.__...1._...._.�_•_.._,_..1._. ,.,._..�,�_; J ----;... T. 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