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HomeMy WebLinkAbout0000 YARMOUTH-BARN. TOWN LINE - Health (3) rr4 -iM on Avenue i- Barnstable y A _ 347 i001 Z 9 c G a - TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date I Iq I-Z01-2, Time: In Out Owner LAN 5 1 Iix)A Co rjALk) Tenant Address?-5-4 kQ--c-livi�L— L Address `1 1 �I M ��Iy /�V:c Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water SupplyWC 5. Hot Water Facilities 6. Heating FacilitiesIND 7. Lighting and Electrical Facilities -�\AA C . Vp M(-Ti O w 8. Ventilation -- '`� 9. Installation and Maintenance of Facilities ✓ 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal / 16. Sewage Disposal V 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max Number of Persons Allowed ('max) - Person(s) Interviewed 1 �'"'ti� T Inspector ;' If Public Building such as Store or Hotel/Motel specify here No. Fee — • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS CoAp�pLa'alora kOT[ fOr loigaal petem Con!gtrurtion Permit Perm[tb to ons d:epair( Upgrade(/Abandon( ) VCompleteSystem ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel No fi4/RtS7 YAFA- S. .& i.IAJ1>A AS- C®NAWA Assessor's Ma /P el ! —J>�!I-141d 1 t7E 1 SIM P.SeA! AV,C " —'Installer's Name,Addre s,and Tel.No. 21�J Designer's Name,Address and Tel.No Donald W. Monceviez, P.E I;wlqAj C, Kis'""G `778'�-�� Civil Engineer q7 T®w" !e l�mJ�D ����, 3 q4-0.510-9 40 Pond Street �s/ . �tleM-W! Yr ^9 0.267 i Type of Building: 1 WeWDennis,MA'02670, Dwellin No.of Bedrooms Lot Size sq.ft. Garbage Grinder( v Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow :33 O gallons per day. Calculated daily flow -3 3® gallons. Plan Date MY /Z , 2,004 Number of sheets / Revision Date Title `)%W P4P.SAD i1ZnjS_'X UPQe rU r1 Size of Septic Tank &S-O© 1:5;9k. Type of S.A.S. GfVAA44%i RS Oro Description of Soil "/O;� r J! �Inb rn Pi2an.+i --^ti.. a/Ancss_r�u.+1� --.ai ohla\. ������� ���✓ A4�/yr Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system g g g P Y 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 by this Board of Health/ Sig ed Date 42. 2004- Application Approved by Date Application Disapproved for the following reasons Permit No.aoc' i 160, Date Issued ®-i- No. a: „y -X._ Fee •, r.._ Entered in computer: THEvCOMMONWEALTKOF MASSACHUSETTS Yes _ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS � d -"ZIP PYu on for to ogaY p5tetn Con5tructton Permit 0 ( D�� ,� Applicationfor a Permit to Cons ct epair( Upgrade( Abandon'( ) M Complete System ❑Individual Components Location Address or Lot No. /Mf'SoN A V wner's Name Address and Te No. Assess s a /P cel / /419 A4AJ)_!tiG I 4Y` SIMP54o 4v,---. l o®/ X68)'79 -©4" Vd. Yaiera'�v_y-.0r._ Installer's Name,Addre,s sa and Tel.No. ?40 Designer's Name,Address and Tel.No 1 Donald W. Moneevid, P�.E', �Smh9" C. �G/sSA.//v G 77R—O 4 µif Civil Engineer ' Q-7 raw a k �pn /sops) 3 94-os�� >41&~7'H A1p o26y3 l 40 Pond Street Type of B ildmg: - �West-Dennis,-Mkw, 670 wellin No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3� gallons per day. Calculated daily flow —33® gallons. Plan Date OV /a Number of sheets Revision Date Title " oP®SAD . /17?9AW -1.YS'7-,9/y UR (5;e 1>,A ' / Size of Septic Tank /% s040 Gi94 Type of S.A.S. CIVAMBWAS Description of Soil��.��'� ? ►�_SA ____t __-._� IJ 'Ay S�/A t - 'Natum-of=Repairs-or Mtmtions-(Amwerw#te a pdi,-ak4,s -o 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 ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health< Sig ed t -7f Date 11W 42 Application Approved b Date `a` 0 )?)? rr Y (Application Disapproved for the following reasons Permit No. Date Issued ` �-.0 t_( THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that the On-site Sewage Disposal System Constructed(V )Repaired( )Upgraded(V/) Abandoned( )by cl v^ S f l at �1f S/PIPS®/l.! /�Y " . has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o-O U L-1 60 dated l Installer Designer r The issuance of this pe jt s 1Jn�o_ e�onstr ed as a guarantee that the syst m ;1� f nc ion as ned. Date { I 0 �/ InspectoNo. GG9 i Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5po5al i, $tem Con$truction Permit Permission is hereby granted to onstret Repai (�U grade(�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 conditi n . Provided: Construction)must be completed within three years of the date of this pe t. Date:_. I '/ Approved by �1 � O TOWN OF BARNSTABLE Yi9Qt�l o.�tl¢ GAwpGQou,�aS } LOCATION y/ SEWAGE# 2 oo T VILLAGE 8 R s rAfil C_- ASSESSOR'S MAP& LOT a INSTALLER'S NAME&PHONE NO. R p_,4.j C.: SEPTIC TANK CAPACITY 1SO o G TT LEACHING FACILITY: (type) fAgcAgT_r j4x4,0 (size)fin, 21 .3 et'„X�_ NO.OF BEDROOMS 3 BUILDER OR OWNER L. NJ 6 A B I S-r j;J r4 A C 4 Y PERMIT DATE: I I' 12 A o COMPLIANCE DATE: d I d Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 V al to N w IrZ ?ate K_ 7 W� toa'' o I 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM U I, P� hereby certify that the engineered plan signed by me dated la -Z concerning the property located at meets all of the following criteria: a This failed system is connected to a residential dwelling only. There are no.commercial or business uses associatedmith the.dwelling. C The.soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. e There is no increase in flow and/or change in use proposed ` e There are no variances requested or needed. e The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: f A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +adjustment for high G.W. _ DIFFERENCE BETWEEN A and B .�. SIGNED DATE: _ ` �k< 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. moo`' DONALD tiN g W. MONCEVICZ ti 0 No.20487 O e gASeptic\percexemp.doc APp�sG/STE�a s`R SIO.NA1-� P �f Ck,. ciosef sf�►�9e BEpiE'OO/YI c%. C/o. I>W. NTR �f�ss 774 QNALD �1 p p tiN Ghir+�ney ri o W O v MONCEVICZ No.20487 O Q K/TCf� N 36,/O SSIONAL ,�/VT/�Y 157/ ,L oo,e .1-AY4UT 51A IR5 91V _ �s 3o y�CMOUTf-� G��FjylP��U/�!„o S Fi4�2�lsT.�ll3,L�, �sit�} ti 2 a© �7'7/lGt/M�i�l7' Tm - S.4N/Ti4RY IJ AwIN6 )Vo Kl3G—/ iCU-T.crD N� /2 2004 -jar'mouth Camp ground t.2ssociafion, Dnc. WW garmouth, R 02673 November 3, 2004 Ms Kristine Conaway YCGA 41 Simpson Avenue West Yarmouth MA 02673 Dear Kristina, At their October 30, 2004 meeting the Board of Directors of the Yarmouth Camp Ground Association, Inc. reviewed and approved your plans for a new septic system at the cottage. I have attached three copies of this letter and three copies of your approved plan, one for you, one for your agent and one for the Town of Barnstable. All town codes are to be met for this work and any.debris generated by this new installation is to be disposed of by you or your agent via the town dump. 9 When you receive your permit and before it is posted please have a copy made and given to me. I will also need a copy of your agents proof of liability insurance which his insurance company can supply to him Good luck with the project. , Regards, FOR THE DIRECTORS, L. E. Barley, Clerk leb/db Enc. 3 cc: file pens. cones. renov. Established in 18631 as a place to conduct religious Camp 34utings. 9Zeorganized 1946, as a Cottage Community, cooperatively owned by the Cottage Owners. ' c c ` 1 , J L- /G'c' ' 1 c i �T+of�4 Co!RC1% r ,t�iJ' 9f'n ry J !Y\ac�✓%a C DON�uo. CD w_ M m GK C-� � OfST 1^Gom armou, ramp a nd A '\ Inc, Al o J !. rm �t`L i, m s , _ D In �' ® in 4 All cn Co (A 9) N ID svetiY,Fcr To m CD Town of Barnstable 'HE r Regulatory Services ' Thomas F. Geiler,Director • snferrsrAst.E. MASS. - Public Health Division l A. ED MP • Thomas McKean,Director - '200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790=6304 Installer & Designer Certification Form . Date: Jac /s, z oo¢ #, Designer: f Donald W. Monceviq,,,P E.,,,) Installer: C Civil Engineer ' Address: 40 Pond Street Address: West Dennis, MA 02670 On/1 2 2004- kA_VSA,1AfG was issued a permit to install a e (da ) (installer) -;4 2mo4 -4601 ; M�Sortf w, septic system at��/�en�airH liprhPG�x1/�l1�S based on a design drawn by (address) . oiegwiN�` r Dmc/gL0 W /�/OA�C NILz dated/V O /a - (designer) s I certify that the septic system referenced above was installed substantially according to " the design, which may include minor approved changes such as lateral relocation of the yv distribution box and/or septic tank: I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical.relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. _jtl OF Miss o? DONALD W. l afore MONCEvIcz ca (Instet's S1 ) A ,A No.20487�0 9 �GISTE� r.� SS/ON �a6 (Designer's Signature) (Affix signer' p for) 210 y PLEASE RETURN TO BARNSTABLE PUBLIC HPULTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE .ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PU LIC HEALTH DIVISION. THANK YOU. Q`.Health/Septic/Designer Certification Form fF s soAPT/ON --SYSZ"EM Pr A. S•) y�J �"cisTnRlG ,B.�p/2�vn� /E' sEra Svc, D, sip / mimic v 13,a✓Dit'r �s. /0 MAO X. 30 LoivG wiTW 3 CHANIBr."IzS Z�30 d,-AA.. c:P, 5e9 wip.o X /02 GoAja x 36 3'04 G,a, . ..5»,a-t'�t 7 �c. ( x 8. .a D k 3.190,). 2, (/o)(3D) (i© l0 SO4 30)(.2,001 = 4 6 0 scp. FT. /,/ 'E�/r q.83 ry F"Nl>S A&Ilj 2�'7 A�mF SMivO mN S/1> 5. 'LOG S T t APT. 6 LOrAO IAJ4 GARAOI rY 460 _.<r rw S 0.74 G.a�/�Ft 3-4U >1ARmsvrH GAmpGRorwv .4ssmrs�.4r/cru, Lvc. K�P.�c•�€ c 462//39d l D1-!57_/,r3U r10 r Bmx Q G D8--9 H2O 03/2*//974 L.G, p A"..,35`030A; .,S✓mp-sv" A%-K. 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