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Home My WebLink About0019 ARROWHEAD DRIVE - Health 19 ARROWHEAD DR. , - HYANNIS A=271-103 x v 1 tl c _ , e '^ Qi TOWN OF BARNSTABLE SEWAGE # -�i ASSESSOR'S MAP&'LOT S�`�i&3— ° INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) . -1 .'t� ��(size) f Sim NO.OF BEDROOMS BUILDER OR OWNER r PERMTTDATE: U 1I(-, /611'—i COMPLIANCE DATE: Separation Distance Between the: `` ee 11� Maximum Adjusted Groundwater Table and Bottoofof Leachit g Facilitly Feet ,,. e Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet oQeaching facility) /. - Feet Edge of Wetland and Leaching Facility(If any wetlands exist - within.100 feet f leaching facility t �s\ - Feet . Furnished by - 75 Ell) �I lJ J ,0 3 p No. / 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppiication for Migogat *pgtem Cougtruction Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 17 A rc-0O r\JC.� 5 q&ersC I Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ^� Dwelling No.of Bedrooms J Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. i Plan Date Number of sheets Revision Date Title Description of Soil Na re of Repairs or Alterations(Answer when applicable) AJ S�y-� Date last inspected: i 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 � Signed � s�-�C" Date Application Approved by Application Disapproved for the fo owing easons U I Permit No. 76 - 1, 7 Date Issued 14 / G 03 No. / '� .13 7 w Fee ^"' j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION =TOWN OF-BARNSTABLE., MASSACHUSETT, _ fl 0(ppYication for Migonl *pgtem Construction Permit Application is hereby made for a Permit to Construct pp y ( )or Repair(L./)an On-site Sewage Disposal System at: f Location Address or Lot No. Owner's Name,Address and Tel.No. 1.7 Arc-o�-1�c,8 ZZ—, s Cza r vz, rS?.a c.c Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 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 1 Title Description of Soil NE!ture of Repairs or Alterations(Answer when applicable) AJ O c4 cL.Stys-S w/y e C'fC 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 Signed r SLR--b�c Date Application Approved by Application Disapproved for the fo owing easons ` Permit No. Date Issued• //' / � —_----- ------------------.------�THE COMMONWEALTH OF MASSACHUSETTS 1 PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS I Certificate of Compliance r THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( P f on by SC �-�t1\ _ for 2d 9zk 1tC=Z&_ 9 F Cc 60 jz�)C- ' G has been constructed in accordance with the provisions of Title 5 and the for Disposal-System Construction Permit No. G- dated Use of this system is conditioned on compliance with the provisions set below: -- -- -------_— No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS I PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS Mig;pogal *pgtem Construction Permit Permission is hereby granted to to construct( )repair( clan On-site Sewage System located at ot..> t- -a- c;,-r Qrr 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. All construction must be completed within two years of the date below. t CDate: Approved by , i CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated G (t to c , concerning the property located at Z c t cr- k \� meets all of the following criteria: */There are no wetlands within 300 feet of the proposed septic system ✓ There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility ✓ There is no increase in flow and/or change in:use proposed ,✓ There are no variances requested or needed. C , SIGNED: DATE: 1 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUrABER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. �r J- otJ Pik ---4 S 7------ T�.... 5EW_ _ -C4E_P_ER.MIT_1.10.= ST-AL L E-R-S 30i�� 5U-1-LD-E--R 5 Q-A1�/1E- -AD-D-R-E-SS -S D-Q►TE-P-E-R-tv�1T ISSUE-D-, -_ ��_--- - - D-AT_E-CO-M.P-L-I-AJ--l-CE-1_SS U ED n Ira ' UJI Rl a •