HomeMy WebLinkAbout0199 BUCKWOOD DRIVE - Health 199 Buckwood Drive
Hyannis _
A= 171-116-001
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f TOWN OF BARNSTABLE
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' LOCATION /�7 '� G� � SEWAGE #
VILLAGE Sil1VP)S �1 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY / gray G�L
LEACHING FACILITY: (type) �il1'�,4�m JOr'J A/ (size) Y X 33 A o� �
NO.OF BEDROOMS
WNERSBUILDER OR - ,i�lS�1D/�I A
PERMITDATE: Al �X COMPLIANCE DATE: /"
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �f Feet.
Private Water Supply Well and Leaching Facility (If any,wells exist
on site or within 200 feet of leaching facility) "_, �9 -Feet`
Edge of Wetland and Leaching Facility(If any wetlands exist �/
within 300 feet of le hing facility) /1 4 Feet
Furnished by
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No. i�� �ee'
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Application for Migogal *pgtem Com5truction 3permit
Application for a Permit to Construct( )Repair( /)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel, Z ee,-W, t rc�J�h� 1/ef 10k , Wr17
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. / v�6
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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 yo 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
�Natureof epairs or Alterations(Answer henapplic�le)
t✓I oeuun � �
e�ea ',x �,r Z •
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction 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' d o th.
Signed Date
Application Approved by Date O
Application Disapproved for the ollowt g reasons
Permit No L LDate Issued
No. �, �L,��i 3 Fee �'��
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS
_application for Digpogal *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair Upgrade( ' ')Abandon( ) O Complete System ❑Individual Components
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Location Address or Lot No. Owner's Name,Address and Tel.No.
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Assessor's Map/Parcel7-1
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Aeffz;Lo/f`i L'm_47
7 ZZ- 39
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder�elo
t Other Type of Building SipN/_'E' No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 4149 gallons.
Plan Date Number of sheets Revision Date
Title
i
Size of Septic Tank Type of S.A.S.
Description of Soil
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4
Nature of Repairs or Alterations(Answer when applica le) C!' O_Spy a#Date last inspected:
i
Agreement:'
The undersigned agrees to ensure the construction , n' wa,� 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 b• thi Bo d of ealth.
Signed Date /2
Application Approved by Date /d
Application Disapproved for the llow reasons
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Permit No. Date Issued
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THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( Upgraded( )
Abandoned( )by
at_ o 9 .y i has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated I
Installer &Z 624,'Z' h., Designer
The issuance of this permit shall not be co trued as a guarantee that the s s i function as de tgned.
Date ; �e 9 Inspector �.� 5� P
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No. — Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Digpogar *pgtem Congtruction hermit
Permission is her granted to Construct( )Repair(►Upgrade( )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 conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date: //9 --�j Approved by �\
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CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMI T MI'TIIOUT DESIGNED PLANS)
Arin�jf�`ihereby certify that the application for disposal works
construction signed ned by me dated �D�2—�l�� concerning the
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property located at/ � �•� � ��" ZxLO—W11-5 meets all of the
following criteria:
f `acre arc no wc!lands w111fln Jon fcct oNie nrimosed scpilc system
,0 Here arc no privnic wc:ls within i so fee! of the proposed septic system
�4ic obsc, emnnd��ater i�bie s i fe^t �r �rcater heioiv the aottom of the !enc.tin$ facility
w :'ic=e is no incrcnse in lo«• and/or_hnn2e :n ,jse ,7rovosed
/Icre are no-;nrinnc-cs-,cjuestey or ne^aed.
SIGNED
DATE:
LICENSED SEPTIC SYSTEM INSTALLER IN T14E TOWN OF BARNSTABLE NUMBER
Winch a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submittedl.
Wide
+` MAN