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Home My WebLink About0136 CASTLEWOOD CIRCLE - Health 136 Castlewood Circle;Hyannis A=212-051 i a a d 0 [- `TOWN OF B�STABLE LOCATION 3(p -G`�"t UV - k r SEWAGE # VILLAGE— 7 ASSESSOR'S MAP& LOT ,��Oh�1 INSTALLER'S NAME&PHONE NO. C, SEPTIC TANK CAPACITY t V" (O LEACHING FACILITY: pe),J'11,'�e—L S x (size) X j NO.OF BEDROOMS BUILDER OR OWNER _NUr-n eS PERMIT DATE: I I �7 N COMPLIANCE DATE: k 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 //I Feet on site or within 200 feet of leaching facility) - - 1 Edge of Wetland and Leaching Facility(If any wetlands exist-- within 300 few of leaching facilit - A (V Feet Furnished by £ u � ' o9-, LO� fix ® 7-7 ° o, e CI _ No. Fla - Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - PUBLIC HEALTH DIVISION - TOWN OF BARNSTAB•LE., MASSACHUSETTS Yes MN. tr, 01pprication for,aigjn gaf pgtem Con!6truction Permit Application for a Permit to Construct( ,)Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot �No;c�. C�S4Ie c�oocl Owner's Name,Address and Tel.No. �i Gi Assessor's Map/Parcel e� ✓ f / �J v - I taller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ow V Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder.())o 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 Re airs or Iterations(Answer when applic ble) Add 6nKnSC X ,M� 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 Env ode and not to place the system in operation until a Certifi- cate of Compliance has been iss by this Board He Ith. Signed Date Application Approved by r Date Application Disapproved for Mfol0dng reasons Permit No. - Date Issued �_,,, ------ - - - - - - - - - - TOWN OF.Bf.RNSTABLE t CG•S��k:G?U� ( Ci r LOCATION \�`o• SEWAGE-#. ,_f 1_ VILLAGE ASSESSOR'S MAP & LOT_C - �S"I INSTALLER'S NAME&PHONE NO.- V. C1 SEPTIC,TANK CAPACITY' -f X 1 w y O � 0 X. LEACHING FACILITY: pe (size) X. N0.0F BEDROOMS BUILDER OR OWNER .Sw-n es Q_iJG PERMIT DATE: I LI I�l COMPLIANCE DATE: Separation Distance Between the: _ Maxgnum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private:Water Supply Well and Leaching Facility (If any wells exist .oWsite or within 200 feet of leaching facility)' �� Feet Edge of.Wedand and Leaching Facility(If any wetlands exist ryyitliin 300 f of leaching facili r�/�1 Feet' Furnished by �`�....,�--�....r,..:�.--_:_.....�.: - -,-, .-=.rL a- :.:i:. ��.... .-.:::c.y�.' ,._.._ .,t` �.t x.'4q-awi.' --=`:,�,,�;ti:.#•r�,::.r-w=�.+,.- .,::'-�_%;,;;,,�.-..a�e-,L.:.''•h::.+-„r;:: ,E , No. _ 91 Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for Mi gar *r5tem Construction Permit Application for a Permit to Construct Repair )Upgrade( )Abandon( ) O Complete System ❑Indtvtdual Components Location Address or Lot No. ! r Owner's Name,Address and Tel.No. t (� CC,_s-t It v oo r Assessor's Map/Parcel aller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size s' sq. ft. -Garbage-�n:nder Other Type of Building No. of Persons j° Showers/<! ) Cafeteria( ) Other Fixtures ' t Design Flow gallons per day. Calculated daily flow 1 _ gallons. Plan Date Number of sheets t' �'' " `'' Revision Date Title Size of Septic Tank C)UC) Type of S.A.S. Description of Soil Nature of Re airs o lteraitio-ns(Answer when applic ble) Ad o 1 c, � M 1 �� Date last inspected: / J Agreement: 1 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 En Code and not to place the system in operation until a Certifi- cateof Compliance has been iss ed by this Boird He lth. Signed Date Application Approved by Date '2, -'q- 106F Application Disapproved for to follo`Viing reasons ell Permit No. Date Issued ^ r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CFATIFY, that the C -site Sewage Disposal System Constructed( )Repaired (Upgraded( ) Abandoned )by R_5 W 5 at , C G 5 A-\ `J C_ r-'' has been constructed in accordance with the provisions of(Title 5 and the for Disposal System Construction Permit No. - dated Installer IS o \ M V s-w-V` Designer The issuance of this pe t shall not a construed as a guarantee that the system 11 nction as designed. r Date 7 Inspector THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'i5po.5al *pgtem Construction Permit Permission is hereby granted to Construct )Repair(V, Upgrade( )Abandon( ) System located at C S��e_ L.�Ci U a C' r , 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: Approved by �� I it �r r 1019/97 NOTICE: This Form Is To Be Used For.the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPL MAT (WITHOUT DISPOSAL WORKS CONSTRUCTION PER ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the meets all of the property located at following criteria: There are no wetlands located within 100 feet of the proposed leaching facility fThere 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. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W be located less than fourteen.(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) ao.-C/o B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED.: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system.Also If the licensed Installer posessee a certified plot plan, this plan should be submitted]. q:health folder:cert e.. PN!• /, � - '�. E3�� 0 Cx`�� o vv ,, �� `