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Home My WebLink About0045 CHESTNUT STREET - Health 45 CHESTNUT ST. ,HYANNIS MAP-309, PAR-117 TOWN OF BARNSTABLE � ` LOCATION / &S�UT'- SJ SEWAGE # VILLAGE'1 T�/-4_5 ASSESSOR'S MAP& LOT ?C f INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY J 00d76! LEACHING FACILITY: (type) f �►Cc�,tl_TT� aL�' ( �size) �r�r "' _ NO.OF BEDROOMS 3 BUILDER OR OWNER Max, PERMTTDATE: : ' COMPLIANCE DATE: ;Z — 7 c/ `7 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 I a W _0No. Fee 1— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for �Digpozar �bpttem Com6truction Vermtt Application for a Permit to Construct( )Repair(V<u"'pgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. y-5 C Cam^ ST, Owner's Name,Address and Tel.No. Assessor's Map/Parcel W+j14 .3 0 I IT Instalame,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 330 gallons per day. Calculated daily flow YYZ) _ gallons.. Plan Date Number of sheets Revision Date Title Size of Septic Tank T 0 Type of S.A.S. J415,A Description of Soil r Nature of Repai or Alterations(Answer when applicable) Gw t( -ys�m 1 i r L , 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 ' is Bo i Signed Date Application Approved by Date Application Disapproved for the o owing easons Permit No. Date Issued (lip 30 No. — J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp11 uter. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE} MASSACHUSETTS ZippYicatton for Migooar *p!5tem Con6truction Permit • Application for a Permit to Construct Repair(1/� rade( )Abandon ❑Complete System ❑Individual Components PP� ( ) P Pg ( ) P Y P Location Address or Lot No. y S ST Owner's Name,Address and Tel.No.c Assessor's Map/Parcel - 3 , � 7 Instal ,'s:Name,Aodmaynd Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) (,Qther Type of Building No-of Persons Showers( ) Cafeteria( ) . Other Fixtures Design Flow 330 gallons per day. Calculated daily flow -J gallons. Plan Date Number of sheets Revision Date i Title t- Size of Septic Tank a a tk Type of S.A.S. Description of Soil 10 S {q- 'S� Nature of Repai orA terations(Answer when applicable) Date last inspected: Agreement: � �. ., The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage dis @sal 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 's Bo . ofAaa Signed N�Late�= Application Approved by ate 7- !�7 Application Disapproved for the fo owing easons 1 Permit No. Date Issued ----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Eertificate of (Compliance THIS IS TO C tha the O - ' wa a Dis osal System Constructed( )Repaired( )Upgraded( ✓f'"� Abandoned( )by o a ipe ✓ ... at LA s c ,-,S NkTk -5r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r dated Installer /. Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date G .Inspector `l ---g------------------------------------ No. f �J�r Fee � i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpog;ar *pgtem (Congtructton Permit Permission is hereby granted to Construct( )Repai�jL.,�<rade( )Abandon(i) System located at Y� G �'S A-L,-r 5/ 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. e Date:_ - „S 7 Approved by 1 NOTICE: This Form is to be used for the Repair of Failed Septic Systems-Only I ` e _ CERTIFICATION OF SKETCH AN6,APPLICATION FOR A DISPOSAL �..: ... WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) Ic ._, hereby certify that the application for disposal works construction permit signed by me dated a7- concerting the property located at �� -��IT S� �f 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. SIGNED: DATE: LICENSED SEPTI SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. R 1 F TOWN OF BARNSTABLE f LOCATION SEWAGE # VILLAGE 'f ic1 ttil ASSESSOR'S MAP & LOT ? - l INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 7- LEACHING FACILITY: (type) h C�, —,`��`1(size) 222�4 NO.OF BEDROOMS— BUILDER OR OWNER r PERMIT DATE: ?7 - I - COMPLIANCE DATE: - 7 ` >7 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Ch eull 4 . i 6 b k