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HomeMy WebLinkAbout0140 DOLPHIN LANE - Health 140 DOLPHIN LANE,HYANNIS A=268-173 .1_„ TOWN OF BARNSTABLE LOCATION/5"6 ��1� �'— ��' SEWAGE # �+ VII.LAGEi1c, ASSESSOR'S MAP & LOT 0 INSTALLER'S NAME&PHONE NO. /,4,S 7 '7S'_777 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) /,P--AS—� NO.OF BEDROOMS 3 BUILDER OR OWNER A ✓i PERMITDATE:/ COMPLIANCE DATE: -'S Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 R Cn r . . S A ' 3 No. 0 i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS L. OU Zi prication for Dkoo.5al 6p5tem Con.5truction Permit Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 140 Dolphin Ln. Owner's,Name Address and Tel.No. Hyannis , MA 02601 even began Assessor's Map/Parcel 40 Dolphin Ln. ,Hyannis, YA taller' am Ad Tess,and Tel.No. Designer's Name,Address and Tel.No. m. eR(o inson Septic Service P.O . Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. 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 Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) 1 00 gam t in tartk� a D_bAx and. two H-10 stonepacked. precast leach chambers . 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 de and not to place the system in operation until a Certifi- cate of Compliance has been issue by this B d He`a_lth. l` Signed k Co Date / 0, fir Application Approved by f �t/ Date ` Application Disapproved for the following reasons Permit No. -=WZ Date Issued u TOWN OF BARNSTABLE LOCATION/�d vol ti- SEWAGE # VILLAGE Lli /-/y ASSESSOR'S MAP& LOT 0 J� INSTALLER'S NAME&PHONE NO. FOL' �'A-< a SEPTIC TANK CAPACITY l.Sd`G LEACHING FACILrrY: (type') — —,� L C (size) rod-oZe"2, NO.OF BEDROOMS .� I i BUILDER OR OWNER �.. PERMTTDATE: p / — r COMPLIANCE DATE• Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 .100, ... ` 7 4 i M w �.«a'.�-r'� �!"' y' 'ha;p .. --. ..tr;y;Tiv.:na✓.r•-^- .rn� � .'x' .r..y 7.�...-.+,.-�}*..i .. _ O F V No. I�VJJ -'H !t Fee` 5 �l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. 05- es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS _j /� ZIppYication for Mizpool 6pgtem Construction Permit `k Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 140 Dolphin Ln+ ner's,Name Address and Tel.No. 4 Hyannis, MA 02601 1vin Megan Assessor's Map/Parcel0 Dolphin Ln. ,Hyannis, MA Inset.er's,.t,Vame�lddrss11anndo�1e11.N�o�p�iC Service Designer's Name,Address and Tel.No. tNP.O .J!'Box t11089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.;ft. 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 Title y. Size of Septic Tank Type of S.A.S. Description of Soil and Nature of Repairs or Alterations-(Answer when applicable) 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 a and not to place the system in operation until a Certifi- cate of Compliance has been issued by this B9ard Health. / /` Signed . d Co c Date 1 Application"Approved by 2,,eQ Date _ Application Disapproved for the following reasons C �` Permit No. Date Issued I f THE COMMONWEALTH OF MASSACHUSETTS Regan BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO C)Ig ,,that-t O -s to ewe e DD�� osk1,S stteem Constructed( )Repaired(�' )Upgraded( ) uut�.FYx:,,. tt�ebl�'l�o� ��}�`G�C a�"V1CG Abanjd4Wd(bo fl - ._ ' is at ' 1 constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer WM+ E. Robinson Septic S er. Designer v 11 The issuance of this permit,shalYnot be construed as a guarantee that the system will functions s designXe^l�. , Date Inspectora'l /M L/ — Fee ---- -------------------ego �- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Regan Xgizpoar *pme Conotruction Permit r Permission is hereby anted to Construct( )Repair( )Upgrade( )Abandon( . ) Jwn System located at 0 Dolphin Ln. , Hyannis ri ' and as(( described in the above Application for Disposal System Construction Permit. The applicant recognizes s/her duty to,r ' omply with Title 5 and the following local provisions or special conditions. G © Provided: Construction ust be Completed within three years of the date of tl�t� t. Date: / Approved by ��� �✓ (i mo NOTICE: This Form Is To Be Used For The Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated a �'' concerning the property located at 140 Dolphin Lane, Hyannis, MA meets all of the following criteria: * e are no wetlands within 100 feet of the proposed leaching facility. * T re re no private wells within 150 feet of the proposed septic system. * is no increase in flow and/or change in use proposed. * T o variances requested or needed. * If the proposed leaching facility will be located with 250 feet of any wetlands, the bottom of the proposed leaching facility will not 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) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: �.� y / DATE..Z LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). G (� �- c� ," Y� �' _ �{ p,, '�� / � . . p ���. a \ w� .— e