The URL can be used to link to this page

Home My WebLink About0040 FIFTH AVENUE (HYANNIS) - Health 40 FIFTH AVE. , W. HYANNISPORT A=246-188 r TOWN OF BARNSTABLE LOCATION <10 S AV SEWAGE # 7 VILLAGE Gv l�l�) '� ] ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.. &0 SEPTIC TANK CAPACITY /0 c's+ LEACHING FACII.TTY: (type) 3— /J 2. .� /�s (size)�C� NO.OF BEDROOMS Z 3 BUILDER OR OWNER 2g,C'21 PERMITDATE: .l>—'-A 3^'�7 COMPLIANCE DATE: 9`-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 .,� �.. � \ � � ,� � � 1� ��' f -3 ��` } i� No. +� Fee $50 .00 !/ls� THE COMMONWEA OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pphration for Migozal bpfstem Construction Permit . Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 40 Fifth Ave Owner's Name,Address and Tel.No. ( 7 0 3 ) 7 6 8—4 5 8 0 Assessor'sMap/Parcel W Hyannisport, MA Mr & Mrs Robert Dyer ;? 6102 Bayliss Pl, Alexandria, VA 22 10 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Sept Srv. PO Box 1089 , Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 2/3 Lot Size sq. ft. Garbage Grinder Po) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures I 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) Title 5 Septic Repair consisting of new D—box, and 3 stonepacked infiltrators. 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 and Health. Signed J Date Application Approved by -.VK Date Application Disapproved for the following reasons Permit No. -f Date Issued 'YOWN Uf� BARNS AliLE LOCATION ��o S 1 AV SEWAGE # 9 7 VILLAGE Gv -, 1406 2 1 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.�� "'�a '"' ?7,S^�'7 7 l� SEPTIC TANK CAPACITY /Ca 13 A LEACHING mcmrm (type) 3— N�O I.� /�s (size)AG -� S NO:OF BEDROOMS Z"3 BUILDER OR OWNER 12&tc:,- PERMIT DATE: 7 COMPLIANCE DATE: 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 a. . i No. z - !.. u Fee $5 0.0 0 THE COMMONWEA OF MASSACHUSETTS Entered in computer: y Yes PUBLIC HEALTHdDIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Miopogat 6potem Conotruction permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 40 Fifth Ave Owner's Name,Address and Tel.No. (7 0 3)7 6 8—4 5 8 0 Assessor'sMapTarcel W Hyannisport, MA Mr & Mrs Robert Dyer 6102 Bayliss P1, Alexandria, VA 22 10. Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Sept Srv.. PO Box 1089, Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 2/3' Lot,Size sq.ft. Garbage Grinder 00) Other Type of Building No. yf Pao Showers( ) Cafeteria( ) Other Fixtures 7 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. rK Description of Soil sand 1 �r v Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic Repair consisting of neF p-box, and 3 stonepicked infiltrators. 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 and Health. Sign Date 3 — Application Approved byed Date* Application Disapproved for the following reasons Permit No.. lye Issued ---- LL ——————— --�� ''—=--- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Dyer Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X )Upgraded Abandoned( )by at 40 Fifth Ave,, QW11yannisportr MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N --7--Zj dated Installer Wm E Robinson Sr Sept SrV Designer The issuance of this permit shalLnot b� trued as a guarantee that the sys will function as designed.. g Date � Inspector ci No. � �� -------------------- -------—Fee $50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Dyer lwigoar *pztem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 40 Fifth Ave W Hyannisport, MA 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 it. Date: - " '-'-7 C-7 !2 'Z b.Approved �--,' -" l 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 DESIGNED PLANS] I,William E. Robinson, Sr.,hereby certify that the application for disposal works construction permit signed by me dated - - 3-5 ."7 concerning the property located at 40 Fifth Avenue,W II a� nnisport, MA meets all of the following criteria: .; �/Th re are no wetlands within 300 feet of the proposed septic system. * There are no private wells within 150 feet of the proposed septic system. y The obseved groundwater table.is 14 feet or greater below the bottom of the leaching facility. Lf T ere is no increase in flow and/or change in use proposed. There are no variances requested or needed. SIGNED: t ( DATE � LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification plot plan,this plan should be submitted). , S -65 1 � I� J