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Home My WebLink About0139 FIFTH AVENUE (HYANNIS) - Health 139 FIFTH AVE. ,HYANNIS A 245 099 TOWN OF BARNSTABLE } LOCATION .n A �� SEWAGE # `��® VILLAGE +� ASSESSOR'S MAP&LOT INSTALLER' NAME&PHONE NO. SEPTIC TANK CAPACITY SUS LEACHING FACILITY: (ty ) 3 (size) NO.OF BEDROOMS BUILDER OR OWNE 1 PERMTTDATE: 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 �/ • Q �a � ��- `y �. ®� � � , . � C� a o a" � �. � � ! �, . � of No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rtlphratton for Mt 5 p6tem Cow6trurtton Verm t Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 139 Owner's Name,Address and Tel.No. .W - l�Yo��r.a� Assessor's Map/Parcel tJ 0 Installer'si Name Address,and Tel SNo Designer's Name,Address and Tel.No. i 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 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 0-t `Z, �h��✓ Sa n�� Nature of Repairs or rations(Answer when applicable) l--g,\ hc.a h 5DO R. 3 - Sa o //o►, w 3' Sane "o U � 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 Boarjd of Health. Signedj,/_� 44 Date Application Approved by iW Date Application Disapproved or the following reas ns Permit No. Date Issued No. q"o Fee THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: - _ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for 3D igJOgp5tem CCOngtruction hermit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. '/39 Fi ,I, L ' Owner's Name,Address and Tel.No. W- Ia�,c�v.r.�� Qnr-T r.10.�f NUQev`'r" Assessor's Map/Parcel 2 S to O 01 Installer's ame Address,and Tel No. Designer's Name,Address and Tel.No. - 3 Sc �sawy tr.�2. 14 1 Z - Typeaof Building: DwellingNo.of Bedrooms _ Lot Size s .ft. Garbage Grinder 9 g 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 O-2 Nature of Repairs or�}�e ations_(,A swer when applicable) l v.St�.1\ 3 - S 6 O -?A OK 1 [mac '9 S rave / rau C NJ J r 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 Bo d of Health. Sign as Date ,-:Application Approved by gs_—Date Application Disapproved for the following,rea ns J Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - _ certificate of (tompriance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(V )Upgraded( ) Abandoned( )bys�- at IS9 be constructed in accordance with the provisions of Title 5 and the for Disposal System Construction ermit No. dated i Installer Designer The issuance of this permit sha/�1 no be co tx s a guarantee that the sys w'11 function as des gned, Date 1 Inspector _0 J N . -- — - No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigpozal *ps�tem Construction Permit Permission is hereby granted to Construct( )Repair( VUpgrade( - )Abandon( ) System located at 39 tJ . t�yc.Y.r.,s 1te.-r r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes hi /her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons tion m st be mpleted within three years of the date offtlAd Date: Approved byzf LAI I TOWN OF BARNSTABLE LOCATION SEWAGE # 7� VILLAGE ASSESSOR'S MAP & LOT 7 INSTALLER' NAME&PHONE NO. SEPTIC TANK CAPACITY SUU LEACHING FAca rrY: (ty ) 3 J (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 30G feet of leaching facility) Feet Furnished by d Ik �'Sao 1/669 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF S-RITCH :_ND :APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLAYS) hereby ce-uz'y that the application for disposal worts cons=c-,1on pe.,nit simied by me dated 11-/G - 9 9 concerning the property locaied at l3g �� _ meets all of the following criteria: • /• T ^ he faiied system is canneed cc a residential dwelling only. mere are no commercial or business 1vv/ uses assocated with the dwellline. •/The soil is classified as CLASS 1 and the percolation rate is less Chan or equal cc 5 minutes per inch. Vt✓ T'nere are no wetlands within 100 `ee;of the proposed septic srsern •V T•nere are no private wells within 1:0 feet of the orogosed septic srsern •V Tnere is no inc=se in flow and/or change in use proposed •" Tnere are ao variances requested or needed. (-, i fie bottom of the proposed leachin;facliry wiil not be located less than five iee;above the ma..dmm u adjusted groundwater table elevation. [Adjust the goundwater table using the F rimptor medhcd when applicable] l, If he S.A.S. will be located witlt '50 fee:of an-'vegetated wetlands, the bottom of*he proposed leactung facility will not be located!east han feureen(1 4) felt above the maximum adiusted g_*oundw•ater table e!evador- Ple.-Ue complete the following: ?) Too of Ground Sur-.ace elevation(using GiS inlormauon) o�oL B) G.W. Elevauon -the =i,h G.W. a.diusme t . = y D=-RENCE E!E T NEON A and B SiGN+cD DATE: /!—/b _y (Shetca orocosed plan of system on back' q:`al h"older: c c a a C r R ' Y F N1