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HomeMy WebLinkAbout0101 FOURTH AVENUE (HYANNIS) - Health W.HYANNYSPORT 101,I'OURT'HAVE., A=246-097 5 e � ° o i o I ° TOWN OF BARNMULE LOCATION /0/ I�OU/'T z?w, SEWAGE * 97&1?p VILLAGE �� Cj/J�II5 �f3� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 0a� 1 C4/.�ST 77/"�✓2�9 SEPTIC TANK CAPACITY f.5-no Caj N I D LEACHING FACILITY: Lcack ,CA " 2� rcx S (type) �'� (size) IG x��7 413. ) NO.OF BEDROOMS BUILDER OR(j N ,/%QCCGlfO/?+G PERMIT DATE: COMPLIANCE DATE: 1� -- �'a 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 C � o o` � � 1 � i � v i G Dli- tD G �1 op f ti 1 s • 1 �-- TOWN OF BARNSTABLE x LOCATION 1_ / �fA 4ue 11baRmr - SEWAGE # VILLAGE , ,� a ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY to 190 q�Q LEACHING FACILITY:(type) , (size) 00 D NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER (IL) IM-a DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r 3l ` o s o_ t,� o 3� �� i i lam— - c�� � No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pphLdtton for Mt!5po2;aI bpgtem Conotrurtton Vermtt Application for a Permit to Construct( )Repair/Upgrade( )Abandon( ) IM Complete System ❑Individual Components Location Address or Lot No. ®� � Owner's Narye,Address and Tel.No. Assessor's Map/Parcel 11 ye��/� � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 71-1391 Type of Building: ,J Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder(_1W Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L/ gallons per day. Calculated daily flow Z>� //ep gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ®© 4VI Type of S.A.S. 7—_Z0 Description of Soil ���f.�/it'3�2�7 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 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued' y th' B` d Healt l Signed Date Application Approved by — Date Application Disapproved for the following reasons Permit No. Date Issued �" r z7f/off '• No. Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered in computei: Yes 4 .PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS , ZippYication for Mtgogal 6pgtem Construction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) L complete System O Individual Components Location Address or Lot No. D/ ��� �vL/ Owner's N e,Address and Tel.No. Assessor's Map/Parcel W r y/��/t� ®r ���� y � l/ l . Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. c,rw ,BOf 7-0Ca�`i 7 7/-939� I Type of Building: Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder(--w Other Type oftuilding /Q2.sPeWLe No.of Persons Showers( ) Cafeteria( ) Other Fixtures 'J Design Flow gallons per day. Calculated daily flow• gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /1.�®a Type of S.A.S. 1 Z Description of Soil /6 1wX 3y�J—x 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 En ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued thi B d Healt l',J Signed Date Application Approved by '" Date Application Disapproved for the following-re asons Permit No. " t,.._. Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( <pgraded( ) Abandoned( )by OQl'X04�1 C4/l5 at 0/ �0�7` Grl� W /� li'�1�!%5 /1 as been constructed in accordance with the provi 'ions of Title 5 and the for Disposal System Construction Permit No. "' dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --———— e———————————————————————————-- No. �"�/ Zed 7 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -,BARNSTABLES MASSACHUSETTS miqosar *pstert. onstruction Permit Permission is herebyanted to Cons ct )Repair '!' U rade Abandon System located at r 1D'I!h%5 4der 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:JJConstruction must be com leted within three years of the date of thi a t. ~Date: J Approved b E r 10/9/97 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) hereby certify that the application for disposal works construction permit signed by me dated 1..11E�197 , concerning the property located at 14V AW 4 meets all of the following criteria: Y1/ here are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed Y ere 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=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) Z�� 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 posesses a certified plot plan, this plan should be submitted]. q:health folder.cert .ti p53" C8 of fl .4 0 0 S I J � Gov���} /-�s✓�. TOWN OF BARNSTABLE LOCATION IDI OU,^T a SEWAGE # Q'7 4Tf VILLAGE �� �yaar�Is dRy" ASSESSOR'S.MAP & LOT INSTALLER'S NAME&PHONE NO. 0 � f�d/�ST 77/`�✓a�� SEPTIC TANK CAPACITY 1.5 Gct I H l o , Lcnch ,clod ',LEACHING FACILITY: (type) F'• (size) IG x,77 / ..NO.-OF BEDROOMS y ' :'BUILDER L OR . WNE PERMITDATE: /�` Z6-97 COMPLIANCE DATE: 1�--� 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 F ,/:9 b ` d Q _ by 9