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Home My WebLink About0109 FOURTH AVENUE (HYANNIS) - Health 109 ,Fourth Ave es s o o i I i I o - ° i TOWN OF BARNSTABLE LOCATION _ �B�i� SEWAGE # .VILLAGE AgZW,,r &4Z ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 10711)-C�o� C/J'ir 'SE:P-TIC TANK CAPACITY /s �[7 LEACHING FACILITY: (type) b//��1-✓l� .n (size) L*&A y4k �J'o,it, :NO:OF BEDROOMS BITIL.DER OR OWNER PERMUDATE: R -4 - ?7 COMPLIANCE DATE: Separation Distance Between the: Miximum 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 Furrusled by i 22 1 . TOWN OF BARNSTABLE rINSTALLER'S N /�'/ /9�t� SEWAGE # �d1 ,/ ASSESSOR'S MAP & LOT NAME&PHONE NO. zW1Z)-CV r ANK CAPACITYG FACILITY: (type) b/��1-e�'�� (size) �' cftlA y 4L avi� NO.OF BEDROOMS BUILDER OR OWNER IG PERMIT DATE: S`" - 7 COMPLIANCE DATE: 00 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 ,�4 � i I i d � � N. �' 'I � �\ � L \ ?, 1 1 No. 00 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mtgopl *pgtem Construction Permit Application for a Permit to Construct( )Repair(Xpgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.%Oct 1 cu Nk--P, Owner's Name,Address d Tel.No. Assessor's Map/Pare. Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. �42 141 Type of Building: , p Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y �4 0 gallons per day. Calculated daily flow .tA S gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank i SOI �) Type of S.A.S. N4_%S,�.�T! 'VX j!�`Le Description of Soil To 5t> L Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' Agreement: The undersigned agrees to ensure the construction and maintenance of the fore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code an of to place the system in operation until a Certifi- cate of Compliance has been issued b this B th. r Signed Date -q7 t. Application Approved by o Date Application Disapproved for the following reasons Permit No. Date Issued f— No. V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 0pprication for M!6pogal *pgtem Cone4ruction Permit Application for a Permit to Construct( )Repair(1/')Upgrade( )Abandon( ) ❑Complete System El Individual Components_ Y Location Address or Lot No. `QQ Y'"CVI- "0. Owner's Name,Address�qd Tel.No. ��C.�,w.ts �Jor't" l'%oT Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: 14 Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y y 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank SM S)I� yuJ Type of S.A.S. 'S\-, Cc, �-- Description of Soil 1\C0 Sr,� ''Nature of Repairs or Alterations(Answer when applicable) =N-bTo_kk �� 16L Date last inspected: Agreement: The under geed 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 b this B eal Signed ® Date - ` ,.��Application Approved by o ' Date Application Disapproved for the followmg'reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETT.§,�' Certificate of (Compliance �r .THIS IS TO CERR t the O Swage tsposal•System Constructed( )Repaired( ) Upgraded ( ) Abandoned( : )by ►` f� V� _ at O C\ l h b n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ' dated Installeri. Designer The issuance of this permit shall not be!7strued as a guarantee that the system will function as.-designed. Date 7 Inspector - ---------------------------- No. t Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS 'Wigpogar *pgtem on0truction Permit Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon.( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant reco nizes "s/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons cttion t be completed within three years of the date Is pe i . �f Date:' ( Approved by / 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) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at \® q 1:��1� � � meets all of the following criteria: .V • There are no wetlands within 300 feet of the proposed septic system o There are no private wells within 150 feet of the proposed septic system • i • 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. ; I i I • I SI D : DATE: 7 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER' I I [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. I ' I . t +I t . V 9� '' hh QQ V • R TIFI T PLOT PLAN I 1� -1� - f3 Ll p p" O�t� 1101 FOURTH AVENUE MAP 246 PARCEL 97 I N/F KENNETH MACCARONE, ELIZABE/H ANN MACCARONE, STEPHEN MACCARONE & LINDA M. BOURBEAU DEED BOOK 27449 PAGE 266 B100.00' I GRAVEL I : DRIVEWAY EXISANG I gl DECK 24.9'— — I 3 ^ 1 .00 PORTLCLN OF j°po EXISTING DECK I I / LLj 2 TO BE REMOVED w q PROPOSED/ ( I I $ I ON n! �N Nw�ado m Ad cN O ODRW FVIW 'snASSESSORS 550 S.F. ENG No MAP 245 0 DWELLING S PARCEL 112 7,968f S.F. F y . gmOR 018f ACRES a 33.9' •00 z 29.7' M io in 1 4- _ 100.00 _ _ _ S87.19 V IV 117 FOURTH AVENUE ,I' • � 245 PARCEL 111 J - -- g N/F ROBIN GOODBAND, j o 4i RICHARD H. SCHOFIELD & DAWD W, SCHORELD DEED BOOK 18905 PAGE 271 d Qa w O ZONING DISTRICT: RECORD OWNER: RESIDENTAIL RB ASSESSOR'S MAP 245 PARCEL. 112 . KEVIN P. AND PATRICIA ELLIOTT 8 JEWETT TERRACE WORC.ESTER, MA 01605 DEED BOOK 3803 PAGE 246 109 FOURTH AV' ENUE H_YANN11S ,' MA CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE PROPOSED ADDITION SHOWN HEREON IS IN COMPLIANCE WITH FRONT, SIDE AND REAR N OF M SETBACK REQUIREMENTS AS NOTED IN TOWN OF BARNSTABLE ZONING BYLAW AND IS NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. SHANE M: tiN o U BRENNER THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO NO.45917 ESTABLISH PROPERTY LINES. ��Fss�o�G/STEX' Q PREPARED BY• BAXTER NYE ENGINEERING & SURVEYING Registered Professional Engineers and Land Surveyors DATE: DECEMBER 3, 2013 78 North Street- 3rd Floor, Hyannis, Massachusetts 02601 SCALE 1"= 20' Phone'- (508) 771-7502 Fax - (508) 771-7622 JOB No. 2012-020