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Home My WebLink About0136 FOURTH AVENUE (HYANNIS) - Health 1 r '0' Avg 245-1.21 West`H ann s ort a I i o • o D 1 a TOWN OF BARNSTABLE LOCATION 136 L//;rA Ve SEWAGE # VILLAGE IV, N 44 w i2p Q F ASSESSOR'S MAP & LOT4! INSTALLER'S NAME&PHONE NO. Mb C-IjU SC;af [— 732-Od A z SEPTIC TANK CAPACITY Cam+ l LEACHING FACILITY: (type) /A F1 kRoq k)k& �� (size) I x 30 X NO.OF BEDROOMS 3 BUILDER OR OWNER_ zom PERMTTDATE: 140 "'`IF= COMPLIANCE DATE: Al 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 facili Feet Furnished by Z w _ 0 U. r No. /" ' Fee 1-402C 9 ~ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppiication for 3igpogal *pztem Con.5truction Permit Application for a Permit to Construct( )Repair(--rupgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. 136 F04/o-0� gv< Owner's Name,,Address and Tel.No.•L(,Q l7.aLa C �!/YL >✓s P V\ 1 ��t.�LQ Assessor's Map/Parcel In^sttaller's Name,Address,+and Tel.No. Designer's Name,Address and Tel.No. 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 7 15— 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 Nature of Repairs or Alterations(Answer when applicable) ��t��1!.1( ,e 1 L-nac,- c L h, 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 nvironmental Code nd not to lace the system in operation until a Certifi- cate of Compliance has been issued b this Bo o alth. q Signe Date A� / �! Application Approved by Date /G*,- Application Disapproved for the following reasons 1 Permit No. Date Issued �� 4.1�'-�'`/- '..y*`'' "�:'.1'r•"r'1,r^vi,,.r+w•"•it•'"`,r i.,�+,�;{�.;*,s,:.,;.t. ,M.�ra...-.FV�'L,.,r.i` �.,,. { ' .:L' , 4` .. . _. . ,M.i. t.t'Z. ` No. Fee , 4 i 9lh _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i o Yes 5 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication -for Mi.5pogal *pgtem Cougtructton Permit Application for a Permit to Construct( )Repair(,,,upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No.136 -✓4� �� Owner's Name,Address and Tel.No. n v4T_ ,=SP`^ ' coo f` D Assessor's Map/Parcel � 0 Ju �� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Mob--unpe—See(At Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) 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 D' to Title i Size of Septic Tank Type of S.A.S. Description of Soil j e' Nature of Repairs or Alterations(Answer when applicable) 'a,, 1 c U 1 1 Date last inspected: ; Agreement: 4 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 nd not to lace the system in operation until a Certifi- cate of Compliance has been issued by this Boaealt . Signe Date Application Approved by Date /�/.• �f'.r-// Application Disapproved for the follow i g reasons Permit No. Date Issued ————————————=' —————————————————————————— THE"COMMONWEALTH OF MASSACHUSETTS. BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( " ) Repaired (L,4-epgraded ( ) Abandoned( )by M' 0-(=(&0=e at C: ` zm4 has been constructed in accordance with the provisions of de 5 and the for Disposal System Construction P rmit No. « dated 40 Installer Designer .- The issuance of this permit&11not be consitired as a guarantee that the s st i unction as d •fined. Date -9,4e Inspect ——————————————;—————————————--————————— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 't Migpogal 6pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(,/tUpgrade( )Abandon( ) System located at 4 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 pe Date: ,�/S �l �-- �it� Approved by CERTIFICATION OF SKETCII AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, ✓� hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at / �(� �� tie ��`� meets all of the following criteria: tic • There are no wetlands within 300 feet of the proposed septic system There are no private wells within 15o feet of the proposed septic system 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. SIGNED : DATE: `� LICENSED SEPTIC,SEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER YST [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. � I . . .n �� J _�. s � '. — i � c a _ \� 1 1�1 � ^ l / �V �/1/ V I ' T `^ I 1 9 �J ` r �f TY �, ��! � ,