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Home My WebLink About0055 GUNWALE ROAD - Health 55 Gunwale Road, Hyannis TOWN OF BARNSTABLE LOCATION �'a'yby�c% �C.l� SEWAGE # VILLAGE T �{i�o�'� A �` "" `� --ASSESSOR'S.MAP & LOT ;, ` D6 � INSTAL•LER'S,NAMEi14ONE NO. SEPTIC TANK=CAPACITY 1 SCi)-c �t \6rti> tc— LEACHING F CILITY- (type) it�,hC�e/X:.t:�i'i ML.cL (size) o NO.OF BEDRQOMSBUILDER jOR,OWNER PERMIT DATE: —� �[� —3 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 �; �� t � -. - � is • .,� ,� �� . ` � � � a .. �, i No. y(a S ® Fee J'O d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for Mi5pont *pgtem Cougtruction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot NoZ G ,v � Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Nalmee,Address,and Tel.N . -7 -79-0 fn 8''f Designer's Name,Address and Tel.No. 'Se P" '+�Ii x.- a�Q-PDI s Type of Buil ing: Dwelling No.of Bedrooms I,�of Size sq. ft. Garbage Grinder( ) Other Type of Building BSI bE10—f l�lo. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L) gallons per day. Calculated daily flow 3 9 gallons. Plan Date Number of sheets Revision Date Title 1 &k Size of Septic Tank I SO 0 (AL-O N Type of S.A.S. C-A r a Description of Soil z• ature of Repairs or Alterations(Answer when applicable) -lZeFr r S l ls'" -f S ! S 1 I� 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 Environme tal Code and not to place the system in operation until a Certifi- cate of Compliance has been iss i and of Healt ` Signed Date 1/ 7 Application Approved by e 20P. Date 1/6-17 Application Disapproved for the following reasons Permit No. 9e_7-6.-a Date Issued 7 ———————————————————————————————-:fir. ———— a+ K� ,•,/6S�- TOWN OF BARnNSSTTABLE LOCA'(`iON.';J-(7 ('��rvu/ � IIJ� SEWAGE # 27 ��' VII.LAGE �ASSESSOR'S MAP & LOT" D6 � INSTAI;I:ER'S NAM &PHONE NO. vb`a5� �..t/`DeS i SEPTIC:LANK CAPACITY 1'S(7U G►tA►��et� I�— LEACRVd FAC1LrTY: (type) P2 i tit== (size) NO.OF:BEDROOMS BUIL15ER;:QR OWNER $gf==1A YW&,S PERM:f-b-ATE: LL COMPLIANCE DATE: I a. 14 — 7 Separatign Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private.. ater 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 i within300 feet of leaching facility) Feet Furnished by i i s: 4 i 8 J. .'.l I k Fee ' a!� r~� o. _O �f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 Yes - `PUBLIC HEALTHY DIVISION -TOWN OF BARNSTABLE, MASS CHUSETTS Z[pprication for Migpogar.0pacm Congtructidn Permit -- Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or L'ot No. �jvyvk �e Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel NJ —7 -78 6 Wr Designer's Name,Address and Tel.No. M)vu Type of Building: w ' Dwelling No.of Bedrooms � { Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S(fl�.r�'T/N l f Persons Showers( ) Cafet•ia( ) Other Fixtures c Design Flow 3 13 O gallons per day. Calculated daily flow ' 3 y / gallons. Plan Date Number of sheets Revision Date Title W Q:. 1 G Wr Size of Septic Tank Type of S.A.S. �.--- Description of Soil s/t M �. r 7 ,,QP>a1< of Rers or Alterations(Answer when applicable) S 1n Ghk c b �2 C G IT ��- I(.; tt7 S / Js e 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 Environme tal Code and not to place the system in operation until a Certifi- cate of Compliance has been and of Healt . ' Signed j Date 11"4`c17 Application Approved by l Date 7 Application Disapproved for the following reasons Permit No. .5 7-6 S V Date Issued L/9 ` 7 THE COMMONWEALTH OF MASSACHUSETTS _ BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(� doned( )by �°(� 1 k1. " C )R P I;— (�"j l C- ` K y has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be,-ponstrued as a guarantee that the systewi function as designed. Date _ 7 1 Inspector �� I dy THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE., MASSACHUSETTS migogar *pgtem Conotruction Permit Permission is hereby-granted to Construct( )Repair(Upgrade(` `)-Abandon( ) System located at U h t.N Y\cAk— i 1) h1 YU l S e o ?- I 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 pejmit. Date: /�G Approved by d g z? a } 1019197 NOTICE: This Form Is To Be Used For the Repair Of Failed ? Septic Systems Only. J CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certifythat the application for disposal works 1 construction permit igned by me dated 11�� ,concerning the j property located at �(7v �-� �qv) meets all of the I following criteria: I " • There are no wetlands located within 100 feet of the proposed leaching facility V/• There are no private wells within 150 feet of the proposed septic system V • There is no increase in flow and/or change in use proposed f (- • There are no variances requested or needed. L • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will t14t be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please com lete the following: � A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) ya, B)Observed Groundwater Table Elevation(according to Health Division well map) t SIGNED: DATE' —�c c(7 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]. t q:health folder:art ! a j.. \Y a �+'". .� �q ' �� i . .,., *% •-�. � I _� �. 't � � i ^.�. aao � �" �,�,� - F c. � r. �- �..__. ,_ II 5 .. l a �.: