HomeMy WebLinkAbout0015 HINCKLEY ROAD - Health 1.5 Hinckley Road.
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Hyannis
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TOW F BARNSTABLE
,OCATION IS wC P}7 SEWAGE# ! .40
VlTsLAGE ASS SSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. Hi9 e1071- `-33
4 SEPTIC TANK CAPACITY /J OOQ
LEACHING FACILITY:(type) 14�ZC— (:' e
NO. OF BEDROOMS /) /9
OWNERf� T
PERMIT DATE: l o�7/Q6 COMPLIA t DATE: .31
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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) J*7 /1q Feet
Edge of Wetland and Leaching Facility(lf any wetlands exist within 300 feet of leaching facility) o Aq Feet
FURNISHED BY_143oAy
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s1
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Rpptication,for aigogal gppftem Congtruction Permit
Application for a Permit to Construct X Repair( ) Upgrade( ) Abandon( ) ❑ Complete System Individual Components
Location A dress or Lot No. Owner's Name,Address,and Tel.No. •7rf
45
Assessor's Map/Parcel ! I I—Q-0 /s Hi Rqt
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Instal isame A N , dress,and Tel o. Designer's Name,Address and Tel.No.
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Type of Building: (761t1jPa2e+A1 .2j(q jou,��� Se�vef acC�
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) N A gpd Design flow provided 1 9 gpd
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) f160o 1 04 hate
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 Certificate of
Compliance has been issued by this Board of H lth. L6iC�.�Zf s- 61nr10/(--
Signed
t Date /67
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
( r-f V-,�e BARNSTABLE, MASSACHUSETTS
r U rp�` pert fichte of Compliance
�u.
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (��.) Repaired ( ) Upgraded ( )
Abandoned( )by 6 , Ir-r l
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. )001n`02 9 dated 1 L j G'6
Installer S-rY1 Y\.Q Y- - Designer
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#bedrooms �° 1 �.LI �uw�, �n v,:P t — "r ,�c �(v� Approved design flow a ,•t gpd
The issuance of this permit stlall not b construed as a guarantee that the syste f 1 func' n =gn .Date Inspector �„ � �
No. ;0, _ ;1 Gij Fee /S 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS
aiqo.5ar 6p5tem Con!trurtion Hermit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( )
i
System located at Kle y �d
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 ermit..r}
Date Approved by 1 `,, ;
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