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Home My WebLink About0067 IRVING AVENUE - Health 67 Irving Avenue Hyannis - A = 286 - 014 1 I . TOWN OF BARNSTABLE LOCATION ^1/4!2 1?tle SEWAGE# VILLAGE,. t7' ST /`7 ASSESSOR'S MAP & LOT 75�dJ/ INSTALLER'S NAME&PHONE NO. sD� i �� 7 SEPTIC TANK CAPACITY 480 9O°/ LEACHING FACILffY: (type) �� /7�i�r>�` (size) A0 ;c- L�— NO.OF BEDROOMS / BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: f r' r `"' � 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 eaching facility) Feet Furnished by �� ok 0 r' No. /0 .Fee' SCJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYtcation for Miow5al *proem Conmrurtton Vermtt Application for a Permit to Construct( )Repair( /)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.� .�j9Yin� age Owner's Name,Address and Tel.No.7 Assessor's Map/Parcel Installer'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(/IJ Other Type of Building `' 1riG No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow O gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ZP'Op .�A Type of S.A.S. iv/ .17, Description of Soil Nature f Repairs or terations(Answer when a 474ypplicable) :- gL ti ��® lAw 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 issue y t ' oar of He JJ Signed Date 1111,7 e q Application Approved by Date Application Disapproved for the following reasons ool �o �Q Permit No. 9� Date Issued No. (v ./ / 03• S 1ee� t� "THE COMMONWEALTH OF MASSACHUSETTS Entered"ncomputer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS d ZIppYication for Mi000l *p!tem Conotruction Vermit Application for a Permit to Construct( )Repair( r)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 40, Assessor's Map/Parcel Installer's Name,Address,'and Tel.No. Designer's Name,Address and Tel.No. Aff)0�0Go rf�iL'o031` . 7 7/ 9?�q Type of Building: Dwelling No.of Bedrooms_ Lot Size sq. ft. Garbage Grinder(,e i Other Type of Building g,5 jW,0W ,- No.of Persons Showers( ) Cafeteria( ) Other Fixtures //// Design Flow gallons per day. Calculated daily flow l/b1 gallons. Plan Date Number of sheets Revision Date "A Title Size of Septic Tank Z P,0�1 1`II104 Type of S.A.S. / ea►� /�i' /�iq, J Description of Soil Nature of Re airs or Alterations Answer when applicable) 6a?, 64D.i� lick 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 issue y t is oar of Health, j Signed _ Date Application Approved by G _ Date Application Disapproved for the following reasons l Permit No. -9(., (, /D Date Issued —————————————————————————— _ .... THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( //11upgraded( ) Abandoned( )by & �f/-efil-izleL at y has been constructed in accordance with the provisions of+ftie 5 and the for Disposal Sy tem Construction Permit No. /O dated Installer Designer The issuance of this permits 11 note�e construed as a guarantee that the s �y' 1 functionas.desi gn Date .., r" Inspect r� No.�h � �!� ------------ Z —d/ / Fee �� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogar *pgtem Cootruction Vermit Permission is hereby granted to Construct( )Repair(/Upgrade( )Abandon( ) System located at 4 77o4I/%4 al,6f 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 permit. , Date: ,!/ - `!�G Approved by C 0 � � a � � N c_ � o � o J 1 ' f CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONS'TRUC;TIU.N I'Ejt5tI'I' (WI THOW' DESIGNED PLANS) i, Akf�%T b �B�, hereby certify that the aPPlication for disposal works construction permit signed by me dated concerning the property located at 6 7 4Z-Pk1,y1 ape meets all of the following criteria: here ire no wctiands within San feet of the proposed septic"em here arc no private wells within 1{0 fcci of the proposed septic system he observed gronndn•ater tables ;A rc or grater beioiv the Bottom of the leaching fmcility /Tnr icre is no incrcnse in Clow and/or change in use proposed Vere are no varinnc-csreliiesled or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN 714E TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also irthe licensed Installer posesses a certified plot plan, this plan should be submittcdl. T. .,;j - �.3 sgs...' S+�-� tsi' �r,� '' 'rp�tn� -.`ate•+ `A.:� �'.. �.y.. -'3 �--4'w•.n � ti. � ..yrt.r t7 `t� c.- .� ... r