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Home My WebLink About0048 ISALENE STREET - Health 48 ISALENE ST., HYANNISPORT A=267-045 LOT 18 i TOWN OF BARNSTABLE , LOCATION '4 ? :t75iiLS; -. 5 ! SEWAGE # VILLAGE ASSESSOR'S MAP &LOTJ 6 7-d�h INSTALLER'S NAME&PHONE N0. f c SEPTIC TANK CAPACITY i S` [T� �►\\G`� LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 3 - 5 COMPLIANCE DATE: 3 --q' 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 ti �., C-4 M C2 o"v, . r� No. Fee ek* CCC THE COMMONWEALTH OF MASSACHU TS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yication for i� o ar *potent Construction jermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. A LV4S Z3T Owner's Name,Address and Tel.No. Assessor'sMap/Parcel �R�'l �yaD `ZG Installer's Name,Address,and Tel.No. �� y Designer's Name,Address and Tel.No. � t c� :r 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 mo gallons per day. Calculated daily flow I-SkA9t gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I Type of S.A.S. Description of Soil F N S 90-ND Nature of Repairs or Alterations( nswer when applicable) l �d� > l� k L'TV C',-te(LS (�/ `-A f S0YV.�Wily- S i S —1- 1 Li tC 1 P 6 g»—nr�et. �l 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 C de and=t to place the system in operation until a Certifi- cate of Compliance has been is b this Bo Signed Date —� Application Approved by Date �`' "1 67 Application Disapproved for the following reasons Permit No. Date Issued -- t No: + J Fee m✓ 61- 7 THE COMMONWEALTH OF MASSACHUS TS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zippfication for Migo ai *p5tem CZongtruction Permit Application for a Pemutto Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. Lr6:=S a L.E t S :nrC Owner's Name,Address and Tel.No. . Assessor's Map/Parcel f A 1�Y✓��D V Y ��C� ,I� e\aN^ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 14 Type of Building: Dwelling No.of Bedrooms _ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2, Design Flow �.a(_) gallons per day. Calculated daily flow gallons.', Plan Date Number of sheets Revision Date Title - E Size of Septic Tank f Type of S.A.S. C Description of Soil M F S►4cti-� Nature of Repairs or Alterations( nswer when applicable) SOD S. r r L=NN C-. a S 1 ST c.l t t` 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 is e b this Bo Signed Date f2lago- - Application Approved by Date 2;0 Application Disapproved for the following reasons Permit No. Date Issued +�" F THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS } Certificate of Compliance O THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( r/) Abandoned( )by at has been constructed in accordance s with the provisions of fiitle 5 and the for Disposal System Construc on ermit No. a dated._, .e Installer .1—J& Designer �. The issuance of this pe 't sh�(arll�not be construed as a guarantee That the system will function as designe"0 Date �� — / Inspectors No. ®' / � Fee f . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS xiopoga[ gtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(4 )Abandon( ) System located at 16/t � f r 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. r� Provided:Construction must be completed within three years of the date of this permit. Date: lm Approved b .� 101'9/97 ` +. r I • t NOTICE: This"Form-Is To Be Used For the Repa>ir.Of Faded ; Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) � I hereby certify that the application for disposal works coon permit signed by me dated ��" ,concerning the I constm pe 6 _ a tti rC located at meets all of the property y following criteria: ( /: eere are no wetlands located within 100 feet of the proposed leaching facility ere are no private welts within 150 feet of the proposed septic system re is no increase in flow and/or change in use proposed i ; • am no variances requested or needed. ' If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will 11at be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. { .; Please complete the following: Z� .�_ A)Top ororound Elevation(according to the Engineering Division O.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) ti aI NED: DATE: SIG - r LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER } I. [Atteeh it sketch plan or the proposed qAtm.Also If the licensed installer posesses a aerdAed plot plan, 4 this plan should be submitted). t � gc MWth fblder eat 1 � ' (C TOWN OF BARNSTABLE C CATION .-'S$LR;We, 51 SEWAGE# 0 3 ..'VILLAGE �S O f� ASSESSOR'S MAP &LOT 6 7-D�h 4STALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1� U'fl C, 0• &� ,LMCHING FACII.TTY: (hype) d4size) ,�D�'a�' 2�►. CQ :OF BEDROOMS 3 MpER OR OWNER J lEkMITDATE: - IT COMPLIANCE DATE: 3 —9 9 S Segaadon Distance Between the: Iviaxxittum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Priv t.e Water Supply Well and Leaching Facility (If any wells exist site or within 200 feet of leaching facility) Feet Frdge.of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Vuri6hed by F777� .. .. .,'