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Home My WebLink About0030 KENT LANE - Health ol 30 KENT LANE, HYANNIS A--291-128 C 0 o TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOV INSTALLER'S NAME&PHONE NO. SLCJ SEPTIC TANK CAPACITY �L LEACHING FACILITY: (type) 414��acc-S (size) U �J NO.OF.BEDROOMS `BUILDER OR OWNER ?ERMTTDATE: al-COMPLIANCE Q }COMPLIANCE DATE: 5�� Zo�!C1 ' 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 f t of leachin (1` Feet Furnished by = . e 3 QC,c, a o i ,. Mal No. 9 7-1 Fee t1 l THE COMMONWEALTH OF MAS CHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipp[fcation for Migpool *pe;tem Construction Permit Application for a Permit to Construct( )Repair( ))UPgrade( )Abandon( ) ❑Com lete S stem ❑Individual Components Location Address or Lot No. ��M a LG%A C Owner's Name,Address and ,Tel. ,,No. Assessor's Map/Parcel �- 1 -' e" le��U r r w�^e_y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �( � Una G�cS Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ev� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank M' G_ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) &C11 two L amud I u Z�G1�e5 ynd f 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 Cod fi nat to place the system in operation until a Certifi- cate of Compliance has been issu y this Board of Healthh.., Signed Date Application Approved by i Date Application Disapproved for the following reasons Permit No. r` Date Issued `� TOWN OF BARNSTABLE LOCATIQN SEWAGE # '"VILLAGE !-f i r, ASSESSOR'S MAP& LOT*` INSTALLER'S NAME&PHONE NO. Sw SEPTIC TANK CAPACITY 1 SDo CAL LEACHING.FACILITY: (type) c � c� (size) + JK-1 NO.OF BEDROOMS PBUILDER OR OWNER c—osNor PERMITDATE: 9 7 COMPLIANCE DATE: a 14 Separation Distance Between the: r y Maximum Adjusted Groundwater Table and Bottom of Leaching Facility U''�-� Feet Private Water.Supply Well and Leaching Facility (If any wells exist ,� 1 on site:or within 200 feet of leaching facility) !U�)N� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 f t of leachin �)tJ Feet Furnished'by` 4 It 3 EA2 paosc Uy 46s� 0 0 . t3 �C3ox 3 ? • /a No. ^ i Feet/V THE COMMONWEALTH OF MAS CHUSETTS Entered in computei: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS - �ppYication for Digozar *p5tem Construction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System, El Individual Components Location Address or Lot No. ,��M�- L � Owner's Name,Address and Tel.No. Assessor's Map/Parcel ^ H 1 C ''�� /,�e��^U r Lit/ ^e (9 - V V�.C./� i ` Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. oLCc v nA Q—J U , 7 GwAIS Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(/M ; Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures I t Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank/5Z6. Type of S.A.S. 4 1 Description of Soil ! Nature of Repairs or Alterations(Answer when applicable) SS } �d Date last inspected: i 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 _.place the system in operation until a Certifi- cate of Compliance has been issu y this Board of Health. Signed Date 9 Application Approved by Date Application Disapproved for the following reasons i Permit No. .A r Date Issued Z !!' I ——————————— ————/— ———————————————— { — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, at the On-site Sewage Disposal System Constructed ( )Repaired( Vj Upgraded( ) Abandoned( )by at has'seen constructed in accordance with the provisions of Title 5 and the for Dispos System onstruction Permit No dated Installer 4 t=� 1 JnA� CZ. A L4 Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. j Date 1 Inspector t3--1 — --------------------------- —"-- No. / / „——. � Fee �`I> THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopozaf 6potem Construction Permit Permission is hereby granted to Construct( )Repair(VUpgrade( )Abandon( ) System located at :10 NkR)' c�nP �.0 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 it. Date: -'" ��" / Approved b tz .tF NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FORA DISPOSAL NVOIIKS CONSTRUCTION I'EItMi'I'(IVI'I'IIOU'I'DESIGNED PLANSI hereby certify that the application for disposal works construction permit signed by me dated �� I 1q 7 , concerning the property located at 33- 1&t meets all of the following criteria: e There are no wetlands within 300 feet of the proposed septic system "- • There are no private wells within 150 feet of the proposed septic system 1-� The observed groundwater table is 14 feet or greater below the bottom of the leaching facility j There is no increase in flow and/or change in use proposed i There are no variances requested or needed. I I SIGNED: DATE: LICENSED.SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER lAttach a sketch plan of the proposed system. Also if the licensed Installer posesses a certified plot plan, this plan should be submitted). �n C� -yp 0 O ' C:M,