The URL can be used to link to this page

Home My WebLink About0063 MIDWAY DRIVE - Health 63 MIDWAY DRIVE, HYANNIS A=252-070 TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE IYY,4 4��SSESSOR'S MAP &LOT Z ` � INSTALLER'S NAME&PHONE NO.AV✓ /tJ60yr- 771-4e3 SEPTIC TANK CAPACITY /SOD G�L LEACHING FACILITY: (type) Z"v1,CL•��ow1 (size) NO.OF BEDROOMS 3 BUILDER O OWNS PERMTTDATE: Z`� � 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 v,4 6 � � 0 o 6 1 �Gss No. d Fee so. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Oigoar *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(i/ )Abandon( ) 1' Complete System El Individual Components Location Address or Lot No. e kl 10r, Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0045 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(Ae4& Other Type of Building /��5�G e No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1169 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank C5-400 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t_%:j`/G G�.t�9/ll 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 issued b this Bo d of ealth. �/ Signed Date Application Approved by Date A40, pplication Disapproved for the following reasons '`.rn t No. -mil �� Date Issued TOWN OF BARNSTABLE LOCATION �I/C�Gt�7Y �I" SEWAGE# p7�✓Z I% /-ASSESSOR'S MAP &LOT- 2- ' ; IN$'TALLER'S NAME&•PHONE N0. /^/ 1��ST— 77/—�✓�1�9 :SEP'TIC TANK CAPACITY SEA (size).CHING FACII.T . type) ��X•2g '��,' <NO OF BEDROOMS 3 i BUILDER 0 OWNE - I DATE: —2 7 COMPLIANCE DATE: — Separation Distance Between the: Maiimum Adjusted Groundwater Table and Bottom of Leaching Facility Feet `Rrivate Water Supply Well and Leaching Facility (If any wells exist tin site or within 200 feet of leaching facility) 19 Feet >rdge of Wetland and Leaching Facility(If any wetlands exist Feet �. .. ... within 300 feet of leaching facility) - Furnished by r 4 i} 9 1 � } 9 i No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pplicattot 'IfOr Migoof bp$tem (fon5truction Permit Application for a Permitto Construct( )Repair(-`)Upgrade(V)Abandon( ) ct/com System ❑Individual Components Location Address or Lot No. 'I�,� Owner's Name,Address and Tel.No. Assessor's Map/Parcel J C er��Yewr'i/%/�. I_a/// Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �O/P toGofi'`j COrlb�; I- V Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq;ft Garbage Grinder(11� Other Type of Building XP��f' No. of Persons Showers( Cafeteria( ) Other Fixtures Design Flow I io gallons per day. Calculated daily flow .�34y gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 45-00 Type of S.A.S. 3 M&,-rjMyz.er.5 Description of Soil Nature of Repairs or Alterations(Answer when applicable) r/_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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b=thiisod of ealth. - Signed Date Application Approved by Date ./Z->JP- Application Disapproved for the following reasons Permit No. 2 7-7 26 Date Issued f Z-Z9---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ZZ a 70 BARNSTABLE, MASSACHUSETTS (Certificate of (tompriance / THIS IS TO CERTIFY, that the On-sit Sewage Disposal System Constructed( )Repaired ( + )Upgraded(v) Abandoned( )by !' �e 5 at 4 3 "t/ k f? /'; G!7 L'rlx) jam- has been constructed in accordance with the provisions of Title/5 and the for Disposal System Construction Permit No. 7- 7 36 dated /2'Z 9-9 7 Installer Designer The issuance of this permit shall no be construed as a guarantee that the system 11 function as designed. Date ��, � 7 Inspector 1� -----------------------------L— _ -- --- No. /A �7aFee � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS &5pozai 6potem (Con.5tructton Permit Permission is hereby granted to Construct( )Repair( )Upgrade(VIAAbandon( ) System located at �� ql lily Y &76. 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 ` Date: 12 ' 9- /c 7 Approved by l0/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) Low , hereby certify that the application for disposal works construction permit signed by me dated /Z / <�� concerning the property located at 6J��/��y �� GP/llf'I/a l� meets all of the following criteria: /There are no wetlands located within 100 feet of the proposed leaching facility there are no private wells within 150 feet of the proposed septic system ,. ere is no increase in flow and/or change in use proposed 7t ere are no variances requested or needed. If he proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will=be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.LS.map) B)Observed Groundwater Table Elevation(according to Health Division well map) DATE: SIGNED : 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]. q:health folder:cert j QJ i C-I5 Div Q /M VIJA-y