Loading...
HomeMy WebLinkAbout0073 MIDWAY DRIVE - Health 73 Midway Drivew" Hyannis A = 273015 ,1 o 5 j� a 0 .� TOWN OF BARNSTABLE 6 L LOCATION r�"!� /• SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 7 7���n SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 1 ��'•� NO. OF BEDROOMS BUILDER OR OWNER r� � r'✓ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater-Table to the Bottom of LeacYsexist Facility Feet Private Water Supply Well and Leaching Facility (If. w on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetl sexist within 300 feet of leaching facility) Feet Furnished by --�� 'L.. n �-�' ��� �. - - r �-�. � �r 4 'F lu V �� 1y `� - a - ,� � �r ilk �,� I L , No. � Fee ti THE COMMONW H OF MASSACHUSETTS Entered in computer: 'L/A Yes PUBLIC HEALTH DIVISION - TO OF BARNSTABLE., MASSACHUSETTS Z(pplitation for MigoEW *pztem Cow6truction permit Application for a Permit to Construct( )Repair( '�/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No ets Naike,Address and Tel.No. h-A Ry v��►JLS Rr9 Ott44 Ass sor s ap/Pazcel I taller's Name,Address,and Tel.No. ` Designer's Name,Address an e1.No. Type of Building: Dwelling No.of Bedrooms 5 Lot Size sq. ft. Garbage Grinder( ) 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 Type of S.A.S. Description of Soil Nature epairs or ations(Answer w n applicable) f l r 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 a the sy tern in operatio tail a Certifi- cate of Compliance has been is e b his d o ealth. o� Signed Date 1 Application Approved by Datf Application Disapproved for the following reasons Permit No. / �-' `� Date Issued ;z;" -M No. 'r Fee 7 Entered in computer':, � f THE COMMONW��AyTH OF MASSACHUSETTSYe��/ PUBLIC HEALTH DIVISION - TO OF BARNSTABLE., MASSACHUSETTS Raultcatton for Oigb l *pgtent-tongtruction-Vermtt f Application for a Permit to Construct( )Repair( ✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Co�jpojients A Q� + nets Na e,Address and Tel.No. ��'ca�tiolynAdd�res's`orAot No. ` , � ©� jAss�ssor's Map/Parcel 3 J P Installer's Name,Address,and Tel.No.r Designer's Name,Address and el.No. 45 cjl 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 gallons per day.cC alculal`d 'l ofl�f gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature' epairs or ations(Answer w n applicable) X-t 73 C, t WTI S i n-A31 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 e the sy tem in operatio is it a Certifi- cate of Compliance has been is e b his 'o ealth. Signed �► Date Application Approved by Da r Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS .BARNSTABLE, MASSACHUSETTS (fertiftcate of Compliance THIS IS TO CgR;RFEX that th,-Q*-&' Sewage Disposal System Constructed( )Repaired ( Upgraded( ) Abandoned( )by' l9J at q has been constructed in,accordance with the prove. ins and the for Disposal System Construction Permit No. dated " 2 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector —————————————————————————————————————--— No. Feet a�D THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS f Oigpogaf *pgtem Congtruction Vermtt Permission is hereby granted to Construct( )Repair )Upgrade( bandon( ) System located at -7 i kK)= 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. Provided:Construction must be completed within three years of the date of this a 't. Date: „'^`� Approved by f 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FORA DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, r hereby certify that the application for disposal works construction permit signed by me dated 2 ctq concerning the property located at -7 :�' 1 t \\�C� �Q • meets all of the following criteria: V• The failed stem is connected to a residential dwelling only. There are no commercial or business system g Y uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. V' The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor 1 / method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation ��+the MAX.High G.W. Adjustment. _ ' /0 DUTERE CE BETWEEN A and B SIGNED : DATE: I [Sketch proposed plan of system on back]. q:health folder:cert n QQV Q 30 4-1 ; A ^ t 1 TOWN OF BARNSTABLE C LOCATION o� t A SEWAGE # VILLAGE lY�+'M1�1 , ASSESSOR'S MAP & LOT r INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ,A—— (size) d NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leachin Facility Feet Private Water Supply Welland Leaching Facility/(IfanywIsexiston site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any we within 300 feet of leaching facility) Feet Furnished by f �O7 6 1 4 r� 1 i C I r