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Home My WebLink About0579 PITCHER'S WAY - Health 579 Pitchers Way 270-252 Hyannis I i TOWN OF BARNSTABLE C v LOCATION ` P7e /l.0 VS �.^1 SEWAGE # /7 3 tf�y VILLAGE 14:' t t^-V%-t.f ASSESSOR'S MAP & LOT..7d• INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 0(TO LEACHING FACILITY: (type) �� 1 (size) 5 �/�� ` NO.OF BEDROOMS �G (.TKti.Tti�J BUILDER OR OWNER � �� _ PERMUDATE: "7 -"] - 7 COMPLIANCE DATE: `7 - % 7 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 l� �1 No. �! O zI: Fee `' .— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYication for �Di� o Y *p5tem Con!Aruction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 5- Owner's Name,Address and Tel.No. Assessor's Map/Parcel v4y 0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. y � " Type of Building: Dwelling No.of Bedrooms ::S Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow :j--'so gallons per day. Calculated daily flows gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 5F—; i JT t noo Type of S.A.S. Adk Description of Soil _ " Nature of Repairs or Alterations(Answer when applicable) :r -OLIk L4l —,i.�Li f /UlZf94 t6 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.W place the system in operation until a Certifi- cate of Compliance hates beef.ugtl this B d of Health. Signed Date Application Approved by 4W Date -� Application Disapproved for the following reasons -21 Permit No. Y 7 3d Date Issued 7 s TOWN OF BARNSTABLE LOCATION SEWAGE# 7 3 VILLAGE i v�wt� ASSESSOR'S MAP &LOT • 3- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� ,V � t`-�1 _(size) yztiiC� l.T 'r`�j N0.OF BEDROOMS BUILDER OR OWNER PERMTT DATE: `7 - 7 COMPLIANCE DATE: i Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) -Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) :Furnished by ..... . -- TT iF 10 . 7 � No. Fee' p ` THE COMMONWEALTH OF MASSACHUSETTS ":'Entered m computer: Yes PUBLIC HEALTH DIVISION - TOWN OF,'BARNSTABLE., MASSACHUSETTS ZIpprication for Migpot [*p5tem Congtructiori ermit Application for a Permit to Constnct( )Repair( pgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. l tGl� S � Owner's Name,Address and Tel.No. v ' Assessor's Map/Parcel Y l O LA�h`^ j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 92 Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures j i Design Flow gallons per day. Calculated daily flow 3_1H gallons. Plan Date _ Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. r `�t '�.•L. Description of Soil 1L Nature of Repairs or Alterations(Answer when applicable) "["jk_i Sc,*1 r4 1 T- vA :=gk— 1(_X v c.'r u 0 l,A,' t S'T'G v-c /�h.. 51 Y)rT 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 t place the system in operation until a Certifi- cate of Compliance has been issued b this Bo of Health. Signed Date?� Application Approved by Date 2g Application Disapproved for the following reasons Permit No - d Date Issued 7 J 9 w — -- ——— ——— -- — — —————— ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS „ { Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7^S dated 7 Installer + Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date -7 Inspector No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS m _ PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ~ ` =igpogar *p5tem Ongtruction permit Permission is hereby granted to Construct( )Repair( Upgrade( ).Abandon( ) System located at and as described in the above Applieationifor Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. tt Provided:Construction must be completed within three years of the date of this permit. Date: 7-e 9 7 Approved by NOTICE: This-Form-is-to be used- r the Repair ofIfailed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) r r h---, �- ��✓ hereby certify that the application for disposal works construction permit`signed by me dated -7�7 1 , concerning the property located at "► �- ��' s w � meets aU of the following criteria: • There are no wetlands within 300 feet of the proposed septic system F. • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. e SIGNED : 1 DATE: —�� 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]. f .. i I v�4 I ��.', enh .,� .. V C� � � `\\ \ .. -�� 1� �-. -� V LOCATIO SEWAGE PERMIT NO. VILLAGE 1NSTA LLER'S NAME & ADDRESS c U U I'L D E R OR OWNER C, a - - - DATE ERMIT ISSUED DATE COMPLIANCE ISSUED � i �� G1