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Home My WebLink About0118 RUDDER ROAD - Health 11'8`RU- - ER RD.; W, HYANNISPORT A=247 ',1�77 — e ' TOWN OF BARNSTABLE LOCATION 118 RUDDER ROAD SEWAGE # 98-709 VILLAGE WEST HYANN I S PORT, ASSESSOR'S MAP & LOT:) INSTALLER'S NAME&PHONE NO.FILIS'BROTHERS CONST. CO.362-6237 SEPTIC TANK CAPACITY ® LEACHING FACILITY: (type) - � �" C�►Lc (size) C��k �X NO.OF BEDROOMS BUILDER OR OWNER eJ�. PERMTTDATE: COMPLIANCE DATE: Z Y 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 ":4 Ya AIM c �4 1 1 Qr z �7 No. �� '70 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYication for bigo5al *p5tem Construction Permit Application for a Permit to Construct( )Repair 6,/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot o Owner's Name,Address and Tel.No. // i� �. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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. Calculated daily flow � gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / Type of S.A.S. 10 I�CiA Description of Soil �� V -._7 ~�v✓�, Nature of Repairs or Al erations(Answer,wh n applicable) W f T t f 7J . IDS 1�_111 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 Titl f the Environment,4 Code and not to place the system in operation until a Certifi- cate of Compliance has been issue is Board of Hea Signed Date Application Approved by Date Application Disapproved for tVe following reasons Permit No. Date Issued I TOWN OF BAMSTABLE LOCATION 118 RUDDER ROAD SEWAGE # 98-709 VILLAGE WEST HYANNIS PORT, ASSESSOR'S MAP & LOT - INSTALLER'S NAME&PHONE NO.ELLIS` BROTHERS CONST. CO.362-6237 SEPTIC TANK CAPACITY IS c: r LEACHING FACILITY:(type) 33 C�'�- (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE:1l-1 —ik COMPLIANCE DATE: .-.Z e1 9 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 �2! �a ucs�zD yrS.tY✓�' . A � ;. ,-•-,• tk.i sy,w''d-r-w,.cp--•y---.. .J sr ^-- _./�'.,. ....ywb,..ta+-r'F^. r..-y.,.er�.Y,:wsrr..,".;-,�YrFnKsu^'ri.� .,._ .. rw.-y.,.-;..r' .c ♦ -.. .. -t e 9 � �� i Rom— 1 s• No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Rppricatton for Di5po5af *potent (Conotruction Permit Application for a Permit to Construct( )Repair(V Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. zoo,7 Assessor's Map/Parcel ,J �� A Installer's Name,Address,and Tel.No. Designer's Naive,Address and Tel.No. 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. Calculated daily flow Sti gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. U � e, 310 Ati A Description of Soil �� , ^ICU W, t 7 Nature of Repairs or Al erations(Answer when applicable) z.S �T�. J-) o Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance ofthe'Aforedescribed on-site sewage disposal system in accordance with the provisions ofTitl f the Environment Code)atid of to place the system in operation until a Certifi- cate of Compliance has been issue is Board of HealAn / r Signed '�' Y Date L Application Approved by= Date Application Disapproved for t e following reasons Permit No. / rC - 7 05' Date Issued > THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired 64� )Upgraded( ) Abandoned( )by at ✓ 4-1 4 v" - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Constru tion Permit o. .�7� dated f Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 1 - ie� - �� Inspector No. — Fee S v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Dfopozaf *p5tent Construction Vermtt Permission is hereby granted t Construct )Repair( )Upgra e( )Aban on( ) ,A System located at p/k-o1/ ,� 1 J i/ �+' a G iC 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 permit. Date: - - Approved by Y �T ~ � 10/9/97 NOTICE: This Form Is To Be UsedFor the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated `—f , concerning the / me] property located at �� ti � � 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 • There is no increase in flow and/or change in use proposed • There are 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=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.I.S. map) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNE DATE: LICENSED SEPTIC SY EM 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]. r q:health folder:ccrt I z� Q�all /�` •�y)I - i c /Ti �/