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Home My WebLink About0028 RUSTIC LANE - Health 28 RUSTIC LANE, HYANNIS A= /o t f o II I 0 f I f i I� `TOWN OF BARNSTABLE A LOCATION AS' Rauridh�`19,7e- SEWAGE # 9e':_ l 7t VILLAGE cznnet ASSESSOR'S MAP & LOT/ "9-00/ INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY 0 0®® LEACHING FACILITY: (type) =.3"88 041/An Cat y-ve//S (size) .3 !J S10n NO.OF BEDROOMS--�� BUILDER WNER I—le,C?/,/lid PERMTTDATE: 3 ,3a COMPLIANCE DATE: J19k s Separation Distance Between the: , Maximum Adjusted Groundwater Table to the 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'leacnhing facility) Feet Furnished by -`C - r D (� 0 0 o�-yy.J No. 9,4 ` !i Fee b i/ THE COMMONWEALTH OF MASSACHUSET S Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for Digaal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( rpgrade( )Abandon( ) O Complete System ❑Individual Components Location A ess orC e-Lot No. Owner's Name,Address and Tel.No. -SA tg�� —\�.c�r.�� -��e�•�e. H�c�\vim►� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. o`Lfrea Q Type o Building: Dwelling No.of BedroomsL Lot Size sq.ft. Garbage Grinder Other Type of Buildin 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 d-L Natur of Re airs or Alterations(Answer when applicable) C v�� 'tt.� .� �ry`✓�/� J y� �ne OQ_s'�c% aid an 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 issu d by this Board of Health. Signed Date 3d 48' Application Approved by - Date Application Disapproved for the following reasons Permit No. Date Issued t No. Fees THE COMMONWEALTH OF MASSACHUSE VS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for �Dizpogar *p!gtem Construction Permit Application for a`Pemiit to Construct( )Repair( W6pgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. t Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'L 6 Type o Building: a Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( Other Type of Buildin 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. i Description of Soil n-7 sub Nature of Repairs +or Alterations(Answer when applicable) 1 v+s t�� zwo So o d L-4 ea 1S 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 by this Board of Health. Signed Date -s /4j Application Approved by Date �+ Application Disapproved for the following reasons Permit No. Date Issued THE C'O.MMONWEALTH OF MASSACHUSETTS BARNS1'AB,L,1E, MASSACHUSETTS Certificate of (Compliance f THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded ( ) Abandoned( )by at C. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No, dated --` � Installer I A Designer The issuance of this perinit shall not be construed as a guarantee that the system will kunction as designed. Date_ _ ) . q Inspector — - _ ."No. --'-- —Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wiOP05al *pg;tem Construction Permit Permission is hereby granted to Construct( )Repair( pgrade( )Abandon( ) System located at 2st 9,35. a h C ,.A 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 it. Date: L "' Approve �w� $ 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WO11KS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 4 .. hereby certify that the application for disposal works construction permit signed by me dated 31:36 C " ,concerning the property located at meets all of the following criteria: There are no we located within 100 feet of the proposed leaching facility 6fc- There are no private wells within 150 feet of the proposed septic system 6cc • There is no increase in flow and/or change in use proposed p tG • There are no variances requested or needed. 00 If(ite proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W 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) A) - 9� SIGNED:_ S<�� DATE: o 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:cent IC KEY �. 2$2-+ cxr� Wa Ar, I! N Z10 a I I � f 3Z UO �J i t k 6 38 Rosary Lane Hyannis, MA 02601 508-771 -4128