HomeMy WebLinkAbout0065 SECOND AVENUE (HYANNIS) - Health 65 Second Ave
246-088-004 Hyannis
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TOWN OF BARNSTABLE t�
LOCATION 150co. SEWAGE # 9;7
VILLAGE 4-�'�s,!J��� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. ��+'n gew /t
SEPTIC TANK CAPACITY 0 roo
LEACHING FACILITY: (type) Gil It,a (size) 12'Y! ZS ,A 2
NO.OF BEDROOMS �J
BUILDER OR OWNER AV, ;5�e'Iti W./G�
PERMITDATE: �'9—9 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
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THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpplication for Mizpoot *pgtem CC®ngtruction 3pErmit
Application is hereby made for a Permit to Construct(De)or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. ,5 Owner's Name,Address and Tel.No.
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Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
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Type of Building:
Dwelling No.of Bedrooms 1— Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow i gallons.
Plan Date Number of sheets Z. Revision Date
Title - Illy, fl " L'C-9 14 w TRAVivicv—
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Description of Soil O"`Z �� t L, I-
i l' c-a��uJ al a'� o>�J
Nature of Repairs or Alterations(Answer when applicable)
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 Cod and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signe Date
Application Approved by
Application Disapproved for the following reaso&/--
/
Permit No. Date Issued
TOWN OF BARNSTABLE
LOCATION
3r�co„ �� /�✓� SEWAGE # 7
VILLAGE L//, �y �H r i y dc,'� —
ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) Gti�fl c v (size) /?'. 2S�� 2
NO OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: �" '9,7 COMPLIANCE DATE:
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
ry
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r ^No. ��t'CO irk -4, 4 's,>... Fee IDO
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Application for ;D gpogal *pgtPm Cottgtruction Perron
Application is hereby made for a Permit to Construct(De)or Repair( )an On-site Sewage Disposal System at:
- Location Address or Lot No. / Owner's Name,Address and Tel.No.
Lam- sN� AUE 970,PL( T CkST
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Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
-6kXTw, i. 0ye imc.
017,MAIN44;MSE All MA
ST
Type of Building:
Dwelling No.of Bedrooms_�� Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 27 gallons per day. Calculated daily flow gallons.
Plan Date i• (o • 9-7 Number of sheets 'Z-. Revision Date
Title Cam' ??L W • W t NHPr Ct'?.n' APP I-ic-A Nr An Armiw T`aANU)1C*,'
Description of Soil 0"i 1A4,\ W Sy-",#IL. (A 4�� Z� - 11� -t-�pIJ Mb'n SA-W, CG�
Nature of Repairs or Alterations(Answer when applicable) i
Date last inspected:
. �- 1•
..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 Cod and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health. ,
Signe Date
Application Approved by
Application Disapproved for the following reaso
!7q
Permit No. — Date Issued a2dy
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of Compliance -
THIS IS TO CERTIFY;that the On-site Sewage Disposal System installed(. )or repaired/replaced( )on
by for _.
as een constructed in accordancer
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Use of this system is conditioned on.compliance with the provisions set forth below:
No.� —� ———.——— —— — Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
ligogar *pgtem Con5truction Permit
Permission is hereby granted to D I
?D
to construct(repair( )an On-site Sewage System located at YVA/cy
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.
All construction must be completed within two years of the date below.
Date: `�'''f y Approved by
1Y
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