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Home My WebLink About0120 SECOND AVENUE (HYANNIS) - Health 120 SECOND AVE., HYANNISPORT A=266.620 ' TOWN OF BARNSTABLE LOCATION 1 `vti .Q 5-� C 05-o, 1, SEWAGE # 1 VILLAGE 6 ASSESSOR'S MAP & LOT Z(06 62C> INSTALLER'S NAME&-PHONE NO. l(,i. -'s C. SEPTIC TANK CAPACITY /S . LEACHING FACILITY: (type) (size)II NO.OF BEDROOMS BUILDER OR OWNER f NA f+-!� PERMIT DATE: //- 9 -7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching/'acility 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 wetl ds" exist within 300 feet of leaching facility) < Feet Furnished by �-<✓ r /��- , .. i No. Fee$5 0 . 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 0[pprication for Miquar *pgtem Cow6truction Permit Application for a Permit to Construct( )Repair(x�Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 1 2 0 Second Ave Owner's Name,Address and Tel.No. 617 871 —6 8 6 6 Assessor'sMap/Parcel Hyannisport., MA Steven Franklin . 6 pZ® 65 Cedarwood. Rd Hanover MA 02339 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 775-8776 Y Wm E Robinson Sr Septic Service O� PO Box 1089, Centerville, MA 026 Type of Building: Dwelling No.of Bedrooms 4 Lo Size sq.ft. Garbage Grinder(no) Other Type of Building No. f Per ons 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 sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic consisting of 1500 tank, D—box and four H-20 stone asked infiltrators . 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 E ironmental ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi ar f Health. Signed L J e Date Application Approved by Date Application Disapproved for a following reasons Permit No. Date Issued a TOWN OF BARNSTABLE LOCATION 1 t .= o,-of . (. SEWAGE # 7 / VILLAGE 1 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO._A&SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 3 S' NO.OF BEDROOMS BUILDER OR OWNER fix.�'�-!<r PERMITDATE:1/— 3 1 COMPLIANCE DATE: L — �r 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) f.'` Feet Edge of Wetland and Leaching Facility(If any wetl ds exist within 300 feet of leaching facility) Feet Furnished by ��..,. -----,-; ! i I ;�'% ;� r ` �i: /./ �� ,. ��v ;.. �� { 1 )' �' 1 ��, � //�`j c .. ...... ____ i ----�---.___..._..._..�_..�� j.J--- No. Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes ZippYication for �Bigonl *p5tem Con6truction Verna Application for a Permit to Construct( )Repair(x)o Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addre(or Lot No. 1 2 0 "Second give Owner's Name,Address and Tel.No. (6 6 7)8 71 —6 8 6 6 i in Assessor'sMap/Parcel z6�yoZoport, MA - Steven 65CedarrwoodlRd, Hanover,MA 02339 Installer's Name,Address,and Tel.No. Designer's Jame,Address and Tel.No. - 775-8776 __n g I� Wm E Robinson Sr Septic Service �11 l PO Box 1089, Centerville, MA, 026 1 �- b Type of Building: - ;Dwelling No.of Bedrooms )~r Lot ize sq.ft. Garbage Grinder(no) Other Type of Building `, No. Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow f 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 sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic consisting of 15009 tank, D-box and four H-20 stontpacked infiltrators. Date last inspected: k ` Agreement: The undersigned agrees to ensure the construction and mainte ance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5�En ' mental ode and not to place the system in operation until a Certifi-cate of Compliance has been issue by thih. ,,. � n Signed t t a Date Application Approved by �%r �r Date + Application Disapproved for ttefollowing reasons '°�•� .. ' Permit No. — cI Date Issued + --------------------------- THE COMMONWEALTH OF MASSACHUSETTS Franklin BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( x)Upgraded( ) Abandoned( )by at 120=Second Ave H annis ort MA ha bee constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d Installer Wm E Robinson Sr Septic Sry Designer The issuance of this ermit shall of be construed as a guarantee that the system 11 function as designed. Date - — Inspector - ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Franklin 'Wi5po5al *pgtem Construction Vermit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon System located at 120 Second Ave Hyannisport, MA Installer: Wm E "Robinson Sr Septic Sry 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. 4 Provided:ConstructiWIA c 4mpleted within three years of the date of t 's permit. Date: lq' 1 Approved by ,, NOTICE: This Form Is To Be Used For The Repair Of Failed Septic Systems. Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, William E, Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated Z11-3` concerning the property located at 120 Second Ave, Hyanisport,_MA. meets all of the following criteria: * There are no wetlands 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 with 250 feet of any.wetlands,the bottom of the proposed leaching facility will n9t be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: g7 A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) 3 7 B)Observed Groundwater Table Evaluation(according to Health Division well map) 2�, SIGNED: 1 DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach.a sketch plan of the proposed system.. Also if the.licensed installer.posesses a certified plot plan, this plan should be submitted). � --_ �_ � i � � w � �, !; �` � �� ti i