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Home My WebLink About0052 FIFTH AVENUE (HYANNIS) - Health pr 52 Fifth Ave Hyannis • A = 246 -117 I i TOWN OF BARNS1ABLL LOCATION J� 'I"((' e SEWAGE # / 1 d 2 i 'S MAP & LOT - 7 VILLAGE �`/ y��.�ti s ASSESSOR L� INSTALLER'S NAME&PHONE NO. /`-�'`� 6e'-{� SEPTIC TANK CAPACITY �— LEACHING FACIUN: (type) ��`'� `— `r d✓�S (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: 21~�7 r 7 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 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 0 0 l��f Az TOWN OF BARNSTABLE LOCATION y4@ SEWAGE # r VI]-LAG ASSESSOR'S MAP & LOT II l INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l 2 SG��c_ LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: ',9-—"7 --L COMPLIANCE DATE: 2- — 11 Separation Distance Between the: I . 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 -� I i �� ' � c O O I. 6 No. .� Fee / THE COMMONWEALTH OF MASSACHIjSETTS Entered in computer: !� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zippficatiou for 30izpaat *pe;tem Cott!truction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. b a'F:I Vc_ tq W 1 fbrr7 Owner's Name,Address and Tel.No. Assessor's Map/Parcel , t r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ao goo-em*-OZ FAY 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 -3-3>n gallons per day. Calculated daily flow '3 30 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / 00 Type of S.A.S. �hj 2S CA Description of Soil e4 F A S.f4vt.� Nature of Repairs or Alterations(Answer when applicable) =-=to-5t` 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 and of Health. Si ned Date Z Application Approved by Date ,? % ;2 Application Disapproved for the following reasons Permit No. 7 Date Issued L �/. i a. No. Y �57� °.� 3„ Fee THE COMMONWEALTH OF MASSACHIfSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for Migaar *pgtem Construction Permit Application for a Permit to Construct( )Repair�pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. C- (n � �a �I 1 Owner's Name,Address and Tel.No. fp Asessor's Map/Parcel a_ \ ' i 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 33v gallons per day. Calculated daily flow 3 30 gallons. Plan Date Number of sheets Revision Date i Title Size of Septic Tank / 00 Type of S.A.S. N LT f�To 25 Gv Description of Soil M F 0 5 44-t- Nature of Repairs or Alterations(Answer when applicable) �wST�t` t-3 S'�'acz -- �°` JD-�u ud -A' a t-_ . 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 oard of Health. Signed Date a-7 7 Application Approved by Z14 X Date �2 - 7 - 9 7 Application Disapproved for the following reasons Permit No. 7 ' Date Issued of /? THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C�FjY,that the On-site=ewageDisposal System Constructed( )Repaired( )Upgraded(!/f Abandoned( )by at � k" V- +V ee-- VD o Z has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. S 54 dated -2 Installer 1--, Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date _ 1 •, �t i Inspector 1 -------�---------- ------ Fee THE COMMONWEALTH OF MASSACHUSETTS x.. PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigozar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at j c�-- ��t2T k A-"e-- t��t tP -� 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: .2— 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 DESIGNED PLANS) Ir77'�' k —4'�S , hereby certify that the application for disposal works construction permit signed by me dated Opt —�—`� , concerning the property located at ,j moo— � �y��— ��`f� tp o 2� meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • 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. SIGNED: 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]. jxert 1� �I 5 'i