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Home My WebLink About0008 HOMEPORT DRIVE - Health 8 HOME PORT DRIVE, HYANNIS A=268.104 TOW' OF BARNSTABLE LOCATIONb�� " SEWAGE# VILLAGE ASSESSOR'S MAP&LOT 26 INSTALLER'S NAME&PHONE NO. 7> —.;> S7 3 SEPTIC TANK CAPACITY I S'®'n, 4::� LEACHING FACILITY: (type) y i✓r,�?2nTQit (size) /O !C 3 X NO.OF BEDROOMS BUILDER OR OWNER J N' r`'/''� S PERMITDATE �!?�� COMPLIANCE DATE: D—GG- 117 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland 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 d� �e•��f,�,/� ^ ^ /6,*q5 h I No. (� .�, Fee to THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE.1 MASSACHUSETTS 0[ppricatiou for Migogar *potem Cougtrurtiou 3permit Application is hereby made for a Permit to Construcf`(s;.;.)or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. ,/ Owner's Name,Address and Tel.No. !®roc I G2� GI)d� f�xa4141., Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /910-Gay 5 7- Type of Building: Dwelling No.of Bedrooms 3 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 Description of Soil Nature of Repairs or Alterations(Answer when applicable) OP 24A 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 issue this loard of He Signed Date Apphcation Approved by r' Application Disapproved for the following reasons Pemut No. CQ5Date Issued xg ,4y'avtii,gw"d,�..r�,*..,�.; � w.�,. .,r�Mr�'.,-..,.,,,,.s.•.4`.fc'rG, :.:.+�dfl:ern.f�{ r+a..� f _a _ ,. _.w. _-..__ �, .-.e-F«+!•+""""..-„5.' ip�rFf No. . ' g j e -.� Fee-- r� " ' -THE COMMONWEALTH OF MASSACHUSETTSF 4 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Miopo.5ar *pgtem Con.5truction Permit f Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. �• - O .,6'OF,C / 4i A Installer's Name,Address,and Tel.No. i Designer's Name,Address and Tel.No. 1 /4GZGe" ljr57- �/ �5 � 6 � =f # Type of Building: 3 Dwelling No.of Bedrooms 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 Description of Soil Nature of Repairs or Alterations(Answer when applicable) ., �,, 3' 1 Date last inspected:' / 1 i 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- t,: t cate of Compliance has been issued-by this Board of(Health`al Signed f� I /1 Date c'Application Approved by _Application Disapproved for the following reasons '��Permit No. Date Issued ` E t 8. 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 }- ?C/J �z� �. S for 3. A, , 7- 4're[nconstructed in accordance 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 be]o s No. � . � Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS xji0pd al *p!6tem Con.5trurtton Permit , Permission is hereby granted to— �"� �AJ A, 5 ' to construct( )repair(,�)an On-site Sewage System-located at le r and as described-in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5;a /e following local provisions or special conditionsfl;lLorill All construction muompedwith:n two years of the date below.Date: I /� .4 Approved by TOWN OF BARNSTAB LE (/— LOC ATION �� P-a2 r SEWAGE# VMLAGE Ct'y/'''" s ASSESSOR'S MAP&LOT�. �lLc,u 7 7 5^/.34 INSTALLER'S NAME&PHONE NO. / SEPTIC TANK CAPACITY LEACHING FACILITY: (type) • ?.4To it (size) /o se3 2 x NO.OF BEDROOMS BiMDER OR OWNER PERMTTDATE: /-4/of 7 COMPLIANCE DATE: /D—L/ 9 7 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 �y I 1 h oX /, v `7`QATo•e f' 1 �• 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) I,Z�I'e 3, B c/ hereby certify that the application for disposal works construction permit signed by me dated h s/�� , concerning the property located at 1-10,-q PQ,,eT ✓1 ivt� meets all of the following criteria: •/Thheeree are no wetlands within 300 feet of the proposed septic system • Th a are no private wells within 150 feet of the proposed septic system • Teo served groundwater table is 14 feet or greater below the bottom of the leaching facility /� • �re-is no increase in flow and/or change in use proposed There are no variances requested or needed. , SIG 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]. �� v� °' o 1 � i `I t d b .. y �� ]1 - t�,� 4� y �, 0 1\ la c a �� J ��o `, ri