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Home My WebLink About0010 MYRTLE DRIVE - Health (2) 10 MYRTLE LANE, HYANNIS A = 1 i I I WSO ' my 0� TOWN OF BARNSTABLE - , - vl qqewg LOCATION ( SEWAGE ri p /� VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Ali C,'Qe f-C SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) .1.r/IIJY-irH 10A X (size) NO.OF BEDROOMS BUILDER OR OWNE PERMITDATE: qlqlqq1 / 1 / 1 / COMPLIANCE DATE: qIffiqq of 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � � W � � �� r L�1, to 1-> e . G .� � ' t' :, .� a i .� . � A l No. � L � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ves PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zppfication for Migotai *pgtem Congtrurtion Permit Application for a Permit to jCckn ct( )Repair( )Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot N `IQ tti� Owner's Name,Address and Tel.No. Assessor's Map/Parcel � 0 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 -M30 gallons per day. Calculated daily flow 73114c gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank V)66 Type of S.A.S. }C CQ or-a nk L Description of Soil Nature of Repairs or Alter tions(Answer when applicable) G`7 E CL 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 ea Signed Date Application Approved by ' Date r 1� Application Disapproved for the following reasons Permit No. Date Issued �J� TOWN OF BA.RNSTA.BLE NEqq0W9LOCATIONSEWAGE 1� VELLAGE ASSESSOR'S MAP & LOT D o� o INSTALLER'S NAME&PHONE NO. is 7)'F- 6 rr SEPTIC TANK CAPACITY / S o c► LEACHING FACILITY: (type) AIX X (size) _ � 111.2S NO.OF BEDROOMS BUILDER OR OWNE i PERMTTDATE: qCOMPLIANCE DATE: Separation Distance Between the: i I 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 j Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by FZ7 - �r� -O-7TrV - r V � I 1 No. t / ( '✓ ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARN STABLE., MASSACHUSETTS ZIppiication for Miopozar bpotem Contruction Permit Application for a Permit to Co ct( )Repair( )Upgrade( )Abandon( ) Complete System ElIndividual Components Location Address or Lot N r 4 cL-V_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel ^-7`r �1 O �l10001-AV✓ k Installer's Name,Address,and Tel.No. 1 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 3U gallons per day. Calculated daily flow :K4 gallons. Plan Date Number of sheets Revision Date Title '\Size of Septic Tank Ste"571 4.A.c VY)a Type of S.A.S. — c Description of Soil gAu✓ Nature of Repairs or Alt e lions(Answer when applicable) r 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 e Signed "�� Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CER , that the,On--site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by — _ at a — has been constri wed i accordance with the provisions of Title 5 a the for Disposal System Construction Permit No. d ' Installer Designer The issuance of thisp ris all t be construed as a guarantee that the sy t 1 Xn 'on as gne Date Inspector r _ l No. �. ,7-------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Mi.qpogai &pfstem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( .-<andon( ) System located at 0 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 st be corn feted within three years of the date of this t. Date: Approved b 1/6/99 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) hereby certify that the application for disposal works construction permit signed by me dated ��5'�S�j , concerning the property located at /at-_l meets all of the following criteria: b,AXTnhe failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. ( The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system • /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. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] �If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation ��+the MAX. High G.W. Adjustment _ o DIFFERENCE BETWEEN A and B tP 7-1— SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder:cert Q �