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Home My WebLink About0062 PINE STREET - Health 62 PINE STREET ,. Hyannis A = 249 - 048 i+ . J TOWN OF BARNSTABLE LOCATION �� /'/�Z3a S SEWAGE# . VILLAGE— ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. aj!.3f_ StioT�P_ SEPTIC TANK CAPACITY LEACHING FACILITY: (type)T�i (size) NO.OF BEDROOMS .BVI.,DER OR OWNER PERMITDATE: I� -S—e/7 COMPLIANCE DATE: C� `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 ,S t v O IL 1 TOWN OF BARNSTABLE bodo s`= LOCATION l�s�( /"� ;5 SEWAGE# VILLAGE J//*71/7eJ ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15�po LEACHING FACILITY: (type) e/ Srtck�, (size) NO.OF BEDROOMS BUILDER OR OR OWNER l` &':� PERMTTDATE: g4 —S—�COMPLIANCE DATE: - 1A Separation Di tance 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 C No. Fee �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for nigpo at *papm Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. oxe, 5i- Ceww" Owner's Name,Address and Tel.No. Assessor's Map/Parcel _�Lj—a(41" �c CJ ' Installer's Name,Address,and Tel.Nov. Designer's Name,Address and Tel.No. zta Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building f11LG 4?Wcr_No.of Persons . Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I`�;00 Ga4N`pk_,1 Type of S.A.S. Description of Soil Illy Nature of Repairs or Alterations(Answer when applicable) L W� Date last inspected: Agreement: M 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 thi of Health. Signed Date Application Approved by Date Application Disapproved for th follo 'ng reasons Permit No. to Date Issued ` < 41V No. " . r Fee �/� r Entered in computer: THE�COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplicat o'n for Dizpogal *pztern tenztruction Permit Application for a Permit to Construct( )Repair( /upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. p� yt �jr � ,,T�,t Owner's Name,Address and Tel.No. O Assessor's Map/Parcel 1DL\_\k_Uq� SG p ' N 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 E1 Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 yS gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I� Arx✓ Type of S.A.S. IA,c Description of Soil p Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 4 Agreement: I 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 Boar, f Health. Signed -..^'' f Date Application Approved by Date r -ram 7 Application Disapproved for th ollo g reasons i# Permit.No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS i (Certificate of Compliance THIS IS TO CER that the 00 s' a Sewage Disposal System Constructed( )Repaired(V Upgraded Abandoned( )by at _Z4- V1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No._ dated- Installer Designer The issuance of this permit shall not be construed as a guarantee that the system wiij-function as designed. Date - Inspector �.� No. Fee i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS xji!6pogar *pgtern Construction Permit Permission is hereby granted to Construc )Repair( p rade( )Abandon( ) System located at 1 t�>. v� E 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: to - 7 Approved by � y' 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 97 , concerning the property located at 62a- P� s ��w-z��-Jl�- 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]. -I i 1C\\ Li3 i