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HomeMy WebLinkAbout0761 PITCHER'S WAY - Health 761 PITCHERS WAY, HYANNIS A=271=134 i a I I °-7 TOWN OF BARNSTABLE LOCATION `�l � �✓� � SEWAGE # VILLAGE �'r s ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. � �G� / Cl✓� ���� ��� SEPTIC TANK CAPACITY 13yo Gi-L LEACHING FACILITY: (type) (size) /o'1,30 ' X 2 NO.OF BEDROOMS Q BUILDER O OWNE Ltd d PERMTTDATE: �7 - 1 7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �t 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 facili Feet Furnished by ��� >' t, s � :" lntir S� �S v �A t No. «. . �.. Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplic tion for Migoal 6potem Cun.5tructiun Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. W Owner' Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 71-?YW Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(✓- Other Type of Building wal No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 Design Flow gallons per day. Calculated daily flow 3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 14WO 3111l 4r)e% 7`/sf9 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(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 been issued b is o o ealth. Signe Date Application Approved by Date Application Disapproved for the following reaso .o Permit No. Date Issued � i.% ..a `Y,.w+l".. .. r f .:r�•y,,.:r ,e ".r..i.;..mt ..;;,.f�:i"'al�.�+r*„"'7v��......,w-.'t�wf. �,.. �-.... i-.,. ...,�,.•.s s . �loNo. Fee THE COMMONWEALTH OF MASSACHUSETTS " Entered-in computer: es -PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplication for ]0igp0gar *pgtem Conl 5truction PerftTit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / �j ,�C Owner'5 Name,Address and Tel.No.©vrz?, Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.,No. _7 7/ Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(� Other Type of Building CS/ PA,CeNo.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow A41 gallons per day. Calculated daily flow 3 o gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1*;x/P _'zi- /e,63®l Date last inspected: Agreement: r 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 b is o o ealth. Signed i Date ✓�/fir•� Application Approved by Date Application Disapproved or the following reason v Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS 2 71 13 7 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY,that the On-site�e wage Disposal System Constructed( )Repaired(✓)Upgraded( ) Abandoned( )by d/ ��LO/ C(�� , at /1>1G te/1-5 WZ11 Y41 ,S has heen constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "' I dated Installer Designer The issuance pLthis permit all t b construed as a guarantee that th ip will function as desi`!he . Date 7 Inspectrbr9 - -__-�= _,� - - -----=--=-------=firT-13-1-1- --No. � / z ( Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'WiOpogar *pgtem Congtruction Permit Permission is hereby granted to Coo structt )Repair( !�Upgrade( )Abandon( ) System located at zt / Imo/�N 1e!'S 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 co leted Athi, hree years of the date of this p Date: .-' Approved by L = 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 PERK UT (WITHOUT DESIGNED PLANS) I, � �� �l��e / , hereby certify that the application for disposal works construction permit signed by me dated s 10A?f concerning the property located at ,11 �l�`Gf��1'S cp IA1 ~161 meets all of the following criteria: ✓ The failed stem is connected to a residential dwellin g ng only. There are no commercial or business uses associated with the dwelling. /Thesoil 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 rr' There are no private wells within 150 feet of the proposed septic system * b' There is no increase in flow and/or change in use proposed +� There are no variances requested or needed lo/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 �O +the MAX.High G.W. Adjustment. 21 = �2 DIFFERENCE BETWEEN A and B SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder cert .� . . I� i� 7 Q