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HomeMy WebLinkAbout0075 SECOND AVENUE (HYANNIS) - Health 75 Second Ave i 246-090 West Hyannisport i ✓� TOWN OF BARNSTABLE LO :A';ION � 1s fe�' SEWAGE # 0 VILLAGE /06d!T ASSESSOR'S MAP& LOTP fit~ 69,1 INSTALLER'S NAME&PHONE NO.W/1-•A, PC) B f IS-0J✓— 77d= 9 -77 SEPTIC TANK CAPACITY Zr LEACHING FACILITY: (type) (size} r—4VIA43- NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE:T1,oZ V 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 i �t CJ1 ,-Ca I ASSSESS©RS WP ND� No. �°'"' ��� V Fee 40 .00 THE COMMONNWELAL ffi PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Apphration for �Digoga[ *pgtem Cou6truction 3permit Application is hereby made for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 75 2nd Ave Mr Sheridan W. Hyandnisportx Instte.'� .arn A grl ns and Tson I Septic S e r V 1 C e Designer's Name,Address and Tel.No. P.O. Box 1089 Type of Building: Dwelling No.of Bedrooms 2 Garbage Grinder(no) 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 sand Nature of Repairs or Alterations(Answer when applicable) install a 1 , 500 gal septic tank, d-box and Title 5 leachtrench 2 ' x4 'x60 ' pump and fill old cesspools 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 thi ard,6f Health. Signed 1 Date 2_15__� Application Approved by Application Disapproved for the following reasons Permit No.� tl�<" <J e� Date Issued 7 � s le 40 00 ,I No. Fee THE COMMONWEALTH.OF MASSACHUSETTS PUBLIC HEALTH DIVISION.- TOWN;OFBARNSTABLE., MASSACHUSETTS { 0(pplicotton for MigpogAY-*p!5teTn Co,n5truction permit ; > Application is hereby made for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: � . Location Address or Lot No. Owner's Name,Address and Tel.No. 75 2nd Ave Mr Sheridan W. Hyannisport Inst er' am A d ss,and Tel. o. Designer's Name,Address and Tel.No. . onsonetic Service P.O. Box 1089 Type of Building: Dwelling No.of Bedrooms 2 Garbage Grinder(no) 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. *" sand r �y Description of Soil - Nature of Repairs or Alterations(Answer when applicable) install a 11r 500 gal septic tank, d-box and Tttle` 5 leachtrench 2'x4 'x6O ' pump and fill old cesspools { so".. Date last inspected: Agreement: . The undersigned agrees to ensure the construction and maintence of the afore described on-site sewage disposal system 1 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 an f Health. Signed / _ � Date 2_ Application Approved by Application Disapproved for the following reasons Permit No.�7 b!' .� Date Issued ," i` 9,-_-- 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.(x )on by W.E. Robinson Septic Serv, for Mr Sheridan as 75 .2n—a Ave W. Hyannisport has been constructed in accorda ce with the provisions of Title 5 and the for Disposal System Construction Permit No. 46 dated Use of this system is conditioned on compliance with the provisions set fo below: No. e— Fee 40.00 ` Sheridan THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS dig oga[ *pgtem ctCongtruction Permit Permission is hereby granted to W.E. Robinson Septic Service to construct( ..)repair(x,)an On-site Sewage System located at 75 .2nd Ave W_ Hyanni sport 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. All construction must be completed within two years of the date below. Date: `� . /"'" �?) Approved a CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I hereby certify that the application for disposal works construction permit signed by me dated concerning the r property located at 'j l� , meets all of the r following criteria: / 6 A i • There are no wetlands within 300 feet of the proposed septic system .,t • 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. i ti a �_��� .- SIGNED : G �� 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]. O Q 1 � b �c 0 R 1