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Home My WebLink About0083 HAMBLIN'S HAYWAY - Health 83 HAMBLIN HAYWAY-1.. A=030.016Cq� G : TOWN OF BARNSTABLE LOCATION llm t" L(/lwd SEWAGE # VILLAGE M4r6?ohS 1AZIS / ASSESSOR'S MAP & LOT 03d INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /5 DO LEACHING FACILITY: (type) 3 `YlAA1 (size) .39X l/ NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: .COMPLIANCE,DATE: I 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 . r � 5,06 c S fI � No. G !/ Fee THE COMMONWEALTH OF MASS?'HUETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNE,, MASSACHUSETTS ricatior� forigo�ar *pteuttructtorterntit Application for a Permit to Construct a air )Upgrade( Abandon ❑Complete System ❑Individual Components PP t>(liYIF'P ( ) Pg ( )Abandon( ) P Y Po Location Address or Lot No. /P jj /f4N "Ijo' Owner's Name,Address and Tel.No. 93��'i f;4.,Ow�rams myls / (f OAF aw G ro.S� Assessor's Map/Parcel030 49/6 3-3 { H.V[eL Installer's Name,Address,and Tel.No. Zf%7—d j,-1 9 Designer's Name,Address and Te.No. Type of Building: Dwelling No.of Bedrooms o3 Lot Size sq. ft. 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 Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Al era tions(Answer when applicable) r% O /T i" k/! � ' D // '/0 o 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 this Board of Health. Signed Date 4/1—/5— qS Application Approved by Date Application Disapproved for the following reasons Permit No.— Date Issued - - - - -- - -- , 6- < a� TOWN OF BARNSTABLE LOCATION y14 u l,!/d SEWAGE# VILLAGE !M.46t0k7 i� ASSESSOR'S MAP & LOT 032 INSTALLER'S NAME&PHONE NO. /2, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) .?-9 X l/ NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: /0 COMPLIANCE DATE: 10 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 t7 �� No. Fee THE COMMONWEALTH OF MASSA HU TTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNS LE., MASSACHUSETTS 01ppYication for Migpooar*pgtem C ngtruction Vermit Application for a Permit to Construct(4,..)<epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 8 3 YAryy b/1*H H q4 (. AOtl Owner's Name,Address and Tel.No. ZI Q Assessor's Map/Parcel 4f,VrS rao.$ WWj -/-. G 0/a-aw 6/OSY-- a3o 0i6 Installer's Name,Address,and Tel.No. Designer's Name,Address and Te.No. Jose py awl does-o.S / , 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 gallons per day. Calculated daily flow 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 Al erations(Answer when applicable)// Fs/� rmirlrlri �i-�S f�2oZ iu� Tl�i H D /T // 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 this Board of Health. Signed Date_ 4— Application Approved by Date Application Disapproved for the following reasons Permit No. k19, Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site'Sewage Disposal System Constructed(e )_$,@paired( )Upgraded( ) Abandoned( )by o c 40Z 0 0 9A0~92$ at / ' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Constrdction Permit No. '- "aa—iedzh�-� Installer ,�e_ s-e—eh .0— Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ('� - ` Inspector s-,\ f!5> No.=��Y'"' -----------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS l3 7,6 Mi5pogar *rglem Construction Permit Permission is hereby granted to Construct( 4��epair( )Upgrade( )Abandon( ) System located at x.5 A-/kitE Jill-ki 14ja u 6d4 y 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 rmit. Date: ��" � .• lip Approved, r� 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Styptic Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAsL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated ,concerning the property located at �3 h��d�h Hi4� w� meets all of the following criteria.:. There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system �T"here,is no incroase in flow and/or change in use proposed V There are no variiances requested or needed. • if the proposed le-aching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will npi be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) '570 _ SIGNED: rc � -� DATE: /D--/S 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). q:health folder,cart � $3 y' / S 3 O O