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Home My WebLink About0038 CAPTAIN ELLIS LANE - Health 38 Captain Ellis Lane'.,g, Hyannis :a . A = 250 �106 0 0 90 No. Fee a 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Rppricatiou for Zi!5pool *pgtem Com5truction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel �� 4� v ��+ "t 0�U C0.1A1- �.f lc'S Lai � a Installer's Name,Address,and Tel.No. Designer's Name,AddrAs and Tel.No. t-. '' ni�tts- 3 /rr sa arc sT YRe_at_eL0(_MR.02(675 pe of uilding: 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 Alterations(Answer when applicable) 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 Co and not to place the system in operation until a Certifi- cate of Compliance has bee s y this Board o al Sign Date Application Approved by75M ® Date Application Disa roved for the following PP PP g r s n f Permit No. Date Issued No. =`; \ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS P Application fo'' Migpogar *pgtem Construction Vermit H•r Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. I'LOwner's Name,Address and Tel.No. p ! tso " Assessor's Ma /Parcel �'� 7 Ct� � Installer's Name,Address,and Tel.No. Designer's Name Address and Tel.No. 1rr, in 1; YR►2trz -k 11` R.C�2�75 Type of wilding: 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, i f t Title / i Size of Septic Tank ' Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) IN J Date last inspected: 1 yf Agreement: The undersigned agrees to ensure the con structionland maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Cogdr,and not to place the system in operation until a Certifi- cate of Compliance has beerr�Ts—_Stutb'ythis Board of42al Sig hi` "'. ' Date Application Approved b 0 V5 DateR. i. Application Disapproved for the following r a ns .. I "o, Permit No. _ a� Date Issued r' . -------i----— -----------------C— ------ THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) - Abandoned( )by 41 e �` at r2,_ 0 E Ill rti. 1 why as bre zconstructed.in ac ordance with the provisions of Title 5 a��t`d the for Disposal System Constru tion Permit No. �~ ated Installer k' K� Designer The issuance of this permit sha, no ' e construed as a guarantee that the syste .``R ,un tion as designed. Date 'S Inspector .- No. � -------.--- ------ ----------------Fee__ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS �f migpoga[ &pgtem Construction permit o Permission is hereby gra t tg-C nstr ( ) epair( )dJ grade( )Abandon System located at 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: Co truc on must b11;, e completed within three years of the date of this p t. /0 Date:__ _ Approved by 4,v f -FROM :down cape engineering inc FAX NO. :15083629880 Aug. 22 2005 11:15AM P5 S k Town of Barnstable vfTME?a�, Regulatory Services Thomas F. Geiler,Director SAR''TA� t 'Public Health Division i6}P ao 59. Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& llesi Certification Form Im ('er Date: Sewage Permit# Assessor's Map\Parcel Designer: Uin1 r Installer: W Address: /3 q r (a Address: �J o L l a,./'M o l®e�. a �, A-14- On ^was issued a permit to install a (date) (installer) septic system at-36 - CLA;j 11` Lr:— based on a design drawn by (address) dated Z 1 ,5 —�� ( signer) Zi cI cfy that septic the tic system referenced above was installed substantially according to P the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF to S q ARNE H C�� o OJALA (Installer's Signature) civil.. No. 30792 �¢- FSS�O (De.i er's Signa ) (Affix s Stamp Here) PLEA F RE URIY TO BAR STABLF PUBLIC HEALTH DIVISION CERTIVICAIE OF COMPLIANCE WILL NOT BF ISSUED U IL BOTH THIS F RM AS-8Lr1L CARD ARE RECEIVCD BY THE.BARNSTABLE PUBLIC HEALTH DIVISION. THANK YQU Q.Hcalth/Scptic/Dcsigner Ccrtification Form 3-26-04.doc i oCV `.„/ s Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. ✓ V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for Migool bpgtem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade(1/)Abandon( ) ❑Complete System Py dividual Components Location Address or Lot No. r Owner's Name,Address and Tel.No. 35- Assessor's Map/Parcelff/q#�v� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size a 5:16 sq.ft. Garbage Grinder(Wo Other Type of Building A4) No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date N her of sh ets Revision Date n Title 5 l j Size of Septic Tank !!ype of S.A.S. G 4a9 Description of Soil 993"t 30,k Z- Nature of Repairs or Alterations(Answer when applicable) 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 this Bo d o Health. Signed Date Application Approved by _ Date 2 Application Disapproved for the following reasons Permit No. I)-o g Date Issued t A� t � N5 Fee 4THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes 'PURLICAEALTH .DIVISION -TOWN OF BARNSTABLE.,.MASSACHUSETTS F ZIPPricat on for Migozaf bpetem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(1/)Abandon( ) ❑Complete System FIndividual Components Location Address or Lot No. r Owner's Name,Address and Tel.No. Assessor's Map/Parcel eo/5 ago- 14- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7y Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( � I Other Type of Building A 5> eWe e? No.of Persons Showers( ) Cafeteria( ) Other Fixtures _ Design Flow gallons per day. Calculated daily flow gallons. i Plan Date L !� _ Number of sheets Revision Date Title f/ / ldl0 7'� _ ca l�/rI , Size of Septic Tank //�fJ� type of S.A.S. 3�Od !:�W Description of Soil k I I Nature of Repairs or Alterations(Answer when applicable) 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}this Bo d o Health. Signed /9 Date Application Approved by _ Dale Application Disapproved for the following reasons Permit No. rj-U V ;L` Date Issued ——————————-—---—--- ——-——THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTffY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(� Abandoned( )by at has been constructe. in ccordance with the provisions of 41-5 and the for Disposal System Construction Permit No. QCV.2- dated ;? G i Installer Designer '1 The issuance of thi permit shall not be construed as a guarantee that the syst ill f ction as d psi d. i D9P ate 2 Inspector r Uo d 7 No. Fee THE COMMONWEALTH OF MASSACHUSETTS i aU � � PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migog;ar 6potem Construction Permit Permission is hereby granted to Construct( )Repai )UP�grade(✓)Abandon System located at ` and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to ,s 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 t. w� Date: U 2 Approved by a TOWN OF BARNSTABLE f c LOCATION f�°7, 8141 L,v SEWAGE #0?00?/�L_ VELLAGE wnni ASSESSOR'S MAP & LOT INSTALLER'S.NAME&PHONE NO. � d SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Eno G� C ��..�_ (size) /O tC '42 NO. OF BEDROOMS BUILDER OR OWNER -F a // PERMITDATE: 5r.2 67- COMPLIANCE DATE: 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 Wetland and Leaching Facility (If any wetlands exist ^t' z within 300 feet of leaching facility)' Feet Furnished by bey- 4eAf �3� S$ emir