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Home My WebLink About0105 CAPTAIN ELLIS LANE - Health 105 Captain Ellis Lane oil Hyannis A= 250-099 l TOWN OF BARNSTABLE LOCATION/®S CA P T - C-f /� .G�'-�� SEWAGE # — VILLA ASSESSOR'S MAP & LOT_.�4'--,d p INSTALLER'S NAME&PHONE NO. i � ` o.6 i,,(Z-77S 7,_3, 7 C-_ SEPTIC TANK CAPACITY d! LEACHING FACILITY: (type (size) NO.OF BEDROOMS -� BUMBI R-OR OWNER �1 PERMTTDATE: j, 6 ` /6 COMPLIANCE DATE: Separation Distance Between the: 4, - Mai imum Adjusted Groundwater Table and Bottom of Leaching Facility ; Feet Private Water Supply Well Leaching Facility (If an;%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; � � V 1� r � .�� '-- �9 � �� *t No. Fee 40 .00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Migogal *p9tem Congtructfon 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. 105 Capt Ellis Ln John Wetterlow Hyannis 919 N.E. 11th St Installer's Name,Address,and Tel.No. eslgner's ame, ress an el.7.. W.E. Robinson Septic Sery P.O. Box 1089 Type of Building: Dwelling No.of Bedrooms 3 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 o>f ai or Alte ations(An ,er when ap 11icable) install 3 #3 3 0 high c ap c i t y infi �a�tors to exisw ing syVem 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 Environrngntal Code and not to ace the system in operation until a Certifi- cate of Compliance has been issued by this Boai;d of l Signed fl Date Application Approved by Application Disapproved for th follow' g reasons Permit No.�� 11,7 Date Issued � '- ._.:^_._tom:..`a.,+,1Y�` �_�{y{Tl-: „ .w�j+.J `-riJ4' Gig°.}.....R..r".e:.y.�,+,..,�:r ..�". 5u t'C�".�t''�'-"yf/'` �,v^..:*Wr�wrrl'1 J•M+'•ti"!� .J�� Cwa' � No. — ' Fee —40 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS A' application for Migpogal *pgtem Congtruction Permit t Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: r r Location Address or Lot No. Owner's Name,Address and Tel.No. 105 Capt. Ellis Ln John Wetterlow Hyannis 919 NOE. 11th St In st Her's Name,Address,and Tel.No. esigner's ame, dress an e. o. CE. Robinson Septic Sery P.O. Box 1089 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(nc) 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 Nato ai orAltea extninengh sy temle) install 3 #330 high capcity infYftai`tors 4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordancemith the provisions of Title 5 of the Environm ntal Code and not to lace the system in operation until a Certifi- cate of Compliance has been issued by this Board of IM A QQ Signed l Date S` ic— 7 Application Approved by 44 Application Disapproved for th follo • g reasons i a Permit No. Date Issued 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 Sery for JOhn Wetterlow as 105 Capt Ellis Lane Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the.provisions set forth be w: 4 +" >0CC sue" s No. J/J Fee 40.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x gpool *pgtem tongtruction permit Septic Service S W.E. Robinsone Permission is hereby granted to P to construct( )repair( x)an On-site Sewage System located at 05 Capt Ellis Lane Hyannis aM 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 by John Wetterlow a � . 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 f , concerning the property located at 16 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. L 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]. �JIS a