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Home My WebLink About0015 FISHER ROAD - Health 15 FISHER RD.,HYANNIS A=309.044 i i i I I TOWN OF BARNSTABLE LOCATION /S hs6ii�" ar SEWAGE # VILLAGE #a6anh/S - ASSESSOR'S MAP & LOT 509 - 9 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) -J'M 61 (size) 5 X /3;2•. NO.OF BEDROOMS BUILDER OR OWNER J04.4 L01r 1'17- PERMITDATE: l 2 COMPLIANCE DATE: /2,a 3-57? 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 facilility� Feet Furnished by � %/y -� • t �_ `�/"`S � • 'O _- �, ,n r' � t---- j i; f' 4J'r J,,, •� No. Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for 30igaal *pgtem Construction Permit Applicatiodfor a Permit to Construct( )Repair( e,4pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 16- Ad Owner's Name,Address and Tel.No. fc�nc% L n �1T Hy hH/s /s I":q i1 /^ Q�faca Assessor's Map/Parcelef' y O t�r/r1iS Installer's Name,Address,and Tel.No. 4/"1'9- O3`19 Designer's Name,Address and Tel.No. jo epl, !7� l�ar�rc�S Sly / G Type of Building: Dwelling No.of Bedrooms 3 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) i'x//S r, r 1p��s &,,s �..[..195r"l 6S•DD 6,,,1 )('/ — � LOB K, 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/2r /7-Val-9 l Application Approved by /11 mj Date Application Disapproved for the following reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION /5- f;stii--r �� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT S09 - a 9 y INSTALLER'S NAME&PHONE NO. 417 3419 os �'1a D C ,gv��aS SEPTIC TANK CAPAC= 1,700. LEACHING FACILITY: (type) --5-a0 (size) S X NO.OF BEDROOMS BUILDER OR OWNER Job,N Lorr r 1T PERMTTDATE: (�L COMPLIANCE DATE: 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 A u� AJ I ��.No. � .. Feeso / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF-BA 1.4 RNSTABLE., MASSACHUSETTS 01ppfication for Migpogal *pgtem Construction Permit Application for a Permit to Construct( )Repair( �pgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. I s F134,5 r' Rd Owner's Name,Address and Tel.No. 4_,9 L, n-e-2 1-r Hy�nris /s' FsLi,�r Qofoc� Assessor's Map/Parcel 4 -109 yy H IoNHFS` Installer's Name,Address,and Tel.No. N'7T U3 yq Designer's Name,Address and Tel.No. � ✓aS��O�i Q� (�r9Nrv$ it Type of Building: Dwelling No.of Bedrooms .3 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 1 Size of Septic Tank / Type of S.A.S. Description of Soil S•gH�l�1 t Nature of Tay��s Repairs or Alterations(Answer when applicable) /:x� r s 9nbo/1 lSDo 6d/ .�T 2- S"Oo,O ./ / seL Td i .ss,,Arrs w,rA y' 5r4.nc �ro�rti� 2 " f eW Sr0k7 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 a Date /2-/7-93' Application Approved by o Date Application Disapproved for the following reasons 1 � Permit No. y Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Eompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired (C_)-Hpgraded( ) Abandoned( )by ✓oS zp� d� �i4rvo5 at l S F1 .-r H �a iS e ec cted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer D, Qahras Designer Jese rro The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date t - 1L ) Inspector C\ ----------------- No. WITT Fee\�' ( // �O y oY T�-- THE COMMONWEALTH OF MASSACHUSETTS y PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(grade( )Abandon( ) System located at / S h t,^ /� , H��s9i�%5 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. Provin2# n s b co leted within three years of the date oft/"n�oz Date: Approved by4,�Z�vJ7 � - f 10/9/97 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 PERMIT (WITHOUT ENGINEERED PLANS) I, Josz--,P�aes hereby certify that the application for disposal works construction pem-tit signed by me dated 2- /7- 1? ,concerning the property located at /S /� � � /1� f�N��H�s 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 sere is no increase in flow and/or change in use proposed ere are no variiances requested or needed: • If the proposed Icaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will pol be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete ithe following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) 124 B Observed Groundwater Table Elevation(according to Health Division well map) I SIGNED: �/� � DATE: /2 !7— 9� LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER �rY (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:cert �x,sri�q C",froa� e Fravt T � - Seo G�� pry cvr-�ls