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Home My WebLink About0025 MARYALICE LANE - Health 25 MARYALICE LANE, HYANNIS A=291.076 f. I� TOWNOF BARNSTABLE LOCATIONr' SEWAGE # VILLAGE" -I�•z - ASSESSOR'S MAP"& LOT1-676 INS`11U.LER'S NAME&PHONE NO. L¢&y-� -7`ID �S �. SEPTIC TANK CAPACITY . , LEACHING FACirI is (type) Y1 o W+w.X V (size) 0/1.goo NO.-OF.BEDROOMS BUILDER OR;OWNER K' a iv7 -ft .,r PERMTTDATE �/L��..•�_ COMPLIANCE DATE: -/T.f' Separation Distance Between the: P _ Maximum Adjusted,Groundwater Table and-Bottom of Leaching Facility Feet Private WafW upply Well and Leaching Facility (If any wells exist on site,6rwithin 200 feet of leaching facility) Feet Edge•of Wetland and Leaching Facility(If any wetlands'exist�,. within'300 fe t f leac 'g fac' ' Feet- Furnishe'd by �� , � � � . �. c -, � �� ,� �. �' ...._ �.. --y � _ -� � � �. � _ , . _ �. t� ..; Q/y��• _ .;1 .�.. .. �+` . s �a.� r. , i Y .. ` + _.i No. Fee 6t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: J Z PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS es ZIpprication for Migaal *p5tem COugtructton i3ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( O Complete System O Individual Components Location Address or Lot No. Ow er's Name,Address d Tel.No. Assessor's Map/Parcel C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. (1-1—e t fL.. a 1 Cj J pC %tea w rx o Type of Building: �q Dwelling No.of Bedrooms Lot Size ° 1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons 2-- Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �D Type of S.A.S. .57-Q'iq Description of Soil Nature of Repairs or Alterations(Answer when applicable) Uq� 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 is u d by ''s Bo f Health. ?yq` Signed Date [7 Application Approved by Date Application Disapproved for the fo owing asons Permit No. .J Date Issued TOWN OF BARNSTABLE LOCATION 7i� SEWAGE # J VILLAGE I-L ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO._K,�-g, L eg, ,,,, '7LjD SEPTIC TANK CAPACITY IAlJf LEACHING FACILITY: (type) 1A X v (size) NO.OF BEDROOMS BUILDER OR OWNER ci PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjdsted,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 300Attfieeac ` g fac' ' Furnished by Feet y 96 No. aZ Fee .J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 2 Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS ZippYication for Miopoml *pOtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon(--Y'�❑Complete System ❑Individual Components Location Address or Lot No. Z S PP^Q L;i Owner's Name,Addres�pd Tel.No. Assessor's Map/Parcel '2_ _ O -4) C e Installer's/Name,Address,and Tel.No. Designer's Name,Address and Tel.No. P1 C O Y � � Type of Building: ix Dwelling No.of Bedrooms Lot Size 1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons 2-- Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank !ED eq Type of S.A.S. ;M Description of Soil 0 Nature of Repairs or Alterations(Answer when applicable) UIe 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 is su d by t 's Boar Health. Signed . Date �7 1 Application Approved by Q 4 Z 4 Date Application Disapproved for the fo wing Pasons Permit No. Date Issued 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 at has been constructed in accordance r with the provisions of Title 5 and the for Disposal System Construction Permit No. - dated '` C Installer Designer The issuance of this permit shall not be cotmtrued as a guarantee that the syste will functionas designed. Date / 0 Inspector Y 0 Zo. -L �7 �!/ ` ,J --- --------------------- Fee dd THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS MiOpOai *pgtem Construction Permit r Permission is hereby granted to Construct( 1)Repair(>�'Upgrade( )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: Construction must be completed within three years of the date of this permit. Date: Approved by 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, L- a` , hereby certify that the application for disposal works construction permit signed by me dated C �, concerning the property located at czr 4 < < 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 • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W 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) `2-t SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALL 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:cert