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Home My WebLink About0043 QUAKER ROAD - Health 43 .QUAKER RD., HYANNIS A=310/307 I 'Y J TOWN OF BARNST LE " LOCATION ��'� �`"r 2 _ SEWAGE VILLAGE �''�"��` � ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. I- SEPTIC TANK CAPACITY 7- LEACHING FACILITY: (type)3 /'7Ax,ii S;2r (size) f/ k `� X NO.OF BEDROOMS 3 BUILDER OR OWNER_ �I rF— PERMTT DATE: -7. 64 8i 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 cv tv �•Y No. CT / " Fee • d,_...._ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -AZ Yes / PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS t/ Zipphration for Migpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System El Individual Components Locat' Address or Lot No. / Owner's Name,Address and Tel.No. `r` /Z I-f/qovw rs Assessor's Map/Parcel �� d Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1062C*6 5-r 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 Alterations(Answer when applicable) i44V 0as 4 f �D W. Ta Z v -171 r /000 Y 7- 3 /zi19W1 0'4 44 -ZA.1 1rllArf02r f�.S?off 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 d not to place the system in operation until a Certifi- cate of Compliance has been iss b is Board of Sign Date / Application Approved by or Date - Application Disapproved for the following reasons Permit No. f�°�'� 7 Date Issued G - No. 9, % G v Fee S" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTIaBLES MASSACHUSETTS Yes 9ppfication for Miopogal *pgtem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System 0 Individual Components Locatio Address or Lot No. Owner's Name,Address and Tel.No. `f� Assessor's Map/Parcel 3%d 3a � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 Revision0ate Title Size of Septic Tank Type of S.A.S. a, V: Description of Soil ?" rf Nature of Repairs or Alterations(Answer when applicable) 194V wF )"/4p ar :\ �; 7a, y i O o 5- 7— 3 ^A.t'{ .-i 'L S Q .�.M.�, /r�I�ro 2�` �'S?y✓.�: l�f 5 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-sitte sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code d not to place the system in operation until a.Certtiifi- cate of Compliance has been issue. b Board of � lftt. Signe. �' .:Date .. 5+ Application Approved by C Date Application Disapproved for the following reasons Permit No. 71"Date Issued 7— G—9, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded( ) Aban °}red( )b}� A R l� � , S i at � 7P &•a kr i 2 2 has been constructed in accord nce with the provisions of Title 5 and the for Disposal System Construction Permit No. g '�� dated 7—6 —g� Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date '7 . Cl`RZ Inspector "J 0. Fee ✓� THE COMMONWEALTH OF MASSACHUSETTS It PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS '=i5Poga1 *pgtem (fon6truction permit Permission is hereby granted to Construct( )Repair( —TGo ade( Abandon( ) System located at "-7- GZ vA /T� Z /ZX 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 Cmust be completed within three years of the date of this ermit. s Date: 7�� /� Approved by C - -4. w, 10/9/97 1 Y 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) 8- ,4 y r7,hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at Z -3 ( vD( /7 2 �� i' �>"ti�s meets all of the follo g criteria: ze e are no wetlands located within 100 feet of the proposed leaching facility • ere are no private wells within 150 feet of the proposed septic system • ere is no increase in flow and/or change in use proposed • ere 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 not 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) 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]. q:health folder:cert �\ �\ � v . x e� �� Q � �� ,t - - �� -��L 1 TOWN OF BARNST LE LOCATION SEWAGE # VILLAGE jay a"may` s ASSESSOR'S MAP & LOT_J"L:�.� INSTALLER'S NAME&PHONE NO. /�a e-f (d,s% 7 ? S /.3 C'2 SEPTIC TANK CAPACITY L S T /o oe 5 LEACHING FACILITY: (type)3 (size) 1 jC -2- '7 X 2 NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: -7 , G I 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 w