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Home My WebLink About0003 WOLLEY ROAD - Health 3 WOLLEY RD.,HYANNIS A=269-173 e 1 r i I f I. 0 TOWN OF BARNSTABLE LOCATION ® � SEWAGE # ��"� VILLAGE ASSESSOR'S MAP &LOTI-w 1 / y - cd INSTALLER'S NAME&PHONE NO. ��b� A'g"�--�' � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) v �'• C (size) NO.OF BEDROOMS 3 , BUILDER OR OWNER ®A- V PERMITDATE: 6—7 -3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland 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 P 4 � � F w No. jY Fee $5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mizpozaf *pgtem Construction Vertu Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 Wo l l ey Rd Owner's Name,Address and Tel.No. 7 71 -81 7 5 Assessor's Map/ParcelHyannis, mA Pat Horiguchi 3 Wolley Rd 26 7_ Hyannis, MA 02601 Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service P O Box 1089 , Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( n9) 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 sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic System consisting of 1500 gallon tank, D-Box, and 2 precast leach chambers.lt2L4 S+a V2 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 th' B arda of He Ith. Signed _ Date Application Approved by E Date f--t3 79..0— Application Disapproved for the following reasons Permit No. Date Issued S=r 3— i • t i i 1 ; TOWN OF BARNSTABLE LOCATION 1` G SEWAGE VILLAGE ASSESSOR'S MAP &LOT- INSTALLER'S NAME&PHONE NO. ��b/ '�'3 �' SEPTIC TANK CAPACITY 6�0� LEACHING FACILITY: (type) a"'� S� (size) NO..OF BEDROOMS 3 BUILDER OR OWNER O t PERMITDATE: 73 2. 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) 4 eet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ' - r . . r+ht 1, •., ♦ , , - . . ..� , � d . ry..n • -.�f'�`{•}�-��'1F....7yr#n�-,,,.•..i'S/4,.....r.r ` .r,...�� q y► � q No. / O /6 ` it - Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliration for �hgpo$al *p5tem Cottgtrurtioti Permit Application for a Pernut to Construct( )Repair.(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 Wolley Rd Owner's Name,Address and Tel.No. 7 71 —81 7 5 Hyannis, mA Pat Horiguchi 3 Wolley Rd Assessor's Map/Parcel 26 Hyannis, MA 02601 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. W E Robinson Septic Service P 0 Box 1089, Centerville, MA 0263 r Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( nq Other Type of Building NP. of p_ersc s Showers( ) Cafeteria( ) Other Fixtures 1 j u 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 sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic System consisting of 1500 gallon tank, D-Box, and 2 precast leach chambers.tc.)y t S•fa► L 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 th' B ard of He lth. Signed Date:7/? Application Approved by c Date S=t Application Disapproved for the following reasons i Permit No. Date Issued S-/ S d —THE COMMONWEALTH OF MASSACHUSETTS Horiguchi BAMSTABLE, MASSACHUSETTS S-1 3 -S Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired (x )Upgraded( ) Abandoned( )by A. at 3 Wolley Rd, Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9f— Z?6 dated Installer W E Robinson Septic Sry Designer The issuance of this p t s 1 not b cp�strued as a guarantee that the system�111� nclion as designed. Date IM " i d Inspector Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Horiguchi xMiopogal *p$tem Conttruction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 3 Wolley Rd Hyannis, MA Installer W E Robinson Septic Sry 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 p t. Date: S �3� / Approved by �ijj f T, NOTICE: This Form Is T® 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, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 3 Wolley Road, Hyannis, meets all of the following criteria: * There are no wetlands 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 ng variances requested or needed. * If the proposed leaching facility will be located with 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 Evaluation(according to Health Division well map) o SIGNED: DATE iS 1,3 -7 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). �-- �� !� v L� �l a N � ` � , ,� � �� C r. v► � . � �.