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Home My WebLink About0062 WOLLEY ROAD - Health 62 Wolley Road, Hyannis A= 270-165 0 TOWN OF BARNSTABLE LOCATION �Z �l/� Y SEWAGE # VILLAGE ti'_dT11,/ G ASSESSOR'S MAP & LOT ZZZ�'- 4;- INSTALLER'S NAME&PHONE NO. l', i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) &'L X y2 NO. OF BEDROOMS BUILDER OR WNER PERMTTDATE: 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 R� Oq II 0 L TOWN OF BARNSTABLE LOCATION Z /; ' SEWAGE # VILLAGE `,n„ c� ASSESSOR'S MAP & LOT . 01 .INS NAME&PHONE NO.TALLER l'r�Lo�`�� SEPTIC TANK CAPACITY vC� LEACHING FACILITY: (type) In�,�1�u.fvdS (size) X o� ' NO.OF BEDROOMS ROOMS :BtUDER O WNER g P ERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) exist Edge of Wetland and Leachin Facility(If any Feet within 300 feet of leaching facility) Furnished by ------------- / � � 0 "Now Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 21pprication for ;Digpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(t/)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f„ Z ��wp� , Owner's�N'�,Add s V11,11, 0. Assessor's Map/Parcel V + eI/ aml-5 Installe's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(4-1617 Other Type of Building _A I_Ize 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. l1 % Vt9iPS Description of Soil Nature of Repairs or Alterations(Answer when applicable) 72 Z-k e 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 e t �od e Signed Date F/ Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued " 1Vo.� Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE--MASSACHUSETTS ZIpprication for Oigpogar *p.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(/ )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Z Owner's Name,Address and Tel No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.. Designer's Name,Address and Tel.No. f Building: �'Pe o d g• Dwelling No.of Bedrooms 3 Lot Size s .ft. Garbage Grinder Other Type of Building ,C5/G'e- 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. L/ Lfi?' i�f7`�'iP5 Description of Soil Nature of Repairs or Alterations(Answer when applicable) / / _u 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 Environmental4Code and not to place the system in operation until a Certifi- cate of Compliance has been issued - t ' Board o ealth s LL i Signed Date Application Approved by ® e I Date Application Disapproved for 4 e following reasons 16/ Permit No. or Date Issued — --� - --------- ------------- -- -- - — — THE COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE, MASSACHUSETTS { Certificate of Compliance THIS.IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired( ' )Upgraded ((/) Abandoned( )by All 1-4 h ✓ 4/l, �''�i at /, t/ r been constructed in accordance ; with the provisions of Title 5 and the for DisposalSystem Construction Permit No. dated Installer-_& 6il14&/ G4iL5T Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date "1 1 Inspector \ti ———-- ——-———— —————— — — — No. �_ ��f�Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Di5po!9ar 6petem Con5truchon Permit- Permission is hereby.granted to Conct( )repair( )Upgrade( �bandon( ) System located at 67 u/4/!y r i I 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 mu t be completed within three years of the date oft s pe t. Date: / Approved by i i fn II �. J / V rt '. _ �3r�:,V x, `�„aR'...�y- �.�. �`''¢r�..a1.,+a''k..T':_$�S#,-�!t„J�r�R.kh,:/ �. ia�r �' s�-': � c-•. - - NOTICE This Form Is To Be Used For the Re air,,-ailed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I. �hereb�vycertify that the application for disposal works construction permit signed by me dated `l/7G e concerniniz the property located at ��` /G�, �1/� meets ail of the ?i in foilowQ criteria: ere are no wetlands withinfeet "�00 Le..OI the DTOpoSed Septic SVstem 1 / here are no private veils within i 50 feet or zhe❑r000sed septic system v ne observed Groundwater tabie is i- feet or?*eater beiow the bottom or the eacninz faciiir; here is no increase _n tiow ana%or c anee in use proposed -'_er_ 10 vana.r:cz!s requeste Or Q. 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 pCan s1ii4Q 'be subadned]. s �"_