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Home My WebLink About0029 EDLEN LANE - Health 29 Edlen Road' Hyannis A= 292-088 t � TOWN OF BA.RNSTABLE _ SEWAGE #LOCATION ''k3 VELLAGE �S ASSESSOR'S MAP &LOTee j epos INSTALLER'S NAME&PHONE NO. Sf A- :2-J'S— G SEPTIC TANK CAPACITY LEACHING FACILITY: (type)Ca C'P—e-k VC*?AbS" (size)T�� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 11 I�i 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) � c) ' Feet Edge of Wetland and Leaching Facility(If any wetlands exist ,1within 300 feet of leaching facility) `�- Feet Furnished by hells/ y ar f No. -3a Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETT 01ppYication for Mtgozar *p5tem Congtructiou Permit Application is hereby made for a Permit to Construct( )or Repair( �n On-site Sewage Disposal System at: Location Address or Lot No. O ner's Name,Address and Tel.No. QG E4kK'-\ U�� Installer's Name,Address,and Tel.No. Designer's ame,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder 0 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 Description of Soil Nature of Repairs or Alterations(Answer when applicable) ('"ubo l cyc ® at tin f) r ref r i 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 issy this Board H Signed A Date C�) r' Application Approved by Application Disapproved for the fo wing r sons Permit No._ / =3 Date Issued j --------------------- •,. •.w.: :.- . .. .r S.i�'''r'Y t �.ri�' .+.� w1'"'r"""`u`"'"'_.d�.w. ,�..,,,,,- i:::.pv:� a ... 4� - .. ... ,�, P�.. 6.� �.` ...v,:... ,- i;.-...-� No. ! o� ' S Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION, TOWN OF BARNSTABLE., MASSACHUSETT 0[ppricatiou for Mt!5pogaY *pq;tem Comarurttou Vermtt Application is hereby made for a Permit,to Construct( )or Repair( On-site Sewage Disposal System at: Location Address or Lot No. O ner's Name,Address and Tel.No. C1.t�\ CAI cry (,'� �'1 Installer's Name,Address,and Tel.No. Designer's Kame,Address and Tel.No. l 2 Type of Building: Dwelling No.of Bedrooms J. 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 l Description of Soil Nature of Repairs or Alterations(Answer when applicable) n l S v Dx 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 Codeandnot,to place the system in operation until a Certifi- cate of Compliance has been iss d by_th* BB rd Signed_ 5 Date !22 7 0 Application Approved by Application Disapproved for the foVowing r sons= Permit No. — 3 j Date Issued -- THE COMMONWEALTH OF MASSACHUSETTS \ PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certiftrate of Compliance THIS IS TO CERTIFY,that then-site Sewage Disposal System in talled( )or repaired/replaced� )on by 17�C6t\ for MuL ciCS `� C�G1� c.i.n 3 ha Keen constructed in accordance with the provisions of Title 5 and the foeDisposal System Construction Permit No. �?&_,:3 2 dated Use of this system is conditioned on compliance with the provisions set forth below: No. f Fee THE COMMONWEALTH OF MASSACHUSETTS l PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mtoomr *paetu Congtrurttou Permit Permission is hereby granted to Sc-O� c-� ��r�-�� to construct( )repair Q )an On-site Sewage System located at S J 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. All construction must be completed within two years of the date below. II p Date: � - � � / � Approved by CEICHFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL NVOIIKS CONSTItUCTION I'EltMfl' (NV1'1'11OU'I' DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated _ , concerning the property located at Cj .C� r L-cA,� meets all of the following criteria: • There are no wetlands within 30U reel of the proposed septic system • There are no private wells within 1 SO rector the proposed septic system ' • The observed groundwater table is 14 feet or greater below the bottom or the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan or the proposed system. Also irthe licensed Installer posesses a certified plot plan, this plan should be submitted). i �� ,�:p. ,�/,s�� C �� 1 t�