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Home My WebLink About0017 MAINSAIL LANE - Health 1 17 MAXNSAIL LANE, HYANNIS A=288.061 i TOWN OF B STABLE LOCATION SEWAGE # �® S26 VILLAGE m .,ASSESSOR'S MAP & LOT 2,98- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (typef (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMP CE 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) 'r Feet Edge of Wetland and Leaching Facility(If any wetlands exist �A within 300Lfeetof lea fa '' ) /a Feet Furnished by Q PIK C -J . F i ati _ $� i e I �e /all . No. 8e p��n r seJ-ll r Fee—�—`� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppiication for Mi4po5a[ *potent Con6truction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 17 Own ' Name,Add �s and Tel.No. Assessor's Map/Parcel � �f�_0 6 1 04,L r� Installer's Name,Address,and Tel.No. De gner's Name,Address and Tel.No. e 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 �qj gallons per day. Calculated daily flower 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) 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 issVfd by Board-o ealth. ' I Signed Date Application Approved by ` Date Application Disapproved for he fo owin easons Permit No. Date Issued o e o � TOWN OF B STABLE LOCATION / SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHO N0. SEPTIC TANK CAPACITY LEACHING FACILITY: (type GCS (size) NO. OF BEDROOMS BUILDER OR OWNER Q PERMTTDATE: COMP CE DATE: Separation Distance Between the: s Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet j Private Water Supply Well and Leaching Facility .(If any wells exist on site or within 200 feet of leaching facility) y Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of lea • fa ' ' ) N ' Feet Furnished by No. O � J�l7�. `�� ma's u-s"'' � �;��s�. �=ds + Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I Yes'-- PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYicatioit for MkgpoM 6potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 17 Own ' Name,Add and Tel.No. ` Assessor's Map/Parcel � ��Q C. �y Installer's Name,Address,and Tel.No. De gner's Name,Address and Tel.No. F e of Buildingvy Dwelling No.of Bedrooms 3 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 & .30 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) Y { 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 iss d by Board o ' ealth. Signed Date Application Approved by Date Application Disapproved forYhe fo owing easons } r J 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(X)Upgraded( ) Abandoned( )byx. at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.' 0 dated Installer Designer The issuance of this permit shall of be construed as a guarantee that the sy em will:function as designed. ' Date " I t( Inspector ��No. --------------.----------.--Fee ] [/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS i Miopozal *p5tem Construction Permit Permission is hereby"granted to Construct( )Repair(,K)Upgrade( )Abandon( ) System located at x r--m4 4 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: / 9 Approved by r -- + t, 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) l ,hereby certify that the application for disposal works con ruction permit signed by me dated s _, concerning the property located at 1L2�% meets all of the follo g criteria: There are no wetlands located within 100 feet of the proposed leaching facility -/ private wells within 150 feet of the proposed septic system There are no P There is no increase in flow and/or change in use proposed e 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 n.QJ 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: 1 9 LICENSE OPTIC 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]. i q:health folder:cert