The URL can be used to link to this page

Home My WebLink About0005 CHEQUAQUET WAY - Health 5 CHEQUAQUET WAY, CENTERVILLE ' A=191-007 w No. 42101/3 ORA , ESSELTE 10% O 0 0 0 ,1 / rnAPr 191 y vc�"t — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Miow6af *raem Comaruction 3permit Application is hereby made for a Permit to Construct( )or Repair`(__/an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 2i Ae-40-1k\1F WAS ��CJ►►� 'KQ t[�� J � CG'�s�evJ�t'E. 4, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No r Type of Building: Dwelling No.of Bedrooms 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 Description of Soil Nature of Repairs Al erations(Answer when applicable) � � >� < a l �s/ ►� 1 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 by this Board of Health.Signed _Date .� —1 b Application Approved by ` Application Disapproved for the following reasons - Permit No. Z6i 2 Date Issued "" to fla -A ———————————————————————————————————— ,14 Fee O+mo P THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpplication for W5poga[ *pgtem Congtruction i3ermit Application is hereby made for a Permit to Construct( )or Repair r-,16 an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. t<U Pw9 ' Ce►„ v J:l'f. a, Installer's Name,Address,and Tel.N;. Designer's Name,Address and Tel.No. mco4 ,s .tM4 . OX(A . Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No.of Persons . Showers( ) Cafeteria( ) Other Fixtures r.. Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs Aerations(Answer when applicable) es ��- s "v Cesg;— _ t k < � R o S ¢„IzdO n GI_ % + T . --2, 1 sae- Y ' s cL,Yo+ per i w+'c N_. Date last inspected: Agreement: ti 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 by this Board of Health. Signed Date Application Approved by Application Disapproved for the following reasons 'y Permit No. 9��/ Date Issued 15 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance THIS IS TO CERT/I+FY,thatthe On-sitejSewag Disposal System install d( )or repaired/replaced�)on� c�tk4lt",� . W��1 b ( OLr +� 1�xuj 4-6 -(CS, for d`C V.1Gr�`.w o 1kdk w.® S as 0 L4 ) Vj 2�r . has been constructed in accor ance with the provisions of Title 5 and the for Disposal System Construction Permit No. " dated _4"-1114 Use of this system is conditioned on compliance with the provisions set forth be ow: � . No. `+''/ Flee 4o 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogat *pgtem Congtruction Vermit Permission is hereby granted to 0_l'\,", \-�"r: CA(-I- to construct( )repair an On site Sewage located at G e 5 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. Date: 1 '— 9 Approved b � _ TOWN OF BARNSTABLE t LOCATION 6) f G k SEWAGE # VILLAGE a ASSESSOR'S MAP & LOTI A — ®O 7 INSTALLER'S NAME&PHONE NO. CaiAg J Nei V:Ats �77-;(M S SEPTIC TANK CAPACITY 450ci rl i LEACHING FACILITY: (type) 3"3}b a NO.OF BEDROOMS , . _ , , ,7 PGr, BUILDER OR OWNER 8'f r k,3 0XA:?k) S r P 4 99 COMPLIANCE DATE: J A r PERMITDATE: 'Separation Distance Between the: r Maximum Adjusted Groundwater Tableand 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) N R Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet 94leachi g facility) N Feet Furnished by kA- qe ° c J CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) { hereby certify that the application for disposal works construction permit signed by me dated I�rz�T j 1`f �O , certli4the..the property located at —t,��e s �-e- Wa- QfKj ;1lmeieu till bfthe r following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility. • There is no increase in flow and/or change in use proposed x • There are no variances requested or needed. Y � 4 SIGNED : �`�"�- � � DATE: m ( (o 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 cei ied plot plan, this plan should be submitted]. R 1 �S If Ce SS�aU 'fib e- b