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HomeMy WebLinkAbout0052 DUNASKIN ROAD - Health 52 unaski y 229-003 Centerville, 1 i I I i i I i li 4 I w a a w H I W � • s U z a x o � u l i +1 I i I i I i i I 1 t No. 7 Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Migaaf *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. v/1 Q 5 1 Owner's Name,Address and Tel.No. Assessor's Map/Parcel g ` `� T��v�r�r� �/ "l to Installer's Name,Address,and Tel.No. Designer's ame,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms f Lot Size 6-6"-sq. ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow e / e) gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank © � Type of S.A.S. — 3 eAre S - Description of Soil "7ellhl Nature of Repairs or Alterations(Ans er when applicable) /5 5' 0 I ✓ d✓� -!5� — :5 � l2 (a v �C S 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 t e&P Enviro7nmental C de and not to place the system in operation until a Certifi- cate of Compliance has been issue lth. Signed Da �i Application Approved by Date 7 Application Disapproved for the MowinVreasons Permit No. 7 — �O Date Issued /M 0 � - a y No. 6LI Fee ! i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for Migaal *p.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's ame,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms �` Lot Size dak-sq.ft. Garbage Grinder Wr 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 _ Size of Septic Tank /<O O Type of S.A.S. -- 3 O C ✓ Description of Soil Nature of Repairs or Alterations(Answer when applicable) 45 Q a ,5 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 oft a Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue f-hI lth. Signed Dat44 Application Approved by Date 7 Application Disapproved for the fwowinkkeasons Permit No. 7 O Date Issued THE COMMONWEALTH.OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,t the On-site Sewage Disposal System Constructed ( )Repaired( ) Upgraded Abandoned( )by ! at ✓ 40 �--;A +P f n— has been constructed in accordance with the provisions of itle 5 and the for Disposal System Construction Permit No. 9 dated Installer Designer r/ The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - I y Inspector . 1�� No. / — C. Fee _Z"•_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS igogar *pgtem (Co truction hermit Permission is hereby granted to Construct( )Repair( ( )Abandon( ) System located at e i. T42 5 :.� �00e? C 6`J /P/"�(/� Ile r 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 7 Approved by C 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 DESIGNED PLANS) I, / � , hereby certify that the application for disposal works construction permit signed by me dated j -�) , concerning the 0property located at J CI rJ G(. l`� �'! �� meets all of the 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 • There are no variances requested or needed. SIGNED : DAT TO LICENSED SEPTIC SYSTEM INSTALLER IN THL OF BARNSTA E NU ER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j xert T WN OF BARNSTABLE � LOCATION sU OCPA4 117 oq-_ SEWAGE # - /0 VILLAGE eEelfP� �� ASSESSOR'S MAP & LOX22,9-00 INSTALLER'S NAME&PHONE NO. A(1ffl11,'?AW/S --,X-4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Of/ C" / 1 c (size) NO.OF BEDROOMS - BUILDER OR OWNE PERMUDATE: Z i 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 I C , TOWN OF BARNSTABLE LOCATION 52 6Dv� /9 S f� SEWAGE # ��y VELLAG ASSESSOR'S MAP & L0iZ-2,/-'00 INSTALLER'S NAME&PHONE NO. 0) SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNE C� PERMTTDATE: COMPLIANCE DATE: l 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 9 p? '� `7 J LL .� 1 4- � C No. --- - fl� Fee----- -- . BOARD OF HEALTH TOWN OF BARNSTABLE Appricat ion,forWell Cootruct ion Permit Application is hereby made or a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: yt Location — Address — Assessors Map and Parcel -- -- Owner Address ------------------------------------------- - - ----- - - Installer — Driller Address Type of Building Dwelling------ — -- - ---------- Other - Type of Building----------------- No. of Persons------------------------ Type of Well AL4� — Purpose of Well------ -� «'—'-------— Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Si ---- ate Application Approved date Application Disapproved for the following reasons:-------------- - - --- -- - ----- ----- —13/0 date Permit No.- © "�I _ — -- Issued----� - - - ---------- - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of COMPliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ----------------Dated----- --------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. -- Ins ---------------------- --—DATE------------ --------- — Inspector----------------- No.-- � �-- Ov --------- / !. Fee------- --- ------_� BOARD OF HEALTH TOWN OF BARN-STABLE Zippiication-*rVell CongtructionPermit j i Application is hereby �made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: __ /iv_s_t _i�a/ _/�ri' �P•yi PiC ell [I, 0� Location —Address Assessors Map and Parcel Owner Address -- — —-- Installer — Driller Address Type of Building Dwelling ----- -------- Other - Type of Building------------ - No. of Persons------------------------ TYPe of Well 5A-7/---------- Ca acit Purpose of Well --- — -- Agreement: 1 The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. S' ne �� ---_-- - — ti(�_ -- . "date B Application Approved — — --—--------— p date Application Disapproved for the following reasons: --------— - - ----- - ---——-- i ' -—----—-- — - -- - ----- -- --——------ — date Permit No. l :Locq �� _J_ Issued----"-- fe-r-- - i - w•� BOARD OF HEALTH TOWN` OF BARNSTABLE Certificate Of Compliance TTHIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) �• "Flfvrt/ � ----------- --- - bY- �__--- -- --- - -- - -- -- --------- "`t------- Installer r has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------Dated---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. ' , DATE----- ---------- --- Inspector-------------------------------- ----------=- BOARD OF HEALTH TOWN OF BARNSTABLE Well con5tructionPermit No. �to Fee i Permission is hereby granted - - --------- --to Construct lV`), Alter ( ), or /Repair ( ) an�ndividual Well at: No. ---s��--^ n�S 1L-i +� C - ----- — ------------------------------ - Street as shown on the application for a Well Construction Permit i No. ---w CD4C)b q 0/ O ------- Dated__ - _� ----- -------------------------- -- - — ---DATE )-3/0 — /„ Boar o Health_ — lU / ____ W� . iQQQ� I UMIT OFWORIC � WS174TORO-WN I � o a °O Z' p � � --- --- ppp �C o ® € ,OI I a ........ .... .......... . 00 d g. ..... I Y V a � N �11 I � TUNG/CORCORAN RESIDENCE LYNN HOPKINS,ARCHITECT REVISED 28 AUGUST 2000 FIRST FLOOR PLAN ( 52 DUNASKIN AVENUE 45 MUNRO&ROAD s z M1= IW=1'-0" BARNSTABLE.MA LjDaNGTON,MA 02421 ° 11 OCTOBER 2002 (781)89-2585 y I