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HomeMy WebLinkAbout0042 MIZZENTOP LANE - Health 42 Mizzentop ]Lane Centerville r A = 247 — 060 LL s� UPC 12534 .2-153L / No. Duo) 43 J 7 - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplication for 30igo5al bpgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade AAbandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel a o/ �0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �"�� ���?�`lii`C ���'"07 a'�' ,CS�l�s.6 a3• hjatJ'©,'v Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 0P e�T No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow •�® gallons. Plan Date Number of sheets Revision Date Title w O A.? Size of Septic Tank �s`/ ,A4 Type of S.A.S. X_X 'jC-KKA 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 issued thi Board of Health. Signed Date Application Approved by _ Date 111th., Application Disapproved for the fo owing reasons Permit No. Date Issued y U No. DUO) -IS 7 """ Fee .,.'a. ' �' , y. / ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Migpogar *pgtem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. �1��f�/, ��w7Of� Owner's Name,Address and Tel.No. Assessor's MapTarcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) r IOther Type of Building OP&,r No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title ` Size of Septic Tank �3 ©� ,��1 T-��+'k' Type of S.A.S. ZY "-K-zy �N(.-2r Description of Soil .' i Nature of Repairs or Alterations(Answer when applicable) if •4,,A 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 issued _ thi Board of Health. Signed , � Date t Application Approved by Oh� �. Date l X Application Disapproved for the fol owing reasons i I Permit No. Gv a -f Cam► Date Issued ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance ,w THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by ( //� CCdP��c�"l//� at y-� �►/ z ��.joP iP0 has been constructed in accordance ' with the provisions of Title 5 and the for Disposal System Construction Permit No.b7uv 2-/S;7 dated I/ �6 u z Installer r?'/ni �cF�®�Gi� Designer The issuance of thi permit shall not be construed as a guarantee that the system will-f nction as de i ned. Date 4 �1 '� il l. Inspector rj Aj � I --------------------------------------i-- No. r o a h Fee ✓" - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *p.5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade Abandon( ) System located at Ax 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: / Ct Approved bysb. TOWN OF BARNSTABLE LOCATION _ � I Z 7v/0 SEWAGE # VILLAGE SSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. LZ�' "' '�� °� Z-7 f SEPTIC TANK CAPACITY �c,9C LEACHING FACILITY: (type) die>� (size �'{� NO. OF BEDROOMS '' BUILDER OR OWNER ✓d-�l '-' eta la'l ®w PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 4914 i d _ A Z-" e' TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT '{` �O INSTALLER'S NA & PHONE NO. L7f "' ���a�®� ME �7S" "®2 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size .^r_� s'i X� " NO. OF BEDROOMS BUILDER OR OWNER .4.hi Z*/ od--�A �I IL v PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: ; Maximum Adjusted Groundwater Table to the 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 1 $ ev 14 Z ', D .2 , A Z"IP, 3fo E:3, 40 46 a�L, O` ASSESSORS MAP : /�a7`�S = TEST HOLE LOGS PARCEL : --�`�C� �,, SOIL EVALUATOR: �c„�� / , ,�t C• /� -7- / / 1l FLOOD ZONE: /�� /�/ �/ / �e �dl ,S 7L /i;.'� WITNESS : lam/ REFERENCE �L� _.._000' DATE: .7 _ .._ 1 7 PERCOLATION ATE: /�1/ J` ��- ✓��^--/ ��-=- � � �` TH- I TH-2 4 L )7,571c, Ile' 5 tea ✓ LL �l L � / r SG V1 UQ 41 LOCATION MAP(V.7.TS) �� /d ye ,3e 414/-�e::;Ll H&c/Ccarfc ��Y,U � L ✓ �� � /•� N �2 ��!'`n)ilil o. 7�iU� /��� ne�64- M 7-/u SEPT I C SYSTEM DESIGN FLOW ESTIMATE .3 BEDP.04MS AT //G GAL/DAY/BEDROOM t-� 3O GAL/DAY1-?e PQ _ SEPTIC TANK A?e J /7-7G e`'l !i'�O�` Gel t �� ��C..C� if C,��+�J 1�l G.- 7 N6'( (� �3OGAL/DAY x 2 DAYS USE/SG JGALLON SEPTIC TANK IVi q G / SOIL ABtORPTION SYSTEM J -�.;� o USA. -_._...�'... .... -�'`� ,�•'' �� � r `' S • SIDE AREA: 2ZX 7 - 10I BOTTOM AREA: ` 7 3 �►, a '��" w PT I C SYSTEM SECTION ON ��'L�W `1 ____ ___ kA IF 4. rlLr � 4, (\. `` / � �V / /' / .. ._� v ......<,X•: � - �� i/"l�i W 1�t. r s w rr w. J_ 53� o ; e p,L�[T,1,--- 16( SEPTIC TANK Q-1 !It4 3 ,I p 31 •icy SITE AND SEWAGE PLAN r LOCATION : ,.tom ,2 /,12 PREPARED FOR : N M o SCALE: g DAV I D B . MASON DATE:' DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833- 2177