HomeMy WebLinkAbout0189 PATRIOT WAY - Health No. 42101/3 ORA
ESSELTE
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O O O O
n,
G TOWN OF BARNSTABLE
LOCATION /�.�Li evT3 �' SEWAGE # -'
VILLAGE ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO. CW IJJ,
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) /�17— AJ E-40i� (size) Cp
NO.OF BEDROOMS 3
BUILDER 014
PERMIT DATE:�/��4'o� COMPLIANCE DATE: & G "�
Separation Distance Between the:
Q
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �d � 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) �i� Feet
Furnished by
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ASSrSSOR'S MAP NO. I`%'� PARCEL
L9CATIU t
CA
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V L IAGI
I MST ALLER'S NAME & ADDRESS
3 UILOER OR OWNER
C0MPLIANCE ISSUE0
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No. Fee
30'�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYtcatton for Mtgpool *pgtem Congtructton Vertu
Application is hereby made for a Permit to Construct( )or Repair fp<)an On-site Sewage Disposal System at:
LocationAddress es Lot No.7E4�� Owner's Name,1 /AAJ andZ Tel.No. �,w
J,wj1 I/ L��i ," "� OT�S Oct —
In is ammee Address,and Tel.No. Designer's Name,Address and Tel.No. ,2ol
Cr"—M ,�tS�Nr.�tact c F7t C.tr�=
y,v1�-�'r,�.�.s �►�ins ,�q-. 0�N T' --r<'-e�✓�� eee'�
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 (? p-K t &#A-,A XcSt 4a)!` , l�— 7�-u 4Z.44 C,
Nature of Repairs or Alterations(Answer when applicable) A- l0 UO /96 W
,a✓t�,4-
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 by thi�od It
Signed Date JD/y
Application Approved by / !---
Application Disapproved for the o lowin reasons
Permit No. ! ! a!7' Date Issued
------------------- ------ — — _ ---
rC ' , -s•E.� ter.. , a..— •—. �il,..ty �. . ...,... v..•Y'ir. 'wZ_r....s � tiw - .. i :,s. . ,•.. ..
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No. Fee
AY
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC.HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS `
2ppfication for Misspoof *pgtem Construction Permit
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.
.Inst er's�am���e,Address,and Tel.No. Designer's Name,Address and Tel�Nr2t,��st , V"�o-rn «ems;-�.,�-rv� c(�aW� CIA 1��1
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date 7 -3l J 7 E_ Number of sheets Revision Date
Title
t Description of Soil (� �a t e_4A-,A - �SU a__5-c,t_ , y - 7.3 ���5� �Q <<C A-4 EA_
_;
Nature of Repairs or Alterations(Answer when applicable) A- /G UOSAJ ` k i W
�.S�t'-tl tJ�.- �'i`>5 '%�� `�'�tS�7��- .�C� S �.5�`G`.N� E ;�✓L.f�4-
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
Y
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 by thi o d of H It .
Signed Date `k1/`� 46'
Application Approved by - / -
Application Disapproved for the o lowin reasons �.
Permit No. �� O a•C� Date Issued
————————————————= —————————————————————THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance -
a
THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/rep]aced(,6 on
by _`bC L4 F1 0)AS4_"T_(WCrZ01*4 for _J6Rt l
C. fa.S+"r/W 1k_Lr , as been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Use of this system is conditioned on compliance with the provisions set forth belo
s
r
No. 71� Fee _7Q
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
lwitpogal *p6tem Construction Permit
Permission is hereby granted to "-go -71 y1CW-701i
to construct( )repair(t>L)an On-site Sewage System located at l F5 ,P-A 01--5 W_*1 _ C 1�s.!`,
f
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: Approved by
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 11LI concerning the
property located at j -5 `,47t S z j)-4-V (E-41V 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 system
septic stem
P
c/ • The observed groundwater table is 14 feet or greater below the bottom of the leachingfacility
ty
��There
ere is no increase in flow and/or change in use proposed are no variances requested or needed.
SIGNED : DATE: fj ly
LICENSED SEPTIC SYSTEM INSTALLER IN TIE 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].
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