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Home My WebLink About0040 SACHEM DRIVE - Health 4'O SACf Ell-DRIV.E"CEN7C,2VIL.CC A= 209,204 r No. 42101/3 ORA ESSELTE 10% (* O O O O - -- - ---- TOWN OF BARNSTABLE LOCATION 54 0,t&J Akulg- SEV4 AGE # VILLAGE Cgj7s�(jella, n ASSESSOR'S MAP&LOT41iff02 INSTALLER'S NAME&PHONE NO. R l;�K� !'sSLt.i1 7,7 F—o I/ SEPTIC TANK CAPACITY /S"cm) Crr LEACHING FACILrTY: (type (size) /O X WX ! s NO.OF BEDROOMS_-0 14_ f BUILDER OR OWNER C f c PERMITDATE: 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 �9 clod �}Toi- 2y-6 RS'o 38# �!ro S To p ro 3 A3/•G 6 -o3 Sz-c A -ro V-3 9.3 Q to '1- 30,6' y .r G 7 c4.9,� 0 No. Ie PARCEL Fee f1. t7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Ziopont Opgtem Construction Vermtt Applic ' n is r y de for a 't to Construct( )or Repair an On-site Sewage Disposal System at: Location Add�f ss or Lot No. Own is Name,Address and Tel.No. 5 /4T Installer's Name,Address,and Yel.No. Designer's Name,Address and Tel.No. &,.41) c (�/�$SW 'l 76.,I-0 W-v, Type of Building: Dwelling No.of Bedrooms Garbage Grinder(*O) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow za gallons per day. Calculated daily flow yob gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) WC-7,-/ ,n�/ r✓ /601C 1� Lod, F6A2 w t-Li 3 ! 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 beemissued by his�1�oard of HeaSigned , .�. -v C Date 11 /S � Application Approved b ` °---- Application Disapproved for the following reasons Permit No. Date Issued CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) i 0 I, C, hereby certify that the application for disposal works construction permit signed by me dated ijo) Is �5� , concerning the property located at to ,—ArL-CA MOG C6 k2tFA Oi 11p. 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 : C, DATE:. /s LICENSED SEPTIC SYSTEM INSTALLER IN OF BARNSTABLE NUMBER 0' [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. =I�v All � 2� oz r v� No. - Fee -So, THE COMMONWEALTH OF'MASSACHUSE°TTS" PUBLIC-HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication .fox MgooaY bpotem Construction Permit Applic on is ereby de fora t to Construct( )or Repair(cJ)an On-site Sewage Disposal System at: Location Addrrss or Lot No. Own is Name,Address and Tel.No. l0 S�CI`C.�f �'�� CE u-f6jQvllr(c ' Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No. a, J C_ (,J, Type of Building: Dwelling No.of$edrooms Garbage Grinder(4,M Other Type of Building , i: No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /fn gallons per day. Calculated daily flow gallons. Plan Date i -f Number of sheets Revision Date Title i Description of Soil Nature of Repairs or Alterations(Answer when applic ble) WC Ll 12!! .477c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system x 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 his Board of Heal h. Signed Date ll is ..r or Application Approved b � Application Disapproved for%the following reasons a Permit No. L Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC,`EALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate Hof "Compliance ' THIS IS T,Q°CE ,that the O}}--s'site Sewage Disposal'System installed( )or repaii•ed/replaced(l on moo'` S / by `'�"lfJ��'� i X, .Gig for as ' has beeri'constructed in accordance with,the provisions of�Title 5 and the for Disposal System Construciion Permit No., dated Use of this system is conditioned on compliance with the provisions s t forth below: a 4 Y No. \ Fee•- �� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS migonl *pgtem Congtruttion hermit Permission is hereby granted to v� G C t SSL 1.0 to construct( )repair )an On-site Sewage System located at C: aa44 4A l�� 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 __.— ,9lcs fi--�•9T wu r—ck --..... - _.__.. _ a — -- I YtJ� .E�OJ,✓ v i q