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Home My WebLink About0525 SOUTH MAIN STREET - Health 5Z5 SOUTH MAIN STREET Centerville A = 206 — 068 S M E A DR KEEPING YOU ORGANIZED No. 12534 2-153LOR SUBLE MIN.RECYCLED FORESTRYSTAINA ATk INITIATIVE CONTENT 1 . Certified Fiber Sourcing POST-CONSUMER www.siiprogram.org SF1,01M MADE IN USA GET ORGANIZED AT SMEAD.GOM t, v No. �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for MispoSal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair(k1 'Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot No. 572�5uv Ah Ma- Sr Owner's Name,Address,and Tel.No. ce i,e ►i i /�vc. Assessor's Map/Parcel gC) r (s, O Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 II Lot Size sq.ft. Garbage Grinder( ) Other Type of Building /PS/UP.41141 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3U gpd Design flow provided J yn gpd Plan Date /,�k-/T- XO P 0 .Number of sheets % Revision Date Title Size of Septic Tank A,OM /,5C��5/YJ CWbrn Type of S.A.S. f� Description of Soil Nature of Repairs or Alterations(Answer when applicable) r&!; a ,2wyo ' i( AGyl)l • .1- C M ba, «tt i�yi ic,.5 toc't c,.ac� ci are x 1 LPoch APld 45 of D/i,�✓ 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 Certificate of Compliance has been issued by this Board of Health. Signe Date 5--.A Q- A U;�,0 Application Approved by Application Disapproved by Date for the following reasons Permit No. Date Issued -)/a(a �� TOWN OF BARNSTABLE LOCATION SEWAGE#q;�Qa_J6 VILLAGE I p ASSESSOR'S MAP&PARCEL P QG G _ INSTALLER'S NAME&PHONE NO.--) SEPTIC TANK CAPACITY 2,OOO /SOO/<7ip Ccht4n o LEACHING FACILITY-(type) t p O (size) 20 X i7-3 K NO.OF BEDROOMS OWNER- C?i 1 U t, PERMIT DATE: S—&G 2-00-0 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 e i& MAN NCB 17 12, 5 `l 3 29 S �� -c- `r . a No. cif cac— Fee . �c✓/i. THE COMMONWEALfH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYieation for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components .a Location Addressor Lot No. 5'2S Stw�h Ma:, 51- Owner's Name,Address,and Tel.No. LP-jt-etry IS) (' Assessor's Map/Parcel g o(, �4p Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. } Type of Building: Dwelling No.of Bedrooms '7, Lot SizeZi��,, sq.ft. Garbage Grinder( ) 'Other Type of Building /ps/CJp,�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3:%0 gpd Design flow provided _3 y4 gpd Plan Date /,-+ -/5-9 pa Number of sheets / Revision Date Title Size of Septic Tank 42,DM )/<AnClWbnType of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �,; �� Cr r�,� 6//,,,� �it /E rtjj F)t �)01fc lnr,%o C) -to/x 2 U Date last inspected: r Agreements' X 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 Certificate of Compliance has been issued by this Board of Health. Signed ,. _ Date R cY 2 O?42 Application Approved by 4-1 Date�".7 h-�X2 v�- Application Disapproved by Date�� 4 for the.following reasons Permit No. a �) �J Date Issued ---------------------------------------------------------------------------- ---- -- ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(!� Upgraded( ) Abandoned( )by�D A R f v w)A) a at r,jj� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. (1 d l dated InstallerDA 17 a N N T,ic Designer #bedrooms 2 Approved design flow -r2K) and The issuance of this permit shall not be construed as a guarantee that the system wi I fimctio a e ed. Date �; i '=' taj � Inspector ----------71--------------------------------------------------------------------------------------------------------------------- ------- No. 0- Fee _..-. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS w -Misposal A�pstr�Construction V'ermit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at 5:1 5 15ooib _,41, ',A j '51' l 6-111 le and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 (I/ 1; Approved by kcy �3 LO CATION S� A G E PERMIT NO. VILLLAGE dn i/-- 4/1 INSTA LLER'S NA i ADDRESS OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED T r2t'A R h r� v d Q} i r r y ni :, R 'i� _ 7� ,ram 'i., ■ d j 7}'. ', �...,, I ,. PC GPM WN-2 MIA .ii■e� _ - ar 6a 'II ��, �� _" I'a.r I,. a t� '�. e; ±,_ I�. �. q•"4 1• , }. ,N� 1 =} �1 49 Fes. !* . �� ?U _ ,. �� E 'h k.�ie ._ d--ciP :ti de - .'i'p �F"�. "■ '•ri l= n.;.t' ■ � F.Y. �1.,-'. ■ -�`" a m,i c-`■7:f� - i '! - F.'_•i � i. L a� , �, ,} ■, c r q -. .} . �:..■ ,i :. n ` i n e;, d C•1 '•1+: 1 I+ 'h �,i r�l; I+",r�`I�� n = .n q.. }I n' _ i 6 ■ �7 Thz instailati-on shall cioniply with the St tu f. Title'a nvirorim,��ntal Code vl an� Town o o� I 3ojird C of Health ReguiationS. -'sed t wn -taller ille septic system as P.Wvsed of,ffii Plan shall not be installeduntil a lice:, 0 ins T N T400— receives approval .4nd an instadatior,permit from the applicabl"e town. __ 12-1._ Friar to installation,i Pic'n zra Ile- Oiall verify the location of utilities,se vjI� wer R F E A A- ts, sewer oi-np.5 .77 jild existing Septic' components prior to installation. All gravity sewer pipingis to be 4 inch schedule 40 PVC at 8"per foot. Tfi,� firs! feet ou' 1-7, I i�l 1 _,I X 1�,,e distribution box shall b�� level. All piping connections to be glued. L01W L/ AV This septic design Mar, is not to be utilized for property line determination Cr for any other AGO lb Purpose other Lh<n the proposed septic system installation. C) 17 _J All Title V compor-ents are to meet Title V specifications, ; Parking shall be prohibited .-,der Title V components unlea�cnrnponents are H2O loaded. A. 8) The existing leaching er cesspoois shall be pure red and filled With material per Title V 1 abandonment proceduees Ueaching ard cesspools)and contarninated soils within the proposed SAS shall be removed and replaced with clean sand pe f Title V spec i fit-a t;:o n 10 r2. t Z.11 i i j�� •�)'j C* -72_ Septic components are to be 10' from a water service line. Sewer lines crossing a wate( line ;;t: 4_0 V.; Z" be sleeved with an appropriateiy sizf.d 5chedule 40 PVC with end"grouter. Tbp water servicL- Nile or the septic line(.art h)e sleevpd wh.h the sleeve being adistance of or, i_ 62.$O o�. 1 ��` ��} �P c� � i tl�l rssing the line. AA If i garbage grinder exists in tl-,e structure, it is to be removed if the septic system is not designed to accommodate a 'garbage grinder. Oqx>x.- A t.1; TbE installer is re�,pon.-;ibie foi cai P f excavation around alluliiities or. the property and AL 117 t,,f all structtires Liu ring the installation proces f the Sept protecting the structural integritv s 0 t C I-C IL r This plan only represents that a >eptic systenicar, be installe.,d on the proptqy mc t� g Tide e n requirements. 0 T Y The property ownert-hal! review desigpi criteria to approve fl,e totaf nLlMt1eF of bedfoorn, s and design flow. Installation of the septic system as proposed and receipt of payment for the desigi, shall be deemed approval of the denignCriteria by prOperty oWner or agent w. 14) Trie validity of this plan si all expire with the expiration of the town installation ern-Tit Y hir, plan or the valldRif of this plan shall expire on the expiration ofthe Certificate of Conip,li r-,v4 K..(U�r -A, +.s pluiN issue iN d for the itrist tallai -A 'V. r L kx CZ. 1 4 Z, A. T 5_9'� 3 -T io lb LC Vv4P#?4L _TD 3A qv4p VFK14VC Y f77&7 15 Fi ci ZCC 9T*4 r And AW INC_ ................ ZZOO C 0 ��OF_pi� DAVID�11S\ �;.a,:.�,.,..._-...,.�,.r-�...�.,,w:.�,.. ..�...,...�..�...: ._� _ _ ,...., Mr/ B JVIA�ON A NE) 0, 0 L NO.1056 GISTS?:�� L J C A T 14 . Ali ,�) Vl U4 ZM_0 .4 PV 1�6 T A W* N'T S N' ! 11 4 0 A 1i 44 7' �;j LAJ-)