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Home My WebLink About0062 MARIE-ANN TERRACE - Health 62 - IYARICEARR, CEN7ERVILL� �A= 189-095 No. 42101/3 ORA Lr- ESSELTE 10%® O O O O TOWN OF BARNSTABLE LOCATION 6r2,, ��ff/i AVIV SEWAGE # ?f' 5`—/!F7Z- VILLAGE Can �y�`G� /AS,S�/E/SSOR'S MAP&LOT /A eI Q 96 INSTALLER'S NAME&PHONE NO. Aef r®L mil// Lo�Syr�Gy`j�/Y SEPTIC TANK CAPACITY /5ZV 6,C(- LEACHING FACILITY: (type)�1t/-e-- bck�,<ry 3?Q (size)yz X 9 NO.OF BEDROO BUILDER OR WNER/ /pp PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Jo 4- 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 f Feet within 300 feet of leaching facility) Furnished by 2- FEE THE COMMONWEALTH OF MASSACHUSETTS , MASSACHUSETTS j a' �kyyfirafivn for Bisposat Sg$#em C�IIz�str�tcttIIz� jJerntit Application is hereby made for a Permit to Construct( )or Repair(04an On-site Sewage Disposal System at: Location Address or o. Owner's Name Address and Tel.No. Lf,^JE fib IVVA- Q.,1G 2,.)-- Installer's Name,Address,and Tel.No. Designer's Nam�eQ*Address and Tel.No. ,,661L-4 0 e_07-17 C. 7,, SJ47— t t3da1 v P1 C(lP�arj AD dv� . ✓✓i�a.t.S ✓ate G�,.=9� Type of Building: Dwelling No. of Bedrooms Garbage Grinder¢' �Q Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow YYQ gallons per day. Calculated daily flow v `� gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or.Alterations(Answer when applicable) �I )N,9 /:560 ��t �►�►� 1Y.?p C J L Y� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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 beerosued by thi B rd of Health. Signed Date Application Approved byj Date q S Application Disapproved for the following reasons Permit No. �'12 Date Issued 7d - No: ' ' FEE THE COMMONWEALTH OF MASSACHUSETTS , MASSACHUSETTS 4, t/ &&pplirattun for (gunstrurttun F"mit Application is hereby made for a Permit to Construct( ) or Repair( Kan On-site Sewage Disposal System at: Location Address or Owner's Name,Address and Tel.No. 6� AN� t; ;-Fx , 77,1 Y soU Z4 C� its L C_ex-Jr7_&*LV UA_,LE 1 444 Gam, ?_.3- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,7Q/(�i U LU777 GO,`i4-7— (�G —tj Lp,rt CrOn�S i -7 C,'97 6JA-1_1-r6 y /lA Type of Building: Dwelling No. of Bedrooms Garbage Grinder(-j Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow yYd gallons per day. Calculated daily flow y�3 ��- gallons. Plan Date Number of sheets Revision Date Title Description of Soil -2 AtA-AA U(.,&.SF,I tr Nature of Repairs or/A�lterations(Answer when applicable) l/VS �t� ��O S.t,PTZC i • + _ l— CJ-Of, C� C.c.s tr.i E G z !D�.s i�. i'L..�_�vl�� '30 v�r'i3 C.L4 W912. S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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 ' sued by this o rd of Health. / Signed Date Application Approved by Date Application Disapproved for the following reasons f 17 Permit No. (� Z Date Issued3 THE COMMONWEALTH OF MASSACHUSETTS 0� '� , MASSACHUSETTS dEpertifirate of Cfomylianre THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( ) or repaired/replaced(4on by _2P/L 0 a Tr1 C 11,Js'T t77 t*j fo C=4=-r ±�j L.Td L)Z 4_ at ��- d�4/Q-�� 4 iJtil '�' � �r t has 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 below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on G DATE �- 1 �- �i Inspector THE COMMONWEALTH OF MASSACHUSETTS No. , MASSACHUSETTS FEE �d — ptsposal *stem (gonstrurtion f errait Permission is hereby granted to �� (.p 73 7 L.nat-.r to construct (, ) or repair( man On-site Sewage System loca)d at lev1-- f/I/1A-r�3-E nlfJ 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 three years of the date below. , DATE �_Ll:, ?S Approved by FORM 1255 Rev.3/95 A.M.SULKIN GO.-BOSTON,MA J t 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 �� 1/ 9� , concerning the property located at &V X4£ .�1-iJ�1 `%v/"C-L meets all of the CJ�"fvJ�lC� following criteria: • There are no wetlands within 300 feet of the proposed septic system C�• There are no private wells within 150 feet of the proposed septic system e/ The observed groundwater table is 14 feet or greater below the bottom of the leaching facility t/• There is no increase in flow and/or change in use proposed `� • There are no variances requested or needed. SIGNED : — DATE: 141- 10196• LICENSED SEPTIC SYSTEM INSTALLER IN THE 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]. f S i ' •�,`^f �' ^*� .`` k "k,r rr kr 2 �r;j ..- ' q„",,¢¢c'. r�"S i,r.^ Y 9 a ✓ ,`yv 3 , 4"+ry S `.<'��° o -ti .r.♦ 'r >24� '� s - i"; ..- - s •°.i"" �s`' G"' aw. �.tit 4. yr yo-,� a :�5 xk .z•'2wr .e. a-?-y �,:t: R�a a =L^s•+�„ r':';' .� Y '+�F 't ..a �'s "[ �'�,r.:. yx. :..'� S .dS .rFn:�•) .. `•ra 1 z'c `�r5i. y..m• ,r. �F 7yE�b `Ctvf r < •f .".�, c ;� [ x cS ,L p s i..:�YC `n. `t .':• ""' J'.'� r �!•. -4'I ",:} 'k"un!?`w w u v^'.. sf.� ..,:y i t"" s �, 4` i - ,rS"�"e v �ti5 z'fLr, ."`•, ,}� � -•s�F.s� �}:� rt_:�;.�:d' �..:.,..n sr�;r::�.'+1•, �;"N vx �:fs'�s� -r. 3ffi z�� ;'�w'� �'�-'f ��,�a� ✓�� a,.,n�= ro �+yc k�s`i..F-. � y'�h-"� �`�•.,,rr,� r Y.�,ar...�..R r _:�,, � s'•,t-� � rf t a � .�Q� .'"� xi:�� a" �f��' YZ +� '� '� ,y,•r,� h .rtM. .r'„t,• r f �a-, a� ,��, � � Ts,�9 �f� '.�3„ a � °Y a�C"y�'Si� �;..;� xq� ,�xx�tip,- ��ri'z',k,�,. �`Y`,4sr'��F� r:'��.F� �,�r:.'s,`j ua,'"�.u,P -.r '.�, 1.1,:_.s . .�- 'k;- .:" A ::�"� n�- .. .•a x L z :.... 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