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HomeMy WebLinkAbout0058 OAK STREET (CENT./W.BARN) - Health 58 Oak Street - Centerville A-173-008 EM EADO No.2. 59M UPC In" 1 amNd mm • Naft In USA �A 1 r-�� ` 7J (/Q Fee ' No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLE,s MASSACH SETTS ZIPPYication for laigpogal *pgtem Congtruction '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. J j; tell W �arnsfa�/ sQ�, ✓ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /-PLo 10#51- 11��llw���°'✓ ✓'� � J`�' dhiQi°s1�� Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ® Other Type of Building ee No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow r3 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applica le) 4 4,0 �ragd ',�PD/ L1 —/0) stl<eee/C 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 B d of ealth. Signed Date J� Application Approved by Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS 3`© PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage.Disposal System installed( )or repaired/replaced( on by D! d GO ' /, // GDH6 for we ,parr4�e1ie_p_ as has been constructed inacsordance p with the provisions of Title 5 and the for Disposal System Construction Permit No. dated .UP � . Use of this system is conditioned on compliance with the provisions set forth be ow: No. F�k'�r l [/Q Fee �y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS j i Digoal 6p.5tem Construction Verrait Permission is hereby granted to del- f ld/l% C' wr7 to construct( )repair( V,�an On-site Sewage System located at 4—tr ©4�(' 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 { f I 1 s Fee if W a o©� No. 1 ,w THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACH SETTS `0[pphrAtion for Migpoal *pgtem Com9tructiun VPrm t /an Application is hereby made for a Permit to Construct( )or Repair( On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 57 01111 If r. ,kph Gu1-114Q1y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �1iQy-BGo�i Ceast. F 0 .Z'hdust✓ ✓'o� H r-�' NOD✓s�y a Type of Building: j 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 3 M gallons. I Plan rDate Number of sheets Revision Date Title Description of Soil i } I Nature of Repairs or Alterations(Answer when applic ble) .0y I5r40 4-el Date last inspected: Agreement: j 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- cateof Compliance has been issued th' B d of ealth. Signed Date S Y Application Approved bye . "-2 1 Application Disapproved for the following reasons a � Permit No. so, vg/ Date Issued —� _. _._----------------------------- TOWN OF BARNSTABLE LOCATION s5 ®®4 S;0"-' ti✓. A'Q s'S*,W-'1K SEWAGE # ?,V/ VILLAGE 1A ASSESSOR'S MAP &LOT>7 —Oeff INSTALLER'S NAME&PHONE NO. G't*?,s0 771-,P3f0V SEPTIC TANK CAPACITY �5�� F-90� LEACHING FACILITY: (type) (size Y Ind o NO.OF BEDROOMS BUILDER OR OWNER ga/? PERMITDATE: Jr— 7—9'C COMPLIANCE DATE: 5" Separation Distance Between the: f Maximum Adjusted Groundwater Table and Bottom of Leaching Facility J 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)3_by6-. O p 1 °� 3 Y toor �Ho" l \� 17 siprPc, T noo! - 'fox � dKy� CEI HIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL 1VOltKS CONSTRUCTION ITH51111 0VITHOUI'UESIGNEU PLANS) 1, Roj&f At'&J®//) , hereby certify that the application for disposal works construction permit signed by me dated f' /?�/ , concerning the property located at rf Do,L s �,v�,��y�s �C� meets all of the following criteria: /There are no%veilinds within 300 feet of the proposed septic system V/There are no private wells within iSo feet of the proposed septic system W The observed groundwater cable is 14 feet or greater below the bottom of the leaching facility ✓ here is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED Z.y DATE: l 7fQb LICENSED SEPTIC SYSTEM INSTALLER IN 714E TOWN OF BARNSTABLE NUMBER [Attach a sketch plan orthe proposed system. Also irthe licensed Installer posesses n certified plot plan, this plan should be submittcdl. i