HomeMy WebLinkAbout0175 ARROWHEAD DRIVE - Health 175 Arrowhead Drive
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TOWN OF B STABLE
LOCATION 1715 0��tVW��i SEWAGE #
VILLAGE ? y4��1 f S ASSESSOR'S MAP & LOTS
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 5120' L _
„LEACHING FACII.ITY;.(type)Lv 6l (size) !l �( 33 �(—'7 '
NO.OF BEDROOMS' `
BUILDER OR OWNER '7`'fe��iQ.S
PERMIT DATE: G//%�� `' "J COMPLIANCE DATE:
Separation Distance Between the: `r
Maximum"Adjusted Groundwater Table and Bottom of Leaching Facility o �` i= Feet
Private Water Supply Well and Leaching Facility (If any wells exist 4
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 7.
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No. �, � Fee'
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
0[ppYication for Zigogaf 6pgtem Congtructfon permit
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Application is hereby made for a Permit to Construct( )or Repair( V)/an On-site Sewage Disposal System at:
Location Add ss or Lot No. Owner's Name,Address and Tel.No.
173
Ands 7 S %✓ro�� �,;
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�✓'raGo�l �®�87;
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder
Other Type of Building eif-e No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 49 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or AI erations(Answer when applicable) h,51ell
O -ZO v1e1i$
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 this o of alth. p
Signed Date 1� l
Application Approved by
Application Disapproved for the following reasons
Permit No. Z17�� �Ir Date Issued d ` 7`��
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I7 "'� L7�� T Fee �• i' V
No.
THE COMMONWEALTH OF MASSACHUSETTS,
PUBLIC HEALTH DIVISION ;TOWN OF BARNSTABLE., MASSACHUSETTS
Application for Migpoe;ar 6p.Mettt Con!5tructton 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.
l75_" fir/ou���o��r
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder(Ale 1
j• Other Type of Building g p,}i �<� No. of Persons Showers( Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
,a Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
,0 ew q {/-ZO, 77h 4
d ;1-
Date last inspected:
Agreement: 1
I
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 Vthis oa off•"alth.
Signed Date
Application Approved by _
Application Disapproved for the following reasons
r
Permit No. 7 do , Date Issued
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THE COMMONWEALTH OF MASSACHUSETTS ^Z7D
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
Certificate of Compliance
THIS IS TO CE,�,}}ZTIFY,th t the On-site Sewage Disposal System installed )or repaired/replaced(v )on
by Al '1 e�O LOrIS /4iC % for ti D v> �Q rJ�`%l ti5
as 7 Jr' 4d'4V11 Po' �^, Nrl%S h s been construc pd inj�c�rdan e
with the provisions of Title 5 and the for Disposal System Construction Permit No.4zt dated
Use of this system is conditioned on compliance with the provisions set forth Blow:
No. � ! 7l/ Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migogaf 6pgte/m,Con!5truction Permit
Permission is hereby granted to ,rr�Ze// 6-7eS
to construct( )repair(V/ an On-site Sewage System located at / 7 S '41 w�h7"P
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 inust be completed in two years of the date below.
Date: / � Approved by
CtRI-IFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONS'TKUC;WON I'1;R1 IT OVITHOUT DESIGNED PLANSI
7 �/'�� ereby certify that the application for disposal works
construction permit signed by me dated Z l , concerning the
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property located at /jJ�I�'I°DG�����r� meets all of the
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following criteria:
T ere are no wetlands within 300 feel of(lie proposed septic system
T re arc no private wells within 15o feet or the proposed septic system
T e observed groundwater table is 14 feet or greater below the bottom of the leaching racility
T e Is no increase in(low and/or change In use proposed
There are no variances requested or needed.
SIGNED: DATE: !�
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
tAtlach a sketch plan or the proposed system. Also If the licensed Installer posesses a certified plot plan,
this plan should be submittedl.
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