HomeMy WebLinkAbout0025 PORTSIDE DRIVE - Health 25 Portside Drive
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C• TOWN OF BARNSTABLE 4-01
LOCATION4 R Rim --T— SEWAGE #
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VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE N' . ��L� 7
SEPTIC TANK CAPACITY �`� "(—
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNE
PERMITDATE: COMPLIANCE DATE: 2b
Separation Distance Between the: p
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
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L ® T.IoN SEWAGE PERMIT NO.
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N TA LLER'S NAME R ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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No. G Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
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PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
„ eo--9 01pprication for Migogal 6potem Construction permit
Application for a Permit to Construct( )Repair( Upgrade( Abandon( ) ❑Complete System ❑Individual Components
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L ation Address or Lot No. K^ Ow er's Name,Address and Tel.No.
OX,Aftapl ,,e
ler''s Address,and Tel.N& Designer's Name,Address and Tel.No.
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Type of Building: �j
Dwelling No.of Bedrooms k Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Aro�Naturevf Repairs or Alterations(Answer when applicabl —
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 provisio e 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been i s Bo
Signed Date / 7 ��
Application Approved by Date
Application Disapproved for the following reasons
Perink-No. Date Issued
No. — fee
" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t
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PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
� eu.D 21pprication for Mf 6pogal *pztem Con!5truction Vetmit
Application for a Permit to Construct( )Repair(/pgrade(1, bandon( ) ❑Complete System F-1 Individual Components
LL attio(n Address or
Lot No. , Q Ow er's Name,Address and Tel.No.
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I aller's Name,Address,and Tel. Designer's Name,Address and Tel No.
Type of Building: Jam'
Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of.Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons..
Plan Date Number of sheets Revision Date
Title
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Size of Septic Tank Type of S.A.S.
Description of Soil
Naturepf Repairs or Alterations(Answer when applicabl .
Date last inspected: x°�
Agreement: �R •
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisio le 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been i . e by is Bo
Signed Date O 7 ¢�
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
f THIS IS TO T F+Y tha e to Sewage Disposal System Constructed ( )Repaired ( )Upgraded(
Abandoned(
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system ill function as designed.
Date ll7—- Inspector
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No. Fee
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THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION = BARNSTABLE, MASSACHUSETTS
Mi!5pog;ar *pgtem Construction Vermit
Permission is hereby,g�nte to onstruct( Repair Made(4,,�bando
System located at . �n� ? "P_�
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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.
Provided:Construction must be completed within three years of the date of this permit.
Date: Approved by
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CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
l hereAcertli, the application for disposal works
construction permit signe by me dated "``� concerning the
property located at IT meets all of the
following criteria:
a""There are no wetlands within 300 feet of the proposed septic system
0 There are no private wells within 150 feet of the proposed septic system
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,4 The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
'- 1 here is no increase in flow and/or change in use proposed,
"ere are no variances requested or needed. �
SIG
DATE: ,
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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].
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L0 "TON S I W A C I PERMIT NO.
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VILL GE
N TA LLER'S NAME & ADDRESS
8 UILDE R OR OWNER
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DATE PERMIT ISSUED e o
DATE COMPLIANCE ISSUED
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