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Home My WebLink About0474 STRAWBERRY HILL ROAD - Health 474 STRAWBERRY HILL RD. , 40 .. „ A=248-058 _.._ J I lJ Fee No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zip p[ication for Zigooaf *p!5tem Con5truction 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. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. l '7 Type of Building: 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 rnz) gallons. Plan Date Number of sheets Revision Date Title Description of Soil —r� Nature of Repairs or Alterations(Answer when applicable) 6UK :X"L LG� 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 En ' onmental Code an not to the system in operation until a Certifi- cate of Compliance has been issued b Signe Date�� Application Approved by Date�7 Application Disapproved for the ollowing reasons Permit No. 313 Date Issued �- t �, � � /, Fe�eNo. a �— ? 4 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Moozat bpotem ctCongtruction Permit Application is hereby made for a Permit to Construct( h )or Repair( �an On-site Sewage Disposal System at: : Location Address or Lot No. 4rdtb4-1 Owner's Name,Address and Tel.No. Assessor's Map/Parcel i ✓ 1/V� , r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: �m Dwelling No.of Bedrooms Garbage Grinder( ) � -.Other Type of Building No.of Persons � ( )Showers Cafeteria( ) Other Fixtitir ' �L/ I� F Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil -r�_ Nature of Repairs or Alterations(Answer when applicable) 60c -k L~� -�0 4- a- 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 En orun ntal Code an not top E6 the system in operation until a Certifi- ! cate of Compliance has been issued by-this ar ,of" --i Signed" Date 77'-- Application Approved by 0. Date 7 ; . Application Disapproved for the ollowi g reasons i ? Permit No.�7i�A 13 Date Issued — —— ——— —— ———————————————-- �` — f THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance Z IS,� TO-CER ,that the On-site Sewage Disposal System installe ( )or repaired/replaced( �o by 61 c-e.- ®. e vet Installer�+ V-c 1 `' at W �-( %1rr1W\0e_r f 1i +\i U_ 'A i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7Z-3 9 3 dated Date Inspector _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. No. �- - .------- ----------Fee THE COMMONWEALTH.OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ;i6pogal bpelem Conotruction Permit j Permission is hereby granted to r"M'� �� to construct( )repair( On-site Sewage System located at No.# k'71-4 MVU VY-- v*r V k� 1( lC tr-t". K x i I Street and as described in the above Application for Disposal System Construction Permit. 94,-3 q ' -1�--& No. Date"' 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: �} 7- Approved Approved by l Board of Health i i a i 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 -- ; Otto , concerning the property located at ��`� ST �r"`"' °`��°� �' �' meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. i SIGNED: DATE: . —7 � iC`3 LICENSED SEPTI 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]. �� e �` ., �� -" � �;- ��' � � Q C , �'� _ TOWN;OF.BARNST LE L ''ATION � 'S'yb�2r4` �1� SEWAGE # VILLAGE ¢6'`2Ilt ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO.AN/) ��'� �e °c -F(f6 9-5i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) � 22tf2CA CJ (size) �X �O 2� .NO:OF BEDROOMS S ^' BUILDER OR OWNER—, i Xt;: I PERMITDATE: COMPLIANCE DATE: �G, Separation Distance Between the:,, 9 Maximum Adjusted Groundwater Table and Bottom of Leaching Facility f 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 x , ithin 300 feet of leaching facility) +Feet" Furnished by x. . 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