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Home My WebLink About0029 BANFIELD DRIVE - Health 29 BANFIELD DRIVE, COTUIT i i a TOWN OF BARNSTABLE LOCATION f /� �C DL*r�t9� SEWAGE # �8'23/ VILLAGE_C►6&' ASSESSOR'S MAP& LOT d Z 3 OLL INSTALLER'S NAME&PHONE NO. y77-07Y,? ,1oSe,,4 SEPTIC TANK CAPACITY /fW LEACHING FACILITY: (type) NO.OF BEDROOMS �f / BUILDER OR'OWNER 1;4wflorz PERMTTDATE: 7—F—91 COMPLIANCE DATE: 7 —2 2 - Y8 Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 leachin facility) ° Feet Furnished byaau.�/ • " (� £,� o _ � o a. 5 ,�� ® ——— � � 1 ,�h _ • . �� . � . z � . . _ .. is ;� �� fir. 1 z_ _ TOWN OF BARNSTABLE LOCATION EWAGE # VILLAGE CoTI> l ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ? SEPTIC TANK CAPACITY D®O LEACHING FACILITY:(type) (sue) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER PopLfC-. JaUWDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: •VARIANCE GRANTED: Yes No �Zo � oc TOWN OF BARNSTABLE LOCATION _2 SEWAGE # VILLAGE_ ASSESSOR'S MAP & LOT o�z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) --�-Dy 10r:'�' /--/" (size) 3:2X I3 7 NO.OF BEDROOMS !2 / BUILDER OR OWNER ,/ rb/d l4„1 17 11h PERMTTDATE: 7,Q-BLS COMPLIANCE DATE: 7 -2 2 - 93 Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 leachin f✓ility) Feet Furnished by� n � ;�a l9GK 0 1 7 i Cl No. T Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migozal *pgtem Construction Vermit Application for a Permit to Construct(1, Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components �. Location Address or Lot No. 2 Q D1,105 0 nn is Name,Aodress and Tel.No. Assessor's Map/Parcel C.°�`r �iN r�� Orgl�h 023 n iN/d/ 19r. v viT Installer's Name,Address and Tel No. �/�7'9 O �f 9 Designer's Name,Address and Tel.No. Jaseph Oz (' 0,-a.S Type of Building: Dwelling No.of Bedrooms 3 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 Nature of epairs or Alterations(Answer when applicable) F/l 2 GX/ST<`I� e,___55i0Oo/ WI r �/�1V41 -- 1*n__ . 14kgr#// IS20 G,w/ St 6 -ligx ii.<^s w�rl _-T"Yroo'e #la4w 1 // Der .!'rotii3 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 is ued by thi Board f Health. Signed 6ril.G c� o✓1 Date — Application Approved by C— -. t Date Application Disapproved for the following reasons Permit No. 24a, 3 Date Issued r i, No. Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: `, Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migogar *pgtem Congtruction Permit Application for a Permit to Construct(!/pair( )Upgrade( )Abandon(' Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. IV /3,44 ,lM/ A-1-05 Own is Name, dress and Tel.No. 412 9' / 601vi r �a rAld M190"111*4 Assessor's Map/Parcel 0 ,21 ,23 v/ 7 n N r. v vi Installer's Name,Address and Tel.No. N`9'7 O 7'I f Designer's Name,Address and Tel.No. J�epy Di ,(f,�rroS Type of Building: 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 Size of Septic Tank Type of S.A.S. Description of Soil Nature of epairs or Alterations(Answer when applicable) F/ �X/ A/NI W/r,0 L"', l 1,risry// 1120 Ga/ 7' fgx�r�ii ma's wlrA 3 .Sroo-e #bo�(,H 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 is ued by thi Board f Health. Signed �+ .GG✓Gi Date - 9'18 Application Approved by - C- - Date 7 9`if Application Disapproved for the following reasons `Permit No. Date Issued `'7--!X THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Corttriance -' THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( 4-T Repaired ( )Upgraded( ) Abandoned( )by "s e ,oe at an i=/ 1 Vim' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �/ y 3/ dated Installer .�asLp! 0.0 Designer A..se-pG, The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ---, ' No. 1�1 L( 3 J Fee �-► V�_"J• THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ig ogaf �pgtem �ongtructton permit' 023 0 y Permission is hereby granted to Construct(l�-ftepair( )Upgrade( )Abandon( ) System located at Or i 1l�� Ca T"vi r 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 mu-s be completed within three years of the date of thi t 1 Date: 7"/ ° Approved by �t j 10/9/97 NOTICE: This Form Is To Be Used I+or the Repair Of Failed Septic Systems Only: CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated -7 9— y,5 ; concerning the property located at 2 19*a�i'i�� Q�r rii= �v�1^ meets all of the following criteria: I "ere are no wetlands located within 100 feet of the proposed leaching facility i VThere are no private wells within 150 feet of the proposed septic system 01-1�ere is no increase in flow and/or change in use proposed There are no variances requested or needed. r � + If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the 1 proposed leaching facility will mi be located less than fourteen 01 )feet above the maximum adjusted j groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.LS.map) B)Observed Groundwater Table Elevation(according to Health Division well map) 7 SIGNED: r DATE: — i l LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER lv,5;1 tAttach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert i i W W � e O 0 O r w � W TO 0 a � � N �s �