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Home My WebLink About0021 CONSTANT LANE - Health 21 CONSTANT.LANE, COTUIT A=040-045 ' L � ti .. 1 i �- N No. ` / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Y� � 01pprication for Migpooaf *p5tem Construction Permit Application for a Permit to Construc ep�i�,(,_+U e( )Abandon( ) ❑Complete System individual Components Location Address or Lot No.�,` �ry�{q��q Y� ��„�� Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0q0—0, t"l� Installer's Name,Address,and Tel.No. '1 Designer's Name,Address and Tel.No. 4( � Qa. �� ,•.�� 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 3c) gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 52>ek Stv GttiJ Type of S.A.S. I Description of Soil N4-a� .5 Nature f Re airs or Alterations(Answer when applicable) s't 1d� d 1.�0 I v� VT G a Z o L7T c C M 1 CJ e-i I� Date last inspected: Agreement: The undersigned agrees to ensure the construction and mamtenancp of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of a Environ ntal a and not to place the system in operation until a Certifi- cate of Compliance has be i c c� Signed Date 1 Application Approved by ICY: Date 7 1v.9 r ' Application Disapproved for t e following reasons Permit No. Date Issued 7— /G �� TOWN OF BARNSTABLE C LOCATION 1 CO^<54cw�t- Sri_ SEWAGE # 7 VILLAGE C a l m�-, ASSESSOR'S MAP & LOT_d a� INSTALLER'S NAME&PHONE NO. MO Ca4% SEPTIC TANK CAPACITY 1000 I. LEACHING FACILITY: (type) ZtifrAm^ (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: `7 COMPLIANCE DATE:_=�'� 1 J� j Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet j 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 f�rXo 2aching facility) Feet Furnished by 0 0 -a. W SCE' D / No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: :PUBLIC HEALTH DIVISION--.-TOWN OF BARNSTABLEs MASSACHUSETTS Ye 01pprication for Miopogar 4p.5tem Construction Permit Application for a Permit to Construct( )Re air( e ra e )Abandon( ) El Complete System Individual Components Location Address or Lot No.30Owner's Name,Address and Tel.No. Assessor's Map/Parcel �yC (o'" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. D �C Gh(A.r 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 r'"a gallons per day. Calculated daily flow L�G gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank lr'771b V a< ,a ; Type of S.A.S. il I (�c (�C Description of Soil "0 '4 Nature of Repairs or Alterations(Answer when applicabCle) 0�1 S`L 6 �C') r� �Qyc FO L) � t 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 e Environm ntal a and not to place the system in operation until a Certifi- cate of Compliance has been b this G Q Signed Date �" l `j(/) Application Approved by Date ; /O-9y Application Disapproved for t e following reasons r' • d Permit No. 9 y 3 7 Date Issued 7` /U—c/ f THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by L:= S at —_a\ C n&ZZ >�= L CQ f ca Oti.T has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7i - y3 7 dated 7—/O'9da Installer Designer The issuance of this permit shall not be construed as a guarantee that the system ill function as designed. Date "I ( Inspector No. 3 7 `-----------._._..—Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS 'Wi!6poga1 *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(�)Abandon( ) System located at z\T� �`t" 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 t. Date: -7-/ —,,9 Approved by (� •� 1019197 • is Form Is To Be Used For the Repair.Of Failed NOTICE. This Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DIS ENGINEERED PLANS) hereby certify that the application for disposal works concerning the it signed by medated construction p� g Cow( meets all of the property located at L ` . following criteria: There are no wetlands located within t00 feet of the proposed leaching facility ' / There are no private wells within 150 feet of the proposed septic system i /rG i There is no increase in flow and/or change in use proposed ere are no variances revested or needed. I • if the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the y Ma be lasted less then fourteen(14)feet above the maximum adjusted ` proposed leaching facility will groundwater table elevation. ! please complete the following: Ion according to the Engineering Division G.I.S.map) = A)Top of Ground Elevation( . Observed Grotmdwater Table Elevation(according to Health Division well map) DAT13: SIGNED i LICENSED SEPTIC SYSTEM MSTALLER THE TOWN OF gA�S'I'ABLE NUMBER lAttaeh a•tceteh pane of eh•prep• •Also Irth•11e•nad Irotaller pot•ne••aMlAad plot plan, this plan should be submitted). �r• J o � i i II P 1 � ;t�5 / ,` 1