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Home My WebLink About4007 FALMOUTH ROAD/RTE 28 - Health =4007FALMOUTH ROAD, COTUIT a : . - f i TOWN OF BARNSTABLE LOCATION 5100 9 /0WW0a1--4 SEWAGE # VILLAGE 1 .6601 T ASSESSOR'S MAP&LOT 0 W INSTALLER'S NAME&PHONE NO. 1-/7%-03%1'57 JtP4, SEPTIC TANK CAPACITY Sao LEACHING FACILITY: (type). (size) 3�X NO.OF BEDROOMS BUILDER OR OWNER O WrO s/%rra✓! ClS r/;"rY.�lIIY/D PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: 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 leachin fac�ili Feet Furnished by,� `/�� h L]/ �7 No. 7 Fee 1 74 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Mi5pozaf *potent Cow5truction Permit Application for a Permit to Construct( )Repair(v)Opgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Ll 00 7 Owner's 44arne,Address and Tel.No. C OTv/r A50(to,)r:iV1Mf'N19 Assessor's Map/Parcel 0 y0 OO S Fj^W rl C $ G/gem/Ala U /T IA. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. o., 1.3, e,,-e5 �os eP4 0� �5tpr�+Gs 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 Repairs or Alterations(Answer when applicable) /'i V 2 " )OtiK+ STaHi;:- 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 by this Board of Health. Signed c Date Application Approved by Date Z Application Disapproved for the following reasons Permit No. `l'�— �� 7 Date Issued -NO. / 7 Fee J f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS application for Dtgogaf *p!i5tem Con6truction Permit Application for a Permit to Construct( )Repair(v)'Dpgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. q 007 6414,aark /W Owner's 1iame,Address and Tel.No. C vra,r POCOV Irell'H'(#" Assessor's Map/Parcel 0 w QO S Frio n _/s /A/0 ' e�orw r woo, Installer's Name,Address,and Tel.No. L/,71-40.5 4 9 Designer's Name,Address and Tel.No. L/ 7 7- a.74/q' �/l7S�/oGr d-- 6'O.- 'D5 do s c-P 4 D�13/9v�a5 Type of Building: Dwelling No.of Bedrooms e3 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 ^ I Nature of Repairs or Alterations(Answer when applicable) - - /, C_l- T45rAyll Isw GA , _1 "S - ' 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 by this Board of Health. Signed Date Application Approved by Date ?_-Z s= !94 Application Disapproved for the following reasons Permit No. �l �-- �/ Date Issued - Zf= 9 r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewa a Disposal System Constructed( )Repaired ( )Upgraded(4-4-- Abandoned( )by os,e at D 0 4/ v rti v has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer )0s e ,4 4L Designer z��,yLi /2,,- jg^rO S The issuance of this permit shall not be construed as a guarantee that the system will function designed. Date Inspector R, - : e No. ✓U �� 7 ---------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigpoar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(Z>Upgrade( )Abandon( ) System located at zf 00 7 25,"avn 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: 7 r Z Ste_ 9 Approved bye <• ,7 -� G4 / �r 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, 0se194 hereby certify that the application for disposal works construction permit signed by me dated .9, - 3 - �'8 ; concerning the property located at yoo7 /=,v/,wat, �'g r meets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed 0 There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will nQJ be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) �y B)Observed Groundwater Table Elevation(according to Health Division well map) 3-? SIGNED DATE: 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]. q:health folder:cert I r.sd° r 6ma e / w�r4 3' Or' �4ra%.� yi�TLi i TOWN OF BARNSTABLE SEWAGE # �, L. -117 LOCATION Z�0 � Fl9��s*o y� /�u" VII:LAGE �L�raiT ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. S'77 OS 5'9 SEM- C`TANK CAPACITY /5 0 0 :.: `l �I�9X i rrt//G/^S (size) 3SX 4 LEACHING FACILITY: (type) NO.OF BEDROOMS � i 0 I DER OR OWNER Pi=�ro f / /I4✓1 C/S W r/- B . - $ - COMPLIANCE DATE: 3 PE�kNIITDATE: -�-, Se aration Distance Between the: P... . Feet Maumum Adjusted Groundwater Table and Bottom of Leaching Facility priva(e Water Supply Well and Leaching Facility (If any wells exist Feet 1`oh site or within 200 feet of leaching facility) Esige:of Wetland and Leaching Facility(If any wetlands exist Feet } within 300 feet of leachin facili FuxniSW by ,j a �.