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HomeMy WebLinkAbout0388 OLD OYSTER ROAD - Health (2) 388 Old Oyster Road, Cotuit A=022-036 b TOWN OF BAARRNSTABLE 5 , c LOCATION (�yjr7�il� �`�' SEWAGE # ?7"-2 Z VILLAGE ��� ASSESSOR'S MAP &LOT �Z Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY lno® • LEACHING FACU rrY: (type) jL4, "C'&S7 (size) NO.OF BEDROOMS —J / BLULDER O O R PERMITDATE: —? 7 COMPLIANCE DATE:_ Separation Distance Between the: 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 within 300 feet of leaching facility) Feet Furnished by lf% J� 1p f/rM� No. ;j� ,s Fee �© THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 21ppYication for Migpogai *pgtem Construction permit Application for a Permit to Construct(OfRepair(V/)1U'*`pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ? S Owner's Name,Address and Tel.No. Assessor's Map/Parcel Go/—,w/y— /4e,�A Installer's Name,Address,and Tel.No. / � Designer's Name,Address and Tel.No. 7 /-� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder 4119 Other Type of Building�t°�oGe No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Ile gallons per day. Calculated daily flow j,® gallons. Plan Date Number of sheets Revision Dare Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer w .n applicable) ��/ !�®® Q /eel-- 7;V12 61 '4 r?— 2 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 Signed Date Application Approved by Date Z Application Disapproved for the following reasons Permit No. ���'" �� Date Issued _ No. �* Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Diopogar *pztem Cottgtructiou Permit Application for a Permit to Construct(61�Repair(�pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a o/� y5��f �� Owner's Name,Address an�el.No. Assessor's MapTarcel a C0 // Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. DroGo � Co�5�" t Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(-_tlo Other Type of Building 17,05i eece No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 33Q gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank / ©D Type of S.A.S. dipi'� D>`4 'S Description of Soil Nature of Repairs or Alterations(Answer when applicable) T 045��/� z 33"4 Xz, e2 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 is ar of ea Signed Date Application Approved by Date / — /�TS`7 Application Disapproved for the following reasons Permit No. Date Issued / — roy —`9 7 THE COMMONWEALTH OF MASSACHUSETTS2 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired( Upgraded( ) Abandoned( )by 01` / �i1�9 �rlIC7`l0/� at_� ' g /7/� y,�i f- '1� r� �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.9 2—a�.2 dated ,/��- i 2 Installer 4/Y e Ze i� Designer The issuance of this permit shall not be construed as a guarantee that the system will function-as designed. Date — i Q Inspector No. q 7—�', �, �s " Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS 'Wi5poOar *p5tem Contruction Permit Permission is hereby granted to Construct( )Repair( VUpgrad ( )Abandon( } System located at 3 6 �� and as de cribed 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 f`� 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 DESIGNED PLANS �I X//;'40-zo here by certify that the application on for disposal works construction permit signed by me dated 11W'4'? concerning the property located at ����� v` � � meets all of the following criteria:. 1� ere are no wetlands within 3)00 feet of the proposed septic system ere are no private wells within 150 feet of the proposed septic system e observed groundwater table is 14 feet or greater below the bottom of the leaching facility ere is no increase in flow,and/or change in use proposed There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER � A ,1 proposed system. ' [Attach a sketch plan of the,p p ys em.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert W a a A Eb •d oy cos cir� L G'v7 ab`3� Q�(SrF,.2 (Lp4A. TOWN OF BARNSTABLE LOCATION q �—��`� 1 SEWAGE# 7 q T VILLAGE C�U ASSESSOR'S MAP & LOT IS2 Q-D ZZ INSTALLER'S NAME&PHONE NO. �7 d vs, SEPTIC TANK CAPACITY �OOL—, LEACHING FACILITY: (type) �C'w,�(L-j'�tiTd'�S(y)(size) r;[J*e NO.OF BEDROOMS / BUILDER OR OWNER C�A e y UJI ! ck ykS PERMTTDATE: f - � 1=42 COMPLIANCE DATE:�� L - Y 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 leaching facility) Feet Furnished by �e,01,4� o r v 1,