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HomeMy WebLinkAbout1121 OLD POST ROAD (CT & MM) - Health L OLD POST"PiPCOTUIT A = 075 001 014 r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppriration for Dtopozaf *potent Con�trurtton Vermtt Application for a Permit to Construct(�)Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address'o�I�p�No. Z-I p �,� fys 1' Owne`rTs© Addres Tel.No. G/� mKitih pbv { Assessor's Map/Parcel �'8 "Xk t 7— to Ror? � Q(,t�1 G(�(` � /��} �6 Installer's Name,Address, and Tel.No. Designer's Name,Address and Tel.No. `{� LCZCM 1.f0�u�J ` tvw&k CA14r- IE44�rc4�t.Cr.4(�oIkc , '0�S KkLS ??!-61 3R`t Ste. 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 Jr�J gallons. .Plan Date Number of sheets a Revision Date Title Size of Septic Tank Type of S.A.S. Q® 4?A-t '"AYVA&-n-S Description of Soil -671uv D Nature of Repairs or Alterations(Answer when applicable) 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 bee d y H " Signe Date 6 Application Approved Date Application Disapproved for the following reasons Permit No. "' Date Issued - �v TOWN OF B STABLES G� LOCATION LO� OFF PoS} SEWAGE # ! VILLAGE OR'S MAP & LOTJ 7,r-6 d-141 'S NA &PHONE N0. �& nIo� � o�5rxkINSTALLERME 6A 771- f399 SEPTIC TANK.CAPACITY ISOU C��i I LEACHING FACILITY: (type)' .�(�%�al Leec.k .&i WA (size) 11 ld x ��L X a NO. OF BEDROOMS S BUILDER OR OWNER &A4 A, &J r _ I PERMITDATE: <2 4aX6 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet I 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 ¢h S9 FIE 4 t _ t j , h .sv g S hV No. �" ,V /t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' � es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUS'E S 0[pprication for Mizpoal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address o eyNo. pj ' Owner's Name,Address and Tel.No. G .. oll ��W4� P s t ! �-ot W ,4L ,r•� /01'�lkwt� Poi, Assessor's Map/Parcel T— va t^6- L'AC,(, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S.(J�'t `\l (_6/l.-5 l ' t> NW#-( G.4(3- rcJccy, I*955 'W5 MU-6 Type of Building: Dwelling No.of Bedrooms S Lot Size sq. ft. 1 Garbage Grinder( ) 1 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 53 gallons. Plan 'Date 10 Number of sheets ( Revision Date �- Title Size of Septic Tank !5v a Type of S.A.S. ?A"t 1C4(AYv%6&- t-4 Description of Soil /744 Nature of Repairs or Alterations(�nswer when applicable) 1 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 the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee d y HeaAl Signe Date i 2 Z2 Application Approved Date Y .— Application Disapproved for the following reasons ` Permit No. Date Issued ------------------- -----------THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS FS,TO CERTFFFY, th t the On-site Sewage Disposal SystemConstructed( PIRepaired ( )Upgraded( ) Abandoned( )by '�^"j�� at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Ir dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector _ — _ S ,.No._ ----- ----- -----------------Fee__ — - - f THE COMMONWEALTH OF MASSACHUSETTS ; PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mitpogal *p.5tem (Construction Permit Permission is hereby granted to Constru t )Repair( )=4� Abandon System located,at. 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 st bj completed within three years of the date of t Date: Approved by e t % PRf ;ffILE: NOT TO SCALE 1-�5T f-1OLE LOCH N I'LAYER Off'>/'PEA5TONE EL- /,2 S r`IR5T P1PE' LEN3TH OVER-1/4"-1 V2"POUN-E r0f' rr�LWAncN GO&R6 rO MrHIN ro ref `SET LLVLL WASt1 STOIL= DATE: 2-j Z-->C>3 -j N EL- ./G-, 5 A' OP I'MI51-F1� 6RADr- I`OR MIN. 2' TEST f5Y:�l I l� rIN60 6_RADE WITNESS: J, GcJ.�,//TE fi��ACT�I AryE� 18.) tea, 7,` �ri'q�t a- G PER RATE: L-A � j�c.��.✓.�inic�-/ kr q" A" PV i TOP 0 EL �IZ. O.i Q AO D IS ) 1507cm a EL i 7_ i iwrrM.L&A rg y2.5 y 4/ N N _ r DiST. DOX / �/� 7 d 2 � l G' 6E ARAT ON / �1 tJ ,BctJ G• 5�,, 6/�1.DN G. 5 1 .CEP V, TAW, I `lv y�/,2 zy` y3. c C 1 2, /Zo" •Z DES I CAN DATA �b 7� � 3 3o C�'D FLOW: (3)pEDROOMS x 119 GPD= SEPTL TANK:33�GPD x2O0%_ ;'6-o GPD U6E:/52>OGALLON PRECAST SEPT6 TANK j LEACHING FAGIL(rY: �- USE: 63) S'x r GAPAGITY: ` SIDEWA-L: x �! POTTOM: 13 '.��> X�.�,� j �G" GENERAL NO-EL / J TOTAL: Q �I CONTRACTOR TO P5E RE6PONSI3LE FOR THE LOGATONOF ALL UTLFES, A15OVE AND UNDERGROUND,PROR TO ANY LXGAVAT-ON OR GONSTRUGTON. v 2. SEPTG SYSTEM TO 13E NSTALLED N GOMPLANGE W(rt13O GMR C�DO:T(rLE V n- 3. Tf15 PLAN 5 NOT TO 15E U5E9 FOR PROPERTY LNE DETERMNATON II V .4. ALL P5TURt5ED AREAS TO�E LOAMED AND SEEDED / Q 5. GONTRAGTOR TO PROVDE 2A HOUR NOT-OE FOR ANY RELZURED N5PEGTt2N5 No 00 U �e ow�«•-`may �� / V �_, 10 Mid# l I / i � I � 1TE �ff�Aa' ��AN ,l�f L. �0.3 LOCATION: G%�5� �� �a�T" =✓. ��Tv/ T PREPARED FOR: ' DRAWN f3Y: •5 , J05 N1�113ER: DATE: - WELD A�� A7ff�5 OG ! ,•. SUITE 40 GENTERVILLE, MA 0Uo32 TEL.: (505) 775-0735 I=AX: (505) 775-075A4 PROFESSIONAL ENINfffRS & LAND SURVEYORS