The URL can be used to link to this page

Home My WebLink About0110 OXFORD DRIVE - Health 110 OXFORD DRIVE, COTUIT _ A=021-070 i I TOWN OF BARNSTABLE `\� LOC.'ATION 110 N FQAC_ SEWAGE # VILLAGE Cnf u 1 I ASSESSOR'S MAP& LOTOZ(f-1'rg INSTALLER'S NAME&PHONE NO. 111-'6 C Pgoe- �� SEPTIC TANK CAPACITY D®O LEACHING FACILITY: (type) 27W,-lloel¢0 ( J (size) ��x X-lx NO.OF BEDROOMS CGh� BUILDER OR OWNER V-4 PERMITDATE: 9� 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 leachi facie � Feet Furnished by �' . G w �I N i� No. fi 6,D t l J ` C/ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippfication for lhgpogar bpgtem Conotructiou Permit Application is hereby made for a Permit to Construct( )or Repair( n On-site Sewage Disposal System at: Location Address or Lot No. l r-0 O ro OA Owner's Name, ddress and Tel.No. M6 �,rg u6v� Assessor's Map/Parcel ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures F 6W� Design Flow l� ,� gallons per day. Calculated daily flow " gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of R pairs or Alterations(Answer when applicable) 1 Llvwrr l2s_-_ uz *�f 8 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 vironmental Code nd not to ace the system in operation until a Certifi- cate of Compliance has been issued /2! Signed Date l� Application Approved by 47 Date Application Disapproved for the following reasons Permit No. " Date Issued No. �tf 3P Fee y f 2� j THE COMMONWEALTH OF MASSACHUSETTS I / PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01ppYication for Ziggoar bpgtem Congtruction Permit Application is hereby made for a Permit to Constructk( e)or Repair( n On-site Sewage Disposal System at: Location Address or Lot No. / /D V r0 ! Cott/1 Owner's Name, ddress and Tel.No. Assessor's Map/Parcel A�45 f s Installer's Name,Address,and Tel.No. ,q Designer's Name,Address and Tel.No. 1 � i Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers(:,.) Cafeteria( ) Other Fixtures Design Flow 151— gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Min 5 f Nature of Repairs or Alterations(Answer when applicable) MCA Cj_ -j/ ZWI i Lrye-ira (U 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 d not to ace the system in operation until a Certifi- cate of Compliance has been issued of-I e001 a fh Signed Date 1 ; Application Approved by Date � �� Application Disapproved for the following reasons Permit No. ! '" Date Issued &I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage.Disposal SYjstem installed )or repaired/replaced(�)on � by i . —G G Installer 15 Ur 4 y at i as been construe d,in c�dan�,e� with the proyis}oons of Title 5 the f Disposal System Construe'�� t No. � dated 66! �1 Date ��,� e/ Inspector � � f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED�AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. ----—------- --------------- —Fee .THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE., MASSACHUSETTS migpogal Opotem Conotruction Permit Permission is hereby granted t !Il t tq to construct( )repair( an On-site Sewage System located at No.# �l� f�X o2� Ort ` lr�tv�i'" Street and as described in the above Application for Disposal System Construction Permit. No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. iG Date: "'" � ��'�� Approved by Board of Health CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, % ab� , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at //a 0X1"::O- -r meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED—: DATE: O LICENSED SEPTIC STEM 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]. y .g NIP. o 6 b d ' a ;t LO=CATION SEWAGE PERMIT NO. I c l 66 DRIVE 9 VILLAGE C�/ L� T i4 �S` INSTALLER'S NAME & ADDRESS d7obtj r- M A F F E i `,n ®x �3�3 B U fit D E R OR OWNER ems'C.0 P g!F LZY DATE . PERMIT ISSUED — / ' - 7 � DATE COMPLIANCE ISSUED R I '� � f �..,, ;J