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Home My WebLink About0333 POPONESSETT ROAD - Health 3 3 PC) s e- -.y?OO it , TOWN OF BARNSTABLE LOCATION 3 3 3 \® b - SEWAGE# QL VILLAGE C_nAM), C ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. e F(%vy, 0 L SEPTIC TANK CAPACITY jc XS-V i_S'0 1� �k 1 G B a® 0 e w LEACHING FACILITY:(type) rQ �A Q (, ...(size) 1,9 v j,j X a Y NO.OF BEDROOMS C_L.C`e.\ OWNER 1�C� -�f S®%4 7 CA PERMIT DATE: 43 COMPLIANCE DATE: r ,2 V Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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) A / Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY . e CPS A � /ill No.. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppfication for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(,i(Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No.3 3 3 fteOres Owner's Name,Address,and Tel.No. Assessor's Map/Parcel s 1 cervi Ins ller's Vr Address and Tel.N . p Designer's Name Address and Tel.No Type of ilding: �� %4 Oli 7 ' i.� "O 71 r V 3 `t Dwelling No.of Bedrooms :.,J Lot Size 7 sq.ft. Garbage Grinder(NO Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3 3 Q gpd Design flow provided gpd .r Plan Date C cy(, � `� Number of sheets Revision Date Title Size of Septic Tanlcf !e`K [�� } It Type of S.A.S. ;t 14 krls Description of Soil J c d V - i�.C�� , ��X�9 X Nature of Repairs or Alterations(Answer when applicable) Q fn t1z 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 Certificate of Compliance has been issued by this Board of Health. / 7 grie ct ate h AA D / Application Approved by Date Application Disapproved b Date Cl for the following reasons Permit No. Date Issued No. � l7( Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ° PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS / Tipplicationj10r Disposal *patent Construction 3pPrmit Application for a Permit to Construct( ) FRepair Upgrade-( Abandon( ) ❑Cofnplete System�. Individual Components Location Address or Lot No.2 33 ?b p �CSC c?t� Owner's Name,Address,and Tel.No., 5 K, Assessor's Map/Parcel Installer's Name,Address and Tel.No. Designer's Name Address,and Tel.,No. r j Scoff Vr ,t3 U�, � kG.rv2JVC. c�cjL.w,, ..` cof� G� A u t _ Type of B ilding: -el �N yob '��OW"0 8,5t4 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder O1 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2 3 0 j gpd --Design flow pro d d .Zan �f ' gpd Plan Date� 5 r A Number of sheers" Revision Date jf J 4J Title Size of Septic Tanhf .�A G`t n I � (4 M- - Type of S.A.S. r-) Description of Soil 4. / f Nature of Repairs or Alterations(Answer when applicable) c � _ Date last inspected: __5 Agreement: The undersigned agrees to ensue 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 Certificate of Compliance has been issued by this Board of Health. , s I L . / Date Application Approved by I i / ' I Y ;`^ I JDate Application Disapproved b, Date for the following reasons Permit No. Date Issued L/ ` ."„/THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired V) Upgraded( ) Abandoned( )by SCQti *A �.. at � > -�� has been constructed in acc6�oac aw with the provisions of'Title 5 and the for Disposal System Construction Permit No- InstallerC Mn,V Designer #bedrooms Approved design flow -71 A and The issuance Tf this ermit shall not be construed as a guarantee that the system will functionJ`a as designed. Date � Inspector ------------------------------------------------------------------------------------------------------------------------_ No. , Z Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposar 4pstem Construction 3pPrmit Permission is hereby granted to Construct( ) Repair(V ) Upgrade( ) Abandon( ) System located at 1' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction in u7sThe collipleted ywithin three years of the date of this permit. Date Approved by VARIANCE REQUESTED EXISTING LEACH PIT TO BE PUMPED & REMOVED. REMOVE ALL ASSOCIATED MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT CA HEALTH INSPECTOR CONTAMINATED SOILS 8i REPLACE WITH A A SU� o os n Fo 310 CMR 15.211(1) — SOIL ABSORPTION * + CLEAN MEDIUM SAND PER TITLE 5. ELEVATION SYSTEM TO CELLAR WALL. 20 ft MIN REQUIRED — VARIANCE TO 76 ft �� TOP 26.88 O OF SEPARATION REQUESTED. CONCRETE C�po `� �, PROPOSED SOIL I ABSORPTION . 20 m .00 ft 80 `11 ' �a " ' D SYSTEM OAK �. .t -SEE DETAIL ® 26 BACK 80. oO ft ON / 2 /0 DRIVEWAY Q W � �W MINIMAL GRADING if w PROPOSED �p G o• w° / �0 27 o �/ C� / M }� Q, o�� THIS IS A l UOA Do �Oo COLOR �Q f PLAN fop 0�� USE COLOR PLAN ONLY / ZQ OP " FOR INSTALLATION ��®� / FULL DETAIL IS BEST VIEWED IN 26 �� l FULL COLOR 81�2 fr LEGEND a SEPTIC COMPONENTS / . 1500 GAL / SEPTIC TANK / EXISTING \ C LEACH PIT/ LOT' O o a • CESSPOOL o AREA = 25903 sf+— 27 DISTRIBUTION BOXII PLAN BOOK 94 PAGE 47 TEST PIT ASSR MAP 19 PCL 114 / U U U11 E S WATER LINE GARB WATER GATE D G R GAS LINE OT PLC Q N OWED OVERHEAD WIRE OH UTILITY POLE SCALE: 1 in = 20 ft 0 20 40 • 0 10 20 • ► c • • PRINT ON . 8-1/2 x 14 in • PAPER FOR PROPER SCALE THIS PLAN IS NTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING PLACEMENT OF ADDITIONS, SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SCHOOL STREET ` a �P,cN �F�ass9 OFMgss , SEWAGE DISPOSAL 0 Q o�' DAVID �yG� o' DAVID q�yG SYSTEM PLAN Q CKERS NECK D. D. -TO SERVE EXISTING DWELLING CRo COUGHANOWR N v COUGHANOWR N No. 1093 No. 461 LESLEY ANN c POPONESSETT � S O lJ Z A ROAD ��9 gNSTE1P O/� �O , •.• .F'O DWNER(S) OF RECORD LOCUS NOT a 333 POPONESSETT ROAD N TO - COTUIT, MA = SCALE 155 Geo Ryder Rd S PROPERTY ADDRESS o COTUIT. MA Chatham, MA 02633 Dovidcou@Hotmoil.com I DATE: DECEMBER 5, 2019 O C U S M A P 508 364: 0_ 94 PG.1i2 jca- ETE-4423 I S oOIL TEST BOO '. DD 2810H CALC LATIONG SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE #461 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD WITNESSED BY: DAVID STANTON, HEALTH DEPT. TEST PIT 1 POC ATOb GROUNDWATER MIN/INCH ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS USE EXISTING 1500 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT, INSTALL INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK. 25.85 0-6 O SANDY LOAM 10 YR 2/2 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 6-8 E LOAMY SAND 10 YR 3/1 NONE FRIABLE 8-14 A LOAMY SAND 10 YR 4/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: 23.35 14-30 B LOAMY SAND 10 YR 5/6 NONE LOOSE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE 130-1281 C I MEDIUM SAND 110 YR 5/4 1 NONE I LOOSE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES 15.18 PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. NO GROUNDWATER ENCOUNTERED TEST PIT 2 2 MIN/INCH IN C SOILS THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY ELEVATION DEPTH HORIZON USDATEXT OIL SOIL COLOR E (MUNSELL) MOTTLES OTHER DEPICTED BELOW CAN LEACH: INCHES25.95 0-6 O SANDY LOAM 10 YR 2l2 NONE FRIABLE BOTTOM AREA = (24x12.83)-1/2(3X3) = 303.4 sq. ft. 6-8 E LOAMY SAND 10 YR 4/1 NONE FRIABLE SIDEWALL AREA = (24+21+12.83+9.83+4.24)x2=143.8 so. ft. 8-16 A LOAMY SAND 10 YR 4/6 NONE FRIABLE TOTAL AREA = 447.2 sq. ft. 2328 16-32 B LOAMY SAND 10 YR 5/6 NONE LOOSE FLOW CAPACITY = 0.74 x 447.2 = 330.9 gal/day 32-1321 C I MEDIUM SAND 110 YR 5/4 1 NONE LOOSE I INSTALL THE PROPOSED LEACHING GALLERY AS CONFIGURED 14.95 BELOW. FLOW CAPACITY = 330.9 gal/day WHICH EXCEEDS THE 330 goI/day REQUIRED FOR A THREE BEDROOM DESIGN. "1500, WA LLOoNN SCAT§C TANK DIMENSIONS- 81 DETAILt. SSO§L A�S Oo. U711 § N 4 USE EXISTING TANK IF STRUCTURALLY SOUND. S YS TEM •CONSTRUCTION$ DETAIL USE SHOREY PRECAST-¢500 L' PUMP & INSPECT TANK REPLACE WITH A NEW GALLON LEACHING DRYWEL ° AT TIME OF REPAIR 1500 GALLON TANK DRYWELL 3 ft IF CRACKED, ROTTED UNITS 21.0 ft I in OR OTHERWISE TA PER @ COMPROMISED. ' F29 w Ao y co i o ° S ft- i CD N Zu-, O 8 in N A : NOT = STO 3.5 ft 8.5 ft 8.5 ft 3.5 ft T O NF IO ft-6 �n SCALE 500 GALLON DRYWELL DIMENSIONS & DETAIL INSTALL ONE INSPECTION RISER TO WITHIN THREE INLET OUTLET USE INCHES OF FINAL GRADE COVER COVER & INDICATE LOCATION H-10 ON AS-BUILT UNI T 3 IN�DROP FLOW L 1 NE 33 r. `, BUILDING 10 in 141 . TO "0- in J D-BOX 4 in 8 GAS LIQUID 5 LEVEL BAFFLE 102 in m CROSS SECTION VIEW 6 In STONE BASE INSTALL AN APPROVED GEOTEXTILE SEPARATION BETWEEN INLET & OUTLET FABRIC OVER STONE TEES NO LESS THAN LIQUID DEPTH l CROSS SECTION VIEW F 3/4 in T 24 in o 3/4 in T t USE SHOREY 281-I/2 In GRVEL_ � DEPTHEFFEC I it% n GRAVEL DQS TU1T QBV T§OUV B OW DB-3 H2O In ��.��:� •t;fz?i�z.�%_it�r>"��z.. DIMENSIONS PIPES EXITING D-BOX TO RUN LEVEL 46 in AND DETAIL FOR -2 FEET BEFORE PITCHING DOWN 46 in 58 in 150 in C M12INin -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. —� -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM FROM 1 �O) REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC N TANK u) Lo TO CODE (310 CMR 15). P ^ SAS I ECO-TECH RAPID RESPONSE RECOMMENDS THE INSTALLATION 7. r" OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC PUMPING OF THE SEPTIC TANK. 6 in STONE BASE -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 21 in 2� CROSS SECTION VIEW - 22 o F L L� [� w p 0 TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE 4 in SCH. 40 PVC AND TO PITCH AT 1/8 in/ft MIN EL = 27.53 +— 6 in OF FINAL GRADE 26.00 D= O 3 r MAX ��0��0�� USE H-20 23.00 EXISTING 1500 GALLON o o°oo° PRECAST o°oo�aoo°o oo°°o oo 000�bo°oe o0 °° °� ° DRYWELL °oop�o°o°o°ooi ooO°o 0 0 SEE= TAN z2.82 6 in 22.35 SOL ABSSQRPT�QN 11 EXISTING REFER TO DETAIL BOX 22 52 STOKE 22 25REFER TO I SYSTEM DETAIL BOX 0 6 in STONE BASE IF NEW 5-12 ft (n BELOVt/, EXISTING 13 ft NO GROUNDWATER 20.25 MOTTLING OBSERVED - 14.95 - - COTUIT, MA DECEMBER 5, 2019 ETE-4423 PG 2/2' SEWAGE DISPOSAL SYSTEM PLAN 333 POPONESSETT ROAD Town of Barnstable �tHE � inspectional Services Public Health Division eAatverAerJs, v f Thomas McKean,Director $Q ' 200 Main Strect,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-796-6304 Installer& Designer Certification Form Date: 4_J i 12.0Zn Sewage Permit# Assessor's Map\Parcel Designer: b a ut A D Cou l,t,nuor,— Installer: 7t'c,-V_- Address: lss Ccyrg p,)(, Rl 50 Address: On A /(" ce, was issued a permit to install a (date) (installer) septic system at based on a design drawn by (address) ; tq n,"�'-tr dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in c t the to rms of the 11A approval letters (if applicable) n D r, t„}i CO..'UGHA11401 R (Installer's Signature) No. 093� SA, (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Vio61deptsMALMSEWER connecASEPTICOesigner Cenif3cation Dorm Rev 1W4-13DOC FRs........ � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Db3p l ial Works Tomitrurttnn runttt Application is hereby made for a Permit to Construct ( ) or Repair (\/ an Individual Sewage Disposal System at:........ ...... . Vocation-i\ddr t or Lot No. O vner t Address `1 p` A . Una.t. �l... i S Installer Address Type of Building Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms________3------------------------------- Attic ( ) Garbage Grinder N() aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------- W Design Flow..................................... ......gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.r560.gallons Length________________ Width................ Diameter................ Depth.............. x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No._-.-----_-----...... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-_.-_-._....-__--___._.. r3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....-.................. a •---•---•---------------------'-------'------'------'-•---------•-••----------•......---------...---........................................................ 0 Description of Soil------.-•---------------------------------•--------................------------------------------------------..._..--------------•------------•-•-•----------......---' x W --------------'--'----"----.....-'---'----........------'--"-•'-"--'--"--'-'---'---............. -'�ri .--•----------------- U Nature of Repairs or Alterations—Answer when ap licable.___ _. ..� ._.�iX� . _. �: .... � .... ._..,�.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of CompliAnce has bee tl e board of health. f Signed ... .. ... Date Application Approved By..• ...... r .... . --'- [)are Application Disapproved for the following rearonf: ...................... ................ ..................... ................................ ........................... ................ . ................................. ......................... .................... . . ........................................................ ................ ... . -_ Dare,^��, Permit No. —' ..�1�.-. � - .... Issued ........ .............................. �...... Dace YHR THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Diiripwial Workii Towitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair (� an Individual Sewage Disposal System at: - .� ocation- ;\ddr•ss or Lot No. .._....�:tN ...-cc \ _SOIJ Zen - --------------------------------------•-•--•-------------------------• ... O vner Address ---------------•--•---------------••--- ��: �� ._ �1�_. _... � 'CMA I S Installer Address UType of Building Size Lot....................-------.Sq. feet Dwelling—No. of Bedrooms--------3..................n-----------Expansion Attic ( ) Garbage Grinder (h/O) aOther—Type of Building _________________________°:. No. of persons. ------------------------- Showers ( ) — Cafeteria ( ) 44 Other fixtures ------------------------------------------------r=--- t f W Design Flow..................................... ......gallons per person per day. Total daily flow..------------------------------------------gallons. WSeptic Tank—Liquid capacitv._l�u.galIons Length---------------- Width---------------- Diameter--._...--.--_.-_ Depth................ x Disposal Trench—No- -------------------- Width.................... Total Length-.---____-...___---_ Total leaching area....................sq. ft. Seepage Pit No-------- ---------- Diameter----.------_---.-_ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►" Percolation Test Results Performed by.......................................................................... Date--------------......................... _ a Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.--_.-.---_-___-_-_---- 4q Test Pit No. 2........... _minutes per inch Depth of Test Pit.................... Depth to ground water....................... ----------------•------------------------------------------------........-----•----•••--•----•--•--•----•-•---•----....------....---....- ODescription of Soil -----------------------•-•-•--------------------------------------------------------------------------------------------------------------- .......................................................... -- -- UW ------------------------------------------------•--------------......--------------------•----••------------- _-- -------------------------------- x - - U Nature of Repairs or Alterations—Answer when applicable._. �4. _.._ X� .('�L1_.... 5 _ U......S ......... ...... .�!..o�...�_ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compl' nce has bee t e board of health. `�' �J.. ..v Signed ..... .. .\^- 17..I�-�. Dare Application.Approved By �� ............. sr ... ' Dace Application Disapproved for the following reasons: ....................... ............... ..... ................... _.............._--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................ Permit No. `" � ��`�' .. ��...��--/�.................. Issued -- ..................... '��......� . ...... ----------- Dare >sei�eo��-----emm—e—a—m--m..�.�>.�, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 11'Ertifirate of C�omplia t e THIS IS TO CERTIFI',,That the Individual Sewage Disposal System constructed ( ) or Repaired ( V) by �C C�. .... .................... ^�-�5 e c�.....1� - ....................... --------------------------------------------------------- at .__---- has been installed in accoM ance with the provisions of TITLE 5 of The State Environmental Code as described in J the application for Disposal Works Construction Permit No.' ?._ __.......�. :..;a dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT T SYSTEM WILL FUNCTION SATISFACTORY. i d C Q DATE.... �.. 1.. -... ...- Inspecto ............. - •-........ ........ -- ------ ....... ... .�--- r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 47 TOWN OF BARNSTABLE No. �l%....._� � FEE... ., �ioo�tl orkii Toot "rrmit Permission is hereby granted....... w__ ._.....`'�_�._..........�j _ ------•---------------------------------------------------------- to Construct 1 ) or R air ( �an Individual Sewage Disposal ystem at No Stree as shown on the application for Disposal Works Construction Permit 4--' Dated... --Z-7: .. -••-- ----- Board of Health DATE.....-�•-----=�-� � -----------------------a��- FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION TT kal SEWAGE # Y 2 y2 VILLAGE o T� ASSESSOR'S MAP& LOT( // INSTALLER'S NAME&PHONE NO. )D S 9'V^'as 1-/7 7-0 -1 V 9 SEPTIC TANK CAPACITY l SO 0 (2,21 LEACHING FACILITY: (type) 0'90 c r�hLk (size) /DOS 6,01, NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTrDATE: COMPLIANCE DATE: 3 — /Z _ 97 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by i r 61U Z' A �� I l " �� .J � .. �� - - _,__" ----- - .� I �� I � ._- � TOWN OF BARNSTABLE LOCATION ? 3!3 /fJ.,Ap a� Y,5eI SEWAGE # VILLAGE oTv/T ASSESSOR'S MAP& LOT Q � / INSTALLER'S NAME&PHONE NO. ✓a s elw ��-c �e�rryJ S�7 7-0-1`/9 SEPTIC TANK CAPACITY l 3-0 0 a� LEACHING FACILITY: (type) /p 40 Ji-mil c T�h/c (size) /DOr7 Cih� NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: 3— /7 —Y.r 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 leaching facility) Feet Furnished by `f i ��` � � ,��. ��' ,� ' �. ?.s f a�� :_ ., _ . y TOWN OF BARNSTABLE. Laf')C�ATION ES S &SEW _ VILLAGE ' �L� ASSESSOR'S MAP LOT �? INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)� Z�!b Q (size) NO. OF BEDROOMS PRIVATE WELL PUBLIC WATCR BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GjtA.NTED: Yes No :ray ,, i � ,.. � , \ �� r ,. � � �� . . - . � f .. 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