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HomeMy WebLinkAbout0193 SCHOOL STREET - Health 193 School Street, Cotuit A=020-091 I i i I TOWN OF BARNSTABLE LOCATION 3 ��-`���^ �l SEWAGE # - V LLAGE—Cc Tv ASSESSOR'S MAP& LOT I3--)Q D INSTALLER'S NAME&PHONE NO. 2 Ab, A-S ' SEPTIC TANK CAPACITY 0O �e Tt L � LEACHING FACELrN: (type) NO.OF BEDROOMS ! BUILDER OR OWNER c A e-�/1 &u I l ck KkS PERMIT DATE: `�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 `b` 3� o � ° r i No. 2 . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Digaal *paem Cougtruction Permit Application for a Permit to Construct( )Repair�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � Owner's Name,Address and Tel.No.�3 � Lei C®�►� Assessor's Map/Parcel ©� O c;� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 � I t o gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t j 0� Type of S.A.S. —=0-yL- —'v012�5 Description of Soil AN G Nature of Repairs or Alterations(Answer when applicable) �— r STf�ar-ems o c, S /4 e, 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 E ironmental Code and Otto place the system in operation until a Certifi- cate of Compliance has bey Bo f ealth. Signed Date 7 1 Application Approved by Date Application Disapproved for the Mollowi,ng reasons Permit No. `7 - 3 Date Issued 'I'OWN OF BARNSI'ABI-h LOCATION '� y5 � r"" SEWAGE # 97�2 z VILLAGE C���� ASSESSOR'S MAP &LOT OZ Z�J, INSTALLER'S NAME&PHONE NO. ��J6�'LO � CD�� 7 7/939� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 BUILDER O �R ) 7�la PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Sf 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 �38 IvU W� M� s ]+:..... .. . No. �7 • 5 Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION ;TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for IDigpool *pgtem Qntruction Permit t Application for a Permit to Construct( )Repair�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S�1QoLS� cO tl Owner's Name,Address and Tel.No.3 ` � c,�tl�,. Assessor's Map/Parcel C..h�O ( y K -5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. moose-_;R ,-V5 aU Q►� � P 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 . lip gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I j,5 t70 Type of S.A.S. s6A--4,1 -T v--'rr✓le Description of Soil C t Nature of Repairs or Alterations(Answer when applicable) A \ \SOP S< < ►4 �-- Z�c 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 E ironmental Code andRifft to place the system in operation,until a Certifi- cate of Compliance has bee .ftted-b ��� Signed DateZ Application Approved by Date - Application Disapproved for the ollowing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CERTIFY that the On-site S e Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( )by� 0 c Q. /Y S at ! � 3 _,5 C_ n L •s-T- C n I Q 7has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 7_ .,2 '� dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as_designed. Date 1 - '�4. Inspector- --------------------------------------- �7 No. / - d\—I Fee 5e9 ti THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi5po5al *p5tern (Construction Permit Permission is hereby granted to Construct( )Repair( {/Upgrade( )Abandon( ) System located at 1 c} S L�nn L ST 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: —I z 4 7 Approved by 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) hereby certify that the application for disposal works construction permit signed by me dated —' ���� , concerning the property located at \'3 �S c�,v L S-Z— Cow+ .` 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: 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]. j xert .:+ ) {_. w Q {�0r�� 0 l� iQ 'T Q V c `L