HomeMy WebLinkAbout0108 SHELL LANE - Health 108 SHELL LANE
COTUIT
-- - A = 019 146
i
TOWN OF BARNSTABLE
LOCATION ®� �� :CL 461 SEWAGE # 220-0—41:;7
VILLAGE 60�r I ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. AsAw 4.�
SEPTIC TANK CAPACITY � �-
LEACHING FACILr Y: (type) 'C c►�o, (size)
NO. OF BEDROOMS
BUILDER 0 OWNER �C`U�6G
PERMITDATE: COMPLIANCE DATE:
.T
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) / 6� Feet
Edge of Wetland and Leaching Facility (If any wetlands exist '/
within 300 feet of leaching facility) !C� � Feet
Furnished by d ez
� �t•�
as, �.
�o°
�y°
. ® , �
se . .
�` y�'
rd
' �y,Jpn ONE l/tsl�
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1
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t.
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pplication for 30i.5pozat *pgtem Construction permit
Application for a Permit to Construct( )Repair(4pgrade( )Abandon( ) 10Complete System ❑Individual Components
T Location Address or Lot No. J� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel r/ r L`�� I�
�1W17 J
Installer's Name,Address,and Tel.No. -' 7/ —�i� � Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( �
Other Type of Building liW,_,Ao.of Persons Showers( ) Cafeteria( )
Other Fixtures /J/1
Design Flow Cip gallons per day. Calculated daily flow '7 ! gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank ----Type of S.A.S.
Description of Soil
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 been issued by this oard of lth
Signed Date l
Application Approved by Date r ZC -XV?'O
Application Disapproved for the following reasons
Permit No. Date Issued
TOWN.OF BARNSTABLE
LOCATION SEWAGE # .12Otyd -
VILLAGE
ASSESSOR'S MAP & LOT
� �
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY I od G L
LEACHING FACILITY: (type)'irelhw�s��
(size) _/O 'X SAC
NO. OF BEDROOMS
BUILDER.O OWNER S/yVaG
PERMITDATE: r
COMPLIANCE DATE:
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) !� Feet
Edge of Wetland and Leaching Facility, (If any wetlands exist
within 300 feet of leaching;facility)
,. Feet .
Furnished by
®h
I.
PS /
� I
hs
lee
I .
No Fee '
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipprication for �Diopogal *pgtem Con!6truction Permit
Application for a Permit to Construct( )Repair( i//)Upgrade( )Abandon( ) EY Complete System O Individual Components
Location Address or Lot No. l l� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
7' J '/
51��'�3 Designer's Name,Address and Tel.No.
Installer's Name 7. 7,Address,and Tel.No. / /�- g
Type of Building:
Dwelling No.of Bedrooms Ll Lot Size sq. ft. Garbage Grinder( L�
Other Type of Building /<�✓Jam/' �"�lio. of Persons Showers( ) Cafeteria( )
Other Fixtures ,r /J
Design Flow / gallons per day. Calculated daily flow y f gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank pe of S.A.S. Fi '� 4� � ���`/lJJ`ltS
Description of Soil
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 been issued by this Board of - alt
Signed �%�`"aa.�-= Date
Application Approved by Date l �
Application Disapproved for the following reasons
Permit No ` b Date Issued
-----
THE COMMONWEALTH OF MASSACHUSETTS O7/ 9,'—®�
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIMC,that thg On-si a Sewage Disposal System Constructed( )Repaired(L )Upgraded( )
Abandoned by o L�� . d 0,
( )
at 1�J .-5 ><'72 K e p l T has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.?.0'4`2�' Gy dated aOa
Installer ► Designer %�
The issuance of this pe t s a111 not ,e construed as a guarantee that the system will}function as designed/ U
�! Inspector
Date N V p u
(\lj
No --
�E5d � ------------------ D/ 7 `�/<r� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mir gal 6potem Construction Permit
Permission is hereby granted to Cons"ct(/ )Repai (Upgrade( )Abandon( )
System located at �d S.//-e/� 71
Cry f �/ T
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 t.
Date: ����? a 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 CONSTRIICTION PERMIT(WITHOUT DESIGNED PLANS)
ilVie"' ��� � hereb certifythatthe
Y apphcatton for disposal works
construction permit signed by me dated concerning the
property located.at /O� 5 �4� tneeis all of the
following criteria:
V/The failed system is connected to a residential dwelling only. T'nere are no commercial or business
uses associated with the dwelling.
i fie soil.is classified as CLASS I and the^ere .. otanon,ate is lees than or dual ;o ninutes per inc:t.
/7here are no wetlands within 100 feet of t- e proposed septic system
u -sere are no private wells within.140 ert of he pronosed'se;,tic s�se:n.
h/ :• _.
l sere is no increase in flaw ana/or cyan,in use pr000sea
Y ?here are no variances.requested or needed
' / P
!� The bottom of the proposed leaching facility will not located less than five feet abo
ve the
ma.,mum adjusted groundwater table elevarion. (Adjust the groundwater table.using the ;imntor
method when applicableJ.
/If the S.A.S. will be located with 250 feet of any vegetated wetlands. the bottom of the proposed
leaching facility will not be located less than fourteen(14)'feet above the ma:amum adjusted
groundwater table elevation,,
Please complete the following: ±
2 X
A) Top of Ground Surface EIevation(using GIS information) O
e
B) G.W.Elevation 0+the MAX.High G.W. Adju=ent.
- 'DTFERENCE BETWEEN A and B
SIGNED : 0DATE: ADao
(Sketch proposed plan of system on b&*I.
¢ham folder:oat
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-25'- --- ---
24-4.._.. ._
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6 N CD I
FAM I L
341 sq ft
N
I M
CLOSET i
- -
1 I
_..--
--- -- --14'3_ ..--_ ..-:._....- --. DINING .—
�' 111 sq ft
u ; �
n I,—1JIc i
LIVING
N i i N 292 sq ft
KITCHEN
141 sgft
m Ol
P=i m
2'6
UPUP
i
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1 LAUNDRY
71sgft j
a,,STUDY
230 sq ft °i v
18'3
...2'9 --- rn
IJ! 16,10
CD
L
GARAGE" UTILITY ,
297 sq ft 133 sq ft i
i c
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3'0"4' ... _....:. ... 1511"4
LIVING AREAL y
1368 sq ft
I 2T6
1�
t
ru '
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BEDROOM
OM BATH"
I , 148 ft {
I `
�. 40 sq ft MASTER BATK- I �.
74sgft p I b O
I r 37 _ —_66� I
—4- 12'2`7 _ CLOSET
1 3 sq R
HALL
I �, 89 sq ft CV ,•� i
t MASTER DRM
LL? 2
192sqCLOSET CLOSE 2sqft Lo
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BEDROOM r
i -149 sq ft ='
O O
I N
I CLOSE N p `-
I7:71
-4I-- 12'2 �LOSET _
(D 23 sq ft
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EA
1 759 sq ft'
- 12'8 — 311 12'2—
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GARAGE ANCHOR BOLT DETAIL
SCALE:1/Y'=1W
®❑®COTUIT BAY DESIGN LLC NEW ADDITION/REMODELING FOR:: SCALE: °RAC"°"°.:
43 BREWSTER ROAD 1!4 -1-0
MASHPEE MA. 02649 SINUC RESIDENCE Q
PH.(508)2�4-1166 - m DATE: /�
FAX(508)539-940z 108 SHELL LANE COTUIT, MA z�nols
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