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HomeMy WebLinkAbout0061 PRAM ROAD - Health 61 PRAM RD. " `A = 268 038 ° o e ° . . ° � a ° ° c ry I TOWN OF BARNSTABLE LOCATION r1401 R SEWAGE # VILLAGE Half-146 Ao,-7- ASSESSOR'S MAP& LOT.2G8 '0 Y? INSTALLER'S NAME&PHONE NO. J 5C104 de,/34,01!410s SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) 601-12^/ W9,1`S" (size) 5X I3 r NO.OF BEDROOMS BUILDER OR OWNER M;krr .1 Z PERMITDATE: G — 27-0/ COMPLIANCE DATE: // / 0/ 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 r f,,: L,4 ;, S� y .� �. a �� e �,��; ,�, -. . - 6.J ` h-i 6 No. -''- Fee °'/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' !� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppritation for Miopogal *pgtem Cougtrurtiou 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. Assessor's Map/Parcel Installer's Name,Addressjj and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms ?2 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 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) rai/ 2 " /� ST ��—>✓ 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 B and of health. Signed Date Application Approved by Date e— 17—04 Application Disapproved for the following reaso Permit No. � 4 Q� Date Issued Z -0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes j ,PUBLIC HEALTH DIVISION TOWN OF BARNSTABLES MASSACHUSETTS ZIpprication for �Dizpo.5al*pgtem Construction Permit.' Application for a Permit to Construct( '-)�epair( )Upgrade( )Abandon( ) `❑Complete System O Individual Components Location Address or Lot No. �'y4yY! Owner's Name,Address and Tel.No. G �*R l�'I1 <F �1ial�l2© ' Assessor's Map/Parcel 2 6 8_ Installer's Name,Address and Tel.No. 0 3 G/9 2 Designer's Name,Address and Tel.No. Type of Building: Dwelling `No.of Bedrooms , Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ` t No.of Persons :Showers( ) Cafeteria( ) Other Fixtures i t 'day. Calculated daily flow gallons. Design Flow gallons per Plan Date Number of sheets ? Revision Date Title < Size of Septic Tank r Type of S.A.S. Description 11.of Soil ;r kq Nature of Repairs or Alterations(Answe'rQwhen applicable) 5-00 !-f/C!1 L 4,,1-04/A el 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 provisionsyof 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 B and of Ijealth. Signed Date Application Approved by . 1 Date 6 Z-7-(7 Application Disapproved for the following reason Permit No. y r yy Z Date Issued Z -® THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sew a Disposal System Constructed Q�- aired( )Upgraded( ) Abandoned( )by e161.5 z; i //rd Sew at Z6 � % has been constructed in accordance 01 with the provisions of Title 5 and a for Disposal ystem Construction Permit No.?.!,¢� - 1q Z- ated Z 7 - Installer�5 tto-i 12� 1�6�I'�b Designer—_'As Clci4 a, The issuance of this permit shall not be construed as a guarantee that the syskM will function s designed. Date I �OF� )C,nl Inspector 1/GtitlAd' Aj, t No. `�(//�!`? 7 ----04.67-of r---- �1 D . O3� Fee Y O � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Di.5 po.5ar 6potem Construction Permit Permission is hereby granted to Construct( epair( )Upg de( )Abandon( ) System located ati 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: Constructio n ust be completed within three years of the date of this Date: 6 Z 7 Approved by ' U 14 l/6r99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CER=CATION OF SKETCH .Ati-D .APPLICATION FORA DISPOSAL WORKS CONSTRUCTION PER;ti1I'T (WITHOUT DESIGNED PLANS) I, 6 cS Cp�i �� �I96rd S' hereby uriuy that the application for disposal works i construction permit signed by me dated conc ,lina the prope:ry located at /6 p�� /�� ��/�ss„�is /� -- meets all of the following criteria: !r Zj--'Tae failed system is conne^ed to a residential dwelling only. There are no commercial or business uses associated with the dwelling. one soil is classined as CUSS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 fee:of the orocosed septic s+sem 4!C 'here are no private wells within 1:0 fe`,of the orocosed septic srs e n �Tnere is no increase in flow and/or change in use proposed 4 T•nere are no variances requested or needed. • T ne knom of the proposed leaching facility till not be located less than five fee:above the craw rau m adjusted-oundwater table e!evadon. (Adjust the z undwater table ;sin;the Frimptor rnechcd when applicable] • If the S.A.S. will be located with '_-;0 fe`t of any vegecaced wetlands, the caaom of clue proposed leac:ung facility ,vill net be located less than fourteen(I,) fee; above the m-Lydrnu m adiusted Q*ou ndwater table e!evauon, Please complete the following: A) Too of Ground Surface Eievacian using ( , GiS information) H) G.W. Elevation LZ -the \,L-1 Y. -igh G.W. Adju-TLrnent . D F-F—E-RENCE H E 7,V EEN' a,and J J �� SIGNED DAT—H: G - 27 (Sketch proposed plan of srszern on bac:c]. q:::uch foidcr.c-; � 7 m b.. tw o S� ' p®p1 i >J , s