The URL can be used to link to this page

Home My WebLink About0017 BAYVIEW CIRCLE - Health 17 BAYVIEW CIRCLE, OSTERVILLE ,141-093 - i I o u II v II, l' Fee v �o. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye 1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Ytcatfon for Mi- o.5ar * item Conttruction ermit Application for a Permit to Construct( )Repair(a/)Upgrade( )Abandon( ) El Complete System [individual Components Location Address or Lot No./ Xv jeIZ,_,G/,C lvp Owner's Name,Address and Tel.No. / Assessor's Map/Parcel D,e,-,,er11111ep Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,60,rt Lp7f�/6pr�st 7 7/1 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building ei1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow IM gallons per day. Calculated daily flow 3130- gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /J��D Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) / / _de 42151�A�Oaele 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 is ued this B d of Health. Signe _Zlo Date �l r1�8- Application Approved by ® Date Application Disapproved for the following reasons Permit No.76 Date Issued Fee THE COMMONWEALTH OF MASSACHUSETTS Enterd inlcomputer: ALL_ Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for nigpool *patent Cow5truction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) El Complete System L'�Individual Components Location Address or Lot No./ .7 Owner's Name,Address and Tel.No, Assessor's Map/Parcel 0,5—t- gyp Installer's Name-,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7/' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building Xe49ld�We4? No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //a gallons per day. Calculated daily flow 3,30 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 J—D© Type of S:A:S. /1"'re-9X Z 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 i ued this B and Health. Signe / Date �'.Application Approved by 6 % Date Applicatipti Disapproved for the following reasons 5� Pe it No. Date Issued _- - - - - - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE TIFY, that tjie OnC-site Swage Disposal System Constructed( )Repaired(V )Upgraded( ) Abandoned at /! I/ew File -k 5 ram' x`= as onstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer r Designer The issuance of this pe s 1 np b ed as a guarantee that the s m u ti as designe o. Date Inspector !' .. No. `�� ----------------- � ! _69< � Fee ..�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mizpogaf *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(✓Upgrade( )Abandon( ) System located at 7 E and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 's/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Con cti m be completed within three years of the date of this t C Date: Approved by 1/, © �� r a n TOWN OF//BARNSTABLE e:C� LOCATION a A—eyi✓leiv ewle- `� SEWAGE# VILLAGE ®S7`Grr/i/lam ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. ®tr�111— 4X 7 7/-4-Me ... SEPTIC TANK CAPACITY fro GGL LEACHING FACILITY: (type) Zr 1,"C At/p I C (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMUDATE: 4 � �� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S¢ Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Furnished by o ON Q' x .t w .. l 0/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FORA DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) y I, / �� '�`" L , prx,�Phereby certify that the application for disposal works construction Y permit signed b me dated /��5 , concerning the P g property located at 17 P��/wAA� F��X�� >/��` eets all of the- following criteria: There are no wetlands located within 100 feet of the proposed leaching faciliy There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or•change in use proposed There are no variances requested or needed: r 1/ If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground_Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) ' 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]. q:health folder:cert y y�-DPO , �q g� jlL lS fir- l7 Ui avJ f DD TOWN OF BARNSTABLE LOCATION GI/G�e SEWAGE # VILLAGE ©57�?r!/i/li" ASSESSOR'S MAP& LOT�y�d� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: /,,, (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility St Feet Private Water Supply Well and Leaching Facility (If any wells exist I/ on site or within 200 feet of leaching facility) �U Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 11 Feet Furnished by f v'�C wok � VZ ' O O