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Home My WebLink About0129 BAYVIEW CIRCLE - Health 129 BA ,CIRCLE ®STERVILLE A = I65 001 J 6 No. X1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � n Yes 1` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migool *pztem Construction Permit • Application for a Permit to Construct( )Repair( )/ Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Y Location Address or Lot No./a,? 3$WkA,l C;r 6j-1, Owner's Name,Address and Tel.No. Assessor's Map/Parcel // oc) / — 0V IV Installer's Name,Address,&Tel•CAN Designer's Name,Address and Tel.No. 7 350 Main Street �� 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank —Type of S.A.S. 'noo S Description of Soil Nature of Repairs or Alterations(Answer when applicable) -/9 eS �—�- L � 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 tfie Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board th. Signed Date w �/ Application Approved by Date1h�,�� Application Disapproved for the following reasons Permit No. �� '` �f Date Issued `��4 No. G� wJ f3` Fee c THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS PUB C s 3pp rtcatton for Mtg aar 6potem (Cottgtruction Permit Application for a Permit to Construct( )Repair(. )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.ld? e3gyv;etJ C-t' Oj-/. Owner's Name,Adjress and Tel.No. / Assessor's Map/Parcel Installer's Name,Address,and Tel.No. `-�J Designer's Name,Address and Tel.No. A& ® CANCO 350 Main Street YaFf"OUth MA Type of Building: 2673. Dwelling No.of Bedrooms 13 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow U gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of.Septic Tank 4,5 0 Type of S.A.S. `C'O G S Description of Soil , mot.' _L 4,r Nature of Repairs or Alterations(Answer when applicable) 27A _'J4 4NA 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 Ijealth. ` Signed Date Application Approved by l Date Application Disapproved for the following reasons Permit No. Date Issued ------------------------;1� —————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(,-Ir Vpgraded( ) Abandoned( )by C',�q,/U 6-c.-> at �� (/i e kJ / has been constructed in accordance with the provisions of Tide 5 and the for Disposal System Construction Permit 0A Z, dated X Installer Designer The issuance-of this permit shall not be on Itrued as a guarantee that the system will function as designed) Date - i� Inspector1� ------------------------ — No.�•��' !� Fee Jr 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mtgpogal Opgtem Conotructtout hermit Permission is hereby granted to Construct( )Repair(,�-<pgrade( )Abandon( ) System located at /a F�4 vt-,,/e LJ r✓ ,S / i,i�lo 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, ermit. Date: `�!''�`� � Approved by /j UCU• i-�� .S U D �� / TOWN OF BARNSTdABLE LOCATION /,7 7 &Z V C&&/ Op eC SEWAGE #e2c_rz> ASSESSOR'S MAP & LOT/&5 6 INSTALLER'S NAME PHONE NO. A & B CANCO 775-6264 -SEPTIC TANK CAPACITY mo-o-S- LEACHING FACILITY:(typel��/� r� C��c, � y (size)c52 rw / ? x c2 9 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O `OWNER � (1� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: I' °- VARIANCE GRANTED: Yes No .d. 1. i O N r�. J9 c �� _ '+a w TOWN OF BARNSTABLE :.LOCATION 9 k ---T--45 �'�'� � L- SEWAGE # VILLAGE( V.`l( ASSESSOR'S MAP 6z LOTB INSTALLER'S NAME Si PHONE NO. A & B CANCO 775-6264 ' 5'EPTIC TANK CAPACITY1�� LEACHMO lRACiT.iTY-f-t-. l(= -�e^-•- i�.ti�r c�{a sc�c �aiz.C/n ,5 jil /.j X et NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O .OWNER .. 414, 1 b lz DATE PERMIT.ISSUED:•, Y ! r D1 'TE. COMPI.IgNCE ISSUED. VARIANCE GRANTED' Yes ^ No V. .14 O / _ i F } e - v _ m. M_ - _ f �J 1/6/99 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) I, � _. hereby certify that the application for disposal works construction permit signed by me dated 10 -/f CJC ——I-, concerning the property located at (a —T i ecJ meets all of the following criteria: 4 The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. / The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. / There are no wetlands within 100 feet of the proposed septic system 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, J i --a There are no variances requested or needed. • L The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] / 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 maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) y `� B) G.W. Elevation 00. f +the MAX. High G.W. Adjustment DIFFERENCE BETWEEN A and B �!o SIGNED : J 6) 6-J��d=kn� A D TE. 6! [Sketch proposed plan of system on back]. q:health folder.cert r , � . " � � , - � ,- �. L___._J � , a � —� 4 � � � :� � � • - J �i, `* �. t ,' r i^±' t � ....y, \�. �� y 1+ j' / i n - _ ri frN " - . ! K s , 7777 z .. W .. - �. - - ,� d- rYk''7...,, ts.� � :.,. . .�';. ,-�.�..�� - � y,gi- �-J;,.C— ��:.: ':� e,•� w �4 _< ,�;,�id A3�!'+�s - _ ♦ t -s' :xf � _ 1 ,..�< ,..�. c�,',�v.,'.- r,'r`�} -r, _��,�x ,ram r 1, r.«' ' ��..s .,t.�u, �,��.. � � �:-� a kt " ",�` e, v .a i j L f 4 . , * Nili ..� w { 1 � r ,t. , ;� � •1 is E" 4 -