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HomeMy WebLinkAbout0025 CEDAR LANE - Health 25 CEDAR LANE OSTERVILLE A = 118 060 r r r h i d leg—�6� ©y -3 �No Fee '_ . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Mi000al *pgtem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) 'LJ"Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel No Assessor's Map/Parcel O v/ee4zMe: Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow if p gallons per day. Calculated daily flow —3,30 gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank /5wo .,'l Type of S.A.S. �,'�i 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 b this Bo d of ealth. Signed - Date Application Approved by Date L 6 01 Application Disapproved for the following reaso s Permit No. �� Date Issued L 0 i g —D6D .S No -� . �" — / Fee , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for Migoal 6potem Cou!6truction Permit . Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) LJ Complete System ❑Individual Components Location Address or Lot No.Z s ceao��� l� Owner's Name,Address and Tel N�o®. riC ! �011� /�jJGv�✓GA" Assessor's Map/Parcel 0 5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building:, Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow l�D gallons per day. Calculated daily flow 3.3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /�����Q _Type of S.A.S. Description of Soil k 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 b I this Bo d of Health. Signed Date Application Approved by Date Z G 4 Application Disapproved for the following reasons Permit No. ey wy Date Issued ---------------------------=----------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS, Certificate of Compliance THIS IS TO CERTIFY,that the On�-}s to Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by 7G' ® I lat442r T� �U//� has b en constructed in ac ordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �� b y dated / ZL 0 Installer Designer The issuance of s permit shall not be construed as a guarantee that the system'? 1 fun tioji as diesig`e' d. Date L Inspector C= f l`—'� --------------------------------------- Fee �^— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5poga[ *potem Con0truction Permit Permission is hereby granted sto_Construct(n� ).�epa/�r�(ul�Upgrad e Ab���n( ) System located at 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 Date: /Z G � Approved by ry r - AX��X NOTICE: This Fora Is To geVsed Foc the Repair Of wiled Se tic Systems. Only. _ CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUMON PERNgT(WITHOUT DESIGNED PLANS) V i hereby certify that the application fo r or disposal works construction permit signed by me dated /17-s-��/ concerning the property located..at Z J G' r'/�9 ® f����/�� meets all of the following criteria:. The failed system is connoted to a residential" lt ei a aw n,oniv, Tner„are no commercial orb uses assocated with the dwelling. V/ae soil is classified as CLASS I rand:he percoianon:ate is ins"than or eq• _ La1:0 ., iZI1nIIIeS 7e. :nC1 Ahere are.no we-,lands within 100 lee:of 1e proposed sepnc system zere are no pr.'vate wcHs 1 =�� wttnln. :_0.,._.of:he proposed septic s;�se:n. • :here is no inc.ase in flow and/or c range in zse proxsea here are no variances requested or fie wed +� The bottom.of the proposed leachina facility will not . - _oe"located less than Lv I=above the ma:,imum adjusted groundwatr.-table elevatioa. (Adjust the groundwater able.using the:Iimptor, method when mmlicable). If.the S:kS. will be located with 250 feet 0f any veze a leaching facility will not be located less than fourte ced welands. the bottom of t po he prosed en(14)feet above the ma..-dmum adjusted groundwater table elevation, Please complete the following A) Top of Ground Surface EIevation(using GIS information) `7 3) G.W.Elevation IL12 +`the MAX High G.W.Adjustment.. �✓° _ / - 6 _ „a DIFFERENCE BETWEEN A.and B z SIGNED DATE: ✓` /�� [Sketch Proper Plan of system on back]. ¢hmft"kr CM1 TOWN OF BARNSTABLE LOCATION Z 5`G�'der 14 SEWAGE # ?Wl'��� VILLAGE OS AZ:!1-V1'1/e- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /r14 LEACHING FACMITY: (type) (size) l� BUILDER O OwNER ) ctt�•> { PERMIT DATE: I Z b o COMPLIANCE DATE:T Separation_Distance Between the: Maximum Adjusted Groundwater Table to the Bottom.of Leaching Facilityf 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 Lea lung Facili.ry. (If any wetlands exist within 300 feet of leaching facility) Feet .. Furnished by �o �IV _ - I