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Home My WebLink About0062 FORTES WAY - Health 62 Fortes Way 166-012 Oster'Wile i 1 --- No.—"--�1-�-�� ~�l t Fee—--------------=- BOARD OF HEALTH TOWN OF . BARNSTABLE /��— D�� Applicat ion,for Vell Con5truct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair Nan individual Well at: LocatioK— ress Assessors Map and Parcel ---Owner Owner Address Installer — Driller Address Type of Building Dwelling y — ----------- Other - Type of Building-------------- No. of Persons------------------------------___ Type of Well �( --------- - Capacity---- — ---——---— ——— Purpose of Well----i�a� ___------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by.the Board of Health. / date 1-5 Application Approved — -------------— - date Application Disapproved for the following reasons:-------------— - ——--- - - ----- ---—------- -- --- ----------------------------- -- date �-� o Jt cp Permit No. - --- Issued--------- �----------- -- ----- date d BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f QCompliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by-------- --_ ___—— ---- — ---- -- -- — - -- - — --- ---- --- Installer at- -—-- _--_——_____ -- -- -- ---- --- --- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ____—---------Dated---- ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------ -- — -- Inspector-------------------------------------- • v -- x Fee—------------------- BOARD OF HEALTH —~ TOWN OF BARNSTABLE 0(pplication-*rVell Conotruction3permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair Wan individual Well at: a Location-,Address — —— — Assessors Map aid Parcel --- Address --------------------------—------------ — Installer — Driller Address Type of Building Dwelling ------- Other - Type of Building------------- No. of Persons------------------- Type of Well ' ----_------- Capacity---------- ---——--- Purpose of Well — —'SY%_�------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. / — date Application Approved — ------ -------- -5 J`v/U------ t date Application Disapproved for the following reasons: ----------------- ------------- —— date �/off Permit No. — Issued--------- --,- - -- - -- date BOARD OF HEALTH TOWN OF BARNSMA-ABLE n C ertif irate ®f Compliance b THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer at----- --- -----—----- ------- -------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------------Dated---- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. - DATE—---- ---------- -- Inspector------- - __ :� —----—--- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Construct ion permit No. ------- ----- Fee------Ll ---------- Permission is hereby granted ---------------- to Construct ( ' ), Alter ( ), or Repair (?Q an Individual Well at: N o. ----- ------------------------- ell street as shown on the application for a Well Construction Permit No.-- _ Dared ---- -- ---------- Board of Health DATE -- _ 1 f TOWN OF BARNSTABLE LOCATION fIS fP/�V/Z1Q God ,<kS R sEWAGE# VILLAGES f P.PV/f�� ASSESSOR'S MAP&LOT M INSTALLER'S NAME&PHONE NO. Sfe a SEPTIC TANK CAPACITY LEACHING FACILITY: (type)`A Tn Fi lfiR'q fo 0-c (size)'Q5- /1'X l / NO.OF BEDROOMS 3 . BUILDER OR OWNER _ �. V' PERMITDATE: r o a.r� �I� COMPLIANCE.DATE: 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 µt, ` ile�Q Or' LIOUS� - 193 � � � ai No. v ( Fee ! ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 21ppYication for Migogal 6potetnpanon-site n-5truction permit Application is hereby made for a Permit to Construct( )or Repair( ) Sewage Disposal System at: Location Address or Lot No. �S�y./ overa& Owner's Name,Address and Tel.No. Assessor's Map/Parcel !( � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. v a-0 g► W Type of Building: Dwelling No.of Bedrooms 15 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow - `� gallons per day. Calculated daily flow 1330 gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) L �O-G -v v— '.( `t 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 Upt to place the system in operation until a Certifi- cate of Compliance has be 1 / Signed Date Application Approved b Date Application Disapproved for the follow' g reasons Permit No. 9 �'" l Date Issued I No. 3A / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for 3i.5pogat *pgtem CC n0ruction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On site Sewage Disposal System at: Location Addressor Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0 i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. { Type of Building: Dwelling No.of Bedrooms _ Garbage Grinder( ) { Other Type of Building No.of Persons. Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons gallons per day. Calculated daily flow .` gallons. Plan Date Number of sheets Revision Date Title Description of Soil 6ti6� - 5 A-µ-1p i Nature of Repairs or Alterations(Answer when applicable) Ul ,v✓ �. GG`p r 7L�M is�' �r�• ram. v S t vrJ /� lit.-fix ' 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_Cry de and t to place the system in operation until a Certifi- cate of Compliance has bggD i's&ued-b tl s B ar ealth: Signed Date Application Approved b " Date If Application Disapproved for the follow' /9 reasons { j Permit No. �� i 7 Date Issued f THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS Certificate of (Compliance _ THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(400l'on by _.- f & Installer at _ t esrv� has been constructed in accordance i with the provisions of ltle 5 and the for Disposal§ystern Construction Permit No. dated r �^ Date r) -, /: : Inspector t , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. ---------------------------------------- No. w Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 33igogar *pgtem Congtruction Permit s. Permission is hereby granted JAA Q -T C--- to construct( )repair( an On-site Sewage System located at go.# r Street and as described in the above Application for Disposal System"Construction Permit. No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: /� � Approved by j Board of Health I' CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL NVORKS CONSTItUC1'ION PEItMIT(WITHOUT DESIGNED PLANS) 1, hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at (p')—C YL-rS Wit 4 D �� meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in}low and/or change in use proposed • There are no variances requested or needed. 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]. .�. �v v"" D