Loading...
HomeMy WebLinkAbout0073 HATHAWAY ROAD - Health 73 HATHAWAV° O5TERVILLE A-114.U33 . 1 a u 0 1 TOWN OF BARNSTABLE 6 LOCATION A'�'1'1ra A:A'TZ SEWAGE # �� VILLAGE 06—k rRv-'Me ASSESSOR'S MAP& LOT —03 INSTALLER'S NAME&PHONE NO. c e bl \ f SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) P1O to Z' ry 3 C.a S (size) X NO.Of BEDROOMS BUILDER OR OWNER 'R`1h CR W",l PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 C�f ou 5 s - l � go -> Sox 591 60 j s 1140. 7 T�. Fee 5�. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes ZIppfication for -Miopogar *pgtem Conn;truction i3ermit Application for a Permit to Construct( )Repair(Jej Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.73�A. w,9 x � Owner's Name,Address and Tel.�v o. Osier",/1c 'P,vrth CP, A� Assessor's Map/Parcel f 'f 3 N 033 0�—it, tk Installer's Name,Address,and Tel.No.. Designer's Name,Address and Tel.No. �3"r— C_CQ�_`k.SS\cr F3 1�a ncl ST © n.kkc yae�5�a� Type of Building: Dwelling No.of Bedrooms 4 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_Xn s 161 k VS-0 a C S ca�l , ` 0 o `` e 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 al Signed Date F Application Approved by . Date` ! L�'— Application Disapproved for the following reasons Permit No. Date Issued bd � 0' � T Z Fee •5� •_—•— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mioogal *pgtem Congtruction Vermit Application for a Permit to Construct( )Repair(V-)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.7.3,//d r1/'}�"J�) Owner's Name,Address and Tel.No.. OS c-vr11c- Assessor's Map/Parcel cia.tr��lP.1�a�)A 1�6L/�0a3 (633)• Installer's Name,Address,and Tel.No. II I, Designer's Name,Address and Tel.No. 3�cc �e_c�\\ 5��r; C ► 8S�,,. Type of Building: Dw`elling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers yp g ( Cafeteria( ) Other Fixtures Design Flow gallons per day.-Calculated daily flow gallons. Plan Date Number of-sheets T. Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ` Nature of Repairs or Alterations(Answer when applicabl lT,� \5 O d S 6, ,1 = C h 0 11IN,3 2 S 4 U l 11 3 G l\,\ ` SZ t, e. -3/8,' p u� � r 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 iss ed by this B`pard of eal h. Signed �• G Date �c .,;1 /91 f Application Approved by C - - Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (l—)Upgraded( ) Abandoned( )by _ at 7 3 1cwl- 0 5 e r has been constructed in accordance with the rovisions of Title 5 and the for Disposal System Construction Permit No. 7 7— dated ` 2�' r / Installe �'�c e ``c�CG �e c Designer The issuance of this permit shall n�t b /onstruad as a guarantee that the system io as d�ill; end. Date CY 1 / Inspector No. 91 ---------------------- --Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mioogal *pgtem Congtruction permit Permission is hereby granted to Construct( )Repair(Upgrade( )Abandon( ) System located at T7.3 `� 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 t. Date: 2 / Approved by -MQ.c�. ��s G`'- TOWN OF BARNSTABLE LOCATION? 1�h� 1��wA��l SEWAGE # 9' "'�01 VILLAGE- O s k EfZv:\�C- ASSESSOR'S MAP & LOT —� INSTALLER'S NAME&PHONE NO.�c h�a1 -Jjj� SEPTIC TANK CAPACITY 1 0O G M. LEACHING FACILITY: (type) P10 w Z F_)e l S (size). NO.OF BEDROOMS BUILDER OR OWNER '�R"Zh C.hli��t(} PERMIT DATE: I-01L9- I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 V I © c -� — 1~ ;Y 1 • 10/9/97 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 ENGINEERED PLANS) I, S t-V c ,s\es , hereby certify that the application for disposal works construction permit signed by me dated 1lkq'i , concerning the r property located at meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility • 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. • If the proposed leaching facility will be located within 250 feet of any 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 Elevation(according to the Engineering Division G.I.S.map) (91, B)Observed Groundwater Table Elevation(according to Health Division well map) w.TI� q ;Tt„Q'1 r //JLn/ • SIGNED : DATE: .0�7 S 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 � A:; E rn � ` fl (1'D o Soo ec 33© CANA Ga�� 3�T o� STone